The Orthopaedic Center (TOC) The Orthopaedic Center (TOC)

Regenerative Medicine

Regenerative medicine therapy for treatment of orthopedic conditions

Regenerative medicine therapy takes advantage of the special healing quality of “stem cells.” These cells can help repair damaged tissues in the body. “Stem cells” are found in your bone marrow. The Sports Medicine physicians at The Orthopaedic Center specialize in both BMAC and PRP treatments.

Bone Marrow Aspirate Concentrate (BMAC) Treatment

Bone Marrow Aspirate Concentrate (BMAC) treatment, also known as Bone Marrow Concentrate (BMC) treatment is a non-surgical regenerative treatment for various orthopedic injuries, including moderate to severe osteoarthritis and tendon injures. BMAC is a concentrate of regenerative “stem cells” obtained from the patient’s own bone marrow. The physician removes a small amount of the patient’s bone marrow and uses it to generate a powerful concentrate that is injected into the treatment area.

Why Use BMAC?

Unlike other cells of the body, bone marrow cells are “undifferentiated”, which means they have the ability to transform themselves into a variety of tissue types. When injury occurs, the quantity of regenerative cells needed for tissue regeneration may be inadequate. With BMAC, the injection of regenerative cells provides a more robust healing of damaged tissue and aids in growth and repair by accelerating the body’s natural healing mechanism. While the full benefits of BMAC are still unknown, BMAC has been shown to reduce swelling, relieve pain, and enhance healing of articular cartilage and bone.

What Types of Conditions Are Treated with BMAC?

Numerous conditions can be considered for treatment with BMAC. Currently, moderate to severe osteoarthritis and severe tendon injuries show promising results.

What can be treated?

Knee Osteoarthritis is currently the best indication. Others are listed below.

  • Shoulder – Rotator Cuff Tendinitis or Tendinopathy, or Partial Rotator Cuff Tears, and Biceps Tendinitis
  • Knee – Osteoarthritis, Chondromalacia, Tendon Injuries (Patellar Tendonitis), Partial ligament sprains or tears (MCL, LCL, ACL)
  • Elbow Pain – Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis (Golfers Elbow)

What is the difference between Platelet Rich Plasma (PRP) and BMAC?

In general, PRP may be more appropriate for mild to moderate osteoarthritis or tendon injuries. BMAC may be reserved for more challenging cases such as moderate to severe osteoarthritis or when more potent effects are desired.

How is the treatment performed and administered?

With the patient sedated, the bone marrow aspiration site is locally numbed so minimal pain is felt. Bone marrow is removed from the back of the pelvis (hip) at the posterior iliac crest. The concentration of bone marrow (“stem cells” and healing components), also known as the bone marrow aspirate concentrate (BMAC), is injected into the treatment area. Patients go home the same day.

Is BMAC curative or just a temporary cover-up?

Unlike cortisone/steroid shots which simply mask symptoms (and may damage tissue with repeated injections), BMAC targets the root of the problem and attempts to heal the tissue.

How many treatments are needed?

Most patients require only a single BMAC treatment. However, if a patient experiences significant relief that plateaus, they may consider a second BMAC injection months later.

How quickly can I get back to my regular routine?

For the first 2-3 days, swelling and discomfort may occur in the injected area. By the end of the first week, these symptoms usually begin to resolve. Physical therapy is started within a few days of the treatment, to optimize BMAC effects and facilitate recovery. Patients respond to BMAC treatment along varying timelines.

Are there any factors that would prevent someone from getting BMAC?

Bone marrow derived cancer (such as lymphoma) and active systemic infection are contra-indications. Other types of cancer may be a contra-indication and approval must be obtained from the patient’s oncologist.

Is BMAC treatment covered by insurance?

No. While there is evidence showing the positive effects of BMAC treatment on tendon, soft tissue, and cartilage injuries, BMAC is not covered by insurance companies at this time.

How long does it take BMAC to “work”?

Most patients notice some level of improvement by 2-6 weeks following their BMAC treatment. Increases in stability and strength are typically reported, along with the decreases in pain. A second level of benefit may be obtained between 6 weeks and 3 months following BMAC. Patients should remain active with a physical therapy program and strengthen surrounding muscles during this period.

 

Platelet-Rich Plasma (PRP®) Treatment

Platelet-Rich Plasma (PRP) is produced from your own blood. Platelets are cells in our body that contain growth factors. These growth factors stimulate the normal wound healing process, such as when your skin heals after a scrape. For PRP treatments, we concentrate your platelets (to over 5x more platelets than your normal blood) and deliver them to the area of interest, to help heal injured tissue. Some PRP treatments are done under ultrasound guidance to confirm placement of the PRP in the correct tissue.

Is PRP indicated for me?

PRP is indicated for injuries that have failed to heal despite traditional treatments. PRP treatments can be performed in any musculoskeletal structure, including muscles, tendons, joints and ligaments. Some examples include: partial tendon tears, muscle strains, ligament sprains/partial tears, articular cartilage injury, and chronic tendon injuries.

How is PRP made?

To prepare PRP, blood is taken from your arm with a special kit. This is similar to a normal blood draw. The blood is then placed in a centrifuge that separates the platelets from the blood, creating the PRP. The entire PRP treatment process takes about 45 minutes.

How many treatments are necessary?

Many patients achieve successful outcomes with only one treatment, especially for soft-tissue problems. In some cases, a series of three treatments is required to achieve significant results. This is particularly true for joint treatments. Each treatment is spaced several weeks apart. There is no limit to the number of treatments you can have; however, if you’re not seeing significant improvement after three treatments, you should consider other forms of treatment.

Are there any side effects?

Since your own blood is used, there is no risk for transmitted blood-infections. PRP has a strong antibacterial effect so the risk of local infection is minimal. It is possible to have increased soreness or pain for several days after the treatment. You may be prescribed pain medication to help with this.

Will my insurance pay for this treatment?

PRP treatment is a fairly new procedure, and most insurance companies have not incorporated it yet to their list of approved procedures and do not consider it a reimbursable expense. PRP treatment fees include the PRP kit, blood draw, use of centrifugation machine, disposable equipment, ultrasound guidance (if needed), and the actual procedure. A splint for support may be indicated in some cases (additional fee, likely with some insurance coverage).

What are the potential benefits of PRP?

PRP stimulates healing of the injured tissue by activating your body’s natural healing potential. On average, patients report more than 50% improvement at 6 weeks and up to 100% improvement at 12 weeks after treatment. PRP treatment may eliminate the need for other treatments such as long-term medication or surgery.