Cartilage is an avascular, aneural, alymphatic tissue. It can not self heal. The chondrocytes in cartilage have a very low metabolic rate due to limited nutrient supply and are in a low metabolic state. Therefore, any small injury to articulate cartilage can not self heal for years.

Thank your for your statement. What's your comment about my attached file? From our clinical experience, cartilage do have the potential to heal by itself if we could improve the general environment in the knee joint. Although the regenerated tissue might not be normal hyaline cartilage, it is still durable for weight bearing after 3 years of FU.

To improve cartilage repair you should improve mitochondrial function of chondrocytes

Dear Shaw-Ruey Lyu, cartilage repair may occur spontaneously, but it depends on a lot of parameters as cause for cartilage lesion, size, depth, configuration, general health of the joint, systemic conditions, biomechanics etc. E.g. in case of osteochondral lesions the subchondral bone layer is opened and progenitor cells may invade the forming fibrin clot and finally differentiate into cartilage like tissue. This is a similar mechanism as it is supposed to occur after microfracturing. Stem cells may also invade from the synovia, but again success varys with the different influencing factors. Best regards, Hagen Schmal.

Dear Dr. Schmal, thank you for your comments and positive feedback about "cartilage could repair spontaneously". In my clinical experience and our related studies, we've found a promising concept of treatment to improve the general condition of the knee joint for cartilage regeneration by itself. If you are interested, please read our related papers and the attached book chapter. Warm regards, SR

http://www.intechopen.com/books/osteoarthritis-diagnosis-treatment-and-surgery/knee-health-promotion-option-for-osteoarthritic-knee-cartilage-regeneration-is-possible

I would think spontaneous regeneration of cartilage is a less seen phenomenon.It could be possible if the pool of synovial stem cells is in a greater extent.Cartilage being avascular,stem cell from the bone cannot reach there for any possible regeneration.

The lesion size and the extent of injury contribute to a certain extent.A possible paracrine activation of the synovial stem cells for spontaneous regeneration is required as these stem cells bend towards the chondrogenic/osteogenic lineage.A possible intra articular stimulation with mesenchymal stem cells could possibly stimulate cartilage regeneration.

Dr. Lyu, your question is v. interesting! Does your procedure remove debris around the cartilage or actually cause injury (which in turn), stimulates chondrogenesis? Your Abstract suggests that cartilage was regenerated by clinical parameters. But, its good to prove this in an animal model also. I agree with Charan that stem cells from within the knee cavity may get activated-but that also needs proof. As Dr. Schmal says, you could be seeing"cartilage like tissue" and not real hyaline cartilage. Still, its good if patients can benefit from your procedure.

From our series of studies and long-term clinical observation, we have defined a new entity - medial abrasion syndrome (MAS) and realized that it might be an important etiologic factor for the idiopathic osteoarthritis of the knee joint. This syndrome could clarify most of the recognized symptoms, signs and risk factors of this common disease. Combined with other detrimental factors such as lateral compression syndrome, focal synovitis, chondral debris and meniscus flaps, the normal metabolism balance of articular cartilage is jeopadized and the knee “degenerates”. If these detrimental factors could be eliminated by ACRFP in time and KHPO undertaken, the natural repairing power of the articular cartilage could be revived and the “degenerated” knee might “regenerate”. In our clinical outcome studies, the radiographic evaluations have demonstrated that, by removal of all existing catabolic factors, the anabolic pathway of the damaged cartilage might become dominant and regeneration unveiled. However, more strong evidence such as MRI studies are needed to prove our clinical observation and we hope to provide this evidence in the near future. For more information, please download the attached video clips to see a second-look arthroscopy which demonstrate cartilage regeneration by nature.

http://www.biomedcentral.com/1471-2474/13/226/additional

Dr. Sumantran, I am interested in your studies about chondroprotective effects for OA. Any modalities or techniques of chondroprotection or cartilage regeneration could be combined with our concept of KHPO to form a therapeutic alliance for the optimization of clinical outcomes and quality of life for the OA knee patients.

