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thommo

Had PRP Injections today in my left knee!

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As the title says I had PRP injections in my left knee today. Now I've had cortisone etc in my knee before and local antisetic but wow that was painful. The worst I've ever had. It felt like someone was trying to squeeze a burning hot golfball under my patella. That was horrible. Still pretty sore. Have got the next two days off work to let it settle.

 

Not real confident that it is going to help much to heal or repair the almost missing cartilage on the back of the patella. Have to have another in 8 weeks and then back to see the surgeon 4 weeks after that.

 

If it doesn't help it will be a TKR for me at 38yo!

 

 

So what are peoples thoughts? Will it help me or not?

 

I'm also starting with a pain specialist on 30 March. I'm not in constant pain or any symptoms of CRPS so not sure what he will be able to do for me. My pain is from doing too much on it, having the patella move and grind on the inside.

 

 

 

thommo

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Hunter Pain Clinic did both my knees x3 PRP 5 weeks apart, but all under a twilight anesthetic. Did not hurt one bit, not even after (though my knees were in constant pain, so perhaps I could not really tell the diff).

 

I remember they got worse the day of, but better for a week or two after, then stabilised at perhaps 30% less painful than they had been. I'm sure they assisted the patella cartilage healing somewhat, but def not a miracle cure, I still don't do anything stupid on them......mostly.

 

I've never had another MRI since the real trouble began nearly 4yrs ago, but I'm pretty sure it would show healing as pain is down 50-70% generally.

 

The pain specialist may give you techniques for dealing with pain mentally etc.

 

Don't do too much on them mate. Try to give them time (years) to heal.

 

TKR @ 38 is bullshit. I decided double TKR at 52 was BS for me, trying to heal them more of less naturally. Also now experimenting with fodmaps diet as some food inflame my gut....so perhaps they do similar to my knees?

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Tried Synvisc? Or even had it suggested? Worked for the wife who went from barely able to walk to World duathlon champ in 6 months. Relieved all pain for 6 months then it came backas bad as ever. Another injection and good as mew again, needs them every 6 months or so otherwise its TKR for her as well. On the same topic she had 3 PRP injections in her inflamed hamstring a couple of years ago and it came good after the third one, they were 3 months apart.A friend also used it to cure chronic Achilles tendonitis

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Hi Batman,

 

Yeah I have tried syncisc. It's funny not many surgeons would recommend it. Not sure why. It was good for 6 months and then slowly decreased each injection. Got to the point of 2 months it would last.

 

As for the PRP I've read heaps on how well it works on tendons and ligaments but can find very little about it helping cartilage. Plenty out there saying it doesn't help it.

 

I have a second injection in 8 weeks time and see how it goes. I'm not expecting much to be honest.

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As for the PRP I've read heaps on how well it works on tendons and ligaments but can find very little about it helping cartilage. Plenty out there saying it doesn't help it.

 

The head nurse at Hunter Pain clinic told me PRP reduces inflammation, and stimulates the production of stem cells from the fat pad in the knee (and stem cells can mimic new cartilage).

 

I still think the No.1 thing to do to heal patella cartilage is gentle movement within your envelope of function which stimulates healing, but is not so much as to further aggravate the cartilage. Working out how to do this, is like solving the Da Vinci Code, but has been shown to be possible. I also had damage to the cartilage on the end of my femur, which I'm pretty sure is now significantly healed.

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Hi Batman,

 

Yeah I have tried syncisc. It's funny not many surgeons would recommend it. Not sure why. It was good for 6 months and then slowly decreased each injection. Got to the point of 2 months it would last.

 

As for the PRP I've read heaps on how well it works on tendons and ligaments but can find very little about it helping cartilage. Plenty out there saying it doesn't help it.

 

I have a second injection in 8 weeks time and see how it goes. I'm not expecting much to be honest.

 

 

Surgeons don't recommend synvisc it because it's not surgery. Sports Physicians recommend it because it is an office procedure. Evidence for arthroscopy for osteoarthritis is pathetic, yet there are still production lines of 50 year olds going in for them in every private hospital in the country. Synvisc was taken off medicare because they could only show some evidence of pain relief, not increase in activity or slowing of disease progression.

 

PRP is like shockwave, no magic bullet, flogged as the cure but I've not seen a great deal out of them. PRP evidence seems to suggest it is more effective for knee OA than soft tissue. It seems to hurt like an absolute bastard.

