Supplements/recommendations for aiding in restoring cartilage to the knee. Only 39 years old and is considered level 3-4 arthritic

[FLguy123]

Figured I’d float this out there.

I tore some of the cartilage in my knee (in the trochlear groove specifically) a couple years ago playing volleyball and the pain has been getting worse and limits my activity more and more. I’m 39 and multiple orthos have told me I’m basically screwed and the only option is eventual knee replacement or a cartilage transplant procedure that will take 18 months to recover and the success rate isn’t exactly high.

Was going to try stem cells but it’s hard for me to believe that I would get enough benefit due to how much cartilage I’ve lost in this area.

Anyone had any success with supplementation of any kind aiding in regrowing cartilage?

I also found a procedure that entails distracting the knee joint with external fixators for 8-12 weeks but can’t find anyone in the USA that offers this.

 

[Guided_by_Voices]

Several things:

- Review the "fixes for joint issues" thread
- Eliminate from your diet any high-risk foods that could be causing an inflammatory reaction in joints such as wheat and whey
- BPC/TB500/DMSO as discussed elsewhere here
- GH secretagougues
- Be sure your gait/posture is perfect
- Glucosamine/Chondroitin
- Investigate prolotherapy/dry needling
- Have a proper stem cell eval done. Regenexx is a good provider
- Hyaluronic acid injections

There are other things but that is a good place to start.

 

[t_spacemonkey]

from the list above, definitely BPC157/DMSO. i would apply DMSO daily via dmso gel, maybe add 1tbsp dmso + water each AM in addition.

 

[BigTex]

@FLguy123 I have been having problems with my meniscus for years. I guess it is an old injury either from football or powerlifting. Tried glucosamine and collagen peptides not sure either helped, but I still do both. I have been getting hyaluronic acid injections for about two years and that helps greatly. I started hGH injections 5 weeks ago and that has been a big benefit. I am doing 4iu intra- articular, once a week. Added to that I am also doing TB500 2mg twice a week, with daily injections of 1000mcg of BPC157. I have no pain and have avoided surgery when the ortho assured me I needed knee replacement. I think we have a lot of solutions but unfortunately ortho's can't think out of the FDA box and much rather put people through surgery.​

 

[granger]

yea def try to avoid surgery unless you you cannot stand it and wait 6 more months. know so many guys who saw the awesome young and very rich sports dr who loved giving surgery to anyone he could.. they thought because dr said lets do it it meant it would help... lol more so they make the big bucks in the OR.. and that bit sore shoulder they wish to have back as spent years and years recovering from surgery to get near the old normal pain/movement wise..

I would like to make a note about BPC and TB peptides... just so folks are aware. yes BPC will help pain, however its mechanism of action isn't what you may assume... that is to say, the "healing" isn't healing rather feeling better (which is great), BPC acts on the brain like anti depressants also BPC has a similar side effect profile..flat mood, stimulants work less etc... but also "healing" of broken bones in animals and tendon bone healing is also found in animals(like BPC) with prozac... so the folks who studied the peptides mirrored studies already done by other antidepressants that had shown healing in animals.. as it turns out the "healing" in animals was because under less stress/pain and they moved around less as less social stress... antidepressants are also Rx for pain... something to keep in mind, may not "heal" like u think just feel better. also it seems people who have history of anxiety or depression tend to be the ones who felt BPC "healed" there torn tendon in a week(which of course is not possible), feeling less pain in a day or 2 is though..

TB can increase bodies immune response which sounds great, however if covid taught us anything its that over stimulated immune response with high levels of cytokinins which can cause inflamation over active immune responses. so if take TB def dont take it if recently had covid, may get more antibodies which again is sorta nice but they are also what causes alot of the damage from covid aswell as the vaccine.. that is to say just because a study hasn't looked into long term use or even side effects of whatever peptide doesn't mean they dont exist even if blogs from clinics make it seem otherwise. so proceed with caution with peptides. kind of scares me when people get allergic reaction to TB or thyma 4 and the naturopathy folks say its "detox" and keep using..

