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Has anyone had Platelet Rich Plasma and Hyaluronic Acid Blend Injections?

 Poster: A snowHead
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My knees been giving me lots of agro over the course of this past season so I bit the bullet and saw a Consultant and got my MRI results today and the recommended course of action is TKR in a few years time but in the meantime gonna give Hyaluronic Acid (HA) injections a go along with NSAID's to hopefully manage better. My guy does a blended version of HA with PRP which sounds interesting and he recons in my case it is 50/50 whether it will do any good but cant hurt...

Curious to hear if anyone has had HA, PRP, or, the HA/PRP viscosupplementation injections and if so how you got on... It is relatively new and little clinical evidenced trials bit I recon cant hurt. Planning on getting it done in the Autumn in prep for skiing.
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Try the US forums - they are mad for that sort of thing. pugski if you can't face TGR or Newschoolers.

Have you been NSAIDing them consistently this season?
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Cheers Dave will do, hadn't thought about pug-ski, good shout... Been trying to avoid eating drugs this season and only used double strength Voltoral gel on the knees with neoprene sleeves. Wanted to stop using oral NSAID as I didn't do any race training or technical skiing and didn't think I would stress the joints that much but in hind site not a good idea as todays MRI showed I managed to tear my "good" ACL and it gave me ongoing problems all season with swelling, VMO shutdowns etc... My right knee ACL went ages ago and turns out both medial meniscus are gone, bone on bone with tears in the lateral sides so arthroscopic surgery isn't going to help nor is stem cell therapy...
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I'd be interested to know how you get on. I am probably heading down the same path (TKR) and I'd like to delay it as much as possible.
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@skimottaret, crikey, you're falling to bits! Shocked Hope the treatment works for you.

Quote:

Wanted to stop using oral NSAID as I didn't do any race training or technical skiing and didn't think I would stress the joints that much but in hind site not a good idea
Are you saying that the condition has worsened because you didn't take NSAIDs orally? I have to be careful, as already on Aspirin for my heart condition, so have been relying on
Quote:

double strength Voltoral gel on the knees with neoprene sleeves
plus, very importantly, ice and elevation after exercise. So far this is working, but when I was lazy about icing them, especially the injured one, at the EoSB, the swelling resulted in not being able to get my ski boot on on the last day! I do sometimes top up with oral NSAID but wouldn't like to think that it's absolutely essential to prevent further damage.

Please update as you go along, I'll warrant there are many of us on the forum who are getting progressively creakier around the knees and will be interested.
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@skimottaret, PS, entirely off-topic, but while I've got your attention...have you seen the Picassos at Tate Modern? Knock-out. If not, do combine with a meal in SW11, you'd be most welcome.
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Quote:

Are you saying that the condition has worsened because you didn't take NSAIDs orally?


I think yes in that I didn't effectively manage the swelling/pain and had a lot of problems pressing hard on the skis and a lot of pain when skiing hard pack. Also, a few occasions later in the year when the left knee locked in place for days at a time.. I kinda suspected I did my ACL in Dec but as it wasn't nearly as bad as the first time I tore one so figured it was minor and just soldiered on.. there is a little bit left of the left ACL but I didnt know until today the right one was completely toast along with the meniscus Toofy Grin
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skimottaret wrote:
My knees been giving me lots of agro over the course of this past season so I bit the bullet and saw a Consultant and got my MRI results today and the recommended course of action is TKR in a few years time but in the meantime gonna give Hyaluronic Acid (HA) injections a go along with NSAID's to hopefully manage better. My guy does a blended version of HA with PRP which sounds interesting and he recons in my case it is 50/50 whether it will do any good but cant hurt...


Did you consider a Penis Facial?

https://www.cosmopolitan.com/style-beauty/beauty/a19444832/pint-facial-beauty-treatment/
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@davidof, anything would be better than robot knees wink
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So no prospect of ACL reconstructions then? They'd rather do a TKR?
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skimottaret wrote:
@davidof, anything would be better than robot knees wink


At least you might look 20 years old again !
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@Dave of the Marmottes, Yip , the main issue is arthritis and lack of meniscus rather than ligaments. He ruled out arthroscopic as pointless and turns out I have been doing reasonably well without an ACL for the last n years wink
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@skimottaret, we've discussed this before on another thread but.. PRP is fantastic at reducing day-to-day pain so you can break the "cycle": "It hurts so I don't exercise as much as I did. Because I don't exercise as much as I did, my muscles are weaker and now my joints ache more easily so I don't exercise as much as I did" etc,. etc. It's just a downward spiral.

