Regenerative Injection Therapies, PRP, BMAC
Regenerative Injection Therapy is a new approach, utilizing minimally invasive interventions to induce and accelerate tissue healing, previously damaged by a disease process or trauma. In some circumstances, tissue regeneration can be accomplished, eliminating the need for more invasive surgical interventions.
Why is Regenerative Therapy Necessary?
Certain tissues in your body are prone to wear and tear. This may happen from trauma, occupational exposure or overuse. Specific tissues such as ligaments (tissue bands that connect bones with bones) and tendons (tissue bands than connect muscles with bones) are essential in preserving your skeletal stability, joints and range of motion. When affected by chronic degeneration and trauma, the good collagen and cartilage is replaced by a faulty one; creating painful and sometimes incapacitating conditions. Common conditions such as sprains, strains, tennis elbow, joint pain, heel pain, rotator cuff tears and trochanteric bursitis (inflammation of the bursa) are associated with chronic degenerative changes. Commonly prescribed anti-inflammatory medications, although effective sometimes in controlling the pain, do not heal or regenarate tissues. Regenerative therapy is used in cases in which other modalities such a medication, therapy and neuromuscular training have failed.
Which Types of Regenerative Therapies Are Offered?
Prolotherapy. Consists of injecting a solution of a local anesthetic (numbing agent) along with medical grade glucose, into a specific tissue: usually a tendon, ligament or a joint using sonography (unltrasound) guidance. This triggers a more intense healing reaction in the tissues, thus allowing faster healing. Numerous studies have shown ligament strength increase up to 40 %.
Platelet Rich Plasma Grafting (PRP). An advanced type of therapy, in which the patient’s blood is drawn from a vein and concentrated by a special centrifuge device, ultimately creating a concentrate of platelets in plasma. This concentrate contains up to 500% of bioactive proteins, along with multiple growth factors, which are essential in inducing and accelerating tissue repair and regeneration. The PRP is injected into specific tissues by using the most advanced tissue guidance with ultrasound. Most of the benefit is seen in the connective tissues, bone, hyaline cartilages and development of new blood vessels necessary for tissue healing.
Bone Marrow Aspirate Concentrate (BMAC). This procedure is a more advanced form of regenerative therapy, in which blood is withdrawn from the patient’s bone marrow (Iliac crest) and concentrated in a special device. The concentrate contains a significant amount of stem cells and platelets, which are capable of regenerating tissues to a greater degree than the PRP. The technique is more invasive and costly. It is usually reserved for cases in which there is significant tissue damage, or in patients who have failed other types of regenerative therapy. Sometimes, these grafts are enhanced with fibrin products necessary to create a tissue scaffold, in order to provide a tissue blueprint for regeneration. This new and exciting field is constantly evolving and is at the forefront of regenerative medicine.
Why Not Use Steroid Shots?
Although steroids are frequently injected to treat inflammatory conditions with success, they are not usually effective for chronic tissue damage or degenerative tissues. They can potentially cause tissue damage and significant side effects if performed habitually.
Which Type of Regenerative Therapy is Best for Me?
Upon reviewing your medical records and undergoing a complete evaluation, your physician will determine which specific therapy is best for you. For simple cases with minimal tissue damage or degeneration, Prolotherapy may be recommended. When the condition is more advanced, then Platelet Rich Plasma Grafting (PRP) or Bone Marrow Aspirate Concentrate (BMAC) may be a more suitable alternative.
How Many Treatments are Usually Necessary?
The amount of treatments is dependent on several factors: type and severity of the damaged tissue, location, nutritional state of the patient, age and genetic factors. Usually with Prolotherapy or PRP, several treatments (usually 3-6), four to six weeks apart, are usually necessary to achieve the desired outcome. With BMAC usually one therapy is performed and if necessary, followed by PRP or Prolotherapy.
Where is the Regenerative Therapy Done?
Regenerative Therapy is mostly performed on ligaments, tendon, joints (major and minor), and sometimes nerves. Usually the treatment of multiple sites are the most efficacious and yield the best outcome. The following are commonly treated conditions:
Spine: Sacroiliac joint, Ilio-lumbar ligaments, facet joints.
Shoulder: Rotator cuff-partial tears, Biceps tendinosis, chronic Glenohumeral ligament sprains, Acromio-clavicular joint dysfunction and pain, Levatorscapula tendinosis.
Elbow: Tennis and Golfer’s elbow, Ulnar collateral ligament injury, distal biceps tendon partial tear
Wrist & Hand: Chronic joint sprain and arthritis.
Hip/Pelvis/SI Joints: Pyriformis syndrome, Greater trochanteric bursitis, Sacroiliac joint dysfunction, hamstring strain, bursitis, hip joint arthritis
Knee: Patellar tendinitis/tendinopathy, Osgood-Schlatter’s disease, quadriceps strain or partial tear, degenerative arthritis, rheumatoid arthritis, Chondromalacia patella, Enthesopathy
Ankle & Foot: Chronic ligament strain, chronic Achilles tendinitis, chronic partial tendon tear, plantar fasciitis, arthritic joints.
When Can I Return to Work or Resume My Usual Activities?
Since the procedure is minimally invasive, in 24 hours the patient usually returns to same activity level prior to the procedure. However, every patient is unique and requires specific recommendations. The decision is usually made according to the progress, lack of symptoms and response to therapy. Remember, the regenerative process takes time and usually requires several interventions to achieve the desired goal.
Are There Any Specific Instructions Before or After the Procedure?
With PRP and BMAC, all non-steroidal anti-inflammatory medications (aleve, motrin, ibuprofen, anaprox, etc.) should be stopped for one week prior to and one month after the procedure. According to which specific tissue is treated, certain restrictions will apply. Usually there is localized soreness and discomfort lasting for 24-48 hours. Medications will be prescribed if necessary to alleviate the symptoms. Other instructions will be given which pertains to the specific type of intervention to be performed.
Is the Procedure Covered by My Insurance Plan?
Most insurance plans cover the specific types of procedure. However, the cost of the supplies for PRP and BMAC are frequently excluded. Separate financial arrangements are sometimes necessary.