EDIT:

im sure other things are happening and perhaps not binary however side effect profile and effect just appear to mirror antidepressants so very closely and of course BPC has been studied for its antidepressant properties. I have little doubt that people get relief and that in and of itself is remarkable never mind if help heal aswell! I just would be wary of long term use. would be interesting if cat or dog saliva holds such healing gastric peptides like BPC...

im sure this bone tendon healing study sounds familiar to the BPC folks

Selective Serotonin Reuptake Inhibitor Promotes Bone-Tendon Interface Healing in a Rotator Cuff Tear Rat Model - Tissue Engineering and Regenerative Medicine

Background: Selective serotonin reuptake inhibitor (SSRI) is believed to accelerate wound healing, and thus expected to have a positive effect on rotator cuff repair. We hypothesized that SSRI has a positive effect on the healing of the bone-tendon interface (BTI), and improved rotator cuff tear...

link.springer.com

or

Histologic and Biomechanical Evaluation of the Effects of Social Stress and the Antidepressant Fluoxetine on Tendon Healing in Rats

Thieme E-Books & E-Journals

www.thieme-connect.com

antidepressants heal bone fractures.... sound familiar?

Effects of social stress and fluoxetine treatment on fracture healing in a rat femur fracture model

Mental stress and depressive disorders have negative effect on bone biology and increase fracture risk. Fluoxetine is a widely used selective serotoni…

www.sciencedirect.com

antidepressants heal peptic ulcers...

Tricyclic Antidepressant Therapy for Peptic Ulcer Disease

• The role of tricyclic antidepressants (TCAs) as agents for treatment of peptic ulcer disease is of growing interest. In both placebo-controlled clinical trials and comparative studies with cimetidine, TCAs have proved effective and safe as ulcerhealing agents. The mechanism of action by which...

jamanetwork.com

what's interesting is that BPC was found to reduce serotonin syndrome... one would think it would just be lowering serotonin or at least stopping its release?? or counteracts the drug given to induce SS... SS btw can be caused by antidepressants. imagine may be why some people get "flat mood" /anhedonia/caffiene or ADHD meds stop working from BPC-157.


make sure u get real stem cells if actually want best chance to work, and not the concentrated blood.

omegas and at least a small dose of quality protein mix and fibre, hemp seeds flax seeds 2 tablespoons a day keeps intestines happy and omegas/protein is wonderful, nails hair eyes skin all get nicer/stronger, have to assume helps internals stay lubricated/less inflamed too. aminos with nutrient dense food/vitamins seems to really have a synergy and guess it has to do with chelation to drive nutrients into your body and help growth and healing.

stay away from iron supplements unless deficient as promotes oxidation/inflammation.

 

[t_spacemonkey]

BPC used to give me massive anxiety for 2-3 days. never understood why. but this eventually settled now i can inject large doses no problem

 

[Guided_by_Voices]

Also, a small, portable PEMF device seems like a good addition as well. They have been shown to promote bone healing and appear to have benefits for other tissues as well. I use one from Micro-Pulse which was around $400.

 

[Nelson Vergel]

I have been getting hyaluronic acid injections for about two years and that helps greatly.

Hey @BigTex where did you get them done? You are always exploring innovative options!

 

[BigTex]

Rockets Ironman Clinic on I-10.

 

[BigTex]

yea def try to avoid surgery unless you you cannot stand it and wait 6 more months. know so many guys who saw the awesome young and very rich sports dr who loved giving surgery to anyone he could.. they thought because dr said lets do it it meant it would help... lol more so they make the big bucks in the OR.. and that bit sore shoulder they wish to have back as spent years and years recovering from surgery to get near the old normal pain/movement wise..

I would like to make a note about BPC and TB peptides... just so folks are aware. yes BPC will help pain, however its mechanism of action isn't what you may assume... that is to say, the "healing" isn't healing rather feeling better (which is great), BPC acts on the brain like anti depressants also BPC has a similar side effect profile..flat mood, stimulants work less etc... but also "healing" of broken bones in animals and tendon bone healing is also found in animals(like BPC) with prozac... so the folks who studied the peptides mirrored studies already done by other antidepressants that had shown healing in animals.. as it turns out the "healing" in animals was because under less stress/pain and they moved around less as less social stress... antidepressants are also Rx for pain... something to keep in mind, may not "heal" like u think just feel better. also it seems people who have history of anxiety or depression tend to be the ones who felt BPC "healed" there torn tendon in a week(which of course is not possible), feeling less pain in a day or 2 is though..