Thanks for your interest Dr. Shaw, I do not understand the clinical details since I am a biochemist/cell biologist. But, your idea of combining chondroprotective drugs with the KHPO is good. In our in vitro model of cartilage damage, we tested Glucosamine Sulphate (GS) and different Ayurvedic drugs for chondroprotective activity. Our sample was actual OA knee cartilage from different patients undergoing Total knee replacement. We found 50% Responders and 50% Non-responders to each drug (including GS). Perhaps the catabolic factors were dominant in the Non-Responders? So, some clinical analysis is necessary to predict who will be Responder and Non-responder. Then, you can expect the combination of KHPO and herbal drug to work. Our group published a clinical trial on our best Ayurvedic drugs. I am attaching the pdf. I hope this helps. All the Best with your work!

The question is whether damaged articular cartilage can regenerate by itself ? In my opinion based on a 40-years long clinical practice as orthopaedic surgeon such a spontaneous regeneration is not possible. There were some cases where the hyaline cartilage was substituted by fibrous cartilage, which can be compared with scar formation. Contemporary scientific achievements (stem cells, etc.) are not convincing till present. The publications on results from chondroprotective therapy are very controversial too. Sorry, if my answer disappoints some colleagues.

New evidence of "cartilage could regenerate by nature":

Second-Look Arthroscopic Assessment of Cartilage Regeneration After Medial Opening-Wedge High Tibial Osteotomy. Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 30, Issue 1, January 2014, Pages 72–79

http://www.sciencedirect.com/science/article/pii/S0749806313011602

I agree completely with Dr Tanchev.  Cartilage regeneration means the collagen architecture, chemical composition, cellular arrangement and full histological function has been re duplicated.  This is not the same as viewing fibrocartilage coverage from a distance. I am not even sure we have the ability to measure and compare all parameters of healthy hyaline cartilage with regenerative cartilage.

If the discussion is pin-pointed to the cartilage tissue, may be "repairing" is a more appropriate statement than "regeneration". But, if we take a broader view to the whole knee joint, when the causes of continuous cartilage damaging could be found and eradicated, the damaged cartilage could "repair" by itself (even fibrocartilage is durable). The so called "degeneration" process could then possibly be stopped and the whole joint "regenerates" and regain its function. This is what I've seen from many of my patients' happy experiences after treated by ACRFP and KHPO.

Its good to distinguish between repair and regeneration. I thought repair with fibro-cartilage is not good, because it does not have the load bearing properties of hyaline cartilage. Has anyone done load bearing studies on joints repaired with fibro-cartilage in animals or humans?

"If hyaline cartilage is torn all the way down to the bone, the blood supply from inside the bone is sometimes enough to start some healing inside the lesion. In cases like this, the body will form a scar in the area using a special type of cartilage called fibrocartilage. Fibrocartilage is a tough, dense, and fibrous material that helps fill in the torn part of the cartilage; however, it is not an ideal replacement for the smooth, glassy articular cartilage that normally covers the surface of joints." This statement is quoted from Wiki and might be the most popular impression about fibrocartilage. However, could anyone provide evidence that fibrocartilage is "no good"? Actually, just like all scar tissue, fibrocartilage is more tough and durable than hyaline cartilage. Why is it regarded as "no good" for the damaged articular cartilage? By the way, loose body found in knee joint is another good evidence to demonstrate that cartilage tissue could regenerate by itself.

Anyway, from our clinical experience of performing ACRFP, we've been convinced by the good outcomes of our patients and believed that cartilage do has its natural power of healing (both "repair" and "regenerate") if we could remove all damaging factors and provide good environment for the healing process. "To see is to believe", this is what I've learnt from my patients!

Data Cartilage Regeneration is Possible after ACRFP

Take a look at www.golfersknee.com/aspx to see a series of publications related to end stage degenerative grade IV lesions and their potential to regrow tissue and also the biological basis.  I recommend you get the Guyon and Brand article as it is amazing how regeneration of the joint and bone occurred by spontaneous unloading of the hip.

This publication shows the long term survival of fibrocartilage and conversion to mixed fibro and hyalin after 20 years.

