JG is a 64 year old male with severe knee pain. He works on elevators, and is constantly on his feet and needs to carry heavy tools and machinery. He frequently needs to kneel and climb lots of stairs at work, and could only walk up one step at a time. He was getting concerned about his job because he was not able to keep up with the younger employees, but needed the income to survive and help raise his grandchildren. JG already had physical therapy, arthroscopic surgery, cortisone, and Synvisc injections. He was told that knee replacement was imminent for his bone on bone arthritis.

When JG first visited my office, he limped severely, and looked like he had just rode a horse. He was stiff and sore. After examination, I determined that he had a functional leg length discrepancy (tilted pelvis), which caused him to limp and also produced uneven pressure across the ligaments of his knee, feet, and back. Upon further questioning, he was also experiencing lower back pain.

His knees showed evidence on PHYSICAL EXAMINATION of damage to the medial collateral ligaments and pes anserine tendons. His range of motion was also limited, and all of the ligaments from his L4 vertebrae and transverse process to his lower sacrum were tender on examination. His sacrum was also unstable on stress testing. We reviewed his X-rays and MRIs, showing a severe loss of cartilage on the inside (medial) portion of his knee.

Discussion:
JG had a severe leg length discrepancy that had been untreated and undetermined for years. Combined with the demands of his job, his knees had degenerated. Both his ligaments, tendons and cartilage had shown signs of extreme wear, and he did not want to have bilateral knee replacement. We determined that we would use prolotherapy to correct the leg length discrepancy, and heal the damaged ligaments and tendons, but would use PRP (platelet rich plasma) therapy to help regenerate his lost cartilage. PRP is an extract made from the patients own blood that contains their growth factors and platelets, and forms a biological scaffold full of natural biochemicals that promote growth.

JG underwent treatment over the next few months, receiving injections every 3 weeks. After about 4 sessions, he was experiencing a significant reduction in pain, less stiffness. After another 2 months, he was running up and down stairs without a second thought. Most of his symptoms had been relieved, and his function had returned.

We repeated X-rays of the knees - what we found was a SIGNIFICANT improvement in joint space - presumably from a re growth in articular cartilage!

Even though JGs expenses were mostly out-of-pocket, he avoided major surgery and its complications, and would likely need at least another knee replacement in his lifetime. Furthermore, he took no medication for pain, did no physical therapy, and did not need any time off of work. An investment in health is one that is well spent, and JG got his young knees back, while avoiding bilateral knee replacement. By the way, prolotherapy to his lower back also cured 20 years of nagging lower back pain.

 

Dr. Greenberg is located at the
Magaziner Center Prolotherapy New Jersey