TB can increase bodies immune response which sounds great, however if covid taught us anything its that over stimulated immune response with high levels of cytokinins which can cause inflamation over active immune responses. so if take TB def dont take it if recently had covid, may get more antibodies which again is sorta nice but they are also what causes alot of the damage from covid aswell as the vaccine.. that is to say just because a study hasn't looked into long term use or even side effects of whatever peptide doesn't mean they dont exist even if blogs from clinics make it seem otherwise. so proceed with caution with peptides. kind of scares me when people get allergic reaction to TB or thyma 4 and the naturopathy folks say its "detox" and keep using..

EDIT:

im sure other things are happening and perhaps not binary however side effect profile and effect just appear to mirror antidepressants so very closely and of course BPC has been studied for its antidepressant properties. I have little doubt that people get relief and that in and of itself is remarkable never mind if help heal aswell! I just would be wary of long term use. would be interesting if cat or dog saliva holds such healing gastric peptides like BPC...

im sure this bone tendon healing study sounds familiar to the BPC folks

Selective Serotonin Reuptake Inhibitor Promotes Bone-Tendon Interface Healing in a Rotator Cuff Tear Rat Model - Tissue Engineering and Regenerative Medicine

Background: Selective serotonin reuptake inhibitor (SSRI) is believed to accelerate wound healing, and thus expected to have a positive effect on rotator cuff repair. We hypothesized that SSRI has a positive effect on the healing of the bone-tendon interface (BTI), and improved rotator cuff tear...

link.springer.com

or

Histologic and Biomechanical Evaluation of the Effects of Social Stress and the Antidepressant Fluoxetine on Tendon Healing in Rats

Thieme E-Books & E-Journals

www.thieme-connect.com

antidepressants heal bone fractures.... sound familiar?

Effects of social stress and fluoxetine treatment on fracture healing in a rat femur fracture model

Mental stress and depressive disorders have negative effect on bone biology and increase fracture risk. Fluoxetine is a widely used selective serotoni…

www.sciencedirect.com

antidepressants heal peptic ulcers...

Tricyclic Antidepressant Therapy for Peptic Ulcer Disease

• The role of tricyclic antidepressants (TCAs) as agents for treatment of peptic ulcer disease is of growing interest. In both placebo-controlled clinical trials and comparative studies with cimetidine, TCAs have proved effective and safe as ulcerhealing agents. The mechanism of action by which...

jamanetwork.com

what's interesting is that BPC was found to reduce serotonin syndrome... one would think it would just be lowering serotonin or at least stopping its release?? or counteracts the drug given to induce SS... SS btw can be caused by antidepressants. imagine may be why some people get "flat mood" /anhedonia/caffiene or ADHD meds stop working from BPC-157.


make sure u get real stem cells if actually want best chance to work, and not the concentrated blood.

omegas and at least a small dose of quality protein mix and fibre, hemp seeds flax seeds 2 tablespoons a day keeps intestines happy and omegas/protein is wonderful, nails hair eyes skin all get nicer/stronger, have to assume helps internals stay lubricated/less inflamed too. aminos with nutrient dense food/vitamins seems to really have a synergy and guess it has to do with chelation to drive nutrients into your body and help growth and healing.

stay away from iron supplements unless deficient as promotes oxidation/inflammation.

Great information, Thanks

 

[testiculus]

I started hGH injections 5 weeks ago and that has been a big benefit. I am doing 4iu intra- articular, once a week.

Are you self injecting intra-articular? I know that there were physicians that would do this off-label in the past, but I believe the FDA has shut them all down.

 

[BigTex]

Absolutely I am. Its actually not that difficult. A little ethyl chloride spray. and a 25g 1.5" syringe. The skin will be completely numb and all you feel is the pressure of the liquid. Its actually much easier that doing an IM injection. For the shoulder, my wife does that one. I had my orthopedic doctor show me exactly what do do. Yes, the FDA is too much. Not sure why they are so scared of hGH.