I am confident in saying that the specialist that treated me would absolutely NOT recommend anything that included hyaluronic acid. I've had HA injections (that made no difference) and he categorically told me that you can only have a maximum 3-4 before your body builds an immune response to them and they will just cause swelling. Given that they are generally expected to have a lifespan of 3-6 months, it basically means that they're no use for more than a couple of years.

As an update to the last time I posted on this subject, this was my experience this season: I skied the last 30 out of 32 days in the 3V season. The first day, I skied 7,000m vertical in 3 hours because I felt good. It was probably too much. Over the next 7-10 days my knee got more painful the longer I skied. It would basically be pain-free for the first 3,000m or so and then gradually become more sore. The first 3-4 turns on any new run would be painful but then adrenaline would kick in and it would be ok. But I carried on skiing. It got to a point where I had to "flick" the ski to engage the binding because I couldn't directly pressure it.

BUT, the longer I skied, the better it got. After 3-4 weeks I could engage the binding without any discomfort and was skiing 12,000m+/day without any discernible discomfort. Which is what I said last time, with PRP my knee always seems to get better with exercise/pressure, not worse. Skiing improves it and I genuinely think PRP is a fantastic natural remedy to knee pain.

I will add the caveat though, that my issues are not particularly meniscus based. I do have meniscus damage on both sides, particularly medial but they're not completely shot - the majority of my pain has been from stripped-bare patellar articular cartilage. I'm fairly sure that PRP will still work for meniscus issues but it may take longer and/or more injections.

If you want to read up on it, this is the guy that treated me: https://www.amazon.com/Panacea-My-Veins-Facts-Fiction/dp/1482832585?tag=amz07b-21
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No experience of those medications but found Synvisc injections bought me around another 12 - 18 months before opting for a TKR. Have you tried a Ski mojo?
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RUGBY PETER wrote:
No experience of those medications but found Synvisc injections bought me around another 12 - 18 months before opting for a TKR.
Synvisc is a brand name for hyaluronic acid.
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Thank you @Raceplate, - it appears I do have experience of hyaluronic acid injections!
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RUGBY PETER wrote:
Thank you @Raceplate, - it appears I do have experience of hyaluronic acid injections!

Laughing and what you've described is exactly what my guy said - they'll work for a year or so and after that your body will reject/stop responding to them.

It's why PRP is so much better - your body will never reject its own blood cells.

For me (and I'm sure anyone else) with chronic knee problems, we are all in the hope that the boffins will find a way to recreate articular cartilage through stem cell therapy. From the last conversation I had with a world class surgeon, I'm pretty sure that's their current holy grail. Could put them all out of a job though, so maybe they're not that keen.. wink

For me, I'm beyond happy that PRP has given me a new skiing life and by the time my knee gives out completely, I'm hopeful that stem cell therapy will have developed a way to rebuild it, rather than have to replace it.
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Is PRP only available through private consultants, or any chances on NHS? If the former, any indications of cost?
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Ski Mojo for you bonny lad
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Grizzler wrote:
Is PRP only available through private consultants, or any chances on NHS? If the former, any indications of cost?

Would depend on your local NHS, as to how progressive they are. I've been non-resident for a long time but the last time I looked it was non existent.

It is available privately though and the costs vary massively according to region (London!). Most reasonable I've seen is www.blackberryclinic.co.uk/platelet-rich-plasma-prp
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skimottaret wrote:
My guy does a blended version of HA with PRP which sounds interesting and he recons in my case it is 50/50 whether it will do any good but cant hurt...
.

On the contrary, I reckon it'll more than smart a little. I would.f#$% around with stuff like that until proven long term research comes to light
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@Raceplate, Thanks for the info, I have problematic knee caps as well as per the thread you mentioned and it was interesting reading it. My patella tendons are intact but the back of the kneecaps have severe arthritis (before skiing I played competitive volleyball for 10+ years) and had "jumpers knee" along with Osgood-Schlatters as a youth. Most of my pain when not skiing comes from the patella area.

