Bone Marrow Aspirate Concentrate
It is important to note that we do not use stem cell therapy on every patient. In fact, we use Bone Marrow Aspirate Concentrate sometimes called stem cell therapy in very few of our patients. The reason? We find that our mainstay treatment, simple dextrose Prolotherapy, administered in the ways documented in the research over 70 years, can in many cases, provide equal and sometimes superior results in some patients.
Stem cell therapy research is exploding in the medical field because doctors and researchers see enormous potential in its future applications. But how about today? Stem cell therapy may provide benefit to some patients, but not all. In many people who reach out to our office, we find that they have an unrealistic expectation of success of what stem cell therapy can really do.
For example, stem cell therapy cannot generate a meniscus from nothing. If you do not have a meniscus, stem cell therapy as an injection will not make a new one. If you have a meniscus tear, lesion, or hole in cartilage, stem cell therapy may help create a patch. Stem cell therapy may help turn a degenerative joint disease into a more healing joint environment. But, the treatment, like any medical treatment has it limitations. For most, in our opinion, stem cell therapy is not some type of miracle, single-shot cure. Thinking it is, indeed, is an over expectation of what the treatment can do.
However, stem cell therapy used in conjunction with other treatments and within a realistic treatment program can help patients avoid a joint replacement.
Please refer to these articles for more information on the advantages and disadvantages of stem cell therapy
- Can you repair a bone on bone knee without stem cell therapy?
- Does stem cell therapy for knee meniscus tears and post-meniscectomy work?
- Stem cell therapy did not work for your knee pain – should you try again or something else?
- Is there evidence that direct stem cell injections into degenerated discs can reverse degenerative disc disease?
While research has shown that stem cell therapy in various forms may provide benefits to patients with musculoskeletal conditions, there is also research that suggests that stem cell therapy will not benefit certain patients. The research on the treatment is not conclusive and certainly ongoing. Stem cell therapy does not work for everyone.
In Stem Cell Therapy, we use a person’s own healing cells from bone marrow. They are injected straight to the area which has a cellular deficiency, along with injections to all of the supportive joint structures for a more thorough stem cell therapy treatment.
The goal is the same: to stimulate the repair of injured tissues. Stem cells aid in fibroblastic proliferation where cell growth, proteosynthesis, reparation, the remodeling of tissues, and chondrocyte proliferation occurs. Our bone marrow contains stem cells, also termed mesenchymal stem cells and progenitor cells, among other names. These immature cells have the ability to become tissues like cartilage, bone, and ligaments.
Stem Cell Therapy or Prolotherapy?
Not all injuries require stem cells to heal. For many patients the success rate with traditional Prolotherapy in this office is in the 90%+ range for all patients. However, for those cases of advanced arthritis, meniscus tears, labral tears, bone-on-bone, or aggressive injuries, our Prolotherapy practitioners may choose to use stem cell injections to enhance the healing, in combination with dextrose Prolotherapy to strengthen and stabilize the surrounding support structures for meniscus repair.
In our research published in The Open Stem Cell Journal, Rationale for Using Direct Bone Marrow Aspirate as a Proliferant for Regenerative Injection Therapy (Prolotherapy).
We not only showed the benefit of bone marrow derived stem cells as a Prolotherapy proliferant solution, but also that this exciting field of medicine needs doctors and scientists working together to expand research and technique guidelines.
Typically the tissue that we are trying to stimulate to repair with Stem Cell Therapy or Cellular Prolotherapy is articular cartilage, but we can also proliferate soft tissues structures such as ligament and tendons. This is new technology so we are studying it as we use it to treat patients.
Bone Marrow Prolotherapy involves direct bone marrow aspiration (or also concentrated) to get the stem cells to the site of the injury. Does the study above suggest that direct bone marrow injections without culture expanded and without the scaffold would work? Possibly, but only time will tell as research progresses. But in our experience we have discovered that these stem cells act as great proliferant solutions for Prolotherapy. We use bone marrow stem cells in conjunction with other Prolotherapy solutions to treat large articular defects in the labrum and meniscus areas. Typically, patients are seen every two months. Most patients need 3-6 visits. The good news is during the time of healing, the patient can exercise and start getting back into great shape! Bone marrow and adipose-derived stem cell therapies are gaining in recognition and we are happy to offer them as an option for treating chronic injuries and sports injuries.
Research into the efficacy of any treatment protocol and stem cell injection therapy
There is always conflicting research into the efficacy of any treatment protocol and stem cell injection therapy is no different. Many times a patient will point to his or her own clinical dissatisfaction or research and say, stem cell therapy does not work as well as advertised. Let’s look at some of that research:
“Osteoarthritis is a cartilage degenerative process…No treatment is still available to improve or reverse the process. Stem cell therapy opened new horizons for the treatment of many incurable diseases… In this research, four patients with knee osteoarthritis were selected for the study. They were aged 55, 57, 65 and 54 years, and had moderate to severe knee Osteoarthritis. After their signed written consent, 30 mL of bone marrow were taken and cultured for MSC growth. After having enough MSCs in culture (4-5 weeks) and taking into consideration all safety measures, cells were injected into one knee of each patient.
