Regenerative Medicine Procedures

Regenerative medicine is the process of creating living functional tissue to repair damaged and injured parts of the body. Because regenerative medicine uses a person’s own cells to generate the new tissue, the healing process is natural and may allow the individual to avoid surgery.

Regenerative medicine is also referred to as biologic medicine because biologics use the body’s own blood, or progenitor cells, to stimulate healing. An injection of Platelet Rich Plasma (PRP) calls progenitor cells to the damaged area. These cells then turn into the type of cell needed for healing.

Procedures

How biologics are used

Blood is made up of red blood cells, white blood cells, plasma and platelets. An average platelet count is generally between 150,000 and 450,000 platelets per cubic centimeter. This amount is known as a baseline concentration. The platelets release a multitude of growth factors, which call other cells to the area to initiate the healing cascade. One of the types of cells called to the area is a progenitor cell, which is pleuripotent, meaning that it can differentiate into other cell types, such as tendon, muscle, cartilage, bone and nerve cells. When more of a progenitor cell load is required, the progenitor cells are directly added to the PRP via fat (adipose) and/or bone marrow, which is obtained directly from you, making this an autologous treatment. The obtained progenitor cells can become any of the types of cells in this mesenchymal cell line, which includes: muscle, tendon, cartilage, bone, ligament, intervertebral disc and nerve cells. Often, we use an Autologous Regenerative Matrix (ARM©) consisting of a combination of these biologics to take full advantage of the different healing properties of each biologic. These tissues are processed on-site and re-implanted on the same day. Typically, you are in the office for 1-2 hours. Our cutting-edge technology in regenerative medicine fills the need for a successful treatment option in patients who have failed more traditional therapies.

What is PRP

PRP stands for Platelet Rich Plasma. “Let’s say you cut your arm. Platelets are released, white blood cells are released, red blood cells are released, because the vein has been opened up. Platelets help stop the bleeding. For a long time that’s all we thought they did. Now we know that platelets release many growth factors that call other cells to the site to help the healing. Some of these types of cells are progenitor cells. Those cells help create whatever is needed, whether it’s veins, arteries, bone, skin muscle, tendon, cartilage etc. It’s all pre-programmed to do that. This is actually an inflammatory reaction that is a healing response. When we
give anti-inflammatories, we actually interfere with the healing process. Inflammation is the process through which the healing begins. So when we take PRP and inject it into an injury site, the inflammatory response starts the healing.” – Dr. Joseph Albano

Advantages of Biologics

Advantages of Biologics

i. All Natural

  • Because these biologics are coming from your own body and are injected back into you, the procedure is termed autologous – what comes out of you, goes back into you.
  • ii. Safe

  • Numerous studies shown that complications are minimal. These are safe enough to do in an outpatient setting. PRP involves simply drawing blood and spinning it down. The fat autograft and bone marrow aspirate are more involved, but are still done in the office on the same day.
  • iii. Shorter Recovery

  • Recovery time is shorter than with surgery. Typically, there is increased pain for a few days, which diminishes over 10-14 days. Most conditions have a better recovery if motion is started early. So, with many conditions, motion is started the following day.
  • iv. No Scarring

  • There is no scar formed with these biologics. New healthy tissue is formed.
  • v. Cost Effective

  • Compared to surgery, it is much less expensive.
  • vi. Surgery Is Still An Option

  • If the injury is not fully healed with the use of biologics, surgery is still a viable option. In addition, tendon surgeries may have a better result because the tendon was strengthened with the biologics. If surgery is done, the use of biologics is still an option after surgery, but may be less successful.
  • vii. Short Procedure Time

  • The procedure is completed all in the same day in the office, usually within 1-2 hours. There is no wait for cultured growth of cells.
  • viii. Progenitor Cells

  • Fat Grafts and Bone Marrow contain mesenchymal progenitor cells, which can turn into the type of cell needed for healing. Platelets release growth factors which call these progenitor cells to the area.
  • ix. It works!

