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  1. #76
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    Kinnikinnick
    Are you in the Denver area? Who was your surgeon?

    I suffered severe right knee pain from running on flat dirt road in May. Saw an ortho doc a couple weeks after and he said I had chondromalacia (fancy word for degeneration). Told me to give up running (after 39 years of it). Range of motion is now normal. But, I can still feel things aren't right with the knee. I get that running is out, but I can't walk the dog more than a couple mile on flat ground. Got an MRI that showed a meniscus tear. Saw a different ortho doc last week. He described the tear as cables ripped apart and said it could not be repaired. He offered nothing more than a cortisone shot for pain relief if I wanted. Maybe "minor" surgery to trim part of the meniscus that is bulging out. I see the original ortho doc this week for his opinion. Looking for a third set of eyes.

    Any of you other guys that researched stem cell have any info/opinion specifically for meniscus tears?

  2. #77
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    Hey EO,
    I just PM’d you.

    Dr McCarty CU Sports Medicine is who I used.

    I had two differing opinions on the viability of my repair too.

    One said it won’t work and just have a trim (and expect the 20 year clock for a total knee replacement start). Dr McCarty thought I should try PT and then a steroid shot and then finally a scope with possible repair. He ended up doing a “inside - out repair” .

    I think that that the reality is that they can’t tell that great one way or another until they are inside with the scope. So I’d advise you to try PT 1st and then go with the doc who you feel the best about given your research.

    Some people seem to have success with the stem cell injections too, so if paying out of pocket is an option, you could try that.

    Good luck


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  3. #78
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    Quote Originally Posted by Elkhound Odin View Post
    Any of you other guys that researched stem cell have any info/opinion specifically for meniscus tears?
    I don't know anything about meniscus specifically, but my wife has a pretty significant talar defect in her ankle (two separate ground falls while climbing, one bouldering, one leading), which seems very similar to the ankle's version of a meniscus. Before her stem-cell injection almost exactly one year ago, she wasn't able to walk 3 miles on flat, even ground. It was a slow progression -- she continued with PT from July till November. When she first went skiing iin November, she could only do 2 runs on the bunny slope at Loveland Valley. She overdid it at Christmas in WA, kept at the PT, was able to ski about every other day in Chamonix for two weeks in April, and now she's been skiing both weekend days and doing stuff like Tuning Forks on Torreys after work (refreeze) last month because she wanted to ski more than just weekends. She still has pain sometimes, still hasn't been able to run properly yet, and she wishes she could do big 30 mi, 10k vf days like she used to, but it's SO much better than it was a year ago.

    Since you're in the Denver area, Dr. Karli at the Steadman Clinic in Vail is the one who did her stem-cell injection. https://www.thesteadmanclinic.com/ou.../david-c-karli
    We also looked into the Centeno-Shultz Renegexx clinic, but they were about double the price for a stem-cell injection, IIRC. We kind of insisted on trying a stem cell injection before surgery. The Steadman clinic docs didn't really think it would work given the time since the original injury and that we weren't doing it as part of a surgery. But we're so glad we insisted. And the technology is only improving, and if she needs another one in 5 years, at least they didn't cut out any viable tissue with a surgery.
    Last edited by auvgeek; 07-10-2018 at 12:47 PM.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  4. #79
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    Auvgeek, What was the procedure for the stem cell, and how much was it? (if you don;t mind me asking)

  5. #80
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    They drill into the pelvic crest from the back and extract raw bone marrow aspirate, leave the room to process it, come back about 10 min later and inject the processed stem cells into the desired area under ultrasound guidance. We chose to forego topical anesthesics because we read some journal articles saying lidocaine and other topical anesthesics can kill viable stem cells. The injections were painful and uncomfortable, especially from the pressure of having that much volume injected into a small joint space. She was a trooper about it. Note that the US doesn't allow cultured stem cells (yet), so they have to drill into you pelvic bone every time you want an injection, no more than once a year (only really an issue if you have multiple injuries you want addressed at the same time).