The walking time for the pain to appear improved for three patients and remained unchanged for one. On physical examination, the improvement was mainly for crepitus. It was minor for the improvement of the range of motion.
Results were encouraging, but not excellent. Improvement of the technique may improve the results.”
Video: What type of treatment do I need? Stem Cells? PRP? Prolotherapy?
In this video, Danielle R. Steilen-Matias, MMS, PA-C, offers a brief introduction to treatments. Explanatory and summary notes are below:
Prolotherapy? Platelet Rich Plasma Therapy? Stem Cell Therapy? This is among the most common questions that we get.
A major factor in determining which treatment to get is the extent of your injury and whether this is a recent injury or a problem with degenerative joint disease or degenerative arthritis.
General patient type 1:
- Younger patient, athlete, active, or with a physically demanding job. Recent injury, such as a sprain that has not healed all the way.
- Injury is still causing pain and discomfort.
- This is the type of injury that does very well with dextrose Prolotherapy injections.
General patient type 2:
- Chronic problems from an “old” injury, such as a sprain that happened a few years ago,
- Injury “never really healed,” has progressively worsened. Causing pain, discomfort.
- Injury has not responded long-term to more conservative care options such as NSAIDs, medications, cortisone, physical therapy
- Soft tissue damage continues, joint instability has become more permanent.
- In this patient, Prolotherapy may not be enough. Our first option would be Platelet Rich Plasma Therapy (PRP). This would put the healing factors found in your blood platelets into the damaged joint.
- WE DO NOT offer PRP as a stand-alone treatment or injection. While PRP brings healing cells into the joint, it acts to repair degenerative damage. In our experience, while PRP addresses damage deep in the joint, we must still address the joint instability problem created around the joint. We do this with Prolotherapy. Here damaged or weakened ligaments that are simply “stretched,” can be strengthened with treatment to help restore and maintain normal joint mobility.
- Simple PRP on the inside, Prolotherapy on the outside of the joint.
General patient type 3:
- Chronic long-term degenerative problems. Possibly in need of a joint replacement
- This is a patient who may have had degenerative joint disease for many years even decades. These are the “bone on bone people.” They have exhausted all means of conservative care, they may have had short-term success with PRP treatments, hyaluronic acid treatments, cortisone injections, but none of these are helpful anymore.
- It is important to realize and it will be explained in this article, that it is rare that we would need to go to stem cell therapy in many of these patients. When we do recommend stem cells it would be from your own stem cell sources and mostly taken from bone marrow. We do not offer “stem cell therapy,” from donated source material.
Sometimes a patient will reach out to us and suggest, “I had one PRP injection it did not work, I definitely need stem cells.” That is not always the case. One injection of anything Prolotherapy, PRP, or stem cells, while possibly providing relief in many patients short-term, is typically not a long-term answer. This is explained below.
Improvement in technique Platelet Rich Plasma Therapy combined
We agree that stem cell therapy has benefits but may not provide a full cure. This is why we recommend the use of Platelet Rich Plasma Therapy in conjunction with stem cell therapy. The study above involved cultured stem cells. In our opinion Stem cell therapy is more effective if the stem cells are given better direction. This is where the growth factors in blood platelets can be very effective. Platelets aid the stem cells in their various jobs including differentiation and then aid in the differentiated cells making the extracellular matrix to repair the injured tissue.
Platelet Rich Plasma contains a myriad of substances that stimulate healing:
- Platelet-Derived Growth Factor (PDGF) Attracts immune system cells to the area and stimulates them to proliferate. Has been shown to enhance ligament and tendon healing.
- Transforming Growth Factor-8 (TGF-8) Secreted by and affects all major cell types involved in healing. Similar affects as PDGF.
- Vascular Endothelial Growth Factor (VEGF) Helps new blood vessel formation, thereby increasing vascularity in injured areas.
- Fibroblast Growth Factor (FGF) promotes the growth of the cells involved in collagen and cartilage formation.
Numerous studies have shown that PRP enhances the effects of Stem Cell Therapy5,6 As the study above notes – “Results were encouraging, but not excellent. Improvement of the technique may improve the results.” Platelet Rich Plasma therapy improves the technique and improves the results.
The goal of Stem Cell Therapy – Cellular Prolotherapy
Our ultimate goal with all forms of Prolotherapy is to get the patients back to doing the things that they want to do without pain. It is our hope that the Stem Cell Therapy (Cellular Prolotherapy) treatments will form functionally, structurally, and mechanically equal to, if not better than, living tissue which has been designed to replace (or work alongside of) damaged tissue. It is hard to prove the above statement because we cannot sacrifice human beings after Prolotherapy to see if the tissue looks and acts normally. We can, however, report that the majority of our patients who receive Stem Cell Therapy along with traditional Hackett-Hemwall Prolotherapy get back to activities and have dramatically decreased pain levels using this comprehensive approach.
Links to our other articles for your specific conditions
References for this article
Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. doi: 10.4137/CMAMD.S10951. eCollection 2013. [Pubmed]
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