Edited by Parkside

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Surgeons don't recommend synvisc it because it's not surgery. Sports Physicians recommend it because it is an office procedure. Evidence for arthroscopy for osteoarthritis is pathetic, yet there are still production lines of 50 year olds going in for them in every private hospital in the country. Synvisc was taken off medicare because they could only show some evidence of pain relief, not increase in activity or slowing of disease progression.

 

PRP is like shockwave, no magic bullet, flogged as the cure but I've not seen a great deal out of them. PRP evidence seems to suggest it is more effective for knee OA than soft tissue. It seems to hurt like an absolute bastard.

 

Apparently our local OS has stopped doing the mis-leadingly named 'routine knee cleanout' arthroscopy because he too has realised it often does more harm than good....especially the entirely lacking in good evidence 'patella chondromalacia shave'.

 

Maybe the Titanic is slowly turning Parky?

 

He also said the efficacy of Synvisc wears off quickly, and only uses it sparingly.

 

Don't most practitioners do PRP under twilight anesthetic? I imagine it would hurt like a bugger otherwise. My 3x procedures were very easy and pain-free down in Newcastle....and cheap ($110/knee including anesthetic). Apparently the OS in Tamworth now does it for about $200/knee, and the Sports Drs in Sydney are $500+ per knee.

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Hurt like an absolute bitch. The nurse in helping the doctor said my reaction was the worst he had seen. Mine wasn't done under any anestetic. And was $440 for one knee.

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PRP is way, way overdone

 

4 good trials (RCTs) on PRP for tennis elbow, all showed no benefit

1 RCT on PRP for achilles tendinopathy, showed no benefit greater than a generic exercise program

 

There is mixed evidence for PRP and medial compartment (inside of knee) osteoarthritis.

Not much out there for PRP and PFJ (kneecap, front of knee) osteoarthritis

 

I've seen many tendons much much worse after PRP. I've seen ultrasounds of track marks still visible in a tendon, 4 months after the PRP injection.

 

PRP for most conditions is at best unhelpful, and at worst harmful. Those that get better after it are improving because of 1/ placebo, 2/ reversion to the mean (these things mostly get better anyway), or 3/ enforced rest (the doctor says take it easy for 6 weeks and then gradually return to sport.

 

Tricky thing is, if you fail physio for tendon pain, or knee arthritis, and PRP doesn't work, what's left? Surgical options which no one really wants. PRP is often thrown in as a hope, rather than something backed by a plausible biological mechanism and good science.

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On kneecap/patellofemoral pain, we have just been involved in a (yet to be published) RCT on occlusion (blood flow restriction) training for kneecap pain.

 

Had really, really good results. Basically you use a blood pressure cuff to block off blood flow to the leg, and do some rehab (weights) with it on. I was surprised but the results are solid. Will be one of those things that really takes off over the next few years

 

Hopefully the PRP gets you some improvement!

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I was reading about blood flow restriction stuff yesterday for post op ACL and SLR to maintain quads bulk. If you've got anything you can share shoot me a pm el presidente

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PRP is way, way overdone

4 good trials (RCTs) on PRP for tennis elbow, all showed no benefit

1 RCT on PRP for achilles tendinopathy, showed no benefit greater than a generic exercise program

 

I live in Melbourne and was part of the tennis elbow clinical trial.

 

I had my first and only round of treatment and it worked really for around 8 weeks but started to wear off. Unfortunately the trial was for only one treatment.

 

I then accidentally found out that I received a blood injection (or whatever fancy name you want to call it).

 

I then booked in with Julian Frietag for 3 more and after 3 of the most painful injections over a period of which I cannot remember, my tennis elbow was completely healed.

 

I'm sold on it for sure, because it works, but oh god it's painful.

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On kneecap/patellofemoral pain, we have just been involved in a (yet to be published) RCT on occlusion (blood flow restriction) training for kneecap pain.

 

Had really, really good results. Basically you use a blood pressure cuff to block off blood flow to the leg, and do some rehab (weights) with it on. I was surprised but the results are solid. Will be one of those things that really takes off over the next few years

 

Hopefully the PRP gets you some improvement!

 

I'm trying to figure out why this would work. Is it aimed at the theory that kneecap pain can cause the VMOs (and other quad muscles?) to shut down = self-perpetuating problem, and hence restricting the blood flow while doing rehab weights causes those muscles to switch back on and become stronger?