Johnson LL, Delano MC, Spector M, Jeng L, Pittsley A, Gottschalk A. The Biological Response following Autogenous Bone Grafting for Large-Volume Defects of the Knee: Index Surgery through 12 to 21 Years' Follow-up. Cartilage Volume 3 Issue 1 January 2012 pp. 85 - 98. Cartilage, first published on August 16, 2011 as doi:10.1177/1947603511413568

Andreas is correct that it is indeed strange to assert that an important part of the human body, once worn down, cannot regenerate itself. As we assess thousands of patients with worn knee cartilage we always marvel at the pockets of cartilage surrounding the sites of lesion. For sure, if underlying factors (diet, hydration, exercise, toxins, overuse, etc.) are addressed, cartilage does both regenerate and repair spontaneously, as we have seen tiime and again. But, if nothing is changed in terms of underlying factors, the new hyaline cartilage is swept aside and the problems of the joints persist. Adult stem cells did not all of a sudden become the domain of petri dishes, but have always existed in healthy bodies. Its the unhealthy ones that tend to give us the opinions that once lost it cannot be restored.

Hi Max, First off, let me say that I believe in faith healing both direct & indirect, because I've seen the evidence of it.  Second let me follow that w/my other bias:  I'm a Christian.

OK, I have seen a situation that has no medical explanation other than faith.  Years ago, 1987 to be exact, I did an aerial somersault over the handles of my bicycle & landed on my hands & knees on the sidewalk.  I had to have a corrective arthroscopic repair/removal of my medial meniscus.  The physician who did the surgery showed me the X-rays of before & after & the medial meniscus was definitely gone in the after. He also explained my injuries to my knee were a lot more extensive than what showed up on the X-rays despite the contrast.

Several years ago, that knee became very painful, swollen & stiff after it bent laterally rather than the direction it was meant to bend.  I saw an orthopedic surgeon who ordered an MRI.  On that MRI, he pointed out, among other things, where my medial meniscus was.  Not where it was supposed to be but was actually there--whole & intact w/o any evidence of tearing.

My body spontaneously regenerating the medial meniscus?  I prefer the faith healing idea but have no scientific proof it happened by either means beyond the old X-rays w/contrast & the more recent MRI.

Is there now scientific evidence of cartilage regenerating itself?  I'm interested in any evidence you might have simply to satisfy my curiosity.  

Really interesting idea, Max.  I hope you are able to show a spontaneous regeneration.  

I have a JudeoChristian Biblical world view.

A meniscus may regenerate in a human as seen by present day MRI or an the arthrogram test in the past.  However the are not as large and do not have the same histological nature.  They are ususally more fibrous in nature.  Not likely to have the same biomechanial nature.

However, there is evidence that spontaneous repair can occur with end stage osteoarthritic lesions in the hip and the knee.  see www.golfersknee.com/MedicalLiterature for a series of scientific papers supporting such an idea.  I am  a co author of a pape now in process showing that prolotherapy can cause cartilage to regenerate in human knee joints.  I have shown that dextrose will cause the human synovial explant to make growth hormone, IGF-1 that has been known for years to be anabolic for cartilage.

Hope this helps

www.golferknee.com/MedicalLiterature/aspx

Denise and Lanny: Of course all tissues regenerate continuously, adult stem cells sit ready all over the body waiting to be called upon to convert to whatever tissue is needed in a given site. Spontaneous healing is what the body does...until it lacks the nutrients or laden with toxicities, medications, or heavy metals that can deter it from doing so. For instance, humans grow Alveoli I & II cells continuously and spontaneously and we are able to maintain lung function for life as a result. The same for pleura, epithelial, clear hyalene cartilage, and soft soft bone tissues--but if one smokes (anything) all of that slows way down or stops entirely. On the knees, new articular cartilage comes in continuously as old cartilage wears out---simply exercising can inspire more cartilaginous growth. Hair grows, collagen in myriad forms grow, corneum stratum in the ear canal grows at the rate of about 1mm per day from umbo to aperture, finger nails, toe nails, schlera over the eyes, myelin sheath on the nerves---that's the genomic mission of just about every part of the human body. It is when the damage is overwhelming or traumatic or continuous without a chance to regenerate that we the need to do something to help it along--or, again, when we prevent it from happening due to egregious environmental/lifestyle stressors that push us beyond the speed at which the body can regenerate. We use a number of therapies to speed the process of healing and have yet to find a knee that could not grow cartilage with some therapeutic encouragement.  

