Three alternative solutions we offer for knee pain in our Los Angeles office are Prolotherapy, Platelet Rich Plasma Therapy, and Stem Cell Therapy performed under ultrasound guidance.
These are injection techniques that do exactly the opposite of surgery. They rebuild and strengthen damaged tissue as opposed to removing them. Prolotherapy is the injection of mild irritants, i.e, Dextrose, PRP is the injection of the patient’s own platelet rich plasma derived from a blood draw. Stem Cell Therapy is an injection of stem cells drawn from the patients own fat.
This treatments are often used in combination
The Use of Prolotherapy
Recent medical studies on both treatments support that articular cartilage and meniscal tissue can regrow with Prolotherapy treatment. (1,2)
The Use of PRP
New research suggest PRP can be a very effective treatment for knee defects: Researchers writing in the International Journal of the Care of the Injured wrote: “(this treatment) is a simple, low-cost, minimally invasive way to apply PRP growth factors to chronic patellar tendinosis…20 male athletes with a mean history of 20.7 months of pain received treatment, and outcomes were prospectively evaluated at 6 months follow-up. No severe adverse events were observed, and statistically significant improvements in all scores were recorded. The results suggest that this method may be safely used for the treatment of jumper’s knee, by aiding the regeneration of tissue which otherwise has low healing potential. (3)
In the medical journal International Orthopaedics, researchers noted: “Histological examination and study of angiogenesis showed that the application of PRP enhances and accelerates the tendon healing process.” (4)
Prolotherapy works as an irritant using dextrose (a simple sugar) is introduced in the knee. This causes the immune system of the body to accelerate the inflammatory process. More inflammation? The body’s natural healing response is inflammation. Only when complete healing does not occur does inflammation become chronic and problematic.
What this new inflammation does is bring fribroblast and condrocytes, those cells necessary to rebuild the collagen matrix of the tissue, strengthen and restoring them to preinjury form in many cases.
In Platelet rich plasma therapy, blood is drawn from the patient and is used instead of dextrose. The principle is the same except PRP is usually reserved for patients with more damage to the knee area or for high level athletes needed for a big game.
Stem Cell Therapy
Research is confirming that stem cells, drawn from a patient’s own fat can regrow cartilage. In one study the potential of intra-articular injection of mesenchymal stem cells (MSCs) was evaluated in six osteoarthritic patients. During a one-year follow-up period magnetic resonance images (MRI) at baseline and six months post-stem cell injection displayed an increase in cartilage thickness, extension of the repair tissue over the subchondral bone and a considerable decrease in the size of edematous subchondral patches in three out of six patients. – The results indicated satisfactory effects of intra-articular injection of MSCs in patients with knee OA. (5)
Please see our article on Stem Cell Injections for regrowing knee cartilage.
The Use of Ultrasound
Research in the Journal of Clinical Rheumatology says that “(Ultrasound) Sonographic needle guidance reduced procedural pain and improved the clinical outcomes and cost-effectiveness of intra-articular injections of the osteoarthritic knee.”
The researchers found that ultrasound guided injection over conventional palpation-guided methods resulted in 48% reduction in procedural pain, a 42% reduction in pain scores at outcome, 107% increase in the responder rate and with higher accuracy, less need for procedure, significantly reducing patient cost. (6)
UPDATE: Platelet Plasma Therapy BEFORE Cortisone!
Research in the International Journal of International Orthopaedics say Platelet Rich Plasma therapy BEFORE ethoxysclerol, cortisone, and/or surgical treatment!
Researchers in the Netherlands evaluated the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP) and whether certain characteristics, such as activity level or previous treatment affected the results.
What they found was: “After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful. However, patients who were not treated before with ethoxysclerol, cortisone, and/or surgical treatment showed the improvement.” (7)
1. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Canacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc 2010; 18(4):472-479.
2. Reeves KD Hassanein K Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Alt Ther Hlth Med 2000;6(2):37-46.)
3. Kon, E. et al. Platelet rich plasma: New clinical application. A pilot study for treatment of jumper’s knee. Injury, International J. Care Injured 2009;40:598-603.
4. (Lyras D, et al. Immunohistochemical study of angiogenesis after local administration of platelet rich plasma in a patellar tendon defect. International Orthopaedics 2009;11 February: online.)
5. Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, Farjad R, Baghaban Eslaminejad M. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Arch Iran Med. 2012 Jul;15(7):422-8.
6. Sibbitt WL Jr, Band PA, Kettwich LG, Chavez-Chiang NR, Delea SL, Bankhurst AD. A randomized controlled trial evaluating the cost-effectiveness of sonographic guidance for intra-articular injection of the osteoarthritic knee. J Clin Rheumatol. 2011 Dec;17(8):409-15.
7. Gosens T, Den Oudsten BL, Fievez E, van ‘t Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments.Int Orthop. 2012 Apr 27. [Epub ahead of print]