Regenerative medicine: orthobiologic therapy

Our specialists at OrthoVirginia use cutting-edge technology to help decrease pain and improve function. We use platelet-rich plasma (PRP) and other orthobiologic substances to treat osteoarthritic joints and injured tendons without surgery. We feel strongly that these treatments are investigational and need to be delivered with significant patient education and informed consent. With our research-based approach, we set patient expectations of effectiveness using evidence-based estimates from existing science and literature.

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Regenerative medicine, also called orthobiologic therapy, works to improve the healing of injured muscles, tendons and joints. The hope is that these treatments can offer relief at a level between a more minor cartilage repair procedure and full joint replacement.

Using the body’s healing powers

The body has a strong ability to heal itself. Two cell factors, MSCs and platelets, assist in tissue restoration and regeneration.

These cellular substances may:

  • Stimulate the body’s repair response via signaling and/or cell transformation.
  • Create an environment helpful to accelerated healing, such as reducing inflammation.

MSCs, previously known as Mesenchymal stem cells, and PRP (platelet-rich plasma) are considered biologic therapy. These substances are derived from the body and are injected into the injured or diseased area, such as an injured muscle, an inflamed tendon or an arthritic joint.

What is PRP and how does it work?

Platelet rich plasma, or PRP, comes from your blood. Platelets are cells in your blood that have a lot of growth factors and anti-inflammatory agents, both of which help your body to heal.

If your body is injured, platelets are naturally delivered to the injury. The platelets will then release the substances that they hold that help encourage tissue repair. Almost all tissue injuries heal using this process.

For PRP, a sample of your blood is taken. The sample is processed to concentrate the platelets together into the plasma (a layer of your blood), which is then injected into the part of your body that needs healing. The procedure is done in an office and takes 20-30 minutes. Talk with your physician about any activities that you shouldn’t do after the procedure.

What are MSCs and how do they work?

MSCs can turn into multiple types of cells and tissues. If you break a bone, for example, you will need more bone cells in order to heal the fracture. MSCs are sent by your body to the fracture and grow into new bone cells to repair the break. The same process occurs if you tear a muscle or have a cut in your skin. The description is simple, but the actual process within your body is incredibly complicated.

Mesenchymal stem cells are a specific type of cell in your body. They line blood vessels, and the type used for orthobiologic injection therapy can most easily be found in bone marrow, fat, and amniotic fluid. When injected into an injured or diseased joint or tissue, they don’t turn into other types of cells. Instead, they send out signals to the body to decrease inflammation, pain, and infection.

To receive MSC therapy, you will go to an office or to a procedure center.

Amniotic products are shipped frozen, thawed just before use, and are injected into the part of the body being treated.

Bone marrow products and adipose-derived (fat-derived) MSCs are taken from your body: bone marrow MSCs from the crest of your pelvic bone and adipose-derived MSCs from your belly or flank. In both cases the area is anesthetized (numbed) and a needle is placed to draw out the tissue.

The bone marrow or adipose tissue is processed to concentrate important cells and factors  which are then injected into the part of the body being treated.

Adipose, or fat tissue, gives the highest amount of cells for these purposes that we know of.


Q: Which are better: PRP or MSCs?
A: We don’t have this answer. Research has shown that both procedures are generally effective regarding accelerated tendon healing and joint pain control.

Q: How many injections are required?
A: Scientists are still studying this. Most MSC studies published used a single injection. Many PRP studies are use several injections separated by weeks or a month. Evidence has not shown for certain that multiple injections are better than a single injection yet.

Q: If I have MSCs injected into my arthritic knee, will it grow new cartilage?
A: Studies have shown that areas with cartilage damage may heal better when MSCs are injected. However, the effect of orthobiologic injections is thought to be more pain control than regrowing cartilage. In a knee with arthritis, orthobiologic therapy is a potential bridge between knee restoration and a total knee replacement. You can, however, achieve significant pain control for a period of time. If you have a bone-on-bone joint, where all of the cartilage has worn away, it is very unlikely that an injection with MSCs will give you a new layer of cartilage.

Q: How long will the injection last?
A: Studies have shown that the pain-controlling effects of some orthobiologic injections may last 1-2 years or longer. However, PRP studies mostly look at 6-12 month follow-up.

Q: How fast will the injection work?
A: While the cells go to work immediately, the effects can take 1-2 months before you notice results. The exact amount of time varies by patient and depends on the exact amount and type of damage being treated.

Q: Which MSC preparation is best: BMAC, adipose, or amniotic?
A: Scientists are still working to figure this out. For example, PRP has very effective growth factors, cytokines, and proteins, and few if any cells. Fat and bone marrow have more cells, but we’re not sure yet if more cells means it will work better.

Q: What does research show?
A: Orthobiologic products are a hot button concept in medicine today. Orthobiologics are regularly being used in orthopedics, although we do not fully understand their definition or efficacy. However, scientific studies show good pain relief for people with arthritis and some types of tendon problems, plus quicker healing of tendon injuries with PRP and some MSC products. It could be years before we have all the answers.

Q: Are orthobiologic injections covered by insurance? How much does it cost?
A: Currently most insurance policies do not cover orthobiologic injections since they are considered investigational. Speak to your physician’s office about the price, which varies depending on the product and procedure used. Ask your health savings account advisor to see if these injections qualify.

Q: How do I make an appointment?
A: First, you need to have a screening appointment to see if you’re a candidate for these orthobiologic injections. The screening appointment may involve x-rays and an MRI. The physician will then determine if orthobiologic injections are right for you. A separate appointment will be scheduled for the actual procedure.

Physicians Performing Orthobiologic Procedures

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