This isn't my area of expertise but I have, let's say, a personal interest and came across this fascinating paper - link below. MRIs conducted 2 years apart on 325 adults in Tasmania - mean age 45. They measured defects in knee cartilage. After 2 years 33% of cartilage defects had worsened and 37% had improved (ie partially or wholly regenerated). There was no relationship between age and the likelihood of an improvement though there was a relationship with age in terms of worsening - along with BMI and gender. So clearly cartilage does regenerate by itself and carries on being able to do so well into adulthood. We can argue about the quality of the repair tissue but not the fact that it takes place.

http://archinte.jamanetwork.com/article.aspx?articleid=410037

Chris, this is an excellent study and thank you for sharing it. Without a doubt cartilage is regenerative on its own, and especially, in our clinical observations, when factors that deter its formation (such as steroids, NSAIDs, and abuse of various substances) are avoided and other factors of health are improved. The body is quite dynamic on its own when personal lifestyle and health choices are more favorable to its natural processes. Thank you, again.

 Hi Max and others. OK I am probably clutching at straws here. I've been a very active sportsman, mainly cycling, but pretty much anything. Cutting the long story short, recently diagnosed with Chodromalacia both knees, full thickness lesions. My doc/ surgeon has suggested debridment and a lavage. What I'm currently trying to get a handle on is whether, I could regrow/regenerate/repair that level of damage. One thing I am exceptionally good at is following a plan. Is it worth putting off surgery for say 12 months to 'have a go'?

John you should read Saving My Knees by Richard Bedard. Its an Kindle/ebook. Very similar to you he had Chondromalacia / Patella Femoral Pain Syndrome after training for a cycling race. His website http://www.savingmyknees.com/smk_003.htm. He's actually a financial journalist but he's trawled the academic literature on cartilage and its an interesting and encouraging read. He tried various types of exercise regime over the course of a year. The good news is he got better and is back to cycling. But cartilage repair is pretty slow - so don't expect instant results. His blog is worth a look on the subject of lavage.

John, you would be surprised how fast you can get your articular and menisus cartilage grown back without the the bloody mess and long healing and temporary results of of a debridement or any other sham surgical procedure. If you would like to communicate directly with me on how to get your cartilage back in short order please contact me at [email protected].    

Chris, I read some of the item you referenced. One can grow back knee and other cartilage (mitochondria, ATP, and adult stem cells are no "respector of parts" so all cartilage can be repaired). We see it in our SIRCLE Project all the time, and have yet to see a case where it could not be grown back in short order. 

Chris and Max, morning from the UK. Chris I've read Richard's book. I found it encouraging and also very engaging. I'm a scientist now working in education, so I am trying to get to the bottom of the literature for myself, and it seems more than contradictory. But.... I am very keen to give it a go. Max I will certainly contact you.Very interested to hear what you have to say. If you'll excuse me, I ave done a little reading on your work with SIRCLE, but definitely need to fill in some blanks. Gents, thank you both for getting back to me. jk

John, here is one of my recent seminar monographs on breathing disorders--though this seems change of subject, it was our quest to stimulate growth of clear, hyaline cartilage of the lungs that led us some of your rogue medical researchers on breathing disorders in London on my recent trip there to keynote an international scientific conference. Our surprise was to hear someone else advocate out loud that the human body replenishes cartilage constantly and this notion that it doesn't goes back to the fallacy that so many knee and other joint replacements are needed and that once one has breathing disorders there are no solutions but to live on steroids and bronchdilators for the rest of the (shortening) lifespan. We knew better, and was just glad to have support from various parts of the world. The same applies to the body's ability to repair damaged cartilage. The core to stimulating cartilage growth is getting optimal oxygen and pH to the cells so that mitochondria can proliferate production of adenosine triphosphate (ATP) and bring more adult stem cells to the site of lesion is deep cold laser, adjunctive therapies, and certain nutrients not available OTC.  

