Regenerative Medicine – Evidence Based Treatment and Application

The recent 10 years have seen an explosion in use of regenerative medicine techniques in orthopaedics. The industry is largely a cash phenomenon as insurance companies and Medicare regard most of the treatments as experimental. There is conflicting data on the effectiveness of treatments and aggressive direct to consumer marketing often overstates the scientific support for procedures. This document is meant to be a primer for patients considering regenerative medicine techniques with an emphasis on applying the best available clinical data to optimize the chance that your financial investment provides the benefits you are looking for.

Platelet Rich Plasma (PRP)

Using your own blood, the potion of the serum containing platelets and serum growth factors is processed to deliver either an inflammation producing (full fraction) or anti-inflammatory (leukocyte reduced) response from the body. There is good evidence that full fraction PRP is superior to steroid (cortisone) injections for chronic tendinopathy especially in the elbow, knee and ankle. There is high quality evidence particularly in the knee that leukocyte reduced PRP is superior to steroid injection in the treatment of mild to moderate knee arthritis.

Stem Cell injections

There are multiple types of stem cell procedures involving using your own cells. In general as we age the potency of these stem cells decreases. Adipose (fat) derived stem cells are the most common procedure being touted for the treatment of arthritis. These procedures are very expensive and have little evidence to suggest superiority to placebo. I cannot currently recommend this type of injection.

Another type of injection Bone Marrow Aspirate Concentrate (BMAC) has emerging evidence to support increase rates of healing in surgeries trying to get bones to heal or grow together (fracture and fusions). When studied in the knee BMAC injections are not better than PRP injections despite being far more expensive.

There are stem cell injections that use cell from donated tissue (usually placental or umbilical tissue). There is good evidence that these preparations can help problem wounds to heal, but little data on efficacy for the treatment of arthritis. I can recommend these injections for people who want to try something more cutting edge at a lower price point that the oth cell stem cell procedures.

Prolotherapy

Prolotherapy involves injection of high concentrations of dextrose into tissue to try to incite a healing response. There is little efficacy data and I cannot recommend this type of injection.

  •  The American Board of Orthopaedic Surgery
  • Philadelphia University and Thomas Jefferson University - Home of Sidney Kimmel Medical College
  • The Naval Medical Center
  • University of Miami Hospital

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