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Stem Cell-based Therapy for Knee Injuries and Degeneration
Both knee injuries and knee degeneration are frequently reported conditions, and have very limited effective therapy options. Regenerative and cellular therapies for knee pain are urgently needed, both for the treatment of knee injuries, and age-related degenerative knee problems. Treatment of problems related to the knee are among the most applied and researched fields for stem cell-based therapies.
ANOVA offers a unique program with Stem Cell Secretome in combination with Bone Marrow Concentrate Stem Cell injections. Our therapy programs are based on your individual needs and designed for your optimal regenerative effect. Our German Stem Cell Clinic in the heart of Europe offers easy access to patients from all over the world. Contact us today to find out more about your treatment options.
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:.
- 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
Generally Available Conventional Therapies
Knee operations should always be considered as the last option for treatment, after the careful review of the results obtained from diagnostics, and after all conventional and regenerative options have been exceeded. Many studies have shown significant improvement of knee function and reduction of pain with the use of stem cell-based therapies.
Stem cell treatments for Knee injuries and degeneration at
ANOVA Institute for Regenerative Medicine - Offenbach, Germany
BMC, Secretome/Exosomes, PRP
Potency Hypothesis of Stem Cell Therapies
Stem cells possess the potential to communicate with the immune cells that elicit the inflammation and by natural, so far not understood mechanisms may inhibit this immune-over-reaction. Furthermore, stem cells have the ability to stimulate regeneration of tissue thereby counteracting the wear and loss of cartilage in the affected joints. Negative long-term effects similar to cortisone are not expected. The aim of a stem cell treatment is therefore, the fast relief of pain, the slowing of the disease progression and in the best cases to even support joint regeneration. This can dramatically increase the quality of life, especially for patients with severe pain, as well as the movement duration and range.
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 stem cell treatments are experimental, but we only treat patients for whom we believe the risk/benefit ratio indicates treatment based on the state of the art, i.e., medical, scientific evidence.
How does the ANOVA Therapy Differ?
Diagnostics – We Look for the Cause of Your Pain
Prof. Dr. Dr. Dr. M. K. Stehling, the founder of ANOVA IRM and the Vitus Prostate Center , is a radiologist (MD) and holds a PhD in physics. For this reason, the ANOVA Institute for Regenerative Medicine, in cooperation with the Prof. Stehling Institute for Diagnostic Imaging located in the same building, has the capability to use special precision diagnostics such as arthro-MRI and non-radioactive contrast MRIs.
Compared to many conventional MRIs, these methods are often able to localize the pain-causing inflammation, degeneration and damage in your knee. This enables us to determine individually how patients should be treated and where the stem cells should be applied.
Furthermore, in consultation with you and if advisable, we supplement our patient-specific diagnostics with specific blood tests on hormones, inflammation parameters and other factors that are important in your case, or recommend further examinations such as a preventive MRI spinal scan.
How Does the ANOVA Therapy Differ?
We Implant the Stem Cells Precisely Where They are Needed
Based on our specific diagnostics using arthro-MRI and non-radioactive contrast medium MRIs, we can, in contrast to many other clinics, deliver the stem cells with image support, e.g. using CT, precisely to the affected area. This means we can inject into and at the knee cavity as well as tendons/ligaments to specifically and quickly trigger an effect where inflammation causes pain. All interventions are performed under supervision and care of our anesthesiologist and are pain free.
A purely intravenous administration, as many other clinics do, is only performed for the secretome (exosomes) if this is to be used to treat chronic inflammatory conditions of the knee.
Of course, we will thoroughly advise you in the early process and the on-site consultation in advance on all steps and discuss alternatives and expectations.
Are you interested but Uncertain?
Do you Want a Second Medical Opinion?
Book a Counselling Appointment!
We also offer a service for a second opinion on your current medical records (MRI, CT, X-ray) and treatment advice. 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.
Therapy Workflow for Knee Injuries and Degeneration
The precise workflow is described in detail on the stem cell- specific pages of BMC (most often used for OA), Secretome/Exosomes und PRP (as combination therapy).
All therapies are divided into phases such as evaluation of the medical history (we analyze your current therapies and medical records), initial counselling and evaluation of potential, patient-individual benefit of a stem cell therapy (indication statement), preliminary examinations, diagnostics, consultation on all therapy options, preparation of an individual treatment plan including cost estimate, harvesting of tissue, production of the stem cell product, quality control of the product and application. There are two special features for knee-osteoarthritis and rheumatoid arthritis patients. If your previous findings have not found the specific causes of your joint pain, we will examine you in advance with a precise and informative arthro-MRI or an MRI with non-radioactive contrast medium, if you wish. In addition, we often apply the stem cells (BMC) intra-articularly (i.e., directly in the joint). This means that we deliver the stem cells to the exact location where your pain originates.
Unfortunately, according to the risk-benefit ratio, we cannot treat children or pregnant women. In addition, other factors can also be exclusion criteria.
How Long Does a Stem Cell Therapy Take?
The initial analyses and counselling can be done without you having to travel to Offenbach (near Frankfurt/Main, Germany). This period can be 2 weeks up to months depending on the availability of patients slots. If you live further away, we will conduct the initial discussions by telephone or video conference. For the actual treatment, you will travel to Offenbach. Then, depending on the therapy, the tissue collection, quality control and treatment type it will take as follows:
BMC- und PRP Therapy
Preparation and harvest of the fat (mini-liposuction) need once 2 days (consecutive days) in Offenbach, followed by enrichment of the mesenchymal stem cells (Secretome/Exosome) and quality control.