Hi John, if one could remove the cause of cartilage damage in your knee, the defect definitely would regenerate by itself. Otherwise, any modality of tissue regeneration will be only temporally and failed in the long run. In my experience, medial abrasion phenomenon is a common, manageable but neglected cause of cartilage damage. Thousands of my patients have got benefits by using this concept of treatment which I call knee health promotion option (KHPO). Attached links are for your reference. 

http://journals.lww.com/md-journal/Fulltext/2015/04040/Medial_Abrasion_Syndrome___A_Neglected_Cause_of.13.aspx

http://www.biomedcentral.com/1471-2474/13/226

http://www.intechopen.com/books/osteoarthritis-diagnosis-treatment-and-surgery/knee-health-promotion-option-for-osteoarthritic-knee-cartilage-regeneration-is-possible

 Hi Shaw, I hope I have that right. So are you suggesting that I have the arthroscopy, and then follow a specific set of rehab involving supplements etc

Well, it depends on who perform the arthroscopy for you. How could you expect your cartilage regenerates if your surgeon does not have this concept? I am afraid it might be quite difficult to find an orthopaedic surgeon who believes "cartilage could regenerate by nature".

Haha a very good point. Well... a quandary for sure

 What Shaw says here is vital. Anthroscopic surgery has been dissected and studied and found to have a wide range of outcomes and benefits/risks. It very depends on the surgeon and their respect and understanding of the body's cartilaginous generation. I can tell you, though, that a combination of deep cold laser, occupational therapeutic approaches, and adjunctive therapies that bring oxygen and adult stem cells to the site of lesion has been found to be immensely more successful without any of the risks. 

Hi, Max, Lanny, Denise, Chris and all cartilage regeneration supporters, I appreciate your positive feedbacks and cheerful information about spontaneous cartilage regeneration. It seems that we have similar concept regarding this controversial issue. To improve my outcomes of KHPO (>90% of improvement rate), I am very interested in Max's treatment option. It seems could be well incorporated into my KHPO protocol (see Fig.1 of the attached link) as a part of PCRFM. Max, what do you think the possibility of implementation of your treatment modality into our protocol?

http://www.har-journal.com/wp-content/uploads/2015/08/HAR12-3059.pdf

Shaw, this is impressive to say the least. I'm hitting deadlines with a couple of articles and will read this thoroughly in a few days and get back with you. Thank you!

Morning Gents, after you all are so kindly providing me with answers and questions; I thought i would give you an update on where I am at with my knees. I have decided not to go for debridement surgery. This decision was made after reading the RCT trials over the last few years. Stem cell therapy does seem to be providing good results in the majority of people involved; so I have been accepted (pending referral from my surgeon) onto a the ASCOT trial, which is running here in the UK. It compares three arms, ACI v Stem cell therapy v a combination of the two. In addition, I am following an anti inflammatory diet and becoming more convinced by the AI effects of foods such as turmeric, ginger etc. Although this might be closing the stable gate after the horse has bolted. Anyway, I'll be happy to keep you all informed as time goes by. Thanks for all your input so far. jk

I am glad you found a possible treatment plan.  Please let me know what happens!

You may be interested in the TED talk

https://www.ted.com/talks/siddhartha_mukherjee_soon_we_ll_cure_diseases_with_a_cell_not_a_pill?language=en#t-748616

Thanks for bringing this to our attention, Hristina. His perspective matches many of us in Behavioral Medicine. We need a new oncological paradigm for healing, not managing, of boosting up and unleashing the incredible power of human immunology rather than focusing on killing abnormal cells. Excellent thoughts!

You're welcome! I was looking at your contributions and it happens that I am translating the talk now. I don't understand anything about the subject so it is a challenging task. I wish he mentioned something more about environments in general as a part of his model. 

