Knee Osteoarthritis

PRP therapy uses a sample of the patient’s own whole blood, spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active agents such as growth factors, cytokines, lysosomes and adhesion proteins. Orthopedists often inject low quality PRP without ultrasound guidance, which fails to promote healing. To be effective, it is critical to use the right concentration and quality of platelets, and to and follow proper isolation techniques. Ultrasound guidance ensures optimal results.

Osteoarthritic knees sometimes involve tendon ruptures due to knee instability. Matrix is a highly concentrated PRP, diluted and mixed with fibrinogen. At the injection site, the solution becomes a gel-like collagenous substance that adheres to the walls of the tendon tear and fills the space between them, creating a fibrin matrix that helps to stabilize growth factors and attract stem cell migration to the treatment site.

Platelet releasate therapy involves injecting platelet releasate – a mixture of growth factors and biomolecules – into injured muscles and tendons to promote healing. Platelet releasate works by activating leukocytes and endothelial cells, and stimulating blood vessel growth, to increase the flow of oxygen, nutrients and growth factors to the damaged tissues.

Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that typically degrade cartilage. A2M can stop knee cartilage degradation in its tracks, and pave the way for cartilage regeneration.

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers. Prolotherapy is often used for slow-to-heal tendon and ligament ruptures, where low vascularity inhibits tissue healing.

Prolozone takes Prolotherapy to the next level by adding a combination of procaine, anti-inflammatory medications, vitamins, and minerals, followed by a mixture of ozone/oxygen gas, injected into targeted joints or tissues. When performed under ultrasound guidance, Prolozone therapy quickly reduces pain and inflammation while jump-starting the healing process.

Hyaluronic acid is a natural component of joint synovial fluid. Its slippery gel-like properties provide lubrication that reduces friction, enabling joints, muscles and fascia to move freely without pain. In knee OA patients, synovial hyaluronic acid tends to break down, causing bony structures to rub against one another. Hyaluronic acid replenishes synovial fluid to reduce friction and relieve pain.

Hyaluronic acid is also a primary component of fascial tissue, providing its slippery gliding properties. Hyaluronic acid injections can help to restore hydration to densified fascia, to revitalize its functional properties.

Knee OA often involves damaged fascial tissue that has thickened and become sticky, often adhering to other structures. The hydrodissection procedure injects a saline solution into densified fascial layers under ultrasound guidance, separating the layers to help restore fascial gliding, and releasing entrapped nerves and blood vessels. Hydrodissection is often used in conjunction with manual fascial manipulation, to fully restore myofascial integrity.

Nerve hydrodissection is a minimally invasive procedure aimed at relieving osteoarthritic knee pain. It targets the genicular nerves that transmit pain signals from the knee joint. The technique involves ultrasound-guided injection of a solution made up of saline, dextrose or PRP, to separate the nerve from surrounding tissues and relieve nerve compression.

Dry needling uses non-medicated filament-thin needles, inserted through the skin under ultrasound guidance. The needles target myofascial trigger points – fibrous nodules of tightly contracted fibers that cause pain and disrupt muscle action. Trigger points are common in knee OA cases, contributing to knee instability.

During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.