PRP/BMAC (Stem Cell Therapy)
Regenerative medicine is a term used to describe the science using autologous regenerative cells and concentrated growth factors to enhance the body’s natural ability to heal. A common source for regenerative cells and growth factors is bone marrow aspirate concentrate (BMAC) and platelet rich plasma (obtained from one’s own blood). Both bone marrow concentrate and platelet rich plasma is used to augment and accelerate the body’s own healing mechanisms. These cells are naturally found in the body and are used to improve the healing of broken bones and injured muscles, tendon, ligament, as well as cartilage. When regenerative cells are used in high concentrations, they help speed up the healing process and can potentially facilitate repair of tissues that are no longer able to do so naturally, such as the treatment for conditions such as osteoarthritis.
To get regenerative cells, your physician will either harvest bone marrow from the pelvis or obtain blood from a simple blood draw. This is followed by a special process which requires a sophisticated centrifuge system to separate unwanted cells and concentrates the regenerative cells and valuable growth factors. There are specific protocols that have been designed by Dr. Palmieri to maximize the beneficial outcome of treating injuries as well as creating a regenerative environment for positive results!
In certain situations, it has been shown that patients can avoid surgery by using regenerative cells from bone marrow, adipose cells or even from one’s own blood. It has also been shown that in certain cases surgical intervention will maximize the benefit of these techniques. If the appropriate environment has not been created in the joint, the injection of regenerative cells would be a waste of time and money. One example of surgery being of benefit would be performing an outpatient knee arthroscopy to remove loose fragments of bone and cartilage which could interfere with the ability of gaining improvement from the regenerative cell techniques. To obtain the maximum benefit and lasting results of these techniques, patients should ONLY rely on the expertise of a board certified orthopedic surgeon with experience in regenerative medicine. In order to obtain maximum benefit and lasting results, Dr. Palmieri can determine whether regenerative injections will be of benefit alone or if this should be done in a minimally invasive outpatient procedure. We hope that with this current treatment protocol we will be able to avoid or postpone the necessity of major surgery such as a knee replacement.
Platelet-Rich Plasma (PRP) Therapy
Athletes and active individuals who endure chronic pain from tendon injuries and/or osteoarthritis may benefit from a safe, nonsurgical procedure called PRP. PRP therapy utilizes platelets from the individual's own blood to rebuild damaged muscles, tendons or cartilage. The use of PRP has been successful not only in relieving pain, but also in jumpstarting the healing process.
Platelet-rich plasma therapy is done in our office and takes approximately one hour. The patient's blood is drawn and then placed in a sophisticated centrifuge for 20 minutes in order to separate out the platelets. The area being injected is cleaned under sterile technique and a local anesthetic is used to minimize the discomfort of the procedure. The anesthetic also helps the patient have little to no discomfort following the procedure as well. The Platelet-rich plasma is then injected into the damaged portion of the tendon or cartilage with the guidance of an ultrasound machine.
Some patients have described mild to moderate discomfort lasting one to two days, which can usually be treated with Tylenol. I recommend individuals avoid anti-inflammatory medications, prescribed or over-the-counter, for five days prior to the injection and two weeks following the injection. This will help patients gain maximum benefit from the PRP injection. Occasionally, Dr. Palmieri will initiate physical therapy or a home exercise program for the first few weeks. Most patients are able to return to their normal activities of daily living immediately after the injection.
We recommend that patients be reevaluated six to twelve weeks after the initial injection to monitor their response. In some patients with more difficult injuries, more than one injection may be required to achieve a successful outcome. Within three months, the majority of PRP patients find that they are able to return to most, if not all, activities they were doing prior to their pain starting.
Stem Cell Therapy
Stem cells reside in both the bone marrow and adipose tissue (fat cells). We use the cells from one or both of these areas to help treat chronic tendon or joint pain. We’re able to harvest the stem cells, with their healing power, to repair your damaged tissue. I am able to isolate these cells from the bone marrow in the pelvis and place them in a sophisticated centrifuge, which provides a Bone Marrow Aspiration Concentrate (BMAC).
