To treat certain orthopaedic conditions, Tucson Orthopaedic Institute is now providing regenerative medicine procedures, including dextrose prolotherapy, platelet-rich plasma (PRP), and mesenchymal stem cell (MSC) injections. Our physicians have experience in both traditional and minimally invasive techniques.
Dextrose prolotherapy is a form of injection therapy designed to stimulate healing. It works by causing temporary, low grade inflammation that increases the level of growth factors at the injection sight and initiates a healing cascade. This healing cascade results in the repair of soft tissue structures, such as ligaments and tendons. Dextrose prolotherapy is a long-term solution to musculoskeletal injuries and pain. It is effective in ligament and tendon pathology and also helps to stabilize arthritic joints. For prolotherapy treatment, please schedule an appointment with Dr. Taduran.
Platelet Rich Plasma (PRP), like dextrose prolotherapy, is a form of injection therapy designed to stimulate healing. Unlike dextrose prolotherapy, PRP is produced after drawing blood from the patient and placing it in a special centrifuge that separates and concentrates the platelets. Platelets contain multiple growth factors that are critical for natural healing. Enhanced healing occurs when platelet concentration is increased with PRP. Our final PRP product produces greater than 4x the platelet concentration of normal circulating blood. The PRP is then injected into ligaments, tendons, muscle, or joints and a healing cascade occurs. PRP is a long-term solution to musculoskeletal injuries and pain, including arthritic joints. For PRP treatment, please schedule an appointment with Dr. DeWald or Dr. Taduran.
The Uniqueness of Stem Cells
Stem Cells have several unique abilities. They can transform into other cell types, such as bone, cartilage, muscle and tendon. And they also serve an important signaling functioning, recruiting other stem cells to the target area and triggering nearby cells to begin the repair process.
What are Adult Mesenchymal Stem Cells?
Stem Cells are undifferentiated cells that have the potential to become other, more specialized types of cells. Stem cells are broadly categorized as either “embryonic” or “adult.” As the name implies, embryonic stem cells are derived from human fetuses, whereas adult stem cells are obtained from, well, adults!
Currently, there are over 70 proven therapies using adult stem cells, while there are none using embryonic stem cells. This is in part because scientists have had tremendous difficulty controlling how embryonic stem cells differentiate; they have a nasty habit of causing tumor formation, including teratomas. Adult stem cells, on the other hand, do not suffer from this pitfall.
Mesenchymal stem cells, or MSCs, are multipotent stem cells that can differentiate into a variety of cell types, including: osteoblasts (bone cells), chondrocytes (cartilage cells) and adipocytes (fat cells). This has been demonstrated in ex vivo cultures and in vitro or in vivo. MSCs are obtained from the bone marrow, most commonly the back of the iliac crest (the “hip bone”)
How Are MSCs Obtained?
Harvesting MSCs for injection therapy is done right in the office. Stem cells can be obtained from the bone marrow or fat tissue. The skin is numbed first with lidocaine. Next, the hip bone is numbed with more lidocaine. A special needle is then passed through the cortex of the bone into the marrow cavity. This is a painless procedure in most cases. The liquid marrow is then very slowly drawn into a syringe. Once an adequate amount of liquid marrow is obtained, the needle is removed and a bandage applied.
To see a brief animated video of how the procedure is performed, click this here. The entire procedure takes about 20 minutes and it is minimally uncomfortable.
In the case of moderate-to-large tendon and muscle tears, such as rotator cuff, tennis elbow, and Achilles, stem cell treatment alone may be less effective because the liquid stem cell solution has less tendency to stay in the tear; it leaks out. In order to combat this, we often will combine stem cells with fat concentrate to create a gel that fills the defect and promotes more effective healing.
Likewise with more advanced joint arthritis, the fat acts a matrix to help hold the platelets in place and also helps activate them to release their growth factors more effectively. Think of a garden trellis that helps hold a growing vine in place. In fact, for moderate-to-advanced arthritis, our standard treatment is to combine the stem cell solution with the fat due to the fact that it seems to work that much better than stem cells alone.
The fat is harvested from the patient’s belly, buttocks, “love handles,” or hips using a gentle liposuction technique. The fat is processed while you wait to help liberate the stem cells and other supporting cells in the fat. The resulting gel fills the tear in the case of tendons/muscles and helps maintain more constant contact with the joint surfaces in the case of arthritis. An overview can be seen here.
How Are Stem Cell Injections Given?
All of our stem cell, PRP, and prolotherapy injections are given under direct ultrasound guidance. We first numb the skin with lidocaine. Then, using ultrasound, we guide the needle to the precise location and inject the stem cells. The ultrasound guidance ensures both accurate and safe injections.
Following injection, for weight-bearing joints (ankles/feet, knees, hip) patients need to avoid bearing weight for 24-72 hours. But it is critical that the joint NOT be immobilized. Gentle protected movement is critical to stimulate healing. For non-weight bearing joints, gentle protected movement is generally encouraged, but forceful or aggressive activity, such as sports, is prohibited. Your doctor will give you more specific post-injection activity guidelines.
What Conditions Might Benefit From Stem Cell Injections?
Stem cell injections are most commonly used for the treatment of conditions that have failed or responded incompletely to other more conservative treatments. Conditions include, but are not limited to:
• Osteoarthritis of the joints
• Chronic partial Rotator Cuff Tears
• Persistent partial tendon tears, such as tennis elbow, plantar fasciitis, quadriceps and patellar tendon tears.
• Partial muscle tears
• Meniscal and labral (cartilage) tears in the knee, hip and shoulder
• Chondromalacia patella (patellofemoral syndrome)
Are There Risks Associated With Stem Cell Treatment?
Any injection is potentially at-risk for causing infection, bleeding, nerve damage. Risks will also vary depending on the structure(s) being injected. However, because we are using your own cells, you cannot be allergic to the treatment! Also, because the injections are done under ultrasound guidance, the risks of damaging surrounding structures, or of injecting the wrong location, are almost completely eliminated. Your doctor will review the complete risks of treatment with you. Nonetheless, the risks of treatment are extremely low.
Are Stem Cell Treatments Covered by Insurance?
Currently stem cell injections are still considered experimental. Most insurance plans, including Medicare, do NOT pay for stem cell injections.
When Can I Expect to See Improvement?
On average, most patients start to see signs of improvement approximately 6-8 weeks after the completion of the complete treatment protocol. This can be less overall pain, an ability to do more activity before pain sets in, and/or faster recovery from pain.
What is the Success Rate?
Studies suggest an improvement rate as high as 80-90%, though some arthritic joints, namely the hip, do not respond as well. Some patients experience complete relief of their pain. In the case of tendon and ligament injuries the results are generally permanent. In the case of joint arthritis, how long the treatment lasts depends partly 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, usually in 1-3 years.
The anecdotal experience in our office closely mirrors that of published studies. Regarding arthritis, our experience is that knees and shoulders respond the best, with 80-90% of patients experiencing improvement. 70% of patients with hip arthritis have a positive response.