Here is one of my latest lecture monographs that may shed some light on the topic, and is in line with Siddhartha's ideas.

Hi, Hristina and Max, appreciate your links. It seems that we are in the same line. These informations give me a shot for promoting my concept of "ACRFP" and "KHPO". The attached file is part of my book which will be published recently. For your reference, thanks!

Dear all

I had a very bad accident and i smashed my heel bone drs did not do any operation and my heel is deformed and i have started to have osteoarthrite in my subtalar and hole ankle joint drs recommend subtalar arthrodesis but i dont want to do that i just want to see if in near future there will be some methods to repair cartlige to help me? And what is your recommendation for that?

Deep cold laser with site preparation with MiraCell botanical solution with added Thyme, Cypress, Clary Sage, and Frankincense (proportioned). 

Hi Jamal, if you have access, Max is right.  If not, can you come to the U.S.?  He works w/a group that can do a whole lot & get that heel reformed & repaired.  Best wishes, Denise

Hi dear freinds i am from Iran. I have studies alor about calcaneus fracture complication and methods to treat and cartlige regeneration process. And it seems so odd for me that with such a advances in medicine still this kind of fracture is challenging all mans life long. And i am really ready to do every thing except arthrodesis to solve my problem. I want to know if there is a center that can help me with out arthrodesis. In that case i want to send my medical history and documents there and then plan to travel there. I will be thankfull if you help me.

Dear Max I am to battle with the arthrits and rebuild my heel bone I hope let mee use your golden recommendations.

I don't have any normal background in this area. I know that cartilage in the joints is surrounded by the synovial membrane and not perichondrium which surrounds non-joint cartilage such as those found in the nasal septum. The perichondrium itself is an active source of adult mesenchymal stem cells which produce progenitors to chondcytes, the matrix secreting cells of the cartilage. I found a study where they observed adult mature rabbits regrowing morphologically identical hyaline cartilage after removing there nasal septum but leaving the musocal flaps containing the perichondrium intact. I would imagine cartilage found in the joints could regenerate in this manner but contain perhaps more fibrous matrix than before. In short I think it regenerates readily where the perichondrium is found and not so readily where it is absent. Here is the research study proving this.

https://www.researchgate.net/publication/6790360_Cartilage_Regeneration_in_the_Rabbit_Nasal_Septum

Article Cartilage Regeneration in the Rabbit Nasal Septum

I have formulated a herbal preparation, which is helping some patients. But it has to taken another formation which is helping to manage synovial fluid. As cartilage has no blood supply, but its nurishment is only through synovial fluid. I can share more information on this subject. 

Excellent assumption, Johann. Yes, all cartilaginous fibers regenerate unless we take certain medications (NAIDS, Prednisone, etc.), experience untreated injuries or infections, long term acidosis, chronic dehydration, lifestyle challenges (high caffeine, tobacco, drugs), significant sleep disorders, or nutrient deficiencies,  all of which can stop or slow the formation of adult stem cells and formation of new cells.  

Yes, see http://drlannysinsoles.com/medical-literature/

The Guyon and Brand reference is amazing

Very interesting references ! Thank you, Lanny.

Humble opinion:

Steadman trained Ortho surgeon molecular immunologist, lifetime dedicated to this field. Yes is the answer in multiple settings. Many 'it depends' to determine of course, and each case has to be consdiered that way, which only way overpaid experts have time to do just being honest. Getting this to happen clinically in a degenerative joint can and does happen in our clinic. No claims tho. We all do this together. Working on device that makes that a definite. Anyway, not an ad for myself at all. Not extraordinary. Just like to think.

There is quite a bit of ortho literature and radiology literature that demonstrate clear healing back to normal (as far as we can determine through current detection techniques) through MR data. These studies are generally younger patients with full thickness defects in patients with normal alignment that shows spontaneous healing even of hyaline cartilage to normal. T2 wetmaps are available, all I use and are the best imaging sequences. Made popular in 2002 by Hollis Potter at HSS. She is a real expert in my opinion.

