Stem Cell Therapy
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. They act as an unlimited supply of repair cells, continually dividing throughout our lifetime.
With increased age or chronic injury, sometimes the optimal amount of stem cells is not delivered to an injured area. The goal of Stem Cell Therapy is to amplify the natural repair system to keep pace with these demands and maintain healthy function of soft tissue of the musculoskeletal system.
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.
Mesenchymal stem cells (MSCs)
Science has shown that therapy using MSCs is an especially good option for treating musculoskeletal conditions involving lost or damaged tissue. MSCs are able to differentiate into all the different cell types within a joint and to moderate the local inflammatory response. They have the ability for self-renewal over long periods of time.
What procedure is best for me?
Bone marrow stem cells
Science has discovered that both bone marrow cells are rich in MSCs. These can be harvested from the patient’s body and injected in a condensed form into an injured site.
Mesenchymal stem cells (MSCs) found in adult bone marrow are extracted from the back of the patient's pelvis or hip bone using a special needle developed for bone marrow extraction. FDA-approved devices concentrate the bone marrow into what is called “Bone Marrow Aspirate Concentrate” (BMAC). The cells are not manipulated or altered with additives. These adult stem cells are considered multipotent stem cells, so are able to differentiate into the type of cell into which they are injected.
Umbilical stem cells
Cellular health of the recipient’s tissue helps to determine effectiveness of injected cells as well as length of time these cells will survive and continue to replicate. The age of BMSCs is a relevant factor as stem cells age similarly to other cells in our body. These factors are responsible for the increasing popularity of umbilical cord stem cell (USC) treatments. Elimination of the harvesting process is an additional benefit of USC treatment.
Many patients choose to avoid the harvesting process necessary for bone marrow therapy and opt for MSCs that are derived from umbilical cord blood. Umbilical blood consists of two types of stem cells:
Blood-forming stem cells (hematopoietic progenitor cells) that have been used for several decades in treatment of blood disorders.
- Mesenchymal cells, a second type discovered more recently, that are currently the subject of clinical trials.
Umbilical stem cells are naïve, meaning they can divide indefinitely. More importantly, growth factors that are contained in the blood, along with stem cells, aid in the formation new blood vessels, activation of endogenous stem cells, modulation of the immune system, and growth of cells and tissue.
- 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 Stem Cell 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 Stem Cell 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 Stem Cell 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 Stem Cell Therapy?
A. Stem Cell Therapy costs vary with type and location with ranges from $3800- $7000. 50% discount is offered for second site.
More Information on Stem Cell 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. Stem cell 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 stem cell therapy for osteoarthritis: current perspectives. Stem Cells Cloning. 2015;8:117-124.
Stem Cell Therapy: Procedure Snapshot
Bone marrow–derived MSC therapy. 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 it can begin its accelerated regenerative healing. 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.
Umbilical fluid- derived MSC therapy.
A local anesthetic is applied to the site of injection. The stem cell solution is then injected using ultrasound guidance directly to the injury and the surrounding tissue. The procedure takes about one hour, and you return home following the procedure. Most patients find desired results after 1 treatment, but some chose to follow-up with a PRP booster to continue enriching cells with nutrients and growth factors contained in their own blood.
- Osteoarthritis. Traditional treatment has primarily been to mask the pain with drugs (eg, NSAIDS or cortisone) or other treatments. Stem Cell Therapy distributes to damaged tissue cells needed to regenerate or re-grow tissue, reducing further damage and accelerating healing. In many cases, Stem Cell 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.
Muscle tears. Muscle tissue heals more quickly and thoroughly when regrowth of tissue is enhanced with MSCs injected into the injury. Acceleration of healing helps to prevent further tissue damage caused through natural use of the muscle.
Common conditions treated with Stem Cell therapy include:
- Degenerative joint disease
- Spine arthritis
- Meniscus tears
- Tendon tears
- Back pain
- 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
All of our biological procedures are performed on the same day with minimal manipulation of blood, bone marrow, or adipose tissue & are therefore compliant with FDA CFR 21 Part 1271, falling under the same surgery exemption in FDA rule in 1271.15 (b).