Orthobiologic Treatments

Orthobiologics implies using your own body’s healing mechanisms to treat arthritis or injuries in various parts of the body. The commonly used Orthobiologic treatments are PRP (Platelet Rich Plasma) injections, plasma concentrate containing A2M (Alpha 2 Macroglobulin), and BMAC (Bone Marrow Aspirate Concentrate) injection that contains some mesenchymal stem cells.

1. What is Platelet-Rich Plasma Therapy?

Doctors utilize platelet-rich plasma (PRP) therapy for a multitude of reasons. Researchers theorize that by injecting areas of inflammation or tissue damage with high concentrations of platelets, it can encourage wounds to heal. It works by taking damaged cells and mixing them into a concentrated mixture of your own blood to stimulate healing and target stubborn injuries. This therapy is used to help reduce inflammation, too.

How it Works

First, a sample of blood will be taken from the patient and put into a specialized device that will spin at a very high rate of speed. While spinning at high speed, the platelets become separated from the other components in the blood. The concentration of platelets is then taken and injected into a specific area of the patient that needs treatment.

What Are the Benefits?

Healing – PRP therapy was first used on patients healing after jaw and plastic surgeries. Now, it can be used to promote healing in patients who suffer injuries to their tendons, ligaments, and muscles.

Inflammation Reduction – PRP therapy can help to reduce inflammation because it can target joints that have become painful and stiff. It is commonly used in treating osteoarthritis of the knee and shoulder and tendonitis of the rotator cuff. Elbow or hip.

What Are the Side Effects?

Most people will not feel any side effects from PRP therapy. Although, some people may feel mild nausea and dizziness after the blood draw. Most people can resume their normal activities almost immediately after having a PRP injection.

2. What is Alpha 2 Macroglobulin?

A2M is a protein that is made by liver and found in your blood. The A2M found naturally in your blood inhibits three major proteins – Cytokines, Matrix Metalloproteinases (MMP’s), and ADAMTS Degradation Proteases that break down your cartilage, causing Osteoarthritis (OA). The protective characteristics of A2M allows this vital protein as the human body’s own defense against Osteoarthritis (OA).

A2M is a Broad-Spectrum Multi-Purpose Protease Inhibitor that captures and inactivates the bad chemicals damaging your joints and causing pain. Once these bad chemicals are trapped by the A2M, the body eliminates them through natural mechanisms.

A significant research study out of Brown University, in collaboration with the National Institute of Health, demonstrated that concentration of intra-articular A2M is insufficient for joint protection and a supplemental intra-articular injection of A2M provides chondral protection in post-traumatic OA by stopping the progression of Osteoarthritis (OA)

What is it used for?

The most common use is for managing osteoarthritic pain in knee and shoulder. It is also being used to slow down progression of post traumatic osteoarthritis after ACL and meniscal surgery.

3. What is Bone Marrow Aspirate Concentrate injection?

Most of so called stem cell treatments are therapies that involve aspirating bone marrow that has cells, concentrating it and injecting it into the diseased area. 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.

What is it used for?

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 marrow also has red blood cells, white blood cells and platelets in addition to the HSCs and MSCs.

The Procedure

The procedure involves extracting the bone marrow containing MSCs 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 concentrate (BMAC) which is injected into the area of disease or injury. All of this is done during the one procedure visit.

procedure involves extracting the bone marrow containing mscs

Conditions likely to benefit from BMAC treatment

  1. Arthritis of the knees, shoulders, hips, ankles, hands, elbows and feet
  2. Tendonitis of the elbow (tennis elbow), shoulder, ankle (Achilles’ tendonitis), and knee (Jumper’s knee)
  3. Plantar fasciitis
  4. Muscle tears
  5. Partial tendon tears
  6. Avascular necrosis
  7. Bone cysts
  8. Rotator cuff tears
  9. Fractures healing poorly

In certain cases, a combination of surgery and BMAC 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.
  2. 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.
  3. Follow up – 3-day checkup 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.

 

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 everyone, 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 yet. However, early results are very encouraging.

Studies suggest an improvement rate as high as 70-80%, though some arthritic joints, like the hip and ankle, do not respond as well as the knee and shoulder. 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.

Costs of Orthobiologics 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. Payment plans are available.