 

If so, does this mean that it is a vascular rather than a neural issue causing the muscles to switch off? Or perhaps restricting vascular flow also switches off the neural inhibition?

 

Regardless, if you get someone whose knee homeostasis is badly out of balance (i.e. even what seem like fairly benign activities take them outside their envelope of function), it might do more damage than good? But if their pain is truly due to muscle weakness/imbalance, then yes I can see how it could help.

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Blood flow restriction allows muscle hypertrophy at much lower levels of training intensity. Growth hormones and all the good stuff are produced at very low levels of weight lifted. You can therefore cause muscle growth without pushing the envelope of function, or loading the knee as much, if we must use that term.

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so, resurrecting this one from the past.

My knee is very clearly rooted.  Saw my orthopaedic specialist today (who saw me in 2017) .  He was not impressed.   And I'm too young for them to recommend a knee replacement (43)

Recommends a PRP shot, and see him again in a month.

I'm booked in next week.

Sounds like it's gonna hurt like a hurty thing?

(and out the window flies UTA100?   Might have to sign up for their freshly released UTA11 option

 

 

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34 minutes ago, Turts said:

so, resurrecting this one from the past.

My knee is very clearly rooted.  Saw my orthopaedic specialist today (who saw me in 2017) .  He was not impressed.   And I'm too young for them to recommend a knee replacement (43)

Recommends a PRP shot, and see him again in a month.

I'm booked in next week.

Sounds like it's gonna hurt like a hurty thing?

(and out the window flies UTA100?   Might have to sign up for their freshly released UTA11 option

 

 

Had them in both knees 3x at the Hunter Pain clinic, but they did them under a twighlight general anesthetic so no pain at all during and not much after....well not from the PRP anyway.

They had minimal benefit though, as my main problem was chronic synovitis.

Define 'clearly rooted'?  Are you bone on bone? Over the decades, I discovered lots of experts will tell you that you're clearly rooted when in fact you are not.

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21 minutes ago, ComfortablyNumb said:

Had them in both knees 3x at the Hunter Pain clinic, but they did them under a twighlight general anesthetic so no pain at all during and not much after....well not from the PRP anyway.

They had minimal benefit though, as my main problem was chronic synovitis.

Define 'clearly rooted'?  Are you bone on bone? Over the decades, I discovered lots of experts will tell you that you're clearly rooted when in fact you are not.

Here it's done at the hospital - not sure of the exact procedure. I like anaesthetics though

My "clearly rooted" was defined, from the MRI, as:

Grade 4 chondromalacia, patellar-femoral, and femorotibial, worst in the medial compartment (basically bone on bone).

Bone edema medial femoral condyle with insufficiency fractures.

Lateral and medial degenerative meniscal tears.

 

It's basically fast tracked viral inflammatory arthritis and degeneration of everything.

 

The worst of my pain seems to be recent development, most likely the fractures in the cheesecake bone.

With the $$ involved for the PRP, I'm hopeful to be one of the folks that get significant improvement?  (over maybe 3 shots?)

 

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On 16/02/2016 at 4:52 PM, thommo said:

Hi Batman,

 

Yeah I have tried syncisc. It's funny not many surgeons would recommend it. Not sure why. It was good for 6 months and then slowly decreased each injection. Got to the point of 2 months it would last.

 

As for the PRP I've read heaps on how well it works on tendons and ligaments but can find very little about it helping cartilage. Plenty out there saying it doesn't help it.

 

I have a second injection in 8 weeks time and see how it goes. I'm not expecting much to be honest.

 

Edited by Parkside
double of prev post, sorry

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5 minutes ago, Turts said:

Here it's done at the hospital - not sure of the exact procedure. I like anaesthetics though

My "clearly rooted" was defined, from the MRI, as:

Grade 4 chondromalacia, patellar-femoral, and femorotibial, worst in the medial compartment (basically bone on bone).

Bone edema medial femoral condyle with insufficiency fractures.

Lateral and medial degenerative meniscal tears.

 

It's basically fast tracked viral inflammatory arthritis and degeneration of everything.

 

The worst of my pain seems to be recent development, most likely the fractures in the cheesecake bone.

With the $$ involved for the PRP, I'm hopeful to be one of the folks that get significant improvement?  (over maybe 3 shots?)