Approximately 4 weeks after the isolation, the therapy begins according to the therapy plan determined with you. You will then come to Offenbach am Main (Germany) several times for the application. The shelf life of the secretome (exosomes) is 2 years.
How Much Does Stem Cell Treatment for Knee Injuries Cost?
Our treatments are always tailored to your specific situation, disease, stage and other factors. The therapies differ in the product used (BMC, secretome, PRP or hyaluronic acid), the frequency of treatment as well as the further examinations and your sedation and anesthesia wishes. A treatment for knee injuries or knee degeneration can cost from a few hundred to several thousand euros. You will receive a cost estimate for all treatments in advance so that you can accurately estimate what a treatment would cost in your individual case.
Does my Health Insurance Cover the Therapy Costs?
Unfortunately, at the moment it is assumed that health insurance companies do not cover the costs of experimental therapies (BMC, secretome, PRP, micro-fracture technique), i.e. you will have to bear the costs entirely yourself.
Other Important Therapy Strategies for Knee Injuries and Degeneration
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.
Frequently Asked Questions:
Stem Cell-based Treatments for Knee Injuries and Degeneration
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.
References and Literature - Stem Cell-based Therapies and Knee Injuries and Degeneration
- Kahn, Timothy L., and Ran Schwarzkopf. "Do Total Knee Arthroplasty Patients Have a Higher Activity Level Compared to Patients With Osteoarthritis?." Geriatric Orthopaedic Surgery & Rehabilitation 7.3 (2016): 142-147.
- Skou, Søren T., et al. "A randomized, controlled trial of total knee replacement." New England Journal of Medicine 373.17 (2015): 1597-1606.
- Metsna, Vahur, Sigrid Vorobjov, and Aare Märtson. "Prevalence of anterior knee pain among patients following total knee arthroplasty with nonreplaced patella: a retrospective study of 1778 knees." Medicina 50.2 (2014): 82-86.
- Riddle, Daniel L., William A. Jiranek, and Curtis W. Hayes. "Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study." Arthritis & Rheumatology 66.8 (2014): 2134-2143.
- Wylde, Vikki, et al. "Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants." PAIN® 152.3 (2011): 566-572.
- Fuzier, Régis, et al. "Analgesic drug consumption increases after knee arthroplasty: a pharmacoepidemiological study investigating postoperative pain." PAIN® 155.7 (2014): 1339-1345. International Osteoporosis Foundation
- Lalmohamed, Arief, et al. "Changes in mortality patterns following total hip or knee arthroplasty over the past two decades: a nationwide cohort study." Arthritis & Rheumatology 66.2 (2014): 311-318.
- Lalmohamed, Arief, et al. "Timing of acute myocardial infarction in patients undergoing total hip or knee replacement: a nationwide cohort study." Archives of internal medicine 172.16 (2012): 1229-1235.
- Singh, Jasvinder A., et al. "Smoking as a risk factor for short‐term outcomes following primary total hip and total knee replacement in veterans." Arthritis care & research 63.10 (2011): 1365-1374.
- Houdek MT. Mesenchymal stem cell therapy for osteoarthritis : current perspectives. 2015:117-124.
- Tang J, Cui W, Song F, Zhai C. Effects of mesenchymal stem cells on interleukin-1 β -treated chondrocytes and cartilage in a rat osteoarthritic model. 2015:1753-1760. doi:10.3892/mmr.2015.3645.
- Mazor M, Lespessailles E, Coursier R. Mesenchymal stem-cell potential in cartilage repair : an update Osteoarthritis. 2014;18(12):2340-2350. doi:10.1111/jcmm.12378.
- Song F, Tang J, Geng R, et al. Comparison of the efficacy of bone marrow mononuclear cells and bone mesenchymal stem cells in the treatment of osteoarthritis in a sheep model. 2014;7(4):1415-1426.
- Ham O, Lee CY, Kim R, et al. Therapeutic Potential of Differentiated Mesenchymal Stem Cells for Treatment of Osteoarthritis. 2015;(April):14961-14978. doi:10.3390/ijms160714961.
- Kristjánsson B, Honsawek S. Current Perspectives in Mesenchymal Stem Cell Therapies for Osteoarthritis. 2014;2014. doi:10.1155/2014/194318.
- Centeno, Christopher, et al. "Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft." BioMed research international 2014 (2014).
- Toh WS, Foldager CB, Pei M. Advances in Mesenchymal Stem Cell-based Strategies for Cartilage Repair and Regeneration. Stem Cell Rev Rep. 2014;10:686-696. doi:10.1007/s12015-014-9526-z.
- Centeno, Christopher J., et al. "Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells, platelet lysate and dexamethasone." Annals of Transplantation 9 (2008): 246-251.
- Orozco, Lluis, et al. "Treatment of knee osteoarthritis with autologous mesenchymal stem cells: two-year follow-up results." Transplantation 97.11 (2014): e66-e68.
- Filardo, Giuseppe, et al. "Mesenchymal stem cells for the treatment of cartilage lesions: from preclinical findings to clinical application in orthopaedics." Knee surgery, sports traumatology, arthroscopy 21.8 (2013): 1717-1729.
- Jo, Chris Hyunchul, et al. "Intra‐articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof‐of‐concept clinical trial." Stem cells 32.5 (2014): 1254-1266.
- Vangsness, C. Thomas, et al. "Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy." J Bone Joint Surg Am 96.2 (2014): 90-98.