Been working hard on stretching the hamstrings and have made progress there and have felt improvements in the knees and hamstring attachment points.

The injections my guy recommends are a mix of PRP and HA, he said a course of three is recommended by the drug company, the second course a week after the first and a third six months later. Didn't specify exact mix or manufacturer, I will make further enquiries.

@Frosty the Snowman, A few guys I know who tried the Mojo thing didn't really rate it but now I know I am lacking ACL's I may look into proper braces but don't really want to go down that route..
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@Grizzler, I am getting this done through Insurance privately so don't know costs.
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Frosty the Snowman wrote:
skimottaret wrote:
My guy does a blended version of HA with PRP which sounds interesting and he recons in my case it is 50/50 whether it will do any good but cant hurt...
.

On the contrary, I reckon it'll more than smart a little. I would.f#$% around with stuff like that until proven long term research comes to light
rolling eyes If it's pure PRP it doesn't hurt at all. Your body doesn't reject your own blood.

There IS long term research available these days and it's becoming much more widely known as a successful treatment for people with primarily arthritic joint pain. Jonathan Bell is also using it for some of his patients, with success. He was a sceptic when I had my knee injected but has changed his opinion on it. You'll find his comments on another thread if you do a search.
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There is a report on Ski Chrono today that Adeline Baud-Mugnier had PRP done a couple of weeks ago.


Last edited by Ski the Net with snowHeads on Fri 18-05-18 10:22; edited 1 time in total
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@skimottaret, for me it is only one kneecap. The articular cartilage is badly worn but it's good on the femur and tibia so the pain comes when bending the knee which pressures the patella. My hamstrings are ok although I do somatic stretches on them before exercise which helps to reset them. I've found stretching my ITB is more effective for releasing the pressure on the patella.

I would steer clear of a combined injection. HA is simply a chemical lubricant with a limited lifespan and a risk of rejection. It will mask the true effects of the PRP so you'll never really know if the PRP is working or not. Dr Hamid who treated me was really quite scathing of HA.

The injection time scale is also interesting. No idea whether that's better or worse than the way I did mine which was 3 injections spread evenly over 6 months i.e. 8 weeks apart. It was originally going to be 6 weeks apart but it didn't fit his schedule. He basically said it wouldn't make any difference to the long term effectiveness but it would give me more time to evaluate if it was helping (as I was funding 40% of the cost).

I remember thinking that the first injection had an almost immediate (couple of days or so) pain reducing effect. The subsequent ones just enhanced it further and over time the muscles and my confidence have rebuilt so as to break the pain=no exercise=muscles wasting=more pain cycle.

Difficult to say if a second injection one week after the first is a boost or a waste? My gut feeling is that it doesn't give enough time for the first injection to be fully effective so it's not the most efficient use of a limited number of injections. Do they have any research that proves this is the best timescale? Maybe it's because it also includes HA although that amount of HA seems like overkill and more likely to elicit a rejection. The cynic in me says that the drug company is trying to produce a "wow" response from the patient while not giving a toss about the best long term result.
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@skimottaret, I forgot to say that the year I had a ruptured Baker's Cyst was the ski season following my HA injection. Prior to that, I had never had any swelling issues - just pain on pressure and severe clicking. I thought the Baker's Cyst was the end for me as it's not an injury as such but a by-product of other underlying issues in the knee. After the conversation I had with Dr Hamid, I've often wondered if that Baker's Cyst was actually an immune system rejection of the HA exacerbated by the increased exercise levels of skiing.

I've had only very minimal swelling since the PRP injections and only for the first few days of skiing. Frankly, it doesn't seem to be any more swollen than my good knee so I think it's more age-related than structural. Probably, "slightly puffy" would be a better description. After a week or so, what swelling there is goes down and the more I ski the less it hurts. I skied 23 consecutive days this season before I had a day off and it just got stronger. By the time I'd done 30 days on snow, I'd pretty much stopped thinking about it.

I very much feel that the PRP has reset my immune system response to my arthritic knee which would be exactly in line with what Dr Hamid always said, "It's a (natural) chemical reaction, not a physical one".
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Raceplate wrote:
rolling eyes If it's pure PRP it doesn't hurt at all. Your body doesn't reject your own blood.

