The Best Treatments for Osteoarthritis and Knee Injuries


2.7 million people in the U.S. were living with an artificial knee, according to a study conducted in 2010 (1). Since more than 600,000 people a year undergo surgery for a total knee replacement (2), that total has significantly increased and does not include other types of knee repair surgeries.


The Agency for Healthcare Research and Quality estimates that “by 2030, about 11 million Americans will have either a hip or knee replacement, making it one of the nation’s most common elective surgical procedures.”


The American Academy of Orthopaedic Surgeons states that “more than 90% of people who have total knee replacement surgery experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living.” However, like any other surgery, it carries significant risks and recovery time. What if there was a better way to repair your knee, with less risk and much shorter recovery time?


Knee Cartilage Basics


Cartilage in your knee is a type of hyaline cartilage called articular cartilage. It is a rubbery tissue that cushions the joint and reduces friction between the bones when you move your knee. It is very tough, elastic, and springy which allows your knee to move smoothly and to absorb shock, up to 20 times your body weight. However, cartilage does not have a blood supply, so it has a limited ability to heal and takes far longer to heal when damaged than other types of tissue in your body.


Cartilage in your knee may be damaged through a heavy impact, such as a sports injury, bad fall, or car accident. Wear and tear may cause inflammation and breakdown of cartilage. Damaged knee cartilage can cause severe pain, swelling, stiffness, and loss of function. Since cartilage does not repair itself well, injuries and damage will often require medical treatment.


Minor damage may only require conservative treatment such as non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, or steroid injections. These treatments do not actually repair the joint. NSAIDs and steroid reduce inflammation and pain while giving the cartilage time to heal, and physical therapy strengthens the muscles around the joint to support it and reduce pressure on the damaged cartilage. When conservative treatment will not work, conventional medicine will recommend surgery.


Knee Replacement Surgery


There are two common reasons that people need knee surgery. The first is to repair a torn ligament or meniscus. The second is to replace a knee joint with cartilage that has degenerated or worn down, usually as a result of osteoarthritis or rheumatoid arthritis.


Your knee has four main ligaments, the lateral collateral ligament, posterior cruciate ligament, anterior cruciate ligament (ACL), and medial collateral ligament (MCL). When any of these are torn, they are usually treated with surgery, which can require 8 weeks to 6 months for a full recovery.



The lateral meniscus and medial meniscus are disc-shaped pieces of cartilage that provide a cushion between the bones. Sometimes tears in the meniscus can be treated without surgery, but surgery is usually recommended if the tear is large, or on the inner part of the meniscus. You are usually fully recovered within 8 weeks.


While most surgeries to repair a torn meniscus or ligament in the knee are successful, unfortunately, the injury and surgery to repair it usually have long term repercussions. You are more likely to develop osteoarthritis in a joint which has previously had surgery to repair a damaged ligament or tendon. In fact, one study found that “Neither conservative therapy nor the current surgical reconstruction techniques have been successful in eliminating or slowing the progression of osteoarthritis following ligament injury” (3).


What is Osteoarthritis?


Osteoarthritis (OA) is a degenerative disease in which the articular cartilage of a joint wears down. When this happens, the bones rub against each other, causing swelling, pain, and loss of function. Eventually, the bone, tendons, ligaments, muscles and synovial lining can also be damaged. OA is different from rheumatoid arthritis, which is a chronic inflammatory autoimmune disorder that affects the lining of your joints and can damage many other parts of your body.



Many factors lead to the development of osteoarthritis. Prior damage and aging are common causes. However, “metabolic factors such as hyperglycemia, dyslipidemia, and obesity affect articular tissues and may initiate or exacerbate the OA” (4). As these metabolic factors are all influenced by diet and lifestyle, it is possible that making changes in these areas may prevent or slow the progression of osteoarthritis.


OA is one of the most common degenerative disorders and is a major cause of disability. Globally, osteoarthritis is the fifth leading cause of disability in women over 60, and the tenth in men over 60 (5).


