Avoid surgery - fasten recovery
Stem Cell-based Therapy for Knee Injuries and Degeneration

On this page we inform you about knee injuries like meniscus, tondon and ligament injuries, degenerative knee conditions, cartilage damage etc. covering an overview on important aspects of causes, treatment options, precision diagnostics that reveals the cause of pain and location of the pain-causing defect, as well as our stem cell-based therapies that we offer in Offenbach (near Frankfurt/Main) Germany.

Jump directly to the following topics:

• Conventional therapies
• ANOVA therapies for knee injuries
  
• Expectations and limits
• Our knee treatment with BMC
  
• Diagnostics of pain-causing defects
• The ANOVA difference: targeted treatment
  
• You want a second opinion
  
• Workflow of the treatment process
• Other important therapeutic possibilities
• FAQ- frequently-asked questions
• Sources and Literature

We treat the following injuries and conditions:.

• Arthritis
• Meniscus Tear
• ACL, MCL, PCL or LCL sprain or tear
• Patellofemoral Syndrome / Chondromalacia
• Pes anserine bursitis, Baker’s cyst and others
• Patellar tendonitis, Hamstrings Tendinopathy and Biceps Femoris Insertional Tendinopathy

Two Targeted Effects: Pain Relief and Progression Improvement

A stem cell treatment can elicit two effects in affected joints that build on one another. Due to the modulation of the underlying immune reaction the stem cell injection decreases or even stops the inflammation. As inflammation, especially in early stages, often is the main cause of pain, targeted stem cell injection often results in immediate pain relief up to complete pain-free movements of the treated joint.

The effects on disease progression builds on the inhibition of inflammation. Upon the halting of the inflammation the joint returns to a resting-phase and regeneration and healing can start. With adequate on-going therapy in combination with e.g. physiotherapy, regeneration of cartilage and partially torn tendons and ligaments can take place. As all effects are patient- and disease stage-dependent and may be influenced by additional, external factors, we always apply individual treatment plans.

BMC - Bone Marrow Concentrate - Autologous

Autologous (self) BMC are our main therapy option for locally-restricted knee injuries and degeneration. In such cases we treat patients with targeted, localized BMC injections. BMC contains autologous meaning patients own, adult  stem cells (hematopoietic and mesenchymal stem cells in natural composition) which we isolate and concentrate from your pelvis crest in a short process under slight sedation.

These stem cells are supposed to inhibit the inflammation thereby relieving you from pain and to stimulate regeneration of the meniscal cartilage or the injured tendons. For an on-going therapy, we combine BMC with PRP (platelet-rich plasma) or Hyaluronic Acid (see below). More information about this type of stem cell therapy is summarized on our page an BMC.

PRP - Platelet-Rich Plasma - Autologous

PRP is a comparably inexpensive experimental therapy as platelets (thrombocytes  naturally containing growth factors and stimulants) are isolated from autologous (own) blood without isolation of stem cells.

For knee injuries, we use PRP often in combination with BMC and is administered in-between BMC treatments to continuously support the anti-inflammatory effect. Besides this, PRP is well-known as a stimulant for wound healing in e.g. paradontits therapy or as a measure against hair loss.

More on PRP (as a combination therapy) is summarized on our PRP overview page.

Hyaluronic Acid - HA

Another, cost efficient supportive treatment is injection of hyaluronic acid into the knee cavity. 

Especially in early cases, this can reduce pain and result in a better "lubrication" of the knee. Bone parts do not crunch directly on another after HA injection.

Hyaluronic acid alone, on the other hand, is not expected to have regenerative effects on the damaged cartilage or bone.

Therefore, we usually combine HA with BMC treatment and HA is given intermittendly between BMC treatments.

MSEC - Mesenchymal Stem Cell Secretome - Exosomes - Autologous

Usually knee conditions are not treated with MSEC.

Secretome/Exosomes is a product that we use for systemic administration in primarily inflammatory diseases such rheumatoid arthritis or in cases of poly-osteoarthritis where more than a few joints are affected. .

