Stem cells / PRP injections for riders

[jumperjockey572]

Just putting this out there to see if anyone has had similar injuries and what your experience (good or bad) was with stem cell treatment.

When I was 16 (six years ago), I broke my ankle in a fall. I ended up needing reconstructive surgery—plate on the fibula, two screws in the tibia. Like most people with serious injuries, it’s never felt the same since.

My range of motion is pretty limited—basically just to 90 degrees now. There’s a lot of arthritis and bone spurring going on too. I can deal with the discomfort, but it affects my riding. I get really crooked in the saddle because of how locked up the ankle is. It feels like my whole right side is jammed, and my right hip is now higher than my left. I’m also starting to worry about how bad this will be in another 10–20 years. I want to be able to keep riding long-term and stay somewhat sound.

I recently went for a consult at a regenerative medicine clinic for stem cell and PRP injections. They said I’m a good candidate since I’m still young and healthy. The goal would be to restore some range of motion, ease discomfort, and hopefully slow down any worsening.

They said there’s basically no downtime with the plasma/protein injections—just take it easy if I feel sore. I can keep riding and doing normal stuff. The stem cell injection would need a little more rest afterward, but nothing major. It’s a series of 5 injections over 5 months.

My biggest hesitation is that I don’t think they fully understand the kind of stress a rider’s ankle takes. I’m worried they might be underestimating how sore I could get afterward. I know I need to do something, but I also can’t afford to take a lot of time off right now and I’d like to be prepared if time off is needed; as well as communicate to my employer that I would need to not ride for “X” amount of days or weeks. I just feel like there is alot of grey area there.

Has anyone had anything similar done? What was your experience like—results, recovery, etc.? Any negative experiences?
I was told there has never been any adverse effects in their 10 years of business.

Thank you in advance!

[Simkie]

I’ve used PRP quite a lot.

It’s not going to fix that arthritis. Once bony change has set in, nothing rolls that back. If bony change is limiting your ROM, nothing short of replacing the joint will change much.

PRP is usually followed by a period of inflammation. That hurts. I find I’m back to baseline in a week or so. Improvement starts to kick in, gradually, around two. There is definitely down time, but not like surgery.

It is not without risk. Risk is LOW but not zero. Joint infection is the concern.

While I like PRP a lot, and find it useful, I’d really caution you on using this particular clinic. Not only are they painting a very rosy picture, the down playing risk is concerning. And even the series they’re proposing is…a lot.

If you want to give it a go, it’s not a terrible idea, especially if you’re looking to avoid surgery, or check every box possible before that. But go into it with eyes wide open that chance of success is pretty low. Things will hurt, at least for a bit. There is a risk of infection. And a series of three is probably more than enough. I’d really start with one and see if there’s ANY improvement.

[JB]

@jumperjockey572

They said I’m a good candidate since I’m still young and healthy.

Candidacy is much less about age and health, and much more about the problem.

Yes, PRP might slow the progression of the advancing arthritis, but it can’t fix what’s already there, can’t make spurs (which are what’s limiting your ROM) go away or even get smaller

I looked into PRP and stem cell as a way to avoid a hip replacement. They took one look at the spurs on the ball of the joint and said “we’d love to take your money but there’s no way we can help that”

That sounds like what this clinic should have told you.

Best you can do is try to slow the arthritis getting worse, so from that perspective it might be useful. Might not.

[jumperjockey572]

@Simkie

While I like PRP a lot, and find it useful, I’d really caution you on using this particular clinic. Not only are they painting a very rosy picture, the down playing risk is concerning. And even the series they’re proposing is…a lot.

I have to agree with you about them painting a nice picture! I went to this one because the consult was free, but I certainly need to look at some other clinics.
Instead of me looking at it as a fix for ROM and pain, would you recommend this treatment as a way for the condition to not worsen over time?

[jumperjockey572]

@JB

Best you can do is try to slow the arthritis getting worse, so from that perspective it might be useful. Might not.

Absolutely I agree
So you think it could be helpful with future problems, that’s kinda where I’m at now. I’d like to be proactive and not let this ankle (or hip) take me down in 20+ years or so.
Do you have any thoughts on laser treatment, cryotherapy, or anything other than stems cells/prp that I should look into?

[Simkie]

@jumperjockey572

Instead of me looking at it as a fix for ROM and pain, would you recommend this treatment as a way for the condition to not worsen over time?

No, I don’t think there’s any evidence that PRP slows the progression of arthritis, unfortunately.

It helps with pain and inflammation, and seems to do pretty well with repair of soft tissues.

