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Structure and genesis of pain in the knee joint

Before we go into details, we will first introduce the issues related to the structure and genesis of pain in the knee joint.

The knee joint is the largest and most structurally complex of all joints. It is made up of the femur, tibia and kneecap. The articular surfaces are covered with cartilage and protected by two menisci, lateral and medial. The knee ligament apparatus includes mainly the anterior and posterior cruciate ligaments, collateral ligaments, medial ligaments and patellar ligaments. A healthy knee joint has an anatomically shaped joint gap, i.e. a gap between the femur and tibia, for ergonomic, painless bending and straightening movements. In addition, this area of ​​the knee is protected at the front by a small bone called the patella. Articular cartilage plays a huge role in the biomechanics of our knee. It consists of cells - chondrocytes and osteocytes. The vitreous part of cartilage is made up of type II collagenand the basic substance.

Another important element present in a healthy knee joint is synovial fluid produced by the synovial membrane of the joint capsule.

This is completely basic and necessary information needed to visualize the complexity of the issue and the origin of pain ailments.

Thanks to the following scenario, everyone will be able to determine at what stage their dysfunction or knee joint injury is.

Due to the forces acting on the knee joint every day, we are practically unable to protect it against wear and thus against its damage. At some point, knee pain is felt, initially only during movement, then also at rest. Acute inflammations appear which, if untreated, become chronic. As a result of the changes, there are limitations in the range of motion in the joint, contractures and a marked reduction in muscle strength. All this leads to the inability to perform our daily activities, which significantly contributes to the decline in physical activity.

In this state, the knee joint ceases to be properly nourished, the consistency of the synovial fluid changes, joint gaps are reduced, the joint biomechanics are disturbed, and joint stiffness is diagnosed. The knees become weaker, unstable, and more prone to injuries, during which the meniscus, ligaments and articular cartilage are damaged. The weakened mechanism that stabilizes our joint ( muscles and ligaments ) and the interaction of static or dynamic external forces lead to changes that overload the joint, which may gradually lead to irreversible degenerative changes. The patient will complain of painful ailments of the nature of morning stiffnesswhich usually disappears after several dozen minutes of knee activity after getting out of bed. The longer it takes for the morning stiffness of the knee joints to subside, the more advanced we recognize degenerative changes.

Each of the above diseases of the knee joint is subject to effective treatment! Properly selected treatment is able to stop the changes and to reverse them, the diagnosis and selection of the right therapy can free us from pain!

Platelet-rich plasma is one of the components of our blood, mainly responsible for the healing and regeneration process. Its composition consists of complex chemical compounds called Cytokines or growth factors. They are divided into 6 basic groups, and each of them is assigned to a different type of collagen. This is important because at the beginning of the article we mentioned the structure of the patella, and in particular its glassy layer made of type II collagen . This is the first point of departure. As we already know, a specific group of growth factors contained in platelet-rich plasma affects a specific type of collagen. The second point of contact is all soft tissues: ligaments, tendons, muscles, menisciwhich are made of collagen. However, the platelet-rich plasma itself without a carrier, about which we will talk about it, can only give positive results in the treatment and regeneration of soft woven, i.e. all pain from this source, or as a support after soft tissue reconstruction, procedures or injuries. In any other case, due to its watery consistency, it will not bring any therapeutic results, regardless of the number of injections and the theories surrounding it.

The administration of platelet-rich plasma directly to the knee joint cannot physically initiate any regenerative mechanisms, due to its very short and fruitless life. The natural environment for platelet-rich plasma is the structure of soft tissues. If we want to influence the structures made of collagen, such as articular cartilage located in the knee joint, we have to "suspend" the plasma on a support whose structure and dense consistency will allow the platelet-rich plasma to survive, and the lubricating properties will prevent mechanical wear of the reconstructed cartilage structures.

In the case of 1st degree degeneration or post-traumatic rehabilitation , especially in young people, a special ( hyaluronic ) acid is used , the structure of which allows the survival and activity of cytokines for about 3 to 4 weeks. However, such a carrier has the intended effect only in these two cases. In the elderly with 2nd and 3rd degree degeneration , or those who are at risk of endoprosthesis, hyaluronic acid will not be a sufficient carrier. After such a treatment, they may experience short-term relief, mainly related to the improvement in "lubrication" of the joint, and not from the process of its regeneration.

For patients diagnosed with stage II or III degeneration, the only salvation is to transplant fat rich in stem cells into the knee joint.

For this purpose, mini liposuction of the abdominal area under local anesthesia is necessary and the acquisition of fatty tissue about 240 ml, where our body stores adult stem cells capable of transforming into any structure of our body except the placenta, which is ethically safe.

The collected material consists not only of adipose tissue rich in stem cells , but a whole range of unnecessary substances that must be separated from the main material in the process of mechanical filtering.

From 200 ml of collected fat, about 15% to 20% of well-purified and concentrated fat rich in young and strong stem cells is obtained .. The autogenous knee graft prepared in this way guarantees many months of impact in the process of cartilage regeneration! Fat rich in stem cells is an ideal carrier for cytokines contained in platelet-rich plasma, which additionally initiate all processes related to the formation, multiplication and conversion of stem cells into chondrocytes and osteocytes from which articular cartilage is made, which I mentioned at the beginning of the article. As you can see, we are talking about the long-term effect of rebuilding damaged cartilage and restoring the proper functioning of the knee joint.

In order to increase the effect, the number of stem cells can be increased by taking more material at the liposuction stage and, after purifying and concentrating it, subjecting it to the process of precipitating fat cells with collagenesis, obtaining a stem cell concentrate .

Therefore, plasma, properly prepared and concentrated to therapeutic values, is of great importance in the process of treatment and reconstruction of our knee joint, provided that it is properly used.

The duo, fat rich in stem cells and platelet-rich plasma is the greatest achievement of our time in the field of Bioorthopedics . Separately, they do not mean much, but together they provide long-term lubrication, material in the form of stem cells and the initiator of all processes in the form of growth factors contained in platelet-rich plasma. If you remember the above-mentioned structure and biomechanics of a healthy knee, as well as the processes accompanying its degradation, we must not forget about the soft tissues and the entire structure supporting and stabilizing our joint.

After a successful stem cell and platelet-rich plasma transplant, we must undergo an individual physiotherapy process , which will slowly and precisely rebuild our apparatus that stabilizes the knee joint and increases the scope of its work, eliminating contractures .

The procedure of transplanting fat rich in stem cells with platelet-rich plasma combined with physiotherapy is the only way to counteract the effects of the degenerative process of our joints.

Could an injection of platelet-rich plasma with prp tubes help?

We think you can answer this question for yourself now!

For all this to work, the following are necessary:

  • correct diagnosis and a long-term action plan
  • knowledge about the possibilities of stem cells and platelet-rich plasma in the treatment process, especially in the context of mechanical damage, which will not be affected by bioorthopedic procedures. (possibly reconstruction of ligaments or other treatments removing mechanical obstacles). There is a need to know what can be influenced by orthopedic surgery.
  • The platelet-rich plasma concentration process monitored and confirmed on the analyzer
  • safe and ensuring the selection of the strongest stem cells system of fat separation and concentration of stem cells in the process of collagenesis.
  • the correct proportions and quantity of the prepared autogenous fat transplant rich in stem cells and platelet-rich plasma
  • correct application, if possible directly to the knee joint, and not to the articular capsule - anterior port
  • preparation of an individual program of physiotherapy, divided into three stages .

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