 

[granger]

seems a little sketchy...lol drs cant even hit the joint forget the stat but was like 30-40% they miss without imaging.

has there been any science on intra articular hgh? or are u guys HA?

because of how it works cant imagine hgh in specific parts would show much if any difference and prob more dangerous/tie consuming than its worth. which is displayed in this study Adding Intra-Articular Growth Hormone to Platelet Rich Plasma under Ultrasound Guidance in Knee Osteoarthritis: A Comparative Double-Blind Clinical Trial appeared to work shorter term(which as we know not really how hgh works) imagine was more to do with edema helping the joints ie would of worked just as well sub-q if thats the case... interesting none the less.. very few therapies I think folks shouldn't be able to access if MAY prevent surgery under MD care. the BIG the FREE, the Texas....

 

[Cataceous]

There are further references in this study on rabbits.

Cartilage growth and metabolism from embryogenesis to adulthood are all regulated by certain specific hormonal factors. Growth hormone (GH) is known to be involved in various growth processes since it has systemic effect on anabolism throughout the body. It can stimulate cell growth, reproduction, and regeneration, including articular chondrocytes. The stimulatory effect of GH on articular chondrocytes can be directly or indirectly, mediated by insulin-like growth factor-1 (IGF-1) [19]. Intraarticular growth hormone has also a local effect on the subchondral bone by inducing a modified angiogenesis which is called morphoangiogenesis. Morphoangiogenesis process induced by GH can produce structures containing histiocytes and stem cells. The stem cells produced in morphoangiogenesis process are capable to regenerate the articular cartilage [5]. A study by Kim et al. also showed a positive effect on articular cartilage of the rabbit with osteoarthritis that was injected with intraarticular GH [10]. Recent study has also shown positive results of intraarticular growth hormone injection compared with hyaluronic acid or placebo [12]. On advanced osteoarthritis of the knee, cartilage destruction is usually severe and involved more than one compartment of the knee. The positive effect of GH on cartilage regeneration has been reported in in vitro and animal studies as well as in human early and advanced OA studies [1, 5, 8, 10, 12, 14, 17,18,19]. However, intraarticular GH injection has not yet been implemented as a standard treatment option since there lacks a standard dose for the knee osteoarthritis.​

 

[Guided_by_Voices]

These discussions tend to assume that the benefit from any treatment modality is coming from cartilage regrowth, however I remember reading a blog post from Dr. Centeno at Regenexx years ago where he said that other factors were involved. Unfortunately I don't remember the details but I will try to track that post down at some point. It may be that the GH is triggering some sort of pain moderation as part of what it is doing. It's interesting that the GH may be an indirect form of stem cell treatment as well.

 

[BigTex]

seems a little sketchy...lol drs cant even hit the joint forget the stat but was like 30-40% they miss without imaging.

has there been any science on intra articular hgh? or are u guys HA?

because of how it works cant imagine hgh in specific parts would show much if any difference and prob more dangerous/tie consuming than its worth. which is displayed in this study Adding Intra-Articular Growth Hormone to Platelet Rich Plasma under Ultrasound Guidance in Knee Osteoarthritis: A Comparative Double-Blind Clinical Trial appeared to work shorter term(which as we know not really how hgh works) imagine was more to do with edema helping the joints ie would of worked just as well sub-q if thats the case... interesting none the less.. very few therapies I think folks shouldn't be able to access if MAY prevent surgery under MD care. the BIG the FREE, the Texas....

There is one study done on humans.

https://www.oarsijournal.com/article/S1063-4584(12)00584-5/fulltext#:~:text=Intra%2Darticular%20growth%20hormone%20injections,arthritic%20ankles%20%2D%20Osteoarthritis%20and%20Cartilage

I also found some documentation that IA injections may not be necessary because hGH injections are more water based and go systemic very quickly.

The only problem I am experiencing is the side effects of 4iu hGH injections once a week. I am like a zombie for two days as I do 4iu in the shoulder and the next day 4iu in the knee.

I can appreciate doctors who believe ultrasound is necessary to guide a 25g 1.5" syringe into the knee joint, but unless you are very obese the joint is very easy to find and only about a 1/2" needle is even necessary. I was able to show my ortho where to inject the 1st time I got a HA injection. Now the shoulder is much different. I had 4 ultrasound guided injections of HA done. They didn't do any better with this method than my ortho did just guessing. I am missing both rear rotators so there is a definite gap that leads straight to the shoulder joint. My doctor showed both me and my wife exactly how to feel the injection point in the rear of the shoulder. With the ultrasound, they went into the front of the shoulder and needed a 2" needle to get in.