I don’t think you’re crazy to consider it here, and it may be worth a shot, but I’d really file it into the “can’t hurt, might help” and “hail mary” category. Once there’s significant arthritis, a lot of this stuff is kind of in that bucket–some people might catch lightning in a bottle & find it really amazing, but most are going to see little benefit.

Have you pursued any other injections? Steroid? Hyaluronic acid? How did those go, if you have? HA might be covered by insurance so could be worth a whack. In addition to it’s “lube” properties, it’s got some nice anti inflammatory action. Even if it’s not covered, it’s sure a lot cheaper than the biologics.

[JB]

@jumperjockey572

So you think it could be helpful with future problems, that’s kinda where I’m at now. I’d like to be proactive and not let this ankle (or hip) take me down in 20+ years or so.
Do you have any thoughts on laser treatment, cryotherapy, or anything other than stems cells/prp that I should look into?

“could” in the sense of “maybe, possibly, but probably not “probably”” unfortunately

I don’t know enough about the other therapies in this context, especially without knowing more details (like how many spurs, how big, all that stuff I wouldn’t understand anyway from just an xray. The big issue is you can’t improve what’s there with therapies. At best, you can slow things down, but the % of slowing, and the % of a given therapy at being successful at that slowing, is what I have no idea about. You’d have to dig deep into research papers

[Kyrabee]

I had PRP for 2 tendon tears and hip arthritis in 2022. It helped the tendon tears temporarily. It lasted a little over a year. With the bony issues in your ankle, I seriously doubt it would help. And the tenodons hurt like a ….it was 3 weeks for it to start turning around pain wise. No NSAIDS to help either (contraindicated for the procedure). It helped the tendons temporarily and it did nothing for the arthritis which rapidly progressed. I had my hip replaced this January and the new hip joint works great. Still fighting the tendon issues but seem to slowly be winning with continued PT and myofascial work.

Sorry you are going through this. It so sucks when things don’t work right.

[red_mares]

I talked to one doc about doing PRP on my crap ankle years ago. For some reason, after that discussion, he gave me a shot of cortisone.

Remarkably, after 10+ years of ankle issues and way overweight, I have only a tiny amount of arthritis in one of them. I think it’s because I’ve done PT religiously and my ankles were mobilized every couple weeks. My coalition foot should have had arthritis in it, but didn’t.

I have talked to my current doc about PRP in my peroneal tendons. I’ve had some docs say you can walk on it, others say a week or two in a boot wouldn’t be a bad idea. I think I’ve had it done as part of surgery; it’s hard to quantify anything good or bad from that.

I’ve not had any significant fractures in my bad ankle, just lots of soft tissue injuries. I did get full range of motion back after it was rebuilt, but it took a couple years. It’s pretty good right now. I don’t ride anymore; I just can’t. I doubt your docs get it. I had a PT who rode, but he rode hunters. “You’ll be fine if you don’t trot much” yeah, great. I rode saddleseat; all we do is trot.

[hoopoe]

I would probably seek the opinion with a doctor /surgeon who specializes in care and rehab and not one who is in a business focuses of regenerative medicine.

It sounds to me they want to sell you a product

You are young and you need the perspective of someone who has been around a lot of damaged athletes and has a good track record. If they think PRP could help thats great. But you are heading for a lifetime of potential issues and it would be best to really have opinions of surgeons and therapists who are going to manage this for the long haul.

[Simkie]

I really disagree–the regenerative medicine specialists are the best guys to see for regenerative medicine. The surgeons who do a little on the side are not the people who are keeping current on this very rapidly evolving field. There really is very wide scope here…just talking PRP, different table top machines have huge variability in purity & number of cells, and then you step up to a true lab process. This stuff matters in your chance of success.

It can certainly be challenging to find the right doctor. I’ve had the most success with Regenexx.

[hoopoe]

but I would make sure to not have a doctor that has only PRP on their mind.

I would get the opinion of someone who deals in specific limb issues. A leg or ankle specialist

If PRP is part of a complete and balanced rehab, great, but I would be cautious to accepting that is the only thing that needs doing, particularly in someone so young

[Simkie]

Sure, if the ankle hasn’t had recent imaging and had a workup, that should be done.

But a non surgical/surgical/regenerative therapy ankle expert doesn’t all exist in the same person, so to get all of those various expert opinions, it’s seeing all those various experts.

I often have my regenerative guy do my initial workups because I’ve known him forever. He can provide an initial opinion and I can take the imaging to other experts for their own opinions.

Every doctor is “selling” something. Not because they’re grubby, but because they ALL have their thing they believe in. The best experts are often very narrow in their scope of expertise because they have had to be to gain that expertise. So go talk to the best experts you can find, in each field.