News that Kobe Bryant was headed to Germany for treatment on his kneebroke late this week.
The treatment was planned and expected by the Los Angeles Lakers medical staff and is a follow-up to previous treatments that Bryant has had on his knees. Bryant suffers from degeneration inside the knee and has had success with treatments in the past.
There are so many questions about this treatment that I wanted to address as many as I can in hopes of easing the confusion.
What is this knee treatment?
Reported in many places as platelet-rich plasma (PRP) therapy, the treatment is actually known as Regenokine. It is similar to PRP, which I explain in this article, but has some notable differences.
The therapy was created by Dr. Peter Wehling, a German orthopedist. Bryant has gone to Dr. Wehling at least three times, once per offseason, though he skipped it once.
With Regenokine, the blood is removed from a patient up to three weeks beforehand, mixed with other substances and then re-injected. It is believed that many US patients have their blood drawn, frozen and shipped to Germany ahead of their treatment by an American affiliate, Dr. Christian Renna.
If you wish to learn more about this procedure, the video to the right from ABC's Nightline gives more details.
Why did he have to go to Germany?
Because of those differences, it is not yet approved for use in the United States. The FDA has not yet approved all elements of the program, specifically the amount of time that the blood is stored before being reinjected. The FDA also requires that the blood be "minimally manipulated" before being reintroduced. The Regenokine procedure does too much to be considered minimal.
More simply, it's where Dr. Wehling is from and practices. There's nothing inherently special about the location.
Is it going to be approved in the US?
While the FDA would not comment on its current status to ABC News in 2012 and again to me in 2013, it is not believed to be close to approval status. As with many drugs and procedures, the FDA's process can seem excruciatingly slow but is designed to prevent new techniques and drugs with long-term consequences from coming to market.
Is this blood doping?
Blood doping refers to a specific practice once used in endurance sports. In this practice, athletes have blood removed as if they were donating blood. They wait several days for their body to replenish the blood supply, then reintroduce the stored blood. This increases the red blood cell count, theoretically allowing the athlete to carry more oxygen in competition.
This technique attempts to recreate the effects of high-altitude training artificially, and was therefore banned in many sports. There are drugs such as EPO and CERA that cause the same effect without the removal of blood, but these are still banned in cycling in other endurance sports. The use of those drugs has often been termed "blood doping" as well.
In tested sports, athletes still try to gain the added oxygen capacity by training at high altitude. Many boxers train in Big Bear, Calif., or in the Mexican mountains for this effect, while the US Olympic Training Center is located in Colorado Springs. Athletes also use hypoxic training, where they wear a mask that restricts oxygen intake to simulate high altitude.
Is it banned?
Regenokine is not banned, and the treatment itself could not be banned by sports leagues. It is a medical treatment between the player and his physician. While blood spinning therapies do often add substances such as human growth hormone before re-injection, players in known drug-testing situations must have this left out. As far as is known, no athlete has ever tested positive for any substance after Regenokine or any blood spinning therapy.
The involvement of Dr. Renna has also been a major sticking point in establishing the legitimacy of the procedure. If that name seems familiar to you, you might remember him from the BALCO investigation. Renna's Lifespan Medicine provided the prescription to BALCO that resulted in "The Cream," a specially compounded mixture of testosterone designed to beat drug tests. Dr. Renna was not indicted for this, but his involvement with Regenokine certainly clouds things.
(Fun facts: Dr. Renna is the longtime personal physician of Oliver Stone and hasappeared in several of his movies, including JFK. Renna was also a consultant on the football movie Any Given Sunday.)
Is it effective?
In the best available study, done in 2008 and published in the journal Osteoarthritis and Collagen, it was found that the therapy showed significant results in 67 percent of patients. This compared favorably to those using the standard hyaluronic acid (32 percent) and a placebo (33 percent.) This study is controversial, though, as it was funded by Dr. Wehling.
Other studies have incomplete conclusions or are questioned by scientific authorities. The anecdotal results are very positive, but it is impossible to say that the treatments are de facto effective. At worst, there is no evidence that they have any sort of short- or long-term deleterious effects. Given most have severe degeneration at the time of treatment, it is hard to imagine much more damage could be done.
Who else has had this type of procedure?
Many athletes have had this or similar procedures. In addition to Kobe Bryant, well known athletes like Peyton Manning, Tracy McGrady, Tiger Woods, Andrew Bynum, Fred Couples and hundreds of other athletes in many sports have had the procedure.
More recently, Seahawks wide receiver Sidney Rice left training camp to go to Germany for a similar procedure. It works for non-athletes with orthopedic issues as well, like UFC president Dana White, Pope John Paul II and super-agent Ari Emanuel.
It should be noted that in cases such as Manning's and Bynum's, it is hard to call their treatments successful. Bynum was not able to return last season for the Philadelphia 76ers despite having the therapy. With Manning, it's more complex. He had Regenokine done as a last-ditch effort to avoid neck surgery. This Regenokine therapy is often referred to as a "fourth surgery" for Manning, even though it is not a surgery at all.
Are there variants on this type of procedure?
Regenokine is actually a variant of a previous therapy known as Orthokine. Both are variants on platelet-rich plasma therapy. In all three, a patient's blood is removed from the body and spun into component parts. Where they differ is in how long the procedure takes, what component parts are kept and if any other substances are added to the injection.
Is this related to Kobe's Achilles injury and rehab?
It is not believed that this has any relation to Bryant's current rehab from Achilles reconstruction. While a healthy knee would certainly help him return to the court and create a more holistic model for the Achilles, Bryant's previous and regular use of Regenokine makes a connection unlikely. More simply, it was just time again for Bryant to have his annual visit.
What should we expect from Kobe after this procedure?
This should not change any timeframes or expectation. While Bryant is still rehabbing from the Achilles reconstruction, his previous success and comfort with this procedure makes it almost routine.
In the season Bryant skipped his annual re-do, there weren't any notable differences in his statistics or apparent skills, so it's hard to say that there has been any real effect besides improving Bryant's comfort and confidence. The Lakers are perfectly willing to go along with anything that Bryant feels will help.
As I recently said in a radio interview, if Kobe wants a woobie, Kobe gets a woobie. Elite athletes are often coddled, so allowing this kind of procedure is a no-brainer for the Lakers.