In the study above Dr. Dunn does 5ntra-articular injections of 5.0 mgm of Human Growth hormone(Omnitrope, Sandoz) were give weekly for 5 to 12 weeks. I believe that came out to 15iu. Hard to tolerate that much I can assure you. At his practice he is giving 4iu once a week for 6-8 weeks. the difference was getting the FDA to approve the injections.

there is also a study on the BPC 157 and TB 500. I am sure I posted that one too. there seems to be a few places in Florida who are doing this successfully.

Intra-Articular Injection of BPC 157 for Multiple Types of Knee Pain - PubMed

BPC157 is a peptide with regenerative properties that can be used to relieve multiple types of knee pain.2,3 Future studies are needed to look at the different causes of knee pain with follow-up MRIs to document the peptide's benefits. BPC157 has the potential to repair tears, build cartilage...

pubmed.ncbi.nlm.nih.gov

full study

https://instituteofhormonalbalance.com/wp-content/uploads/2022/02/Intra-Articular-Injection-of-BPC-157-for-Multiple-Types-of-Knee-Pain.pdf

Not sure why these guys do 3ml injections when they can easily be reconstituted to 1/2 ml - 1ml.

The problem is, there seem to be some off-label ways to help with the pain and possible healing of arthritis but the FDA is not approving it, nor are doctors willing to try. This is just like HA injections. They are approved by the FDA for the knee but not any other joint. Thank goodness my doctor knew someone in one of our major hospitals that would do the off-label treatment.

Here is a diagram of the knee joint: Notice the patella tendon and the two empty spaces on the lateral and medial side of the patella tendon. This is called the medial tibia plateau area. With the knee slightly bent the joint opens enough to easily feel this gap on either side of the knee. This is where intra-articular injections are done. Again, unless you are huge obese, it doesn't take much more than 1/2" needle to penetrate to the joint. I have watched my doctor do mine with a 1" needle and not even 1/2" goes in.

 

[granger]

always trust studies lol!!! here is a quote. "The safety, high per cent. of success," lol sounds like I wrote it. I kid, small mistake nbd.

again, I think the issue is of course GH will help cartilage but no evidence injecting it in your joint makes it work better than simple sub-q... ie does a higher % of people get relief from intra articular or perhaps sub Q offers even more relief.. also would need the old placebo aswell for FDA to go along with it. edit(see one study did just that compared to injection placebo, just need the sub-q vs interarticular and no reason they wouldn't approve! thats the most interesting to me as sub-q will help your knees too so how much better is interarticular vs sub-q)

I guess im just be wary as guys dont grow larger abs if inject GH in there stomach.. you dont grow one larger bicep if inject gh into that bicep etc. its QUICKLY moved away by the body and half is gone from your body in hrs never mind the specific spot its injected. I wish needles esp long ones near bones didn't give me heavy jeebies, if can be done safely and dont mind the extra time, I say giver.

now is it GH specifically that causes cartilage growth? or resulting increase in IGF1? maybe the idea is that it may last a bit longer in the joint fluid? ie doesn't need to be taken daily or 2x a day to keep levels up and acts like a slow release GH/allowed to work specifically in that location vs IV or sub-q that is eliminated pretty quickly resulting IGF IIRC last longer and increase in IGF can be seen next day vs GH itself.

at any rate obv not enough science on it to know as one study says helps for a bit but than stops in largest double blind test. but prob not enough time IMO for gh to really work 2 months.

 

[Guided_by_Voices]

I guess im just be wary as guys dont grow larger abs if inject GH in there stomach.. you dont grow one larger bicep if inject gh into that bicep etc. its QUICKLY moved away by the body and half is gone from your body in hrs never mind the specific spot its injected. I wish needles esp long ones near bones didn't give me heavy jeebies, if can be done safely and dont mind the extra time, I say giver.

