Regenerative Medicine

What are Stem Cells?

Stem cells are found in various tissues throughout the body, such as bone marrow and fat. They are capable of renewing themselves through cell division. Mesenchymal stem cells (MSC) are pluripotent, meaning they have the ability to differentiate into many types of tissues. This ability has generated promise of potential treatment for chronic injury, specifically for cartilage cells (chondrocytes).

Where are the Stem Cells obtained from?

Bone marrow aspirate concentrate (BMAC) is the safest and most feasible source of MSC. It can be extracted from various sites, most typically from the posterior superior iliac crest. This can be done with minimal pain in the office under only local anesthesia. Once collected, it is concentrated through centrifugation, similar to platelet-rich plasma (PRP), and injected back into the injured area.

Will Stem Cells restore my arthritic joint?

There are studies for arthritic disease reporting improvements in pain and function, but few controlled trials. Like PRP, stem cell therapy has proven to be safe and well-tolerated (without serious side effects) in multiple studies, including patient-blinded, placebo-controlled trials. FDA draft guidance advises that same day concentration of BMAC without additives is safe.  Currently there is no evidence that Stem Cell therapy using any of the available methods regenerates cartilage or cures arthritis, however studies do demonstrate improvement in pain for at least a year in a large percentage of patients.

Is Stem Cell therapy for joint pain safe?

This treatment is considered investigational, as the efficacy and mechanism of action are still to be completely understood. As of now, the Federal Drug Administration (FDA) has not yet deemed it effective and thus, it is not covered by standard health insurances. This is a treatment option for those who have failed all other conservative first-line treatments and/or are not ideal surgical candidates. While the hope is that these may stimulate regeneration of cartilage in arthritic joints, this is unproven but early studies do demonstrate a reduction of pain in degenerative joints for up to one year.

Dr. Moore is highly experienced in Stem Cell therapy and committed to appropriate and safe use of this promising treatment.

What is PRP?

Platelet-rich plasma (PRP) is a preparation of autologous (your own) human plasma with increased platelet concentration formed by centrifuging a large volume of a patient’s own blood. It is a helpful form of treatment for injured or degenerative ligaments, tendons and muscles.

How does this help healing?

Platelets contain many growth factors which can be concentrated during the centrifugation to a number greater than what is typically found in our body. Normal platelet counts range from 150,000 to 350,000/uL. Suspected improvements in healing occur with up to 3-5 fold increase in concentration, ranging up to 1,000,000/uL. By obtaining concentrated amounts of your naturally occurring growth factors, we are able to enhance your body’s healing potential in injured joints and tendons.

How is PRP therapy done?

In general, whole blood is collected and then mixed with an anti-clotting agent prior to centrifugation, separating the red cells from platelet poor plasma and the “buffy coat”, which contains concentrated platelets and leukocytes. This concentrated plasma is then injected back into the injured area.

This is an office procedure and requires about 30-45 minutes.  NSAID’s (Motrin, Advil, Aleve, Ibuprofen) are not allowed for up to 3 months after this procedure as they directly counteract the platelet activity.  Ice and Tylenol are recommended for post-procedure pain.  As this procedure is encouraging a healing response from your body, the relief is not instant; depending on the specific injury, there is a period of weeks or months required for full healing and frequently some physical therapy is needed.  However, it is thought that PRP-enhanced healing will occur more quickly than unenhanced recovery.

Is PRP safe?

There are multiple studies proving its safety and low side effect profile. Unfortunately, there are many different preparations and systems, so variation exists in protocol and preparation; platelet capture efficiency, isolation method, speed of centrifugation, type of collection tube system and operation. These variations create challenges in interpreting literature regarding clinical efficacy and, as such, the FDA has not yet certified its utility.

Can PRP cure my arthritis?

Recently, PRP has become more prevalent for osteoarthritis (hip and knee primarily). Leuckocyte-poor PRP (fewer neutrophils) is injected into the arthritic joint. Excellent studies have shown reduced pain and function for up to 12 months in knee osteoarthritis; but long-term studies are still needed to ascertain how long this lasts and whether any change in the progression of arthritis occurs. The benefits have only been demonstrated in mild to moderate osteoarthritis. 

What else is PRP used for?

PRP is occasionally used to augment surgical repair; rotator cuff repair, decreasing donor site pain with ACL reconstruction, etc. There is some movement towards using it for ankle sprain, muscle injury, and fracture non-union, but significant benefits have yet to be proven.

Dr. Moore is highly experienced in the appropriate and safe use of PRP in a variety of injuries and conditions and combines ultrasound guidance with PRP therapy to optimize its success.