Saturday, August 25, 2012

If You’re Resolved to Have Surgery or Medical Treatments, Here Are Options to Consider

I’m not a big fan of surgery for chronic knee pain, to put it mildly. Some procedures absolutely make me shudder (“lateral release,” e.g.). Others I imagine could be useful, in certain circumstances.

If I were desperate enough to seek a medical intervention, I’d favor something as natural as possible. That means a procedure that encourages my own body to turbocharge the healing process.

With that in mind, here are treatments worth looking at (Note: that’s not an endorsement of any of these, and anyone with knowledge of, or experience with, any of the following, please add your thoughts below). Also, important caveat: These procedures are more for problems with tendons and ligaments than cartilage, as far as I can tell.

(1) Prolotherapy

I was first introduced to this on Doug Kelsey’s (now defunct) blog, The View. As many of you know, I have tremendous respect for Kelsey, whose thinking about chronic knee pain greatly influenced me during my recovery.

Kelsey’s genius on matters of physical therapy probably derives in part, unfortunately, from his own misfortune -- he has a number of ailments, including a knee problem of his own. Anyway, he underwent prolotherapy.

My understanding is that the treatment involves a series of shots that cause an inflammatory response in the body’s tissues that spurs healing. It is painful, apparently! (Inflammation often is.)

(2) Injections of platelet-rich plasma

Scientific American took a look at this treatment almost three years ago (not the freshest information, but a decent place to start). A small vial of your blood is spun in a centrifuge to separate out the platelet-rich plasma, which is then injected into the injured tissue.

The theory behind why this should work: The injured areas, such as tendons, have a poor blood supply, so healing sometimes becomes difficult. The concentrated platelets in the plasma bolster the nutrients and growth factors at the site, aiding healing.

Notice the word “theory.” “PRP” has its skeptics. Still, the doctor in the Scientific American article said that, of his patients who have undergone it, maybe 60 percent have gotten better.

(3) Whatever Kobe Bryant had done

Bryant, of course, is the NBA superstar who plays for the Los Angeles Lakers. His right knee, under the kneecap, is missing so much cartilage that it’s practically bone on bone, he has said. He flew to Germany for treatments that apparently worked wonders, leading other athletes to make the pilgrimage to the same doctor, hoping for similar results.

What’s the procedure? Apparently it’s a more vampiric undertaking than PRP (“as much blood as they took the first day, I didn’t think I’d have any left,” said this patient). Again, the blood is centrifuged, but heated first, because the objective is to capture anti-inflammatory proteins, rather than platelets. The resulting orange serum is then injected into the ailing joint.

So there you have it. Three novel treatments worth a look (if you’re resolved to have some kind of treatment anyway). Anyone familiar with any of them, feel free to share your thoughts below.


  1. Without detailing the emotional and physical trials and tribulations of the 9 month long, non-recovery odyssey and fall from grace of the middle-aged super-fit, to person on bad knees wobbling and struggling down the stairs to get the mail (I don‘t go down the stairs any longer)… In part the result of "a simple chondral shave" and lateral release (my surgeons bonus and prerogative). I can say, that in my case, if I could do it over again, I would have at least waited longer before electing for the procedure and at best waited a lot longer while employing a more nuanced approach to physical therapy, fluid resting regime, etc., etc.

    After reading Richard’s book and then the more I thought about (my) cartilage degeneration/injury and the nature of cartilage (read the book), the more it made sense to me that cartilage healing times are vastly different than our usual healing paradigms. Maybe there is a knee miracle (that doesn’t involve inorganic exotica) around the corner, but regardless, maybe there needs to be the medical equivalent of “Copernican inversion,” with respect to what we collectively accept and practice, in terms of time-frames and protocols, on the road to healing our knees.

    Now I have to practice patience not only to heal my original cartilage injury, but also to heal from a lateral release and to heal the big chunks of cartilage (“crabmeat”) that the OS cut out. Not exactly a close shave.