Conventional treatment attempts to relieve pain rather than cure the disease. Conservative treatment includes physical therapy, anti-inflammatory medication, and opioid pain medication. When conservative treatments are not enough, injections may be recommended. Corticosteroid injections reduce inflammation and hyaluronic acid injections supplement the fluid already in your joints. Both these injections provide temporary relief but do not heal the damage. When these treatments do not provide pain relief, you may need surgical treatments such as micro-fracture, arthroscopy, or even a partial or complete joint replacement.


Regenerative Therapy Provides Hope for Healing


Ligament and meniscal tears can result in osteoarthritis despite adequate conservative management. The goal of most osteoarthritis treatments is a reduction in pain. Additionally, OA can progress until it requires surgery to replace the joint. Is there anything natural that can be done to slow this progress down?


The answer to that question is a resounding yes. Supplements such as specialized pro-resolving mediators (SPM’s), glucosamine sulfate, chondroitin sulfate, methylsulfonylmethane (MSM), turmeric, or curcumin have all shown some benefit in improving osteoarthritis. Exercise has also been shown to slow the progression of OA, as has physical therapy.


Nutritional supplements combined with regenerative medicine provide an excellent alternative to conventional medicine drugs. Rather than focusing on pain management or using surgery, regenerative medicine works to restore your body’s healing mechanisms by stimulating the growth and repair of functional, living tissue. At Temecula Center for Integrative Medicine, we focus on four proven methods to enhance the body’s ability to regenerate tissue. Our secret to success has been threefold: improve the nutritional foundation, support with targeted nutritional supplements, and use of regenerative treatments which include ozone, ozone clot matrix (a form of platelet-rich plasma), stem cells, and pulsed electromagnetic field (PEMF) therapy.


O-Zone injections are the simplest form of regenerative therapy. They help the body repair damaged and degenerative tissue in several ways. First, it provides more oxygen to cells of the knee joint, which helps boosts healing. It also promotes the immune system to begin the healing process by creating a small amount of inflammation that causes the local tissue to release chemicals that attract the healing immune cells. Lastly, O-Zone reduces scar tissue as an additional important benefit, increasing the function of the joint. Since O-Zone injections work to reduce scar tissue as well as pain, we have found that it is a valuable tool for treating knee pain even after knee surgery, such as partial and total knee replacement.


Sello Lebohang Manoto, et al. studied the effect of Ozone therapy on osteoarthritis and concluded that “O3 therapy is an efficient therapy in the treatment of damaged articular cartilage in OA” because it “inhibits the inflammatory milieu which damages the cartilage matrix and induces apoptosis of chondrocytes in OA” (7). Dr. Daif found in another study that 87% of the 30 patients who received O-Zone gas injections into the affected joint benefited, but only ⅓ of patients who were treated with non-steroidal anti-inflammatory medication and muscle relaxers benefited. 11 of the 30 patients with O3 treatment had a complete recovery and 15 had significant improvement (10). E. Riva Sanseverino studied the effectiveness of ozone therapy in the treatment of both post-traumatic knee disorders and osteoarthritis in various stages and found a significant reduction in the process of joint degeneration as well as a promotion of healing. The author concluded that “knee-joint disorders can very successfully be treated by means of oxygen-ozone mixture locally administered” (6). Many other studies have shown overwhelming evidence that ozone therapy successfully treats knee injuries and osteoarthritis.


Platelet-rich plasma therapy (PRP) has been used since 1987 to promote cell regeneration after surgery and is beginning to be used more regularly for knee injuries and osteoarthritis. A recent review of 14 randomized controlled trials found that osteoarthritis patients treated with a PRP injection in their knee had improved knee function and reduced pain and stiffness for up to twelve months, although the positive effects began diminishing around six-months. Other studies showed less improvement, but this could be due to variables such as PRP preparation methods, the amount of PRP injected, and the frequency of injections (11).


In PRP therapy, the patient’s blood is drawn, spun down in a centrifuge to separate the platelets and plasma from the rest of the blood, then the platelet-rich plasma is injected into the injured area. Platelets contain specific proteins called growth factors which activate your body’s biological healing process to mend and regenerate tissue.


