Hi all,

New here but have found the search button to be beneficial in helping me. Unfortunately, the question I would like to be answered has not come up.

I have developed severe calification of the ankle joint caused by both prior trauma and my hemochromatosis (high blood iron). I have eliminated both issues now but am left with a bad ankle that is bone on bone. Further, I have developed bone lesions from the lack of cartilage.

I am 40 years old and the option of fusion and joint replacement are not on my list and will not be doing them. Through research, I came upon a Dr. Dunn in FL: http://www.iagh.com/ who has had mutiple patients come through and regenerated their cartilage by a combination of debridement and human growth hormone joint injection. I also confirmed his procedure did work with mutiple people. Dr. Dunn even specifically spoke to my case and indicated that he repaired damage to someone close to my condition and removed their lesions while letting the HGH alone grow the bone back as well as the cartilage.

I want to duplicate his procedure locally in Phoenix because Dr. Dunn is difficult to get into as well as being extremely expensive to accomodate weekly joint HGH shots when you need to fly to FL. If I could duplicate his procedure, how would I go about doing so?

Thank you,
Ben

Hi,

First, tell me a bit more about the ankle. What kind of problem are you having?

And can you tell me a bit about you? General health and occupation? What was the trauma to the ankle and what kind of injury was sustained?

Jeff

Jeff,

Glad to do so. Early in life was extremely active with football and track into college. I have since taken up sales and does not require strenuous activity. My Hemochromatosis was diagnosed 4 years ago and I had a debridement on this ankle 9 years ago.

From my MRI report on my left ankle from Nov 07:

Severe osteoarthritis tibiotalar articulation with extensive subchondral cystic change, edema sclerosis, cartilage denuding, osteophytes and joint space narrowing

Degenerative changes sutalar joint and additional calcaneal marrow edema.

Large tibiotalar and small tibiotalar joint effusions

Lobulated 1.2 X 1.1 cm probable synovial cyst or ganglion cyst medial plantar soft tissues.

Mild peroneal brevis tendinonpathy

Nonvisualization anterior talofibular ligament, loose bodies and osteophytes suggesting impingement and previous injury.

I hope this helps.

Ben

Hi Ben,

Not a real good ankle, that's for sure. By the time that you get asymetrical narrowing and subchondral cysts, you 've actually got structural changes in the bone that supports the cartilage. I know this isn't what you wanted to hear, but with that loss of structural integrity of the supporting bone, any attempt at resurfacing the bone is going to have a very low success rate.

Jeff

I wanted to give an update to my original post.

I in fact did the HGH procedure with Dr. Dunn and have after 8 weeks regrown my cartilage to 3.5 mm in the back of the ankle joint and 2 mm up front when I originally was bone on bone. Granted, I will be in a brace from this point on for many months to let the cartilage solidify but I am on the road to recovery!

All cysts are gone and most important, all pain is gone. X-rays are showing that the bone needs to regrow a bit more where he dug it out (cysts, etc.). There are still a few more HGH shots to go and about 7 months to complete the bone and cartilage growth to normal.

My intent is to let others know that there is hope because this procedure does work.

Ben

Ben,
This is most interesting to me. Is he the only dr. in the US doing this procedure? Please keep us updated as time goes on. I'd love to know how you are doing 6,9,12 mos from now.
I'm glad the HGH procedure seems to have worked for you. That is great news.

Hi guys,

I've always looked at growth hormone (growth factor) as a supplemental part of what needs to be performed in the ankle. For instance, when I repair an OCD of the ankle with a graft, I use a Biomet product called GPS. But I still need to structurally change the contour of the ankle. Follow?

Maybe the point here is to perhaps use GPS in earlier stages of chondromalacia. Rather than waiting to address a stage 4 chondromalacia, address it earlier with a GPS injection. I've not seen any literature on this topic, but it may make sense.

Jeff

He is the only one I am aware of that does such an extreme surgical procedure when the bones are in such a serious state of damage. Other doctors were cringing at the extent of "digging" he did.

I have since Dr. Dunn learned of others that do HGH injections only with no surgery. In Phoenix, I can go when I do my right ankle, which is not nearly as bad off.

I will update but for right now, every day brings improvements in motion but there is still zero pain in my joint. Ligaments and tendons still don't allow for full range of motion when walking but I see that improving constantly.

Dr. Oster, he has presented at the ICRS: http://www.icrs2006.org/pdf/icrs2006_final_program.pdf and it may help you in looking into this in more detail. I am glad to hear that you have helped others in the past.

Super. let me know how you fare over time.

Jeff

I wanted to give an update on my progress. it has been just over 4 months since my surgery and have had to date 7 intra-articular HGH shots.

Cartilage is averaging 3 mm with one small area that was a bit less. I was at 1mm to 0 in some areas prior to the surgery. The 3 mm information is from an xray in November so I can only assume it is much better still today. The x-rays show the bone is growing back and is slowly "smoothing out" for lack of a better term.

Pain is nonexistent in the joint itself but the ligaments nned help are being worked on by Prolotherapy. The prolo has been fantastic to tighten the loose ligaments. The ligaments are feeling better as I have been through 2 cycles so far with probably another 4 to go. I started the Prolotherapy in mid November.

I will be in my brace for another 2-4 months minimum before I am allowed to put full weight on the joint but I walk almost normally. The doctor says we don't want to take a chance crushing the new cartilage so the brace stays on.