Dr. Khay Yong Saw and his research team in Kuala Lumpur, Malaysia have been studying stem cell cartilage regeneration for several years. Dr. Saw's protocol involves microdrilling surgery followed by weekly post-operative injections of autologous peripheral blood progenitor cells (PBPC's) and hyaluronic acid (HA).
Dr. Saw and his team propose that the microdrilling surgery creates a blood clot scaffold on which injected stem cells can be recruited and enhance normal cartilage regrowth. The significance of this cartilage regeneration protocol is that it is successful in patients with historically difficult-to-treat bone-on-bone cartilage damage. To date, Dr. Saw has treated approximately 400 patients with this technique. He has published both a case series and a randomized clinical trial on this treatment.
Since first learning about Dr. Saw's cartilage treatment, Dr. Broyles has made several trips to Malaysia to study the techniques and protocol used by Dr. Saw's research team. Dr. Saw and Dr. Broyles have operated together at the Kuala Lumpur Sports Medicine Center (pictured), and were interviewed by a Malaysian newspaper during one of his trips. Read the full article.
Building off of Dr. Saw's methods and some of his own research, Dr. Broyles collaborated with local Hematologist/Oncologist Dr. Patrick Stagg, to design and execute a stem cell cartilage clinical trial at the Bone and Joint Clinic of Baton Rouge.
The main difference between Dr. Broyles’ BAM procedure and Dr. Saw’s treatment is that Dr. Broyles uses fresh Bone Marrow Aspirate Concentrate (BMAC) and Platelet Rich Plasma (PRP) in each post-operative injection in addition to Hyaluronic Acid (HA). The reason for this modification is two-fold – First, in the US, the FDA regulates PBSC’s as a ‘drug’ and mandates that their use in the knee needs to go through their Investigational New Drug application procedure. This process is arduous and expensive. Second, there is growing evidence supporting the use of BMAC and PRP to augment microdrilling and cartilage cell growth.
 Lund TC, Tolar J, and Orchard PJ. Granulocyte colony-stimulating factor mobilized CFU-F can be found in the peripheral blood but have limited expansion potential. Haematologica 2008; 93:908-912.
 Fortier LA, Potter HG, Rickey EJ, et al. Concentrated Bone Marrow Aspirate Improves Full-Thickness Cartilage Repair Compared with Microfracture in the Equine Model. Journal of Bone and Joint Surgery 2010; 92:1927-37.
 Saw KY et al. Articular Cartilage Regeneration With Autologous Marrow Aspirate and Hyaluronic Acid: An Experimental Study in a Goat Model. Arthroscopy 2009;25:1391-1400.
 Allan Mishra, M.D., Padmaja Tummala, M.S., Aaron King, B.S., M.B.A., Byung Lee, B.S., Mark Kraus, M.D., Victor Tse, M.D., Ph.D., and Christopher R. Jacobs, Ph.D. Buffered Platelet-Rich Plasma Enhances Mesenchymal Stem Cell Proliferation and Chondrogenic Differentiation. Tissue Engineering, 2009, 15(3): 431-435.
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