Instead of PRP, at TCIM we use a similar treatment called Ozone Clot Matrix (OCM) which combines the benefits of PRP with Ozone therapy. To do this, we use the patient’s whole blood and place it into a specialized cup to help clot the blood and activate the platelets to release the growth factors. This process allows for a higher capture rate of platelets as compared to other methods of PRP. After the clot forms, it is withdrawn from the cup and mixed with Ozone and a B-vitamin mixture, providing oxygen-rich red blood cells, as well as nutrients for the stimulated white blood cells to help in cleaning up damaged tissue. This treatment of both ozone and PRP therapy through OCM stimulates this active process for two weeks, as well as promoting the healing process for up to six weeks, providing a much longer period of regeneration.


What additional benefits are seen with Stem cell therapy?


Stem Cell Therapy provides a far greater boost to your immune system than the other treatments. Research shows that stem cell injections cause your own stem cells to work more effectively to regenerate tissue, such as cartilage, and reduce inflammation. Unlike surgery, stem cell therapy is minimally invasive and full recovery takes weeks rather than months.


At this time, procedures involving stem cell products are considered experimental and are not currently approved by the Food and Drug Administration for the treatment of specific conditions, and any claims about stem cells are based on the individual practitioner’s personal clinical experience. This does not mean that stem cell therapy is not safe and effective, it just means that it is still being studied to find the exact level of effectiveness, to determine what conditions and diseases respond well to it, and to discover any safety concerns. Thousands of clinical studies are in progress to determine the effect of stem cell therapy on various diseases, and many are focused on cartilage repair and osteoarthritis. So far, the studies indicate that stem cell therapy is extremely useful for knee cartilage injuries and osteoarthritis. Brian O. Diekman and Farshid Guilak go so far as to state that “the anti-inflammatory function of stem cells may be effective at preventing or delaying OA if delivered at early stages in the disease process” (8).


This is backed by our clinical experience at Temecula Center for Integrative Medicine. We use stem cells mixed with ozone clot matrix for patients with osteoarthritis and have found it reduces pain and improves function in over 95% of patients. Meniscal and ligament tears are also successfully treated with stem cells and OCM.


What are the side effects of these treatments, and how long do the improvements last?


With this combination of therapies, symptom relief is often immediate but may take up to two weeks to notice significant improvement. The knee will continue to improve for up to 9 months. While natural gradual deterioration will continue, one study found that 5 years after knees with osteoarthritis were treated with stem cells they were still better than at baseline (9). The procedure may cause mild pain, stiffness, and swelling, with one in 10 patients experiencing significant swelling. This happens because your system has a robust immune response to the treatment, but it will resolve within 1 -2 weeks.


How does PEMF treatment increase the effectiveness of the Ozone, OCM and/or Stem cell therapies for knee pain?


After treating damaged knees with a type of regenerative injection therapy, we enhance it with Pulsed Electromagnetic Field Therapy (PEMF). Every cell in your body has an electric charge and conducts an electric current. PEMF works with the natural electrical currents in your body. These electric currents in your body are often disrupted from injury and degenerative processes and therefore your body cannot function properly or heal itself. PEMF works to guide the mitochondria (the energy-producing part in your cells) back into optimal performance, creating healthier cells. It helps your cells remove toxins, lowers cellular stress caused by free radicals, and increases the production of ATP, the molecule that stores and transports energy within the cell. Depending on the focus of the therapy, it may be used to alleviate pain and inflammation, improve circulation, energy levels, and sleep quality, and promote cellular detoxification and regeneration.


Ozone, OCM, and Stem Cell therapies all work on the cellular level. Since PEMF energizes cells at the mitochondrial level allowing them to function at their healthiest, it increases the benefits of each of these treatments and ensures that the cells being targeted are provided with the most healing support possible. A study looking at the combination of PEMF with umbilical cord stem cell therapy demonstrated significant enhancement of stem cell activity within the organism (12). Pulsed Electromagnetic Field Therapy also decreases the recovery time needed for each of the other regenerative therapies. We have found it to be so beneficial that anytime you receive Ozone, OCM or Stem Cell injections we will include PEMF as part of your treatment.


