The doctor who helped get All Black Owen Franks back on the field in time for the Rugby World Cup through stem cell treatment was initially sceptical about the science.
Dr Hassan Mubark had been treating a 72-year-old woman for osteoarthritis of the knee when he decided to try the technique which is proving successful internationally.
Following the treatment the woman no longer needed medication because her pain was gone and she could walk unaided.
"I didn't believe it and then I did the X-ray ... and there were signs of healing."
That was two years ago and a turning point for Mubark, whose interest in musculoskeletal and sport medicine drew him to pure expanded stem cell treatment.
Franks, who tore his right shoulder while playing for the Crusaders in April, said he decided on the treatment to keep his chances of making the Rugby World Cup alive. The tournament in Japan starts next month.
Without the treatment he was faced with shoulder surgery and a six-month rehabilitation.
Mubark said with Franks' training requiring him to lift 250kg he needed to maintain his muscle power, which through a long recovery could be lost.
"Owen, he did so well."
The treatment involves 50 grams of fat being removed from the patient via liposuction. In Franks' case, it was taken from his abdominal fat.
It is dissolved, stem cells are removed and sent to the Queenstown-based regenerative medicine company ReGen Cellular where they expand over eight weeks. They are then injected back into the injured area.
Mubark, who carries out the procedure in Auckland's St Heliers, said overall ReGen haD about an 80 per cent success rate. Knees were the most successful, followed by shoulders and then hips. Hands had about a 60 per cent success rate.
For $12,500 a patient can have a shoulder injected with their own stem cells or $15,000 for both shoulders.
Franks, 31, who has won 105 caps for the All Blacks, bounced back after his treatment. He has played two tests this winter and is certain to be in the World Cup squad.
The treatment was developed in co-operation with colleagues at Monash and Melbourne universities. Australia's Melbourne Stem Cell Centre conducted trials with expanded stem cells in 2014 to 2016. Several of the participants had documented cartilage regrowth in a knee joint in one of the first trials in the world to show cartilage regrowth in a human trial.
Mubark, who runs three rheumatology and pain management clinics in Auckland, looks for an 80 to 100 per cent recovery in his patients. In one 82-year-old patient, Mubark treated her hip unsuccessfully, but went on to treat the woman's knee which had a 100 per cent recovery.
Mubark said seeing athletes like Franks, and woodchopping world champion Jason Wynyard — who had the treatment on his hip — get back to their sport was rewarding. But his main motivation was to free people of painful and debilitating conditions.
"I don't like people limping. I don't like metals [inserts]. I just like getting the smile back to people. That's why I got involved with this. When people text me and say: 'Thank you, you got me back to life', this is what makes me happy."
So far ACC has only paid for consultations, not the treatment, Mubark said, and it has been covered by insurance in a few cases. The three areas of health where the treatment is offered are sports injuries, degeneration or "wear and tear", and autoimmune diseases such as rheumatoid arthritis, lupus, scleroderma and even type 1 diabetes.
The aim was to save New Zealanders' money, time and stress when they travel to countries around the world for stem cell treatment.
Mubark said pregnant women and patients with cancer were not given the treatment because it would be a risk.
Medical Council of New Zealand chairman Dr Curtis Walker said the council was careful to make sure the treatment doctors were providing was evidenced-based.
How the treatment works
• 50 grams of fat is removed from the patient via liposuction;
• The fat is dissolved and the stem cells are removed and expand over eight weeks;
• When the cells have expanded to upward of 100 million they are injected into the injured area;
• The process produces more stem cells than required, allowing clients to store them for later use;
• The cells can be cryogenically frozen for 15 years and used to help repair damaged joints in the future.