Our patient care managers are happy to inform you about what information we need upfront (MRI, CT, X-ray), how to transfer large data files and schedule a counseling appointment with our physicians for you. Our patient care managers are happy to inform you about what information we need upfront, how to transfer large data files and schedule a counseling appointment with our physicians for you. Please use our contact form to support a fast processing of your case and request.

You are also always welcome to send us an e-mail about your case. The counseling appointment may also take place per telephone or video chat if you live outside Germany. For more intense counseling or additional diagnostic evaluations you may also book an on-site appointment. We can perform needed MRI on the same day. All services rendered by our patient care team are free of charge and we inform you about all physician appointment charges up-front.

Osteoarthritis is a chronic progressive diseases. Therefore, it is important to also combine any therapy with conventional approaches such as physiotherapy and exercise. We are happy to coordinate our treatments with your primary care physician or orthopedist at your location. In addition, we will be happy to advise you on nutritional supplements or infusion therapies that could support your treatment. Various substances are said to have an anti-inflammatory or regenerative supporting function.

Physiotherapy, Manual Therapy, Osteopathy, Insoles

Orthopedic treatment should always be given for osteoarthritis. Have a check to see if your legs are actually the same length or if you have hip misalignments that create a one-sided or incorrect body structure. In many cases, such as knee or hip osteoarthritis, muscles can stabilize the affected joint. Seek advice from a physical therapist. They can often show you specific stabilizing exercises that, if done regularly, can improve your range of motion. Use osteopathy or manual therapy to relieve any tightness or tension that may be present. Often such misalignments lead to further stress on joints.

Sports and Physical Activity

In many cases, moderate exercise has very positive influences on the course of osteoarthritis. Regular cycling is very promising for knee osteoarthritis. However, have your saddle height adjusted in advance at a bicycle store so that no incorrect positioning occurs. Swimming is also a very low-impact sport. You should mainly do crawl, backstroke or breaststroke with a floater. Here, one takes care to move the legs only up and down, as one would do in crawl swimming. Walking or Nordic walking can also have a very positive effect. However, in all cases, discuss your sport with your physiotherapist. In more advanced stages, water gymnastics may be the sport of choice.

Nutritional Supplementation and Nutrition

There are still few proven correlations here, but there are some promising approaches. A change in diet to a diet low in meat and rich in vegetables can help. Alcohol and nicotine should be avoided as they damage cartilage cells. Anti-inflammatory supplements are often discussed. These include omega-3 fatty acids, curcumin (turmeric), chondroitin sulfate, MSM, green-lipped mussel extract, hyaluronic acids, etc. for osteoarthritis.

You can also find more information on therapy approaches for osteoarthritis in our brochure.

What is the Meniscus?

The meniscus is a piece of cartilage in the knee that acts as a shock absorber or cushion and helps to stabilize the joint. It also shields the bone end that meet in the joint from wear and tear.

What Induces a Meniscus Tear?

In many cases, all it takes to tear or damage the msnicus is a strong twist of the knee, mostly due to fast turns with blocked feet. In addition to the tear, in some cases, a piece of the torn meniscus cartilage breaks loose and moves to the knee joint, causing it to block. Like most knee injuries and damage, a meniscus tear is usually painful and debilitating.

What are Knee Ligaments?