Whether your knee cartilage has been damaged from an injury or from osteoarthritis, regenerative medicine has a variety of therapies that can improve your quality of life, reduce your pain, and help you to avoid surgery. If conventional medicine has not helped, you want to avoid taking medication that can be addictive and harm your body when used long term, or you want to avoid surgery, regenerative medicine is an excellent alternative to consider. To schedule a consultation to discover whether regenerative medicine holds the solution you are looking for, call us at (951) 383-4238 or Click Here.



Dr. Lundquist is Board Certified in Family Medicine with ABFM and he is sub-specialized with the American Board of Integrative Medicine (ABoIM). He has also has received a certification from the American Board of Integrative and Holistic Medicine (ABIHM).


Dr. Lundquist has a special interest in Integrative and Holistic medicine. He is currently the founder and medical director for the Temecula Center for Integrative Medicine specializing in all aspects of Functional Medicine. ​He is a member of the American Holistic Medical Association as well as the Institute of Functional Medicine. He specializes in endocrine disorders, especially thyroid and adrenal dysfunction, chronic fatigue, migraine headaches, cardio metabolic disorders, and chronic pain.


info@tcimedicine.com

951-383-4333

www.tcimedicine.com


1. Maradit Kremers H, et al. Prevalence of total hip (THA) and total knee (TKA) arthroplasty in the United States. Presentation at: American Academy of Orthopaedic Surgeons Annual Meeting; 2014; New Orleans, La.


2. Shmerling, Robert H. "How long will my hip or knee replacement last?" Harvard Health Blog. 19 July 2018. Harvard Health Publishing. 11 June 2019 https://www.health.harvard.edu/blog/how-long-will-my-hip-or-knee-replacement-last-2018071914272.


3. Fleming, B. C., Hulstyn, M. J., Oksendahl, H. L., & Fadale, P. D. (2005). Ligament Injury, Reconstruction and Osteoarthritis. Current opinion in orthopaedics, 16(5), 354–362.


4. Dubey, N. K., Mishra, V. K., Dubey, R., Syed-Abdul, S., Wang, J. R., Wang, P. D., & Deng, W. P. (2018). Combating Osteoarthritis through Stem Cell Therapies by Rejuvenating Cartilage: A Review. Stem cells international, 2018, 5421019. doi:10.1155/2018/5421019.


5. United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Ageing 2015 (ST/ESA/SER.A/390).


6. Riva, S.E. Knee joint disorders treated by oxygen ozone therapy. Eur. Med. Phys., 25 (1989), p. 163.


7. Manoto, Sello Lebohang, Makwese Johaness Maepa, and Shirley Keolebogile Motaung. "Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis." Saudi Journal of Biological Sciences. 09 Feb. 2016. Elsevier. 14 June 2019. https://www.sciencedirect.com/science/article/pii/S1319562X16000498.


8. Diekman, B. O., & Guilak, F. (2013). Stem cell-based therapies for osteoarthritis: challenges and opportunities. Current opinion in rheumatology, 25(1), 119–126. doi:10.1097/BOR.0b013e32835aa28d. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616879/.


9. Davatchi, Fereydoun, Bahar Sadeghi Abdollahi, Mandana Mohyeddin, and Behrooz Nikbin. "Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow‐up of three patients." International Journal of Rheumatic Diseases. 20 May 2015. John Wiley & Sons, Ltd (10.1111). 14 June 2019. https://onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.12670.


10. Daif, Emad T. Role of intra-articular ozone gas injection in the management of internal derangement of the temporomandibular joint. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 113 (2012), Issue 6, pp. 10 – 14.


11. Shen L, Yuan T, Chen S, et al. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2017; 12.


12. Esposito M., Lucariello A., Costanzo C., et al. Differentiation of human umbilical cord-derived mesenchymal stem cells, WJ-MSCs, into chondrogenic cells in the presence of pulsed electromagnetic fields. In Vivo. 2013;27(4):495–500.


#osteoarthritis #pain #surgery #functionalmedicine #regenerativemedicine #TCIM #chronicillness #stemcell


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