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November 18, 2019 - TCO

Q&A: Regenerative Medicine

Some of the world’s most well-known athletes have turned to regenerative medicine to relieve pain and heal from injuries faster, but this option is not just for the pros.

Whether it’s PRP (platelet-rich plasma) injections or BMAC (bone marrow aspirate concentrate) injections, regenerative medicine uses the body’s natural cells and mechanics to heal damaged or painful muscles, tissues, ligaments, and in some cases, bones.

If chronic pain or recurring injuries are impacting your life, regenerative medicine can be an effective solution, and it’s becoming an increasingly popular alternative to surgery.

At Twin Cities Orthopedics, we are passionate about innovation and research. Some of our physicians are currently using regenerative medicine to improve our patients’ quality of life, and they are collecting data to enhance research in this area.

We sat down with our own Brad Moser, MD, to answer some of the big questions surrounding regenerative medicine.

ABOUT PRP

Q: What is a PRP injection?

A: A patient’s blood is drawn and placed in a special centrifuge (a machine with a rapidly rotating container), where the blood is spun down. The platelets are then separated from the red blood cells and concentrated. The red blood cells are discarded, and the resulting platelet-rich plasma is injected back into the patient’s affected area under ultrasound guidance.

Q: How does a PRP injection work?

A: Human platelets are naturally rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments and tendons stimulates a natural repair process. In other words, PRP recreates and stimulates the body’s natural healing process.

Q: Who is a typical PRP patient?

A: Someone who has tried physical therapy, and still isn’t getting back to what they want to do because of a tendon issue. Some patients do really well with physical therapy, and they don’t need PRP, but this is another tool in our shed. We tell patients not to expect miracles, but it’s a way to augment what they’ve already been doing. The more active and the more motivated the patient is, the more success they’re going to have.

Q: Is PRP age dependent?

A: No. We’ve seen active 75-year-olds who are like, ‘Hey, I’ve had some surgeries done on my knee, and I still have some chronic tendon pain (tendonosis).’ This procedure can help improve pain and get a patient back to their normal activity.

Q: Have you done PRP on high school athletes?

A: Yes. There’s a huge handful of kids recruited for college-level sports, who despite only being 18, have been quite active for a long time. We see quite a few of those kids. If physical therapy hasn’t worked, this could be the right option for them.

Q: How long does the overall PRP procedure last?

A: Patients are usually here for 30 minutes.

Q: Does PRP hurt?

A: Typically, no. We do numb up the area beforehand, and the procedure is done under ultra-sound guidance. There might be some slight pain post-procedure, but people usually do great.

Q: How often are PRP injections given?

One injection is typically enough. Over all the years I’ve been doing this, rarely have I ever done more than two injections on one area of a patient.

Q: How long after the PRP injection before you start seeing an improvement?

A: By about three weeks, the patient should start seeing a difference. By six weeks at the follow-up, they’re even better. Then by 12 weeks, they’re even better yet.

Q: Is PRP a permanent solution?

A:  For a healthy, active and motivated patient the answer is typically yes. Many patients experience permanent relief of their pain.

Q: Is PRP safe?

A: Any time a needle is placed anywhere in the body, even getting blood drawn, there is a risk of infection, bleeding, and tendon and nerve damage. However, these are rare. Other complications, though rare, can occur depending on the area being treated and will be discussed by your physician before starting treatment.

PRP is a common treatment for the following injuries and conditions:

    • Lateral and medial epicondylosis of the elbow
    • Hamstring tendinosis
    • Gluteus medius/minimus tendinosis
    • Patellar tendinosis
    • Achilles tendinosis
    • Plantar fasciosis
    • Osteoarthritis

ABOUT BMAC

Q: What exactly is a BMAC procedure?

A: BMAC injections are used to treat osteoarthritis. The FDA approved it for the knee in 2018, and our TCO program launched in April 2018. Bone marrow is taken from the back of the pelvis using a large needle with a syringe attached. The bone marrow is then processed to separate its various components.