The imaging software that should be gold standard in every orthopedic clinic, not expensive. Patients deserve this. It lets you look right at the water being held in by the proteoglycan content in a colorful image that is the most patient-friendly image in medicine period, well maybe after 3D U/S of a baby's face.

Here's the software if you're interested. Most orthopedic clinics that are set up as revenue-crushing facilities don't like these images. Very difficult to sell a total joint to a patient with normal cartilage. I''ll post an example with same patient on top and bottom same cuts. Bottom one year ago. You can draw your own conclusions. very interested to hear what you think . We have hundreds of them now in our database.

https://www.gehealthcare.com/en/products/magnetic-resonance-imaging/mr-applications/cartigram

Honestly the DGMRIC was a far better study but not an option with the Gad revelations.

Here are my opinions in the setting of organic joint disease like arthritis, not everyone agrees. Don't bother reading it if you're already the Rex of this topic. I'm not.

What has to happen for cartilage to grow is two fold:

Understanding that arthritis is not even a disease, but an adaptation of the subchondral bone impact loading that exceeds the material capacity of the structural cartilage including the ECM is critical so you know what to treat. No amount of injection of anything into the joint does anything structurally. Yes they do reverse catabolic conditions in the joint for approximately 2 years (found that out in 2009 when first patients started to fail), the ones from PRP if dense granules lysed 3-6 months, just being honest. All stem cell clinics not run by orthopedic surgeons=sham. That led me to consider why they didn't last longer, but I was so busy as a surgeon I din't have time to really figure it out, until a suprcross crash ended my operative career in shoulder surgery and my mind went back to the nanoworld:

1. There is an absolute requirement for subchondral bone to be at an ideal Young's modulus for impact loading. If this is challenged, there is an immune-driven This usually requires an unloader device and may be as simple as a foot orthotic with medial or lateral heel wedge orthotics. Some extreme cases require tibial osteotomy, a group of chinese surgeeons reported on a mid-fibular resection technique in varus gonarthrosis with good short term results in 2016 I believe? Good idea. Hope that works clinically unlike prp which still strugges for an indication and unless used with HA doesn't activate TSG-6.

2. Assuming that subchondral mechanoreceptors are not being driven into catabolic maintenance of a chronically inflamed joint with normal subchondral bone and normal loading, the physiological conditions within the joint come into play. This is true of all synovial joints, gravity or tendon-pull based loading makes no difference. In other words, the joint has to be stable statically and dynamically. If someone strengthens outside of their range of motion, subchondral bone hardens, see above...

3. The joint must be concentric. 'Ridge riding' maintains a constant, chronic inflammatory environment that will not be overcome by the immune system's inflammatory response to repair. In about two years, the neuro- immune system axis has to make a decision. Should it go on trying to fix this with ATP it's spending it's whole wad on(and looking for a marker) or should it put it on the back burner and let it smoulder (fuse)? The brain chooses in favor of the organism, it's gonna let it fuse. The joint proteome changes measurably. i believe that single cell proteomics at this stage will give us the breakdown and then ubercomputers can figure out the spatiotemporal circuitry. I think this is pretty badass. Every day on this site I see us closer to finding the code underlying the game we all live. Just one country boy's humble opinion, hope you'll share yours.

Parting shot: Just like us, the environmental conditions have to be idealized for cells. It's like bringing a bunch of elite level hollywood celebs (no they don't impress me either I've been amongst too many-just trust me on that, not much to talk about is all,) to a party with no illegal drugs. They won't stay long. Load the place up with desirable cytokine party favors and they'll never leave, at least not until there's nothing left to see or do.

To that end I recommend Ubiquinone, NAD+, n-acetylcysteine and am considering adding quercetin? What does everyone think?

On attached image, look at bone, subchondral bone, synovium, soft tissue. Patient one year later, completely asymptomatic. I can convince myself that the bone is changing and proteoglycan creep can be seen. That means chondrocytes that are making proteoglycan are nearby and that other cells can migrate into that new matrix either from the synovium or through additional injectate possibly.