  2. Racer X, I/we would love to hear more of your story. I've been hosed by doctors before as well (link below), and now I'm also trying to prove them wrong about my knee diagnoses too (damaged cartilage requiring knee replacement).


  3. Hello Racer X,
    I, too, elected for the chrondral shav about two years ago.

    What I found is that I do think it solved problem #2 which was that my knee would lock up and cause extreme pain.

    However, I don't think it helped my original problem #1 which was the meet chondromalacia / patella femural pain syndrome problem.

    (At the time of the surgery I had had the chondromalacia PFPS for about 3 years and had the locking up problem only about 3 months.)

    So, my point is that even two years after the surgery I still had chondromalacia PFPS problem. sigh.

    I've written my own situation on other parts of this blog, so, won't rewrite everything here, but, I do think that Richard has definitely hit on some key points about:

    1) healing the cartilage first (which takes a long time) and then trying to strengthen the muscles after. Trying to strengthen the muscles first just aggravates the knee and can even damage it. :-(

    2) structure isn't everything. Read Richard's post about "structuralism" and about how sometimes people which misaligned kneecaps don't have pain.

    Good luck!

  4. Here is my story(regarding Orthokine - Kobe Bryant treatment):

    My name is Goran. I'm 42 years old. I live in Croatia, Europe.
    I apologize in advance for my bad English.
    For some time I have problems with my knees that do not allow me to live a normal life.
    Diagnosis chondromalacia patella .

    I did treatments of physical therapy ( ozone , magnet , ultrasound , exercise ), but with no particular improvement of the knees.
    In the meantime, I spent a lot of money best orthopedists and physiatrists in Croatia . Some say it will pass, some it won’t. Some recommend hyaluronic acid , another MBST ( treatment of cartilage by magnetic resonance - MBST® - Nuclear Magnetic Resonance Therapy, also started for the first time in Germany ) and Orthokin therapy (Globally known as a “Kobe Bryant treatment”), some of them to carry on with quadriceps exercises.
    But they all agree that the operation does not help a lot if the patella is tracking correctly (in the middle), which is my case.
    I finally came across one of the best orthopedist in Croatia who himself suffer from 4th degree chondromalacia patella, and he also recommended Orthokin therapy(which he also tried after the arthroscopy for micro fractures in subchondral bone and he sad that therapy did help him) and MBST therapy.
    Since he’s fighting chondromalacia for whole life he says that it comes and goes in waves of year or two. He generally had more pain in winter, less in summer when swimming in see etc.
    I also found on the internet very few cases of complete healing or regeneration of cartilage. In the meanwhile, I take diet supplements all the time. Fish oil and tablets or powders with glucosamine ... but it does not help ...

    As described conventional methods of treatment have not produced results , I decided to apply Orthokin therapy for both knees.
    The day after the first injection constant pain in my right knee ( scratching , tension ) has begun to weaken. At the time of writing this post ( three days after the second injection ) pain in the right knee is lower by about 70 % , and I could finally start doing the most normal things like watching television, reading newspapers etc. ..
    My impression is that nothing can regenerate damaged cartilage. Impression of pain is individual and subjective and does not depend or partially depend on the degree of cartilage damage.
    Summary is that Orthokin definitely works because it will significantly reduce the pain with chondromalacia patella . Injection does not hurt nor does it have side effects except for a tiny sting that heals in a few days . Whether this will rebuild cartilage , we'll see . I think there are are poor chances for that. But, less pain means more movement, and more movement means faster healing.
    My plan is also to try MBST treatments and with that, all the possibilities, of so called "modern" medicine, which does not seem to make progress towards complete cartilage restoration method are exhausted.

    REFRESH: 6 days after the third injection in both right knee is still 10 % better , even with the left I feel a lot less pain when lifting from a chair and walk down the stairs.

    REFRESH 2: After 5th and last injection I still feel the pain but knees are much better now.