There IS long term research available these days and it's becoming much more widely known as a successful treatment for people with primarily arthritic joint pain. Jonathan Bell is also using it for some of his patients, with success. He was a sceptic when I had my knee injected but has changed his opinion on it. You'll find his comments on another thread if you do a search.


I have had injections into my knees. and it knacked. I have had treatment to a knee that was fairly new (full reconstruction using carbon fibre), but considered safe, but 10 years later was stopped because it was detrimental to the joint in the long term. The research I have seen on this procedure is NOT long term research (happy to be corrected), I have also seen research that says the PRP can do some good, but that when combine with HA, the results are no different ( which would back up your guy's advice).

Fantastic that it has worked for you, and I am now keeping an eye on treatment.

PS My reconstruction aged 21, was my 3rd op on that knee and I have lived with 110 degree movement and pain for 35 years. The injury ended a promising sporting career and for some reason the old Rolling eyes emoji really p!sses me off
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@Frosty the Snowman, the rolling eyes emoji is what you get when you just post a one line put down of something with no background information for your opinion whatsoever. It's not helpful for any third party reading the thread who is wondering whether they should get the treatment.

From what you've now said, it still doesn't sound like you've actually had PRP injections. They've only been around for about 10 years (in the USA). More likely cortisone? If it is cortisone, then that is well known to have a limited lifespan and human tolerance level. It's nothing like PRP, which is a completely natural product from your own body.

As previously stated, PRP is most suitable for people with age-related arthritic issues. It changes the body's natural immune/nervous system response to reduce the pain. It's clearly not going to work on a carbon fibre knee and I would think that you are a poor candidate for it with a 35 year old structural problem.

From the symptoms that @skimottaret has described though, I would think he has a strong chance of a positive outcome.
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Raceplate wrote:
@Frosty the Snowman, the rolling eyes emoji is what you get when you just post a one line put down of something with no background information for your opinion whatsoever. It's not helpful for any third party reading the thread who is wondering whether they should get the treatment.

From what you've now said, it still doesn't sound like you've actually had PRP injections. They've only been around for about 10 years (in the USA). More likely cortisone? If it is cortisone, then that is well known to have a limited lifespan and human tolerance level. It's nothing like PRP, which is a completely natural product from your own body.

As previously stated, PRP is most suitable for people with age-related arthritic issues. It changes the body's natural immune/nervous system response to reduce the pain. It's clearly not going to work on a carbon fibre knee and I would think that you are a poor candidate for it with a 35 year old structural problem.

From the symptoms that @skimottaret has described though, I would think he has a strong chance of a positive outcome.


rolling eyes One could also use the emoticon for those who quote their own n=1 study results.

https://journals.lww.com/jaaos/Abstract/2018/05010/Mixed_Treatment_Comparisons_for_Nonsurgical.6.aspx

In this meta analysis only intra articular steroids show a benefit over placebo intra articular injections and for function no intra articular injections was better.

Of course all IA injections have a very small risk of infection which should be bourne in mind.
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@betterinblack, good point on the injections having an infection risk which was pointed out by my Mr. and shouldn't be overlooked.

Thanks for chipping in, it has been a while since I coached you but I seem to recall that you are trained in this subject and that you know what you are talking about Wink

I haven't gone through loads of studies as being a layman they wouldn't make much sense to me but the few medical people I have asked have pretty much said for MYSELF HA and or PRP "can possibly" help. My friends make a good point that the studies are varied in terms of efficacy and you need to understand the patient base within the studies. For example those with lots of fat unfit older people who get it done don't see much benefit, nor as in my case those with moderate to severe OA. Thats probably why my consultant gave it 50/50 as it may do little to no good or get some moderate help. Not seeking a magic bullet only hoping to delay the inevitable.. Toofy Grin Toofy Grin

PRP seems to me to be worth a shot with low risk.
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@betterinblack, the OP asked if anyone has experience of PRP injections in their knee. I do. Not sure how you'd expect me to have anything other than n=1 in that circumstance. Terribly sorry for actually answering the question!