 

I reckon I had grade 3-4 patella chondromalacia as well, but I'm convinced that cartilage can heal with gentle movement, time & patience.  I also had Bone edema medial femoral condyle, but not the fractures.  And a very bad medial meniscus tear, had to have 1/3rd of the meniscus trimmed out.

If I had my time over again I would have:

 - ceased triathlon, running, hard cycling immediately

 - kept up swimming (a lot using pull & band so no kick) and gentle walking, maybe very very easy cycling

 - got onto Celebrex for several months to calm the inflammation

 - maintained my weight (or lost a few kgs)

 - slowly, slowly introduced core/hip/glute/quad strengthening (i.e. over 12mths or more)

 - learned more about mind-body connections, bad neural pathways etc. and how to use the mind to control pain and improve a chronic condition.

I doubt I'll race again, but I can do enough including up to an hour of hard MTBing to get my endorphins & stay fit.

 

PS - and what Parky says !

 - 

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Will medicinal marijuana work? At least you'd be a little distracted while you ran 😀

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Yeah, being chased by giant pink bunnies!

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18 hours ago, ComfortablyNumb said:

but I'm convinced that cartilage can heal with gentle movement, time & patience. 

And PRP can hasten the healing (if the claims are true) by increasing the healing factors within the joint space where there is minimal normal healing?

Hoping so!

If the PRP will help, then I'm all over it.

Reducing my activity is challenging.  Happy to stop running for now, but can't stop walking. Well, I could, but it gets worse when I do.

Will increase the swimming again for sure.

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7 hours ago, Turts said:

And PRP can hasten the healing (if the claims are true) by increasing the healing factors within the joint space where there is minimal normal healing?

Hoping so!

If the PRP will help, then I'm all over it.

Reducing my activity is challenging.  Happy to stop running for now, but can't stop walking. Well, I could, but it gets worse when I do.

Will increase the swimming again for sure.

I find a slow 20 min flat stroll is good for my knees when they feel a bit shit.  And all the stuff I read/peo

That was what they told me at the Hunter Pain Clinic - PRP reduces inflammation and contains some stem cells which promote cartilage healibg/growth.  I got some short-term relief for a week or so, but not long term.  BTW each shot (2x knees) was only $140. People I talked to who had healed their patella femoral pain did so by dropping everything except easy walking, pool walking and very very light spinning on stationary bike as the first line of treatment for 12mths+

 

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22 minutes ago, ComfortablyNumb said:

That was what they told me at the Hunter Pain Clinic - PRP reduces inflammation and contains some stem cells which promote cartilage healibg/growth.  I got some short-term relief for a week or so, but not long term.  BTW each shot (2x knees) was only $140. People I talked to who had healed their patella femoral pain did so by dropping everything except easy walking, pool walking and very very light spinning on stationary bike as the first line of treatment for 12mths+

 

Yeah, you pay more in certain locations. Like the boonies. 

If I did that and only that for 12+ months, my knee might be 10% better. But my liver would be shot. 

Mine isnt patellofemoral pain either. The pain is from the bone cheese. 

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12 hours ago, Turts said:

If I did that and only that for 12+ months, my knee might be 10% better. But my liver would be shot. 

Also, don't make the same mistake I did Turts.  I reckon if I'd backed right off for 1-2yrs, I'd have quite possibly healed (others I know did, but they were far more patient than me).

But I hear you, it has been really hard to give it away, other interests to eventually take over and you can find novel ways to stay fit without wrecking the knees further.

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12 hours ago, ComfortablyNumb said:

 'Bone cheese'?  Is that damage to the bone from cartilage loss causing bone on bone action?

Yeah, but it's not superficial damage.  It's weakened through the structure of the bone. 

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40 minutes ago, Turts said:

Yeah, but it's not superficial damage.  It's weakened through the structure of the bone. 

Bone (unlike most cartilage) has a good bloody supply = healing potential.  But it won't heal if you keep smashing it.  The PRP may help, but it will still need gentle movement & care/patience to heal.  There is also evidence that gentle movement improves the quality of the knee synovial fluid = better healing.

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I've had Orthokine injections in my knee for severe osteoarthritis.  They told me it's fine (good actually) to keep cycling and even some running, but I'm supposed to avoid stairs. Bit hard when I work upstairs and there's no lift.  Might have to quit my job 😛

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You should sue your boss for not having a compliant workplace for the disabled and make them put in a lift!

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