REGENERATIVE / STEM CELL THERAPY
Regenerative cell therapy (commonly described as “Stem Cell” therapy) involves the application or injection of fluid (or tissue) into a site of bodily damage or degeneration to promote healing and repair. These treatments aim to enhance the biological aspects of healing through the recruitment of one’s own cells, as well as potential delivery of cells that can develop into a variety of tissue (mesenchymal stem cells (MSCs)). There are a variety of injections available to treat an even larger variety of pathologic conditions. Those most commonly used in orthopedic applications include Platelet Rich Plasma (PRP), Bone-marrow derived MSCs, Adipose-derived MSCs, and placental/umbilical cord allograft tissue.
PLATELET RICH PLASMA (PRP)
Platelets play an important role in wound and tissue healing. Injected platelets into abnormal or damaged tissue can release growth factors that recruit and increase activity of regenerative cells.
Platelet rich plasma (PRP) is a concentrate of platelet rich plasma protein in which the whole blood is placed through a centrifuge removing the red blood cells. What remains is a factor rich plasma concentrate, containing growth factors, including cytokines (proteins that affect communication among cells), that can stimulate cell differentiation and promote tissue healing and repair.
PRP can be injected in a variety of conditions involving the musculoskeletal system. It can be injected into tendons to treat chronic inflammatory conditions (like Achilles or patella tendonitis), or into an arthritic joint, such as the knee. Most injections can be performed in an office setting or outpatient center.
What is involved with PRP?
Blood is drawn from a patient’s own body and spun down in a centrifuge (which spins the blood at a high rate of speed) to separate out the blood products. After this is harvested, it is simply injected into the affected area under aseptic (sterile) technique.
Are there any side effects?
Since the fluid injected is from a patient’s own body fluid, there is no risk of disease transmission or tissue rejection. There can be discomfort from the injection itself, and typical risks of any injection such as infection, swelling, pain, nerve/vessel damage.
How long does it take to feel benefit from the injection?
This can vary depending on the condition and body part injected. Usually, most patients notice improvement around 4-6 weeks.
Are there any precautions before or after an injection?
Typically, it is recommended to avoid nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, within a week of the injection. Restriction of some activities for approximately 1-2 weeks may be advised.
MESENCHYMAL STEM CELLS
Bone-marrow derived MSCs
These are the most commonly used “stem cell” source for a variety of applications. Marrow grafts have been used for aiding in the healing of bone injury for decades, and bone-marrow derived MSCs have been shown to develop into musculoskeletal cells such as bone, cartilage, tendon and ligaments. These cells are readily available as a source, but harvesting does typically involve aspiration from bone, which can be painful. There are potentially other complications from the harvesting process.
Adipose-derived MSCs are harvested through a minimally invasive procedure called “lipoaspiration”, in which a small cut in the skin provides access to subcutaneous adipose tissue (i.e., fat). A series of instruments are then used to obtain aspirate of this proliferative fat, which is a readily available source of mesenchymal stem cells. This procedure is well tolerated and can be performed in either an office or outpatient environment. These cells can be injected into a site of tissue damage and/or degeneration (such as partial tears, tendonitis, or arthritic conditions) to facilitate a healing environment.
Umbilical cord/ Placental MSCs
Another source of mesenchymal cells is umbilical cord tissue (allogeneic). These cells are harvested from umbilical cord tissue (or placental tissue) after delivery. No fetus or persons are harmed in this procedure. Donors are screened and consented for the cells, which are obtained and maintained generally by a third party. Although no procedure is required for the receiving patient, there is a theoretical risk of disease transmission or tissue reaction.
The NSAID restriction of MSC procedures is generally the same as with PRP (within a week of the procedure and even subsequent weeks after) and advised restriction of some activities. It is also advisable to discontinue blood thinners prior to the Bone-marrow derived and Adipose-derived MSC procedures if able medically. Timing of clinical improvement can vary, but generally within the first 6-8 weeks depending on the condition.
There are many options for treating a variety of degenerative and damaged tissues in the human body. Although there is great optimism and excitement for these procedures, more studies should and are being done to learn the optimal use, as well as evaluate the long-term effects of these treatments. Many of these treatments are not yet FDA-approved, and the agency has released its guidelines for “minimal manipulation and homologous use.” The adipose cell therapy, “Lipogems”, has recently obtained FDA approval, however. Most insurers are not covering these procedures at this time, so there is also out-of-pocket cost for patients.
For more information, please contact our clinic or schedule an appointment with one of our experienced physicians.