OrthoVirginia's orthopaedic specialists are on the leading edge of Biologic Therapy. We're devoted to understanding and advancing the science behind this exciting technology.

Harnessing the Body's Healing Powers

The body has an innate ability to heal itself. Researchers have long attempted to harness that process and use it in the treatment of injury and degeneration. Part of the healing process comes from 2 cellular factors, stem cells and platelets. These cell types assist in tissue restoration and regeneration.

The expectation is that these cellular substances may
  • Stimulate a reparative response in the body via signaling and/or cell transformation
  • Create an environment conducive to accelerated healing, such as modulating inflammation.
MSCs (stem cells) and PRP (platelet rich plasma) are considered biologic therapy. These bio-active substances are derived and injected into the area of damaged or degenerative tissue; an injured muscle, an inflamed tendon or an arthritic joint, for instance.

The theory is that these cellular substances might:
  • Stimulate a reparative response in the body via signaling and/or cell transformation
  • Create an environment conducive to accelerated tendon healing, through modulating inflammation and stimulating bio-active proteins.
The objective of Biologic Therapy is to improve the healing environment of injured muscles, tendons and joints. It is also currently being used to address the pain and swelling that accompanies degenerative conditions, such as arthritis. For those with damage to the articular cartilage or arthritis who don't feel ready for knee replacement, the hope is that these treatments can offer a potential "bridge" between cartilage repair procedures and total knee replacement.

What is PRP?

PRP (platelet rich plasma) is derived from your blood. Platelets are those cells in your blood that contain an abundance of growth factors and anti-inflammatory agents (IGF, TGF, VEGF, etc).

If the body sustains an injury, platelets are naturally delivered to the injury site. These cells will degranulate, or release bioactive factors that stimulate tissue repair. This is the natural process by which nearly all tissue heals. A sample of your blood is obtained, and the platelets are concentrated through centrifugation and injected into the desired body part. These platelets will secrete bioactive agents.

What are Mesenchymal Stem Cells (MSC’s)?

Stem cells are more accurately called "progenitor cells." These are cells that have the ability to transform into varying cell types and tissues. So, let's say you break a bone. The body needs more bone to heal a fracture. Stem cells are signaled to populate the area of damage and facilitate the production of new bone. The same goes if it is skin, heart or cartilage that is damaged. Sounds rather straight-forward, but the actual process is exceedingly complicated with likely thousands of metabolic steps. There are a variety of progenitor stem cells in the body. Mesenchymal stem cells (MSCs) live as pericytes which are cells that line blood vessels. These are most easily found in the bone marrow and fat. Amniotic fluid may also be rich in MSC’s.

To date there are several basic sources of Stem Cell therapy:
  • Bone marrow-derived (BMAC--Bone Marrow Aspirate Concentrate)
  • Adipose or fatty tissue-derived
  • Amniotic fluid-derived

How does Biologic Therapy work?

This is still being answered with increasing accuracy, however we do know that these treatments work through a complex series of interactions. Although in the lab stem cells can be turned in culture into many organ tissues, they do not act this way when injected into the body. Instead when injected they act as medicinal signaling cells, or tiny pharmacies, to bring in proteins and cells that stimulate the body's own repair mechanisms to work more effectively in areas of injury or inflammation.

What is the Procedure Like?

PRP

With PRP, platelets are derived from your blood. This is an office procedure and it only takes roughly 20-30 minutes. A sample of blood is drawn from your arm. The blood sample is processed, usually by centrifugation, and the plasma layer of blood (which is rich in platelets) is isolated, removed and injected into your affected joint or injured area.

Your activities after the procedure may be limited according to the treated ondition and should be discussed with your physician.

Stem Cells

Stem cell injections can be performed in the office or procedure center. Amniotic stem cells are shipped frozen, thawed just prior to use and simply injected into the joint---quite simple. Bone Marrow (BMAC) and adipose stem cells are obtained through a minor procedure which may take 30-60mins.

Bone marrow stem cells (BMAC) are derived from the crest of your pelvic bone. The area is anesthetized and a needle is placed into the marrow cavity. A marrow aspirate is withdrawn and processed, usually by centrifugation, and the progenitor/stem cells are isolated and injected into the affected joint or injured area. Adipose derived MSC's (stem cells) are taken from the fatty tissue in your belly or flank. The area is anesthetized and a needle is placed into the fatty layer under the skin.

Adipose aspirate is withdrawn and processed. We use the Lipogems system which is enzyme free, does not involve centrifugation and therefore is a minimal manipulation technique. The aspirate is mixed with sterile saline which rinses the tissue of impurities such as oil and blood and is then put through a filter which leaves us with only the adipose(fat) microspheres which contain the MSC's and their local micro-environment to be injected into the knee. This technique yields the highest amount of MSC's for regenerative and anti-inflammatory purposes we know of today.

Our Team

OrthoVirginia is the largest provider of expert orthopaedic, sports medicine, physical therapy and rehabilitative care in Virginia,
 
Ken Zaslav MD, of our Richmond Region, leads the Orthobiologic and Joint Preservation Initiatives at OrthoVirginia. He is the immediate Past President of the International Cartilage Repair and Joint Preservation Society (ICRS) based in Zurich SW and is a founding member of the Biologic Alliance; a joint task force made of 2 members each from the American Academy of Orthopaedic Surgeons(AAOS),  The American Orthopaedic Society of Sports Medicine (AOSSM), The ICRS and The Arthroscopy Association of North America(AANA). This group is compiling research, setting up a Registry for orthobiologics nationwide, and will speak on these issues as the single definitive voice on issues of Regenerative medicine in orthopaedics to the world community. Most of our Sports Medicine Physicians listed here belong to at least one or two of these important organizations. OrthoVirginia firmly believes in the responsible and reasonably priced use of these products as research moves forward in this exciting area.

View Richmond Biologic Therapy Physicians

William E. Nordt, III, MD

View Profile

D. Christopher Young, MD

View Profile

Kenneth R. Zaslav, MD

View Profile

Julious P. "Jody" Smith, III, MD

View Profile

Paul G. Kiritsis, MD

View Profile

David D. Nedeff, MD

View Profile

Steven G. Reece, MD

View Profile

Michael W. Mariscalco, MD

View Profile
View Northern Virginia Biologic Therapy Physicians
View Lynchburg Biologic Therapy Physicians
View Virginia Beach Biologic Therapy Physicians

Frequently Asked Questions

Which are Better PRP or Mesenchymal Stem Cells?
We don’t have this answer. Research has shown that both procedures are generally effective regarding accelerated tendon healing and joint pain control.
How many injections are required?
If I have a stem cell injection in my arthritic knee, will it grow new cartilage?
How long will the effect of a biologic injection last?
How fast do these injections work?
Which stem cell preparation is preferable; BMAC, Adipose or Amniotic?
What does the research show?
Are biologic injections covered by insurance and how much does it cost?
Do I make an appt for a PRP or stem cell injection?