Monday 2 October 2017

Alan’s PRSF Ski Knee Witch Craft

 Alan’s PRSF for damaged knee cartilage: A possible alternative for the PRP procedure 

Below is my knee history and attempt at knee restoration. It is a slow fix in terms of many months but only takes a few easy minutes a day.  
I’m presenting this information now because it may help someone who has a similar experience to mine, to get ready for the next ski season.  Some people have tried the procedure that I follow and found an instant feeling of relief.  I have found a way to greatly increase the flow of nutrients to the knee using the knee’s natural structure and components. Minimally it improves the lubrication of the knee and ultimately, if lucky will repair the cartilage.  I have practice this for 7 months as a replacement for the PRP which failed me. For me the results are much better than the PRP and I name it PRSF (Plasma Rich Synovial Fluid).  All you need is to be able to count to 5 slowly, a few minutes time every day, and a compression band or 3 or 4. You can skip to the bottom for a description of the procedure if you’re not interested in how this came about.

About five years ago my right knee joint started to fail. Three years ago I mentioned this to my doctor and he recommended a joint replacement and set up a meeting with a local surgeon.
The surgeon told me that the replacement knee joint wasn’t as good as good as mine.  He gave me several alternatives. Three were knee injections and one was a brace.  The three injections were $200, $300 and $500.  I asked which injection was the best and he said the $500, which was the PRP (Platelet Rich Plasma). I opted for the latter and the brace.

I tried the brace route and found it the most painful experience. The hinges on the brace did not align with my knee centre of rotation. This caused great misalignment of all parts of the knee joint.  I gave the company a long detail note on what was wrong and eventually got a refund. That is another story.
Then, I also tried the PRP injection. After a year of 3 PRP injections the last one failed. A week after the last injection I woke up and found I couldn’t bend my knee. Very slowly I was able to bend it. The range of bending was sufficient for skiing. What to do about my knees?

I opted for a replacement and found the lineup waiting time was a year.  Then, I looked at the mechanical contraption that I signed up for and was not impressed.  So I started my research in earnest with the goal of determining what happened to cause the failure, what the PRP is supposed to do and what is the best alternative.  I’m a mechanical engineer not a medical doctor, so some of the reading was hard going. Some of the descriptions of some of the processes were not clear to me.
Platelets for instance are generated in copious amounts every day and their primary purpose is to cause blood clotting in wounds. Their secondary function is to help start healing. If not used, their life expectancy is about 8 days at which time they are processed out of the system. Doing the simple math there is always 8 days of supply in your body for damage control. I could not find a definitive answer for their use in the PRP application. Maybe bone surface coating.
I found some contradictory information. For example the general consensus is that there are no blood cells in normal synovial fluid and yet there are test to determine the white blood cell count in rheumatoid joints.  
I also found that the synovial fluid in the knee has some repair components that fix the normal wear and tear.  Failure of the knee joint is usually cause by excessive overload, infection and rheumatoid arthritis.  When the built in repair system is too slow and can’t keep up with these traumas, the knee joint fails. There is some stem cell work being explored and replacement cartilage is being grown and inplanted. This work is only in the experimental stage and not of much value to me.

In February I met a chiropractor, Jerome Fryer, who asked me to redesign a prototype chair of his for production. During our negotiations he told me about some of his work. One item he mentioned was that you can pump plasma into the lower back joints by bending over and then press on your upper thighs. This process stretches the joints in the back. It should be noted that joints are enclosed by a membrane that keeps the lubricating synovial fluid in the joint. When you stretch a joint, plasma (filtered blood) flows into the joint and fills the space created.  The time frame is in 3-5 seconds. The effect is to make you slightly taller for a while.  For several reasons I declined the project but this last thought intrigued me.

During my knee brace experience I learned about the knee construction and how it worked mechanically. I also learned a bit about all the components and how they function.  Articular cartilage, the amazing bone surface material and its lubricating liquid, synovial fluid, are the basic components that make all joints work.  There is also the membrane surrounding the joint that contains the synovial fluid and filters blood creating plasma. When in operation there is a continuous minuscule flow of fluids in and out of the joint.
The red and white blood cells are filtered out by the membrane leaving nutrient rich plasma to enter the joint.  The bone also supplies materials necessary to rebuild damaged parts.  The plasma and synovial fluid mix acts as both a lubricant and the medium for distributing these nutrients to the damaged area. When the plasma mixes with synovial fluid the viscosity of the mix is high enough to not leak back out through the membrane. (My guess, but some leaking must occurs in order to remove waste.)
The process during loading (walking, riding, etc.) the normal joint discharges a very small amount of the synovial fluid from the loaded surface and when unloaded the same amount is replaced. The displacement, of how much the cartilage is compressed is very small, about the thickness of a sheet of paper. The flow of liquid into the joint is similarly very small when the load is released and this is most likely the reason that the repair process takes so long.
When the knee cartilage is failing or failed, a relatively large space is created. The leg can now be bent both in the normal front to back motion but also very slightly from side to side. The surgeon checked the degree of damage this way. Bending the damaged knee sideways opens a gap about 100 times larger than in normal use.
The knee has two pressure contact points, one on the inner side (medial) and one on the outside side (lateral) of the joint. Either one or both of these surfaces can be damaged. One is a fulcrum in the below process for bending the knee sideways.
Muscles  Pushing Knees Together

So here is my solution for my right knee analogous to the back extension above:
  •   I press with very low force, my right foot ankle against my left foot instep. This bends my right leg sideways, using the muscles for pressing my knees together. My right leg knee is slightly bent.  The gap between the upper and lower bones open about 2 to 3 millimetres( on the medial side).  (I can feel the top of the tibia and the space that opens.) (After 7 months the opening is much less.
  •  I hold pressure 5 seconds then release it. (The plasma fluid in-flow time. 
  • Then I quickly flex and straighten my right leg 5-10 times in the normal direction to mix the plasma and synovial fluid. It helps if the limits in both directions are reached. 
  •  I repeat this process 4-6 times until I feel the fluid fill the space.  It feels cool (in the temperature sense of the word) as I feel the fluid spread across the joint space. No more is necessary.

·         I do this 2 times a day on my bed or sofa, once I get up in the morning and once when I go to bed.

When I stop with my knee bent 90ยบ I can feel the added fluid around the base of the patella (water on the knee). The knee joint is now slightly over filled with a Plasma Rich Synovial Fluid, hence PRSF.

One caveat is that I use a compression bandage biking and walking for exercise but not usually around the house.  I believe a compression band helps to increases the fluid flow between the front and back of the knee engineering wise.  For Skiing I use a compression band with side braces built in for some torsion (twisting) stiffness. At night I use a very light pressure band to keep the fluid in working space of the joint.

Some stress is necessary to ensure appropriate repair. Biking and walking are normal now. I’m holding off on running.  Something is happening and I know it is better. Unfortunately, I don’t have the equipment to determine what it is.  It took me a long time to cause the problem so I figure that it will take a long time to repair. I will know when and if this process stops working, the joint space will be filled and that my cartilage is repaired. The procedure has no effect on my good left knee.

Dare I say that some cartilage is being replaced?  Witch craft!

Next, my rheumatoid arthritis fix for skiers of course. AR