Hello Trainer Road fam! I’m 32 years old and have had 2 acl replacements on my left knee already (1 on my right too, football and wrestling in HS tore 'em up)… Last one was roughly 6 years ago, and the issue is my knee is starting to get arthritic because my cartilage is gone… Enough that it bugs me daily and feel like it’s holding me back… I’ve been looking for potential fixes because after some hard racing this year the pain off the bike is getting worse. Although I don’t have a dual sided power meter I’m noticing my right leg is working much hard than my left to compensate for the pain I’m guessing. On high power workouts it’s really noticeable and frustrating. I used to do 100 mile-ish gravel events but the recovery on the knee is brutal so I’ve dialed it back to 60-70 mile stuff but am still having issues… Training workouts an hour or less are ok but going hard much longer than that usually has it feeling bad for a few days. Has anyone tried PRP or stem cells with similar knee issues with positive results? It’ll likely be a big spend but if it can delay a partial or full knee replacement for a few years maybe it’s worth it… Anyways, hope you’re all having a great riding season!
-Kyle
Dont know if this helps …
But …
My dog had Stem Cell -
We nearly lost her at 9 years old as she was riddled with Arthritis.
We managed to get her Stem Cell treatment and she was almost like a new dog and she was good for another 3.5 years
It was expensive but worth it 
If you’re in the US, I would start w/ something your insurance would actually cover. Synvisc/GelSyn/other brand injections will thicken the synovial fluid/increase viscosity, which may give you some lasting relief. Usually 3 injections, 1 per week for 3 weeks, twice a year. A lot of orthos will use these as a stop-gap measure until it’s time for a knee replacement. You can also research collagen supplementation. Pretty good evidence for it helping thicken articular cartilage, esp if taken 1 hour before exercising the joint. PRP may help w/ inflammation, but it’s not going to stimulate new cartilage growth. Intra-articular (into the joint) stem cell injections are insanely expensive ($3-5K), and haven’t really been shown to consistently improve cartilage growth. On the other hand, there are several fairly new procedures, like MACI, that use your own stem cells to grow a “patch” to put on the chondral defect. LONG rehab process, and too new for me to comment. I had a procedure where the doc drilled a hole into my femur and then injected stem cells into the bone/sub-chondral space. That has worked pretty well so far. You can also research “unloader braces”. I put a lot of patients in the Ossur brand w/ decent pain relief (this would be for every day wear, off the bike)
Excellent, thanks for this info I’ll definitely be looking into your suggestions 
That’s awesome! Sorry to hear about your dog but glad it helped it 
I’ve had similar issues with my left knee (developing arthritis, degenerative meniscus tearing, and a meniscal cyst). I was first diagnosed at around age 48. Currently 54 and going strong without surgery. I had two rounds of PRP injections. They helped almost immediately with swelling and discomfort. The main thing the injections enabled was getting back on the bike. Since I started training year round, I’ve noticed a considerable decrease in pain and swelling, an increase in general mobility, and an increase in knee stability. I know that I’ll probably have to have knee replacement at some point, but I’m hoping to push it into my 60s. Since replacement knees have a known shelf life of about 20 years, I’d like to avoid having to do the surgery again in my 80s (assuming I live that long).
The takeaway: I’ve benefitted from PRP and haven’t had to have repeat treatment in several years. It was relatively cheap (currently $500 at my local university medical center). YMMV, but it’s helped me stay on the bike and extend my time to knee replacement.
FWIW, my surgeon tells me my new knee (replaced Sept 2020) “should” last 30 years so at age 67 I think I’m going to be good. However, he may not have taken into full account all the “stuff” I want to put it through…
We’ll see what he has to say at my one-year check up a couple weeks out – when I’ll also talk with him more about my other knee (before the first knee we were looking at the xrays and his comment was “well, both are pretty well shot ,bone-on-bone and there’s some evidence of further issues caused by the knees being damaged. So you just tell me which you want to do first – and then let me know when the other one is bothering you enough to do that one.”).
I have had Orthovisc, PRP, and now stem cell treatment. Here is my experience:
I’ve had about 7or 8 years of knee issues where the problem was basically that I could not run longer than a few miles without debilitating knee pain. The pain would manifest laterally on the knee, lower part of the knee cap, seemingly on the outside of the joint. It was acute and meant the end of the run every time. Also walking up and (especially) down stairs and sitting with legs crossed would often aggravate it. I tried Orthovisc and PRP with limits success. I had never had any issues on the bike, so I came to peace with the fact that I just wasn’t gonna be able to run anymore. Then, in Leadville 2021, the knee pain showed up on the bike right around Powerline. That was when I decided to take the final leap to stem cells.
X-Rays and MRIs over the years revealed some chondromalacia / pfps and also a little chip of bone missing from the patella. My ortho said none of it should really cause the pain I was experiencing. He did not see anything he could operate on or even clean up. He recommended to start with Orthovisc, then PRP and Stem Cells as a last resort. Over the last 3ish years, I have done just that.
Orthovisc: I did 3 iterations of this as recommended and noticed zero improvement.
PRP: (500USD out of pocket) I was hopeful after this treatment and increased running mileage up to about 10. This was significant improvement, but the pain returned. That was when I decided to retire from running.
*** of note, my Doc said that if you respond at all to PRP, you will likely do well with stem cells***
stem cells: (2500USD out of pocket). So far so good. Started with a few miles walk/jog and just did 6 yesterday. Zero issues or even ‘noticing my knee’ on any runs. The real encouraging news is that I don’t get sore the next day or notice pain going down stairs.
I’m cautiously optimistic now but super encouraged. Yes it’s expensive. But the risk / reward analysis told me I had to do it. It will be the best money I ever spent if it continues to work!
I have a torn Labrum in my left hip and had about 9 months of pain and was off the bike in 2018. A surgeon looked at it and said that surgery was as likely to make it worse as make it better and didn’t recommend surgery. So, I had PRP and stem cells injected in Jan 2019. Now, almost 3 years later, my hip is completely pain free and a follow up MRI showed an improvement in the Labrum. Insurance didn’t cover the treatment so I paid $3500 out of pocket. I figure that even if I need this every 4 or 5 years it is better than a hip replacement. During visits with the orthopedist he told me that his experience was that about 80% of hips had pain either eliminated of greatly reduced. He also said that knees were even better with about 90% showing improvement provided that the joint still had cartilage in it and was not bone-on-bone. Since my injection several friends have had knee injections and both had pretty much complete relief from pain. So, in my opinion, it is worth trying. Worst case is you waste $3500. However, most likely you will get relief and can put off more extremes measures.