Doctor says: “Your knees are worn out”

[alveolar21]

From my late teenage years I started to run, I had no issues until my late 20s.  I began to get pain in my toe joints, when this occurred, I must have started to compensate for this by putting more stress on my knees.  Currently, I have a lot of knee pain, with my left knee hurting much more than my right.  However, my right knee also hurts depending on how it is used; additionally, it also cracks (without pain), when I use it.  Now, I have seen three orthopedic surgeons between two different practices and as soon as they see the report, they want nothing to do with me; they say they cannot fix the problem I have and send me on my way.

Here are the MRI results:

Right Knee:

FINDINGS: The medial and lateral menisci both appear normal. No meniscal tear is seen.  The ACL and PCL are intact.  The collateral ligaments are unremarkable.  The extensor mechanism appears normal.   Diffuse cartilage irregularity is noted along the patellar apex and the medial facet with full-thickness cartilage fissuring and fibrillation along the medial patellar facet.  No other focal cartilage defects are seen.  The bone and bone marrow are normal.  A small joint effusion is present.

IMPRESSION: Right patellar chondromalcia, including full-thickness fissuring along the medial patellar facet.  Small right knee joint effusion.

Some info on these items:
http://en.wikipedia.org/wiki/Chondromalacia_patellae
http://en.wikipedia.org/wiki/Joint_effusion

Left knee:

FINDINGS: The medial and lateral menisci both appear normal.  No meniscal tear is seen.  The ACL and PCL are intact.  The collateral ligaments are unremarkable.  The extensor mechanism appears normal.   Cartilage irregularity, fibrillation, and partial-thickness fissuring are noted along the patellar apex and medial patellar facet, including the formation of a cartilage flap at the junction between the apex and medial facet that measures roughly 6 x 9 mm.  No other focal cartilage defects are seen.  Tiny toci of ill-defined marrow edema are seen in the medial and lateral femoral condyles and lateral tibial plateau.  No discrete fracture is identified.  A small joint effusion is present.

IMPRESSION: Left patellar chondromalicia, including partial thickness cartilage fissuring with formation of cartilage flap at the junction between the patellar apex and medial facet.  Tiny foci of ill-defined marrow edema in the left distal femur and proximal tibia, most likely reflecting stress-related changes.  No discrete fracture is identified.  Small left knee joint effusion.

Some info on these items:
http://www.mayoclinic.org/medicalprofs/enlargeimage5894.html
http://ortho.templehealth.org/content/upload/AssetMgmt/Documents/OrthoCartilageforWebSite.pdf

POSSIBLE TREATMENT
So I started to look for a possible solution, there is a company named Regenex – Where they culture stem cells from your body and re-inject them (there are multiple methods available) back into your knees, from there they will re-grow into cartilage to repair the knees.  

QUESTIONS:
1) I watched a few video/testimonials on this, it seems positive so far, but was curious if there was anyone on here who has had this done and what their outcome had been?  
2) Additionally, what are people’s thoughts on this?
3) Does anyone else have the same or similar issues, how have you learned to cope with this?  
4) Has any physical therapy helped you or any surgery/treatments aside from the genetic method mentioned above?

Any other advice?

[alveolar21]

Thank you for the advice!

[S. Kaul, MD]

Hi there!

Though stem cell regeneration therapy may be effective, it may not be indicated in all cases and is usually beneficial in cases with severe focal defects. I would suggest following a conservative mode of management with rest and anti-inflammatory medications followed by physiotherapy to improve muscle strength around the knee for a few months. If conservative management fails or further degeneration is noted, alternative modes of management may be considered. I would suggest discussing the situation and the suggested management plan in detail with your treating orthopedician.
Hope this is helpful.

Take care!