Basis of Orthobiologics Treatment

MSC Diagram

Adult stem cells are undifferentiated cells found in many tissues. However, the ones in bone marrow are potent and easy to harvest. The human body uses stem cells to replace cells when they are injured or damaged by disease and to help heal the damaged tissue in which they are located.

There are two kinds of stem cells found in the bone marrow:

  1. Hematopoietic stem cells (HSCs) which differentiate into various blood cell types.
  2. Mesenchymal stem cells (MSCs) which differentiate into many different cells. MSCs are the stem cells used in the treatment of orthopedic conditions like arthritis, tendonitis, and muscle or tendon tears.

The diagram below shows the various cells MSCs can form:

The Procedure

The procedure involves removing MSCs from the bone marrow through a process called aspiration. During this part of the procedure, a special needle is used to remove the MSCs. The MSCs are then concentrated to form bone marrow aspirate cells (BMAC) and injected into the area of disease or injury. All of this is done during the one procedure visit.

MSC Process

Conditions likely to benefit from BMAC stem cell treatment

  • Arthritis of the knees, shoulders, hips, ankles, hands, elbows and feet
  • Tendonitis of the elbow (tennis elbow), shoulder, ankle (Achilles tendonitis), and knee (Jumpers knee)
  • Plantar fasciitis
  • Muscle tears
  • Partial tendon tears
  • Avascular necrosis
  • Bone cysts
  • Rotator cuff tears
  • Fractures healing poorly

Combination of BMAC stem cells and surgery

In certain cases, a combination of surgery and BMAC stem cell therapy may be used. For example, a large rotator cuff tear may be treated with surgery and then BMAC to help decrease postoperative pain and promote healing.

Our process for obtaining BMAC treatment involves the following three steps:

  1. Evaluation – The Initial step is an office visit to determine if stem cell injection is the right option for your condition. This is like any specialist office visit subject to co-pays as per your insurance plan. X-rays and MRIs are reviewed and any additional studies needed are ordered. If another therapy option is a better choice, it is recommended. If stem cell injection is determined to be a good option, the procedure is scheduled.
  1. Procedure – This is performed at a surgery center as an outpatient procedure. Under IV sedation anesthesia, local anesthetics are used to numb the skin and tissues around the bone. A special needle is passed through the cortex of the bone into the marrow cavity. Using a combination of IV sedation and local anesthetic allows the procedure to be done without any pain at all. The liquid marrow is then very slowly drawn into a syringe.The syringe containing the liquid marrow next is placed in a special centrifuge and spun until the stem cells are highly concentrated. This concentrate is then injected into predetermined areas affected by disease or damage.
  2. Follow up – 3 day check up is included with the procedure and all other follow up visits are treated as specialist office visits subject to co-pays as per your insurance policy.

Costs and insurance coverage

BMAC based stem cell treatments are currently not covered by any of the insurance plans including Medicare. The cost of your treatment depends on the complexity of the condition, number of areas to be injected and the amount of MSC cells that need to be harvested for optimal results. The cost of treatment ranges from $3550 to $4450 depending upon the type and number of joints treated, amount of Bone Marrow concentrate needed and complexity of the problem. A firm written estimate will be provided to you at the time of your evaluation. Payment plans are available.

Expected results

Our experience is that most patients will have significant relief of pain around 1-2 months post injection. They will often continue to improve for the first 3-6 months after the stem cell procedure. Like any procedure, it does not work for every one and some people will not see any significant benefit. This is still a very new treatment, and there have not been a lot of long term outcomes studies or data as yet. However, early results are very encouraging.

Studies suggest an improvement rate as high as 80-85%, though some arthritic joints, like the hip and ankle, do not respond as well. Results of treatment do vary. Some patients experience complete relief of their pain. Others see some improvement while a few may not report any benefit at all. In the case of tendon and ligament injuries the improved results are likely to be permanent. In the case of joint arthritis, how long the treatment benefit lasts may depend on the severity of the condition. Mild arthritis may not need another round of treatments. More advanced arthritis, on the other hand, may require a repeat course of treatment.