Joint Repair, by Nevin Pratt
Disclaimer: Everything here is my opinion only. I am not a medical doctor, and this is not medical advise. Please consult with your doctor.
Please read the Overview page before reading this page. It sets the context for everything else.
Overview:
I have had chronic joint pain for a few years now. It was initially in my knees, then in the hips, followed by back pain. Right now (May 2025) it is mainly the left knee that is bothering me, but I also have a little bit of back pain. This is my chronicle of my journey through this.
Supplements:
My first line of defense was supplements. I did them all-- calcium, magnesium, vitamin D, vitamin C, MSM, glucosamine, collagen, urolithin A, resveratrol, and anything else that looked like it might help. I did about 18 months of this, with no notable pain improvement.
After about 18 months of supplements I did my first Dexa scan (5/22/24). It reported a bone density of 3.5, which was more than 98% of people my age. So I think the extended use of supplements made a significant impact on bone density. But I don't think it helped much with the pain.
Weight Loss:
In December 2023, I embarked on an aggressive journey of weight loss. Weight loss helped with the joints. A lot. I imagine the supplements also helped, but it is difficult to tell.
PRP:
Around December 2023, I had PRP injections in both knees. There was greater improvement than supplements had given me, but it wasn't very much improved, and it only lasted a few months.
Acupuncture:
In October 2024, I flew to South Korea with Grandmaster Kim, and while there I had acupuncture performed on both knees. I don't think it helped.
Stem Cells:
Around May 2024, I went to Integrated Pain Specialists and had (umbilical) stem cell injections in both knees. This was followed up with another round of PRP around November 2024. At this point, the right knee and both hips seem fine, and the left knee improved by about 50%. It's hard to say which of the things I had tried had resulted in the greatest improvement, but in my opinion it was: (1) weight loss, (2) stem cells, (3) PRP, and (4) supplements, in that order.
There is controversy on the efficacy of stem cell injections, as well as the stem cell source utilized. Some doctors advocate taking stem cells from your own bone marrow, and some favor umbilical stem cells, and some favor fat (adipose) derived stem cells.
I personally favor young umbilical stem cells over old worn-out stem cells taken from your own aging body. If you change the oil in your car, would you put the old oil back in? Or if you were going to build a new barn, would you use old wood? It doesn't make sense to me. Your stem cells wear out, and are getting lazy. That is one reason why we age and eventually die.
Stem cells from your own body are called "Autologous Stem Cells", and stem cells from 3rd parties are called "Allogeneic Stem Cells". Autologous biologics generally have fewer regulatory requirements than allogeneic biologics in the US. Autologous products, derived from the patient's own body, are often exempt from rigorous pre-market FDA approval processes. Many clinics will only use autologous stems cells because of this regulatory difference. In my opinion, their choice is not necessarily driven by what is medically superior, but instead seem to be driven by what the FDA requires, and/or their belief that "the FDA knows what's best".
In the following video, Dr. David Greene says:
"...realize that a major difference is the numbers of stem cells that you get in a bone marrow, donation from yourself, as supposed to the perinatal cell therapy from a donor. The difference is actually tremendous. At the age of 50, you have close to 80% less stem cells in your bone marrow than you did compared to when you were born. I mean think about that for a second, when you are born 1 in 10,000 cells in your bone marrow is a stem cell, and at the age of 50, that’s dropped down to less than 1 in 500,000. So it’s a humongous drop-off, and what it means is that after the age of 50, there’s really no reason anybody should have a bone marrow procedure for stem cell therapy.
So, the bottom line is if you are over the age of 50, and contemplating a stem cell therapy, when you look at the differences between bone marrow from yourself versus the perinatal tissue from a donor, there is no comparison, bone marrow loses every time. And that is something to seriously think about when you are trying to make a decision as to whether you do or don’t want to undergo stem cell therapy, and when you do, what kind do you want to have."
https://r3stemcell.com/bone-marrow-vs-umbilical-cord-stem-cell-therapy/
If you are opting for autologous stem cells for your joints, having them taken from your own bone marrow is probably best. Dr Todd Peters has this to say about it:
"Fat derived stem cells provide the larger volume of adult stem cells, while bone marrow stem cells provide more growth factors that help in the repair or regeneration process. Bone marrow-derived stem cells have a higher chondrogenic capability than adipose stem cells. Bone marrow-derived stem cells demonstrate the capability to treat osteoarthritis."
https://newportspinemd.com/fat-stem-cells-vs-bone-marrow-stem-cells-one-better-joint-pain/
But I personally would opt for umbilical stem cells.
Joint Cavity Injections vs. Bone Injections:
Just as the hair on the top of your head is a protein byproduct of your hair follicles, the cartilage cushion between your joint bones is a protein byproduct of certain cartilage producing cells on the ends of those bone ends.
Which has greater efficacy for cartilage regrowth: injection into the bone (subcondral), or into the joint (intra-articuar)? One study (Pub Med ID: 32617651) states:
Conclusions: Implantation of MSCs in the subchondral bone of an osteoarthritic knee is more effective to postpone TKA than injection of the same intra-articular dose in the contralateral knee with the same grade of osteoarthritis.
There is a Paris study that concluded similarly.
Injection into the bone is superior to injection into the knee joint cavity.
Exosomes:
Injected stem cells will die in about 10-14 days after injection, and yet their effects continue, and even build, over a period of months. It is done through Exosomes.
Exosomes are are carried by, and released from, the stem cells. They are the "business end" of the stem cells, and communicate with other cells, reprogramming those other cells to effect the healing. Thus, stem cells are just a carrier, delivering the actual medicine-- the exosomes.
Since the actual work is done by the exosomes, there is a growing body of evidence to support extracting the exosomes from the stem cells, and injecting those, instead of injecting stem cells.
AOD-9604:
Possibly aids in the prevention and possible treatment of osteoporosis, through direct action on osteoblasts, the cells which build new bone. Also, many clinics combine it with hyaluronic acid injections, because studies show AOD-9604 aids in cartilage regeneration. I haven't (yet) tried AOD-9604 for my knee, but I plan to.
BPC-157 / TB-500
These peptides are known for tissue healing. They will help, but not cure, advanced joint problems. I recommend these two peptides after any PRP, Stem Cells, or Exosomes treatments.
Conclusions:
I believe that for knee joint cartilage repair, exosomal injection into the bone ends of the joint will produce the best result. I am having this procedure done on 6/4/25, by Dr. Jeff Gross, at his clinic "ReCELLebrate" in Las Vegas. I will report the results here. If this procedure fails, I will have exhausted everything I can think of, and will probably need to have knee replacement.
In preparation for the exosomes treatment, and to provide "Before" (and later "After") data, I had an MRI of my left knee done on 3/25/25. Here is the MRI report:
