Failed Surgery, Prolotherapy, and PRP - Knee Pain
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As you know, we receive emails from all over the world. This email really hit home and addresses exactly what we have been trying to tell people with our newsletters and written materials, Journal of Prolotherapy, etc.
Surgery did not fix his problem. He tried Prolotherapy, but did not receive Hackett-Hemwall Prolotherapy. Now he is contemplating one shot of platelet rich plasma (PRP) to help his injured knee. As we have said before, one shot is not going to heal the entire area...
Dear Dr. Hauser, I am having trouble with my left knee. I have been an athlete all my life and trained all my life both in and out of a gym. I am a professional tennis coach but have not been able to train for the past two years. I have debilitating pain (medial) and some loss of strength in my left knee. The knee has had two arthroscopic surgeries, one in 1993 when I was 28 years of age, which removed a quarter's worth of bone from the end of my femur (probably a childhood injury). The surgeon poked the end of my femur to try to stimulate cartilage growth. The surgeon noted the rest of my cartilage was virgin at that time. The surgery relieved pressure under my knee cap which had always bothered me. I had relatively few issues with the knee after this procedure. The 2nd surgery was in 2006 at 42 years of age-a menisectomy (that I wish I would not have done). (See A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears) The surgeon noted considerable articular cartilage arthritis (of course from having the end of my femur knocked off.) The surgery went well and I returned to full activity 60 days later. The last two years both my knees have given me trouble. MRI reveal a tear to the medial horn of my right knee but no real further damage to the left knee. Prolotherapy for 6 months on both knees, along with synvisc injections has healed up the right knee (which I chose not to have surgery on) but my left knee is not well. I asked to have Hackett-Hemwell (Prolotherapy) done, but the doctor was not familiar with this. I am seeing another doctor. He is familiar with Platelet Rich Plasma Therapy. He has diagnosed that my quads and hip need strengthened and has suggested I get injections of euflexxa. Dr. Hauser, I need to be able to run. I have always been very quick and agile. Not being able to run or train is ruining my quality of life. I do not want to do another surgery on this knee. Any thoughts, comments or suggestions.
Thank you
Dr. Hauser's response:
Realistically Prolotherapyis your best bet. PRP is only one type of Prolotherapy. While it is a good option, it is not your best option. For now you need to cycle/do elliptical and the strength training recommended. Probably you also have patellofemoral tracking problems and or knee joint instability that certainly won’t be covered by a PRP injection into your knee. You need a thorough Prolotherapy treatment covering your whole knee for whatever knee injuries you have (simply treating the meniscus with PRP will do very little to get you back to running). We have many patients who come here from all over the country. Most likely we would have to see you monthly for six months. Assuming your range of motion is still relatively good in your knee, the prognosis for you is excellent! Euflexxa doesn’t regenerate structures, it adds a temporary cushion so folks think they are better when they are not; so they play tennis and other activities and end up in worse shape than when they started. Sorry to have to say that, but that's our opinion.
Best wishes, hope to see you.
Ross A. Hauser, M.D.
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