Cell Based Therapy
Orthobiologics have created a renaissance in the treatment of orthopedic conditions, using procedures designed to enhance what the body does naturally… heal itself. The use of orthobiologics in treatment of musculoskeletal conditions is an emerging field, but evidence of their success is mounting at an accelerated rate. Research that examines the biological mechanisms of cellular health and tissue regeneration is extensive, particularly the role of platelets, stem cells, and natural growth factors in the blood.
Cell-based Therapy involves harvesting healthy cells, including stem cells, and precisely relocating them to the injured area. Injured tissues begin to heal and regenerate. Stem Cells are present in all of us, acting like a repair system for the body. They are sometimes referred to as “master cells” in that they have the potential to become many different specialized cell types.
With increased age or chronic injury, often the optimal amount of stem cells is not available. Research has shown that therapy using mesenchymal stem cells (MSCs) is an especially good option for treating musculoskeletal conditions involving lost or damaged tissue. Concentrated stem cells, nutrients, and growth factors are injected into the site of injury to amplify the natural repair system, helping the body keep pace with demands to maintain healthy function of musculoskeletal tissue.
Stem cells, one of several healing factors contained in the concentrate harvested from your body, help change the microenvironment of the injured tissue by activating a healing cascade:
- Promote anti-inflammation
- Induce cell proliferation
- Enhance the process of angiogenesis, the body’s natural formation of new blood vessels to help maintain supply of nutrients and removal of wastes.
- Trigger stem cell migration from other parts of the body
Cellular therapies and their use in regenerative medicine hold almost infinite possibilities for curative treatments. Scientific advances in the understanding of how the body actually heals through tissue regeneration, combined with rapid developments in stem cell biology, have truly created a renaissance in medical treatment.
Bone Marrow Aspirate Concentrate (BMAC)
- Q. Is the procedure painful?
A. With the use of bone marrow stem cells, there is some discomfort during the harvesting. This is reduced by local anesthetic given before the procedure. There is little pain during the administration of the stem cell mixture into the problem area. Discomfort may be felt for 24 to 72 hours after the procedure, but the doctor will prescribe medication to manage the pain. - Q.What is the advantage of Cell Based Therapy over PRP or Dextrose Prolotherapy?
A. Sometimes local stem cells that are activated in the PRP process have become depleted, particularly in the case of chronic injury or osteoarthritis. The demand has simply exceeded the supply. In this case, stem cells must be brought in from a different source. - Q.When will I notice improvement?
A. It depends on the patient, but typically within 1-2 weeks, with continual improvement for months after treatment. - Q.Why is PRP often used with Cell Based Therapy?
A. PRP is rich in growth factors and proteins that accelerate and boost tissue healing and repair. PRP also attracts more stem cells to the site. - Q.When can I return to normal activities?
A. There is soreness for a few days, but most people return to regular activity and work the next day. For people with jobs that require load-bearing activity (eg, heavy lifting), it is best to refrain from this type of activity as well as strenuous exercise for a while longer. - Q.Is Cell Based Therapy covered by insurance?
A. No, insurance does not cover this cellular therapy. We try to mitigate costs, however, by billing for the office visit. - Q.What is the cost of Cell Based Therapy?
A. Cell Based Therapy costs vary with type and location with ranges from $3800- $7000. 50% discount is offered for second site.
Research on Cell Based Therapy
More Information on Cell Based Therapy
- Tetta C, Consiglio AL, Bruno S, Tetta E, Gatti E, Dobreva M, Cremonesi F, Camussi G. Muscles The role of microvesicles derived from mesenchymal stem cells in tissue regeneration; a dream for tendon repair? Ligaments Tendons J. 2012 Oct 16;2(3):212-21. Print 2012 Jul.
- Shapiro E, Grande D, Drakos M. Biologics in Achilles tendon healing and repair: a review. Curr Rev Musculoskelet Med. 2015 Feb 6.
- Gosens T, Den Oudsten BL, Fievez E, van ‘t Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments.Int Orthop. 2012 Apr 27.
- von Wehren L1, Blanke F, Todorov A, Heisterbach P, Sailer J, Majewski M. The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears.Knee Surg Sports Traumatol Arthrosc. 2015 May 28.
- Valencia Mora M, Ruiz Ibán MA, Díaz Heredia J, Barco Laakso R, Cuéllar R1, García Arranz M. Cell Based Therapy in the management of shoulder rotator cuff disorders. World J Stem Cells. 2015 May 26;7(4):691-9. doi: 10.4252/wjsc.v7.i4.691.
- Evans CH. Advances in regenerative orthopedics. Mayo Clin Proc. 2013;88(11):1323-1339.
- Guelfi M, Pantalone A, Vanni D, Abate M, et al. Long-term beneficial effects of platelet-rich plasma for non-insertional Achilles tendinopathy. Foot Ankle Surg. 2015 Sep;21(3):178-81. doi: 10.1016/j.fas.2014.11.005. Epub 2014 Dec 11.
- López-Gavito E, Gómez-Carlín LA, Parra-Téllez P, Vázquez-Escamilla J. Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis. Acta Ortop Mex. 2011 Nov-Dec;25(6):380-5.
