Regenerative Medicine

Orthobiologics – or Regenerative Medicine – is an emerging field of orthopaedic medicine, which uses cellular biology to improve treatment outcomes. Gulf Orthopaedics is a leader in what’s quickly becoming the gold standard in non-surgical solutions for sports injuries when rest and physical therapy aren’t enough.

There are two types of regenerative medicine:  platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC).  In both cases, the body’s own healing properties help to increase function and reduce pain associated with arthritis, damaged cartilage, tendon, and ligament issues. PRP contains hundreds of proteins called growth factors that are very important in the healing of injuries. It uses the patient’s blood to trigger the body to begin healing the injured area.  The body’s natural response to an injury is to release platelets and white blood cells from the blood to begin healing. With modern technology, physicians can concentrate this process and inject the PRP directly into the injured tissue.

BMAC is like PRP in that physicians are utilizing the body’s own healing properties to enhance the process. BMAC uses bone marrow from the hip regions which contains pluripotent cells that increase the regenerative process even more effectively than PRP. Experts are still determining how BMAC specifically works within the body. However, experts do believe that BMAC decreases inflammation and improves long term function.

What Conditions Can Be Treated with PRP and BMC?

  • Knee Pain – tendon injuries, muscle injuries, ligament sprains or tears, bursitis, osteoarthritis
  • Hip Pain – muscle pain or injury, piriformis syndrome, bursitis, tendon injuries, sacroiliac joint pain, hamstring tendonitis or tears, osteoarthritis
  • Shoulder and Arm Pain – rotator cuff tendonitis, tendinopathy or partial tears, bicipital tendonitis, golfers, and tennis elbow (medial and lateral epicondylitis), ulnar collateral ligament sprain or tear

What is Platelet -Rich Plasma (PRP)?

Platelet-Rich Plasma (PRP)

Platelet-rich plasma or PRP is an “autologous blood therapy” that uses a patient’s own blood components to stimulate a healing response in damaged tissues. In response to an injury or tissue damage, your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Modern technology allows us to concentrate platelets and white blood cells from your blood and induce this growth factor release as we inject the solution directly into injured tissue, simulating this same healing response in a more powerful form. By enhancing the body’s natural healing capacity, the treatment may lead to a more rapid, more efficient, and more thorough restoration of the tissue to a healthy state as well as reduce pain.

What is Bone Marrow Concentrate (BMC)?

Bone Marrow Concentrate (BMC)

By harvesting blood and tissue from the bone marrow space of the hip, an injectable product can be produced by concentrating platelets and cells withdrawn through a simple outpatient needle aspiration procedure, done with local anesthetic and light sedation. BMAC contains all the growth and healing factors in PRP, along with concentrated “pluripotent” or stem-like cells which further contribute to the regenerative process.

Your First Step in Regenerative Medicine Therapy

Your First Step in Regenerative Medicine Therapy:  Make an appointment with Gulf Orthopaedics today to find out if Regenerative Medicine Therapy (BMCC or PRP) might be helpful in healing your injury. For your first appointment, please bring:

  • X-rays and previous surgical information
  • Driver’s License or valid ID
  • List of medications
  • Insurance information
  • Any other relevant information

Treatment Plan

Depending on the severity and duration of your injury, one to three injections are suggested. Following the initial treatment with PRP or BMAC, a follow up visit occurs 3-4 weeks later. At this visit an evaluation of your response to the initial therapy is performed. A subsequent visit at 6-8 weeks post procedure will then help determine the need for additional PRP treatments. In general, chronic injuries often require more than one injection. In both acute and chronic injuries, injections will be combined with an exercise or physical therapy program to enhance the success of the treatment.

Treatment Process

Following a formal evaluation and diagnostic workup, an individualized treatment plan will be discussed with you. A full explanation of the procedure including risks and benefits will be reviewed. Once written consent is obtained, blood is drawn from your arm or from a bone marrow aspiration in the back of your hip region, and placed in a special processing unit, which separates platelets, white blood cells and serum from red blood cells. The platelets and cells are then concentrated and collected into a sterile syringe. The skin and soft tissue is anesthetized with local anesthetic, followed by injection of the PRP/BMAC into the tissue targeted for treatment. Depending on the size of the injured tissue, one or several needles are inserted to optimize placement of the product.

To create platelet-rich plasma, physicians take blood from the patient and place it into a device called a centrifuge that rapidly spins the sample, separating out the other components of the blood from the platelets and concentrating them within the plasma. After creating platelet-rich plasma from a patient’s blood sample, that solution is injected into the target area. The procedure typically takes around 1 hour.

To create BMAC, the physician uses ultrasound as a guide to remove bone marrow aspirate (liquid) from a large bone (e.g., the pelvic bone). The liquid is used to make a concentrate that they inject into your damaged tissue that is intended to promote healing. The procedure takes about 1-2 hours.

Are PRP and BMC Injections Safe?

Research and clinical data show that PRP and BMAC injections are extremely safe, with minimal risk for any adverse reaction or complication. Because the injectable products are produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Of note, recent research suggests that PRP may have an anti-bacterial property which protects against possible infection. Most complications for PRP and BMAC are self-limited, with the symptoms including pain, swelling, skin rash or itching, and aspirate site problems. Most side effects generally resolve without any intervention. Knee joint pain and swelling were the most common adverse events.

What to Expect After Your Treatment

For the day of the procedure and the day after limit activity related to the injection site to activities of daily living. Depending on the injection site and procedure performed, you may be on crutches initially until pain is not increased with weight bearing. It is important that anti-inflammatory medications such as Ibuprofen, Naproxen, and Aspirin be avoided following PRP treatments. These medicines may block the effects of the intended healing response facilitated by the injection itself. It is acceptable to use over-the-counter pain medication, such as Tylenol and in some cases a prescribed analgesic, which does not have anti-inflammatory properties, to control discomfort as needed. Pain management options will be discussed with you by the physician managing your treatment plan. Return to higher levels of activity such as running, cycling, golf, weight training, etc. will be directed by your physician and physical therapist. It is expected that it will take up to 6 to 8 weeks to adequately assess your response to the therapy. For the best results, you start rehab 2 weeks after the injection. During the first 2 weeks, you transition from using crutches to increasing your physical therapy and exercise program.  

Additional References

See Additional Resources for further study from the American Journal of Sports Medicine and more.

Finnoff, J. T., Awan, T. M., Borg-Stein, J., Harmon, K. G., Herman, D. C., Malanga, G. A., Master, Z., Mautner, K., & Shapiro, S. A. (2021). American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clinical Journal of Sport Medicine, 31(6), 530–541.

Our Regenerative Medicine Specialist

Travis Bowden, DO

Travis Bowen, DO
Board Certified in Non-Operative Sports Medicine
Regenerative Medicine Specialist

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