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● Prolotherapy
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● How Prolotherapy Helps?
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● Introduction to Prolotherapy
● Why Get Prolotherapy?
● What is Prolotherapy?
● How Does Prolotherapy Work?
● Are You A Prolotherapy Candidate?
● Tendon, Ligament, Reconstruction
● How Safe Is Prolotherapy?
● Finding a Prolotherapy doctor
● When Prolotherapy May Not Work
● 20 Questions About Prolotherapy
● The History of Prolotherapy
● Curing Chronic Pain
● Sclerotherapy?
● Turning to Prolotherapy
● Prolotherapy and Chronic Pain
● The Proof Prolotherapy is Working?
● Prolotherapy: Creating Collagen
● How To Support Treatment

 

The Journal of Prolotherapy

Table of Contents of all issues of The Journal of Prolotherapy

Knee Replacement and Prolotherapy
Ross Hauser, M.D.

This is an article from Dr. Hauser, M.D., that was written for the 1st volume of his book on Prolotherapy, Prolo Your Pain Away. Since the writing of this article Dr. Hauser has published his own research on the growth or articular cartilage in knees and this article is available on this website Cartilage Regeneration in Five Degenerated Knees

There are now 40 million people in the United States with arthritis and this number is expected to grow to 60 million by the year 2020.

Why Are We In a Cartilage Crisis?
This is not too difficult to figure out just from the figures of the number of people needing joint replacement surgery (120,000 hip replacements and 245,000 knee replacements)  as directly correlated to the number of people who are developing arthritis, which is directly related to the number of people who have received cortisone, arthroscopy, RICE treatment, and anti-inflammatory medication over the past 40 years. These treatments accelerate cartilage breakdown tremendously, and thus also accelerate the arthritic process.

What is the Cartilage Crisis?
Most of the joints in the body are synovial joints, that is movable, lubricated joints which are able to provide normal pain-free movement because of the unique properties of the articular cartilage see also Articular Cartilage Growth (see research paper). The articular cartilage covers and protects the ends of the bones in joints. The knee is the largest synovial joint.

At the top of the knee are the massive quadricep muscles which cause the knee to extend. The hamstring muscles are at the back of the knee and cause it to flex. The knee joint has a synovial membrane, which is tissue that lines the noncontact surfaces within the joint capsule. This tissue secretes lubricating synovial fluid, which nourishes all the tissues inside the joint capsule. The knee has internal ligaments (cruciate ligaments) and external joint ligaments (collateral ligaments) which stabilize the joint, especially during movement. The knee also has menisci, pads of fibrous cartilage which help the weight-bearing bones absorb shock. The ends of the tibia, femur, and patellar bones of the knee joint are covered by articular cartilage. This is the structure that is in crisis.
 

Articular cartilage allows near frictionless motion to occur between the surfaces of two bones. Furthermore, articular cartilage distributes the loads on the joint articulation over a larger contact area, thereby minimizing the contact stresses, and dissipates the energy force associated with the load.

Articular cartilage is made of specialized protein structures, called Proteoglycans, water, and collagen. The cells (chondrocytes) of articular cartilage are responsible for the synthesis of both the collagen and proteoglycans that make up the cartilage and have the ability to synthesize all the various components of the specialized proteins that make up the proteoglycans.
 

This ability of these chondrocytes (see research paper) to replicate is really the key question when considering the potential of cartilage to proliferate or to repair itself. It has been shown in studies on adult human cartilage that there is no decrease in cell counts, even in individuals of advanced age. This fact alone suggests that chondrocytes have the ability to proliferate and repair. Additionally upon certain injury such as mild compression, Osteoarthritis, or lacerative injury, the chondrocytes are capable of mitotic division, indicative of growth and proliferation.

The notion of damaged cartilage having no regenerative properties is responsible for many people being subjected to arthroscopies with subsequent joint replacements. This falsehood or myth occurred because healthy cartilage cells have very little, if any, mitotic activity, thus very little or no ability to proliferate.