- Gaweda K, Tarczynska M, Krzyzanowski W. Treatment of Achilles tendinopathy with platelet-rich plasma. Int J Sports Med. 2010 Aug;31(8):577-83. Epub 2010 Jun 9.
- Alderman DD, Alexander RW. Advances in regenerative medicine: high-density platelet-rich plasma and stem cell prolotherapy for musculoskeletal pain. Practical Pain Management. 2011:11(8);49-90.
- Alderman DD, Alexander RW. Harris G, Astourian PC. Stem cell prolotherapy in regenerative medicine: background, theory and protocols. J Prolotherapy. 2011;3(3):689-708.
- Baghaban Eslaminejad M, Malakooty Poor E. Mesenchymal stem cells as a potent cell source for articular cartilage regeneration. World J Stem Cells. 2014;6(3):344-354.
- Bahney CS, Miclau T. Therapeutic potential of stem cells in orthopedics. Indian J Orthop. 2012;46(1):4-9.
- Evans CH. Advances in regenerative orthopedics. Mayo Clin Proc. 2013;88(11):1323-1339.
- US Department of Health and Human Services. Stem Cell Basics: Introduction. In: Stem Cell Information. Bethesda, MD: National Institutes of Health, 2015.
- Wyles CC, Houdek MT, Behfar A, Sierra RJ. Mesenchymal Cell Based Therapy for osteoarthritis: current perspectives. Stem Cells Cloning. 2015;8:117-124.
BMAC: Procedure Snapshot
Bone marrow–derived MSC therapy, BMAC. First, a local anesthetic is applied to numb the area of extraction. The bone marrow is extracted from the back of the patient's pelvis or hip bone using a special needle developed for bone marrow extraction. The collected marrow is filtered and spun in a centrifuge to separate the platelets and stem cells to produce the bone marrow aspirate concentrate (BMAC). The cells are not altered with additives or manipulated. The BMAC is then injected back into the patient's site of injury guided by ultrasound where MSCs are able to differentiate into all the different cell types within a joint and moderate the local inflammatory response. This same-day treatment takes about 1-2 hours. Typically 1 treatment, often with platelet-rich plasma given during the treatment or at follow-up, is sufficient.
Applications
- Osteoarthritis. Traditional treatment has primarily been to mask the pain with drugs (eg, NSAIDS or cortisone) or other treatments. Cell-based therapy distributes to damaged tissue the cells naturally used by the body to regenerate or re-grow tissue, reducing further damage and accelerating healing. In many cases, cell-based therapy can prevent the need for replacement surgery.
- Ligament and tendon injuries. Damage to these tissues is generally difficult to treat as they have poor blood flow, which is apparent from their white color. Muscles, on the other hand, are red because they have a very good blood supply. The lack of adequate blood flow makes ligaments and tendons prone to incomplete healing from injury.
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Muscle tears. Muscle tissue heals more quickly and thoroughly when regrowth of tissue is enhanced with bone marrow aspirate concentrate, BMAC, injected into the injury. Acceleration of healing helps to prevent further tissue damage caused through natural use of the muscle.
Common conditions treated:
- Osteoarthritis
- Degenerative joint disease
- Spine arthritis
- Meniscus tears
- Tendon tears
- Back pain
- Tendinitis
- Tendon pain on thumb side of wrist (De Quervains Tenosynovitis)
- Labrum tears
- Hamstring strains
- Ligament sprains, strains, and tears
- Tennis and golfers elbow
- Plantar fasciitis
- SI joint problems
Leader in orthobiologic treatment for musculoskeletal conditions
Dr. Minotti began performing Orthobiologic Therapy in 2007 and has treated hundreds of patients with amazing success. 82+% of his patients have found significant relief from pain and restoration of musculoskeletal function. The use of orthobiologics in treatment of musculoskeletal conditions is an emerging field with evidence if its success accelerating rapidly. Research examining the complex biological mechanisms of cellular health and tissue regeneration is extensive, particularly the behavior of platelets, stem cells, immune system cells and natural growth factors in the blood. The clinical application of Regenerative Orthopedics has demonstrated promising results and a high safety profile.
Dr. Minotti is Board Certified and specialty trained in Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine by the American Board of Neuromusculoskeletal Medicine. He holds numerous certificates from the Interventional Orthopedics Foundation and is in the process of completing Interventional and Regenerative Orthopedic Medicine Certification (IROM-C) from the American Academy of Orthopedic Medicine and the Orthohealing Method.
Many scientists believe the concept of intrinsic healing is a new frontier. Medicine is changing. The wonders of the human body and its ability to balance and heal itself are at the center of this medical renaissance.
FDA APPROVAL
Scientific advances in the understanding of how the body actually heals through tissue regeneration, combined with rapid developments in stem cell biology, have truly created a renaissance in medical treatment. Stem cells, like other medical products that are intended to treat, cure or prevent disease, require U.S. Food and Drug Administration (FDA) approval before they can be marketed. At this time, only cells harvested from the patient’s own body and that are only minimally manipulated have been approved by the FDA.
Additionally, devices that allow physicians to minimally manipulate blood, bone marrow and adipose tissue for the treatment of orthopedic conditions also require FDA approval. NTXMSK recognizes and welcomes the FDA’s important role in assuring patient safety. All of our treatment protocols are compliant with the published FDA guidelines regarding the use of human cells, tissues, and cellular or tissue-based products.