We also can obtain adipose tissue from the abdominal region which will provide regenerative cells, including stem cells and growth factors, in a concentrated manner. This can then be directly injected into damaged areas. Stem cells can differentiate into other types of cells in the body depending on the environment in which they are placed. These stem cells will also help recruit other cells in the area to reduce inflammation and pain. It’s important for patients to realize that the cells are being obtained from the same individual they will be injected into; therefore, there is no rejection and no moral issue regarding their use.
This procedure can be performed in the office with the use of a local anesthetic, with or without mild oral sedation medication. Occasionally, this procedure is done in the operative suite along with other procedures, such as a knee arthroscopy. The procedure is done in such a case if there is loose and/or damaged cartilage along with bone fragments that are contributing to the patient's knee pain. This just makes commonsense and is another reason why patients should seek a board certified orthopedic surgeon to perform these procedures for the best outcome.
The post procedure protocol for stem cell therapy is similar to what is given to patients who have undergone Platelet-rich plasma therapy. For those individuals who have their stem cell procedure while undergoing the knee arthroscopy, I recommend limiting physical activity for three to four days, at which time they are able to return to regular activities of daily living, as well as returning to work. Physical fitness and exercise routines are generally resumed between four and six weeks. I have found that maximum results are generally achieved within 12 weeks, whether done as an outpatient surgical procedure or performed as an in-office procedure.
Of this several clinics throughout the country that perform regenerative cell treatment using Platelet Rich Plasma (PRP), Bone Marrow Aspiration Concentrate (BMAC), and adipose cells it is generally accepted that approximately 20% of patients WILL NOT achieve the outcome they desire.
I personally feel that successful outcomes are more likely achieved with a team-like approach. The importance of diet, exercise, and a spiritual foundation allow all of us to reach our maximum potential. In other words...we all have to put skin in the game!! However, it still holds true that some individuals will not achieve maximum results despite putting every effort toward a healthy lifestyle.
Both Platelet-rich plasma (PRP) and bone marrow aspiration concentrate (BMAC) are considered investigational by most insurance companies. It takes many years for medical studies to be completed. However, the preliminary studies have been very promising in the area of regenerative medicine. There is every indication that the next 5 to 10 years will have an explosion in regenerative therapy. Until recently, the cost for regenerative therapy has been cost prohibitive for most people, only being accessible to the highest paid professional athletes and the very wealthy. Due to recent advances in regenerative therapy, the cost of doing these interventions has significantly decreased making them an option for many patients. You may have seen many local clinics publishing prices for these therapies; however, to remain competitive, we do not advertise our pricing. When surgical intervention is warranted and your health insurance covers the surgical procedure, the out-of-pocket expense to the patient would be for the equipment needed for regenerative therapy only.
It is important to remember that in order to have the highest qualified individual perform these treatments, you should seek a physician who is highly trained in regenerative medicine and is a board certified orthopedic surgeon. These qualifications are very important in ensure your safety and a successful outcome.
We recommend that individuals interested in being evaluated for possible treatment with regenerative therapy call to schedule an appointment with our office. At your appointment, we will review any recent x-rays and/or MRIs that have been obtained in the last 6 months, as well as any recent medical records pertaining to your injury. As with any intervention, there are patients that are appropriate for this innovative treatment and there are those that most likely will not benefit.
It is important that you be seen by an experienced, board certified orthopedic surgeon who has been involved in regenerative medicine. Your doctor can help you make the right decision for the best personal outcome and help you avoid wasting time and money if regenerative therapy is not right for you. There are many individuals that are not providing insightful, objective recommendations to their patients. Unfortunately, it is difficult for most patients to detect those with credibility and values. I intend to have the highest integrity of the medical profession in this new innovative treatment without instilling unrealistic hope and expectations to the community.