The plasma (fluid portion) contains many proteins that are very beneficial to the process. This fluid is filtered and condensed into what is called a general fluid concentrate (GFC). Once processed, the BMAC and GFC are separately injected into the patient’s affected area.

Q: Who is a typical patient for a BMAC injection?

A: Typically, the best candidates are active people who want to maintain their lifestyle and meet certain radiograph and exam criteria. These are patients who may have had knee procedures when they were younger, and now show signs of early arthritis at an earlier age than they would typically. Knee replacement is usually not recommended at younger ages, so this is another tool in our shed to help patients reduce pain symptoms and improve their quality of life prior to knee replacement down the road.

Because healthy bone marrow is required for BMAC to be effective, there are a number of medical conditions that prevent patients from having BMAC, including but not limited to:

  • Chronic Lymphocytic Leukemia
  • Hodgkin’s and Non-Hodgkin’s Lymphoma
  • Hairy Cell Leukemia
  • Myeloproliferative Disorders (CML, Polycythemia Vera, etc.)
  • Myelodysplastic Syndromes (Anemia, Thrombocytopenia, Neutropenia)
  • Multiple Myeloma
  • Cytopenia, Thrombocytosis, Leukocytosis, Chronic Anemia of unknown cause
  • Fungal Infections, TB and other Granulomatosis
  • Previous radiation therapy to the pelvis
  • Active Cancers

Q: Can BMAC injections be for younger patients, too?

A: Yes. We have done procedures on avascular necrosis (death of bone tissue due to a lack of blood supply) to the femoral head (the highest part of the thigh bone) in 20-somethings. Here’s an example: we had a patient who had testicular cancer at 25 years of age. Chemotherapy and radiation caused the bone cartilage to lose blood supply in his femoral head. This patient’s hips usually would not be replaced at 25 years old, so in addition to doing an arthroscopy on this patient, we injected this patient’s own bone marrow aspirate into the affected area. This procedure assists surgery to help stimulate growth in that damaged area, and I believe it’s something we’ll see more studies of in the future.

Q: Do you suggest patients seek other options first before BMAC?

A: Yes, it’s the same as PRP. Whether it’s physical therapy, bracing, or Cortisone if you want, this treatment is for a patient who has exhausted their options and is still in pain. This procedure is a pain reducer, but it’s not going to replace your cartilage.

Q: Will a patient need to come back for another BMAC injection?

A: We’ll see. We like to monitor patients closely and suggest they come back to the clinic regularly. We bring patients back to clinic on intervals of six weeks, 12 weeks, six months, 12 months, 24 months, and 36 months. We also have the patients fill out the appropriate validated research forms to monitor their progress. The benefit to regular check-ins is that patients report how they are doing symptomatically, and we can track their progress over time.

Q: Is BMAC a painful procedure?

A: No. I use anesthetic on the area, and I do prescribe one pain medication for the day of the procedure.

Q: How long after the BMAC injection before you start seeing an improvement?

A: It’s the same as PRP, about three weeks. At about six weeks, most patients notice their symptoms have changed quite a bit. At 12 weeks, it seems like their symptoms have decreased even more.

MORE ABOUT REGENERATIVE MEDICINE

Q: Why is important to choose the right types of patients for these procedures?

A: We want to maintain TCO’s reputation for doing the right thing for the patient. You can’t just do these procedures for anybody who walks in. If it’s not the best decision for the patient, then it’s not going to bode well for our reputation. I’ve definitely told patients over the years, “You’re not a candidate. I’m not doing this on you.” If you’re healthy, motivated, have exhausted your other options first and meet the established criteria, then regenerative medicine could be an option for you.

Q: Are these procedures covered by insurance?

A: No, most insurance plans in the state of Minnesota do not cover these procedures. For PRP, a charge of $900 is required for the treatment at the time of the appointment. For BMAC, the fee for the procedure is $4,000 and is required at the time of service.

To learn more, we encourage you to visit our regenerative medicine page.