A bulk of research on articular cartilage regeneration was performed in the 1980s and 1990s. Dr. H.J. Mankin discovered that the chondrocytes reaction to injury was to change into a more immature cell, called a chondroblast, which was capable of cell proliferation, growth, and healing. This key fact is vital to understanding the power of Prolotherapy in proliferating cartilage regrowth.

The Role of Prolotherapy in Cartilage Growth
Prolotherapy involves the injection of substances, such as hypertonic dextrose, sodium morrhuate (extract of cod liver oil), various minerals, Sarapin (extract of the pitcher plant), and various other substances including Growth Hormone, which act by stimulating the structures to repair. (The actual substances injected depend on the individual case and the physician.) The current theory of cartilage regeneration is that this irritation acts in the same mechanism as above in inducing the chondrocytes into the chondroblastic stage of development capable of proliferation and repair. The numerous patients, who had no cartilage or were set for hip/knee replacements who never needed them because of Prolotherapy, support this fact.

Can It Be Proven That Prolotherapy Regenerates Knee Cartilage?
It is impossible to do a double-blind study on Prolotherapy because even an injection of sterile water under the skin has a beneficial therapeutic effect. Even if no injection was given on one side, as the control, sticking a needle into a painful area is known to have a beneficial effect (this treatment is called acupuncture). It is very difficult to prove using a traditional scientific model, that Prolotherapy cures chronic pain, sports injuries, and regenerates cartilage tissue.

One doctor trying to validate the treatment of Prolotherapy is K. Dean Reeves, M.D., Physical Medicine and Rehabilitation Specialist, in private practice in Kansas City, Kansas. He has just completed three double-blind studies on using 10 percent dextrose versus water injections on finger/thumb arthritis, knee arthritis, and anterior cruciate ligament injured knees. Injections were given every two months of dextrose or water. After three injections, all patients were given the dextrose proliferant for three more injections. In the knee studies, only one intra-articular (inside the joint) injection was given per knee at each session. As of this writing, the x-rays readings at one year had just been completed. In the finger/thumb arthritis study there was a 53 percent improvement in pain, and eight degrees of improvement in flexibility. In the knee arthritis study there was a 44 percent improvement in pain, 63 percent improvement in swelling, and a 14-degree improvement in flexibility. There was an 85 percent reduction in knee buckling episodes. The loss of cartilage not seen on x-rays by one year and bone spur measurements showed improvement. Of interest was the fact that those without cartilage did nearly as well. In the knee laxity (ACL) study, pain improved 27.5 percent, swelling by 51 percent, and knee buckling episodes by 54 percent. X-ray studies at one year showed improvement in two measures of bone spur and near-significant improvements in thickness of cartilage in the knee. One should remember that this study involved just one knee injection per session and articular cartilage growth was seen. Typically in actual practice, a person with laxity in the knee ligaments may get 20 injections per visit. Dr. Reeves summarized the findings as "...these double-blind studies with objective and measurable endpoints all show that simple injection of arthritic fingers or knees, or knees with ACL laxity, with non-inflammatory levels of osmotic stimulants can bring about favorable responses in pain, flexibility, and x-ray findings."

Cartilage Regeneration with Human Growth Hormone
Despite the majority of Orthopedic Surgeons doubting that cartilage can be regenerated, one physician in their own ranks has shown that cartilage growth is possible. Alan Dunn, M.D., is an orthopedic in private practice in North Miama, Florida, who has been studying cartilage regeneration for 30 years. His innovative approach involves the injection of Human Growth Hormone into the deteriorated joint. He reports, "In the rabbit studies that I conducted, just one injection grew back the whole patello-femoral surface of the knee in five to six weeks. These studies were biopsy confirmed."
 

He is currently conducting a study on human knees using monthly Human Growth Hormone (HGH) injections into knee joints with cartilage deterioration. Dr. Dunn says, "Over half of the knees show major cartilage growth, and most of the rest have a good result. The most amazing findings have been the near-complete relief of pain in these degenerated knees." Dr. Dunn has been giving a total of three HGH injections into the knees at monthly intervals.