    I think it was $2500. We're by no means rich and it was a stretch for us, but it was worth it.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  6. #81
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    Quote Originally Posted by Kinnikinnick View Post
    I think that that the reality is that they can’t tell that great one way or another until they are inside with the scope.
    this is very true, what they saw from my MRI was somewhat different from what they saw with the scope

  7. #82
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    Quote Originally Posted by Elkhound Odin View Post
    He described the tear as cables ripped apart and said it could not be repaired.
    With that type of tear, you're best option is physical therapy…surgery isn't going to do much unless your knee is locking, all they'll do is trim out parts of your meniscus which puts you on the road to Osteoarthritis faster

  8. #83
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    I went for three different consults.
    consult 1: recommends no surgery. can't repair. Surgery for clean up only if function/pain get worse.
    consult 2: surgery possible for clean up to deal with pain. can't repair
    consult 3: surgery possible for clean up. Possible repair by tacking the tear down to the bone. But, recovery is long and outcome not 100%.

    asked what happens if I don't do anything since I have function and pain is tolerable, they said eventually I'll need knee replacement. Consult 2 & 3 said clean up might extend knee life. But, then they provide an anecdotal case where the person didn't do anything and they have been fine for 6-7 years. Consult 3 offered an option for a brace to relieve the strain, but left that based on how my knee is functioning.

    asked all 3 about PT, they said, meh. It won't really do anything to fix the problem

    asked about stem cell & PRP, they said don't bother, won't do anything. Sure, they said I could find a snake oil saleman pitching miracles, but I'd be wasting my money.

    All three told me to stop running. Don't do any repetitive high impact activities like that or heavy lifting. Hike in moderation. Get on a bike, go swimming. Skiing is OK, but don't hammer the bumps all day long.

    Right now, my knee works. It swells up after walking, but so does my other knee. I've got to the point I have to accept I'm old I guess.

  9. #84
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    meniscus or MCL tear/experiences.

    Sounds like a tough call.

    I felt mine was tough call too. Going into the surgery I wasn’t sure whether I was getting trim or the repair. I asked him to try the repair if it looked viable but it was his call in the end based on what he saw.

    I opted for the surgery in general bc it just didn’t get better with extended rest or PT. I wanted to be able to go on long hikes/skis without the days of stiffness and limping around. My hip was starting to hurt from limping.

    I think that that is your decision point -can you do your activities enough to be happy with as it is?





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  10. #85
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    Quote Originally Posted by Elkhound Odin View Post
    asked about stem cell & PRP, they said don't bother, won't do anything. Sure, they said I could find a snake oil saleman pitching miracles, but I'd be wasting my money.
    That's what two of the three orthos told my wife about her ankle and stem cells, also. The other one said it only works in conjunction with a surgery.

    I wonder how those same orthos feel about the recent peer review studies claiming surgery is statistically no better than PT for meniscus tears.

    The key question is what percentage of the patients that they've personally seen try it are the same or worse? The ortho we saw who argued the hardest against the stem cell approach would not give a straight answer to that question -- I asked if he'd seen any who'd tried it and came to him after and he decided it was time to leave the room. And of course, there aren't any real peer reviewed studies of the efficacy of stem cells yet. (And with the current political climate, who knows if they'll ever get funded.)

    Look, I'm not saying stem cell injections are the end all be all of sports injuries. It might not help you at all. BUT we just don't know enough yet, and it's pretty low risk compared to a surgery where they might cut out something useful and actually make it worse.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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  11. #86
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    the truth is usually somewhere in the middle. For example, the doc is correct in that PT will not FIX a torn meniscus- but it will train you to strengthen the muscles and put less stress on the joint, which results in less pain. OTOH, surgical transplantation to regions with low blood flow may or may not work.


    Fyi- there was a May 2018 study that may eventually be the way of the future- "Engineered Healing of Avascular Meniscus Tears by Stem Cell Recruitment."
    (may be free.. https://www.nature.com/articles/s41598-018-26545-8.pdf)

    "Meniscus injuries are extremely common with approximately one million patients undergoing surgical treatment annually in the U.S. alone. Upon injury, the outer zone of the meniscus can be repaired and expected to functionally heal but tears in the inner avascular region are unlikely to heal. To date,no regenerative therapy has been proven successful for consistently promoting healing in inner-zonemeniscus tears. Here, we show that controlled applications of connective tissue growth factor (CTGF)and transforming growth factor beta 3 (TGFβ3) can induce seamless healing of avascular meniscus tears by inducing recruitment and step-wise differentiation of synovial mesenchymal stem/progenitor cells(syMSCs). A short-term release of CTGF, a selected chemotactic and profibrogenic cue, successfully recruited syMSCs into the incision site and formed an integrated fbrous matrix. Sustain-released TGFβ3 then led to a remodeling of the intermediate fibrous matrix into fibrocartilaginous matrix, fully integrating incised meniscal tissues with improved functional properties. Our data may represent a novel clinically relevant strategy to improve healing of avascular meniscus tears by recruiting endogenous stem/progenitor cells."
    Move upside and let the man go through...

  12. #87
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    Interesting. Thanks for the link.
    "Alpine rock and steep, deep powder are what I seek, and I will always find solace there." - Bean Bowers

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