  • There are many laboratory and animal studies showing that these biologics work. Human trials have just begun to come out. Over the years, we have had the pleasure of helping many people decrease or resolve their pain, increase function and, most importantly, get them back to the activities that they enjoy!
  • https://www.youtube.com/watch?v=cI6hSxD5fWE
  • https://www.youtube.com/watch?v=adWZx-49SIY
  • https://www.youtube.com/watch?v=OUAMlR3_vOs
  • Disadvantages of Biologics

    Insurance companies typically deny coverage for regenerative medicine procedures.

    Injuries that Biologics can help with

    i. Tendon Injuries- include tendinosis, partial thickness tears, and full thickness tears that are not significantly retracted.

    ii. Muscle Injuries – Chronic muscle fibrosis (scarring) and acute muscular tears or strains.

    iii. Ligament Injuries – Include chronic and acute sprains.

    iv. Cartilage Conditions

    v. Nerve Injuries – Include mild to moderate compression neuropathies.

    Diagnostic Ultrasound

    Most people are familiar with the use of ultrasound in the obstetrics field to image babies in pregnant women. It can also be used to image superficial musculoskeletal structures. With the advent of improved portable ultrasound machines, this technology has become available for use outside of the hospital setting and in the sports medicine office.

    Common uses of Diagnostic Ultrasound

    i. Musculoskeletal Ultrasound may be used to help diagnose problems with:

    1. Soft Tissue

    • Tendinopathy/partial tears
    • Tennis elbow, Achilles tendinosis, plantar fasciosis, patellar tendinosis, rotator cuff tendinosis and partial to full thickness tears

    2. Muscle Ligaments

    • Chronic strains/sprain, muscle fibrosis (scar)
    • Acute strain/sprain
    • Cysts (such as a Baker’s Cyst behind the knee), bleeding or other fluid collections within the muscles, bursae or joints

    3. Bone

    • Stress fractures, medial tibial stress syndrome (shin splints)
    • Joints
    • Cartilage problems: meniscal tears

    4. Nerves

    • Compression neuropathies, such as carpal tunnel syndrome (wrist) and cubital tunnel syndrome (elbow)

    5. Tendons

    • Tendinosis, as in tennis elbow, patellar tendiand tears, such as in the rotator cuff in the shoulder or Achilles tendon in the ankle

    6. Cysts, bleeding or other fluid collections within the muscles, bursae and joints

    7. Early changes of rheumatoid arthritis

    Benefits of Diagnostic Ultrasound
    • It is noninvasive and painless
    • There is no use of ionizing radiation, which is used in X-rays and CT scans, and is potentially harmful if done repeatedly
    • It is dynamic with images captured in real-time showing the motion of tendons, muscles and joints
    • It is much less expensive than other imaging methods, such as MRI or CT
    • It shows soft tissues very well, whereas X-rays do not
      vi. It is the choice imaging modality for patients with cardiac pacemakers, who cannot get an MRI
    • It is an excellent alternative to MRI for claustrophobic patients
    • Ultrasound may have advantages over MRI in seeing tendon structure, which is better appreciated by ultrasound than MRI
    • Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as aspiration (withdrawing fluid) and injection
    Risk of Diagnostic Ultrasound

    There are no known harmful effects on humans

    Limitations of Diagnostic Ultrasound
    • It is unable to see deep tissue structures very well, especially in obese individuals (MRI would be a better choice)
    • It is unable to “see through” bone. (MRI would be better to image structures deep to bone)
    • It is very operator-dependent, which means it requires much skill and practice to become good at the evaluations and interpretations

    PRP stands for Platelet Rich Plasma.

    “Let’s say you cut your arm. Platelets are released, white blood cells are released, red blood cells are released, because the vein has been opened up. Platelets help stop the bleeding. For a long time that’s all we thought they did. Now we know that platelets release many growth factors that call other cells to the site to help the healing.