Your analogy here is not valid. We discussed this on another thread. The abs and biceps don't have their own encapsulation like joints do which retains synovial fluid. Although the GH will seep out of the capsule over time (a period of hours) as Dr Dunn stated, it will likely reach a vastly higher concentration than would occur from systemic injections where the GH would have to seep into rather than out of the joint capsule. This is consistent with systemic GH users that only experience "joint crowding" after a lengthy period of high systemic doses. The risk/reward seems vastly in favor of at least attempting IA healing in comparison to surgery, which is by no means assured of success. The only risk appears to be lethargy and infection. For reference, Dr Centeno cited a stat that there is a one in 600 risk of infection per injection under sterile conditions. Also note that the "no evidence" argument applied to absolutely everything until people tried it and discovered it worked, at least in some situations.

 

[granger]

the staying in place is certainly a good point/interesting theory. the question is how long? the fact that side effects of GH Are noted day of injection would be a sign its not staying in there thaat much better in my humble opinion. and is it GH that grows cartilage or the IGF from GH injections? from my understanding its the IGF that actually grows the stuff and not GH per say although yes has effects in and of itself, but because of GH short lived nature majority of effects from GH injections come from IGF from my understanding at least IGF is only produced in the liver so would need systemic absorption to garner cartilage growth. HOWEVER, maybe injecting it into the joint effectively slows absorption into the blood stream keeping IGF and GH higher for longer rather then actually acting on the joint itself... of course would be cool to see how big of a difference in absorption is (and if Drs have poor success rate without imagining to hit the joint, how likely are we?)

also we have that other study that the GH with Platelet rich plasma showed no long term benefit compared to just plasma...

I also agree anything preventing surgery is awesome! and yes no evidence doesn't mean something works or doesn't..

just would be interesting to see 4iu hgh intraarticular vs sub-Q and see if any differences.

not being a hater, just learning about this and discussing and potentially raising some Q why FDA or other DRs may not be on board. as long as not getting infections (sterile condition in a clean dr office so presumably higher if at home and if do it 100 times(or 2 years once a week) thats 1 in 6 risk of infection)..and of course may be higher in carpeted room or bathroom if have pets etc or less if your even more careful than DR.... joint infections of course are no bueno compared to sub-q infections or even IM infections, at least from my understanding. So 1 gh is gunna be a tuff sell for cartilage regardless than add increase risk(however big or small) and questionably efficacy it 100% a tuff sell for DRs.

 

[BigTex]

always trust studies lol!!! here is a quote. "The safety, high per cent. of success," lol sounds like I wrote it. I kid, small mistake nbd.

again, I think the issue is of course GH will help cartilage but no evidence injecting it in your joint makes it work better than simple sub-q... ie does a higher % of people get relief from intra articular or perhaps sub Q offers even more relief.. also would need the old placebo aswell for FDA to go along with it. edit(see one study did just that compared to injection placebo, just need the sub-q vs interarticular and no reason they wouldn't approve! thats the most interesting to me as sub-q will help your knees too so how much better is interarticular vs sub-q)

I guess im just be wary as guys dont grow larger abs if inject GH in there stomach.. you dont grow one larger bicep if inject gh into that bicep etc. its QUICKLY moved away by the body and half is gone from your body in hrs never mind the specific spot its injected. I wish needles esp long ones near bones didn't give me heavy jeebies, if can be done safely and dont mind the extra time, I say giver.

now is it GH specifically that causes cartilage growth? or resulting increase in IGF1? maybe the idea is that it may last a bit longer in the joint fluid? ie doesn't need to be taken daily or 2x a day to keep levels up and acts like a slow release GH/allowed to work specifically in that location vs IV or sub-q that is eliminated pretty quickly resulting IGF IIRC last longer and increase in IGF can be seen next day vs GH itself.

at any rate obv not enough science on it to know as one study says helps for a bit but than stops in largest double blind test. but prob not enough time IMO for gh to really work 2 months.

I think it is the increase in IGF-1 levels. We had done some observational experiments quite a while back with treating injuries with IGF-1 etc. We did micro-dosing around the injury and got good results. This hits as many receptor sites as possible but in the end goes systemic.

Systemic Absorption and Side Effects of Locally Injected Glucocorticoids - PubMed

Local glucocorticoid injections are often used to treat joint, soft tissue, or spinal pain, but the systemic side effects associated with these injections are poorly understood and not well recognized. There are significant known risks to systemic administration of glucocorticoids. However...

pubmed.ncbi.nlm.nih.gov

However, it is clear that both intra-articular and epidural injections can have systemic effects for weeks and that complications may be associated with their use.....