Clinically we have a few hundred patients who have been successfully treated with this method since 2006. No, not all of them regrow cartilage but there is what I would call an 'anabolic' difference between the scans. Be great if someone else has a series of these? So much to learn.

only an other ref

Article Cartilage regeneration for treatment of osteoarthritis: a pa...

I have followed the advice on this thread, Penn State research papers and numerous www.ncbi.nim.nih.gov articles. A man was diagnosed with osteoarthritis of the knee due to a severe motocross accident. I've attached his x-rays from before and after the plates were finally removed from his leg. I need advice. Does the second set of x-rays reveal a total healing, or am I just looking at the effects of numerous chondroprotective supplements which were given in the hopes of opening the space in the patient's knee? I ask because it seems to soon to experience this level of healing. I've also attached the patient's supplement list with dosages and dates. Austin Yeargan III

If the subchondral bone is not under pressure and can remodel, yes. if the patient is in valgus, must correct the alignment with at least an orthosis. Those films may be misleading due to the rotation of the Xray beam? Are the films all weight bearing?

Austin Yeargan III , no, the films are not weight bearing.

Especially the Rosenberg view with standing flexion

I have observed early varus and flexion deformity prevention and reversal in arthic knee by

#musclebalancing

Strengthening antigravity muscles and maintain length of gravity assisted muscles

treatment of primary diseases (UTI) can prevent deformation of joints.

isometric quads strengthening

#knee  start with normal or better and one by one Ankle Dorsi flexed knee full extended  Hip is flexed beyond 90 with complete back support at 90 degrees if weak angle can be increase to 100, 120, 150, or even 180  means lying down to start with  make it easier but aim is to left thigh of chair for 7 sec 12times 12hrs apart with extended knee dorsi flexed ankle.

Hcq200mg BD

Urine culture sensetive antibiotics till sterile urine

Pain relief Sos

Avoid cold and acids

Having a life time project on immune component of musculoskeletal disorders

I am NOT a doctor, hence may be wrong.

It has limited regenerative capacity compared to other tissues in the body. While some limited natural healing can occur in certain circumstances, full cartilage regeneration by itself is typically challenging.

Here are a few factors that contribute to the difficulty of cartilage regeneration:

1. Avascular nature: Cartilage is avascular, meaning it lacks a direct blood supply. Blood vessels are essential for delivering nutrients, oxygen, and cells involved in the regenerative process. Without a robust blood supply, cartilage has limited access to the necessary resources for efficient healing.

2. Low cellularity: Cartilage has a low number of cells called chondrocytes, which are responsible for maintaining and repairing the cartilage matrix. These cells have limited capacity for replication and regeneration, further hindering the natural healing process.

3. Lack of nerve supply: Cartilage is also devoid of nerve supply, which can impair the body's ability to sense and respond to damage. Without pain signals or sensory input, the body may not initiate the appropriate healing responses.

While spontaneous cartilage repair is limited, there are some instances where partial healing can occur:

1. Superficial injuries: Minor cartilage injuries that affect the outer layers, such as in the case of small defects or superficial erosions, may have a better chance of healing on their own. The adjacent healthy cartilage and synovial fluid can support some level of self-repair.

2. Fibrocartilage formation: In certain instances, the body may attempt to repair cartilage injuries by forming fibrocartilage, which is a type of cartilage with different properties than the original hyaline cartilage. This process can occur in response to certain types of injuries, such as in the case of meniscal tears in the knee.

3. Stem cell involvement: In recent years, researchers have been exploring the potential of stem cells for cartilage regeneration. Stem cells have the capacity to differentiate into chondrocyte-like cells and may contribute to some level of natural cartilage repair. However, the extent and effectiveness of this natural healing process are still under investigation.

It's important to note that significant cartilage injuries or conditions, such as osteoarthritis, generally require medical intervention for optimal treatment. Various surgical procedures, such as cartilage transplantation, autologous chondrocyte implantation, or tissue engineering approaches, are being developed and utilized to enhance cartilage repair and regeneration.

Hope it helps:credit AI