    Some of these types of cells are progenitor cells. Those cells help create whatever is needed, whether it’s veins, arteries, bone, skin muscle, tendon, cartilage etc. It’s all pre-programmed to do that. This is actually an inflammatory reaction that is a healing response. When we give anti-inflammatories, we actually interfere with the healing process. Inflammation is the process through which the healing begins. So when we take PRP and inject it into an injury site, the inflammatory response starts the healing.” – Dr. Joseph Albano

    Steroid Injections

    Short-term relief is possible through steroid injections. However, additional articular cartilage damage will occur with each injection.

    Viscosupplement Injection

    Viscosupplement Injections, also referred to as “Rooster Comb” shots, are another option for osteoarthritis treatment. Supartz, Orthovisc, Hyalgan, Euflexxa and Synvisc are examples of these medications. These hyaluronic acids are a viscous substance that mimics the normal synovial, or joint fluid. They feel like motor oil.

    Pros

    • Most patients will experience short-term relief for up to 6-12 months, with more prolonged relief compared to steroids
    • No articular cartilage damage occurs
    • The knee joint is generally covered by insurance
    • If this treatment is unsuccessful, other options are still available

    Cons

    • Articular cartilage regeneration is not possible
    • Insurance generally does not cover joints other than the knee
    • A series of up to 3-5 injections is required

    If osteoarthritis causes you pain or keeps you from fully enjoying daily activities you normally love, call Comprehensive Orthopedics and Sports Medicine right away for an appointment and consultation with Dr. Albano. Dr. Albano’s wide range and length of experience can get you back to doing what you love, sooner.

    Biologic Injections

    Platelet Rich Plasma (PRP)
    Pros

    • Articular cartilage may regenerate
    • Platelet Rich Plasma is completely natural
    • Shorter recovery time than surgery
    • Typically combined with fat and/or bone marrow to further enhance the regenerative effects
    • If unsuccessful, other options are still available

    Cons

    • Typically not covered by insurance
    • Usually requires a series of three injections

    Structural Autologous Fat Graft

    This procedure is done using your own fat. The fat is mixed with PRP and/or Bone Marrow and acts as a matrix (scaffold or “spackling”) to which other injected cells attach. A multitude of progenitor cells are in the fat. These cells have a tremendous potential to regenerate the body’s articular cartilage.

    Pros

    • Long-term relief may be possible
    • Articular cartilage may regenerate
    • Autologous fat is completely natural
    • Shorter recovery time than surgery
    • Many progenitor cells are in the fat. These cells have a tremendous regenerative potential and may be able to regenerate the articular cartilage
    • If unsuccessful, other options are still available

    Cons

    • Typically not covered by insurance
    • Usually requires a series of three injections

    If osteoarthritis causes you pain or keeps you from fully enjoying daily activities you normally love, call Salt Comprehensive Orthopedics and Sports Medicine right away for an appointment and consultation with Dr. Albano. Dr. Albano’s wide range and length of experience can get you back to doing what you love, sooner.

    Autologous Bone Marrow Concentrate

    This procedure uses your own bone marrow and has similar pros and cons as to that of the Structural Autologous Fat Graft, although it is more invasive. Your bone marrow and/or PRP may be combined with fat to further enhance the regenerative effects.

    Surgery

    Surgical options may include joint resurfacing, total or partial joint replacement. When undergoing surgery, pain is often relieved. However, recovery time is prolonged, usually lasting a few months. In addition, younger patients may need further replacements as the prosthetics wear out. If, for whatever reason, the surgery is unsuccessful, other options are no longer possible.

    • Foot and Ankle
    • Hip
    • Knee and Shoulder
    • Wrist

    Platelet Rich Plasma (PRP)
    What is PRP? Platelet Rich Plasma is a form of regenerative medicine which uses blood with high levels of platelets that contain growth factors. It is used to heal injuries by regenerating tissues such as bone, ligament, muscle, tendon, cartilage, or other elements. PRP is sometimes implemented as an alternative to knee replacement or an alternative to hip replacement. Platelet Rich Plasma is rapidly becoming a more popular cutting edge therapy.

    Amniotic Tissue/Fluid

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    Placental Tissue

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