For the record, they're not painful. A walk-in, walk out treatment that takes about half an hour, most of which is waiting for the centrifuge to finish. No pain killers, no side effects, no after effects, not even a local anaesthetic (although I was offered one if I wanted). Only advice was not to exercise hard on it for a couple of days afterwards. Otherwise, just carry on as normal.

There are some positive studies referred to here, the first result in a google search: https://www.arthritis-health.com/treatment/injections/efficacy-platelet-rich-plasma-injections

You can be as negative as you like about them but I have first-hand experience which is what the OP asked for. In my case, the results were not just positive, they were life-changing. I am well aware that YMMV.
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@skimottaret, don’t be too quick to rule out Mojos. Myself and many others on here with knee issues have found them very effective- just sayin Very Happy
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@RUGBY PETER, Haven't seen you ski but the people I know that like em tend to ski in the back seat and/or are a bit overweight.... The ex racers and professionals that I spoke to that have tried em don't like feeling of being "spring loaded"

I'm in ski boots 100+ days a year so things are a bit different for me.. The physios all tell me that strength and conditioning is better than mechanical braces but like injections a brace is probably better than new knees ! will probably give em a go at some point if the old knees get really bad but I'm okayish to ski at the moment.

@Raceplate, Can you walk/ get on the tube afterwards without trouble? My guy is in central London and I did read a bit on the net on people who needed crutches afterwards but could be that they were in bad shape to start with.
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skimottaret wrote:
@Raceplate, Can you walk/ get on the tube afterwards without trouble? My guy is in central London and I did read a bit on the net on people who needed crutches afterwards but could be that they were in bad shape to start with.

I would agree that they must have been in bad shape to start with to need crutches. I don't recall any after-effects and I wouldn't see any issue with using the underground unless you're already struggling with steps etc., in which case it will just be the same. You might want to check whether they give you a cold compress knee sleeve or similar after the injection and how long you're supposed to wear it for, though. It won't stop you using the tube but you might want to wear shorts rather than jeans for comfort.

I drove to the hospital each time and IIRC scheduled my appointments just before lunch. I then skipped out of work early, did the treatment, went home for lunch while wearing the compress and then put my suit on and went back to my job. In general, it's a simple walk-in, walk-out procedure and I wouldn't expect someone with your level of mobility/fitness to have any issue at all.

I'm sure you'll be given a do's and don'ts sheet but from memory it's very important not to take anti-inflammatories for at least 3 days beforehand (and maybe after) and also keep your booze intake moderate. It increases the quality of the platelets.

Have you decided on pure PRP or you're going with the HA combo?
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Mojos are very good to help take some of the strain off the legs and therefore probably the knees. They also help with energy issues for us older folk or people who for any other reason have energy issues. I think on the other discussion about Mojos someone referred to a ski instructor who skis with Mojos to good effect. We have just returned from Canada where one of our older friends tried Mojos for the first time, he went out reluctantly and (having borrowed a set) very unsure about what they might do for him, came home pretty much beaming and plans to buy a set of his own for next year !
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Quick update I had injections of PRP mixed with Ostenil Plus HA approximately 1/3 by volume today. They drew blood from my arm and centrifuged it in the treatment room and added the HA there and then before injecting into the lateral side of both knees just below the patella.

He drew a "double" sample of blood and I think ended up injecting the whole lot in. Left knee I hardly noticed it going in but the right one was quite sore and I felt a lot of pressure when injected. Could barely load bear on right leg and struggled to get down stairs resorting to hopping down on left leg when leaving the hospital. After two hours right knee still swollen and I cant fully extend leg (10deg reduction from left) I had just gotten off a long haul flight day before and my right knee has been swollen for last month or so. I wouldn't have fancied walking more than 50 metres or so afterwards... Next morning tender going down stairs and a slight limp.

Next injection in a months time and he said to see how things progress and if no improvement dont bother with a third set of injections which is typically within 6 months of first.

Fingers crossed Wink

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10 days later and swelling down to zero on left knee and as little as I have had for some time on the right. Both feel MUCH better and less crunchy and sore. I did a 30 mile cycle without any stiffness and three days in ski boots with no swelling or pain. Whoop Smile
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@skimottaret, Very Happy
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@skimottaret, great news, please keep us posted.
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