The knee is a highly complex joint that has to withstand movements and force in many directions. Therefore, it needs special stabilizing structures and these are the tendons and ligaments. The knee has 4 ligaments:

• Anterior cruciate ligament (ACL): in the central part of the knee and controls knee rotation and the forward-directed movement of the shin bone (tibia)
• Posterior cruciate ligament (PCL): in the back part of the knee and controls the backwards-directed movement of the shin bone (tibia)
• Medial collateral ligament (MCL): in the central part of the outer knee, stabilizes the inner knee
• Lateral collateral ligament (LCL): in the central part of the inner knee, stabilizes the outer knee

Early Detection of Joint Changes can Prevent Osteoarthritis

While the concept of prevention through early detection of benign precancerous lesions, e.g. colon polyps or "carcinoma in situ" of the breast, has long been established in the case of cancer, such prevention concepts do not yet exist in the case of osteoarthritis. In expert circles, however, the concept of "pre-arthrosis" has recently been the subject of scientific discussion. With the aid of modern imaging techniques, it is possible to visualize early onset structural changes in articular cartilage and subchondral bone structure that indicate the onset of osteoarthritis. Magnetic resonance imaging (MRI) and optical coherence tomography (OCT) play an important role here, although OCT requires instruments to be inserted into the joint. Caught early, countermeasures can be taken: Relieving joint stress, improving biomechanics, exercise, hormone replacement, and therapies with cytokines and stem cells can slow down osteoarthritis.

How Does Cortisone Work?

Injection of cortisone (corticosteroids) into inflamed joints is still widely used today. It typically results in rapid pain relief, but its effects usually do not last longer than 4 weeks. However, in the long run, cortisone injections accelerate joint wear by damaging cartilage cells, which are essential for maintaining articular cartilage.

What are NSAID, NSAP, NSAR?

All these abbreviations stand for anti-inflammatory drug groups that are used for inflammatory processes and diseases such as rheumatism, osteoarthritis and arthritis. NS always stands for non-steroidal, i.e. substances that are not derived from steroids such as cortisone. All non-steroidal anti-inflammatory drugs have sometimes serious side effects such as damage to the gastrointestinal mucosa or heart and kidney damage. Some preparations have therefore been withdrawn from the market.

• NSAID - non-steroidal anti-inflammatory drug
• NSAP - non-steroidal anti-inflammatory drug
• NSAID - non-steroidal anti-inflammatory drug (translated non-steroidal anti-inflammatory drug)

What are Anti-Phlogistic Drugs?

Anti-phlogistic drugs are anti-inflammatory drugs. Anti-inflammatory drugs include the following groups of drugs:

• Glucocorticoids (e.g., cortisone).
• Non-steroidal anti-inflammatory drugs (NSAIDs, non-steroidal anti-rheumatic drugs)
• Immunosuppressants (DMARDs, disease-modifying anti-rheumatic drugs
• Certain novel biologic-derived drugs (biologicals, e.g., JAK inhibitors)

What is Bone Marrow Concentrate - BMC?

Bone Marrow concentrate (BMC) is a source for Mesenchymal Stem Cells (MSCs) and Hematopoietic Stem cells (HSC). It contains many important growth and regenerative factors, in addition to the MSC and HSC in natural composition. The BMC procedure is relatively simple and minimally invasive, therefore it has been a favorite source for stem cell-based therapies in the previous decades. Many clinics rely on BMC as their main stem cell treatment, sometimes with exaggerated claims. However, BMC has demonstrated impressive results for effective treatment of numerous diseases, among them being osteoarthritis. Read more about our BMC Treatment here.

What is Platelet Rich Plasma - PRP?

Platelet Rich Plasma (PRP) is a blood-derived, cellular product with concentrated supply of regenerative growth factors and cytokines, obtained from the patient's own blood. It is very simple to acquire, and it has shown promising results in the treatment of several inflammatory and degenerative diseases. For the treatment of specific diseases, it can be combined with BMC or adMSCs, as it has synergistic additive effects to the treatment. PRP has "special" functions: it serves as a growth medium to maintain stem cells healthy; ensures adequate cellular environment where enough energy is provided to allow the cells to perform their regenerative work.

Is Therapeutic Success Guaranteed?

No therapy can guarantee a 100% success after treatment. However, in the case of experimental therapies such as stem cell therapy, the attending physician must perform a benefit-to-risk analysis for each patient and determine both the benefits and the risks for that particular patient. If the potential benefit outweighs the potential side effects, the doctor may recommend experimental therapy.