Medical research advances enable physicians to find new and innovative ways to use the body’s systems to fight disease and injury.
Regenerative medicine is a field of medicine that uses the body’s own cells and tissues to heal injuries and medical conditions. In the treatment of cancer the cells are used in immunotherapy, which involves modifying patient’s cells to fight the disease. In the field of orthopedics, regenerative medicine specialists use the patient’s own blood cells, bone marrow or adipose tissue to help the body boost its own natural healing properties. These are known as orthobiologics.
At the present time, FDA allows the use of autologous orthobiologics —which means the tissue or cells used must come from the same patient. Donor products are not allowed to be used in clinical setting unless it is used under the purview of a clinical trial. Read here on the FDA guidance on the use of human cells and tissues.
Cell-based Treatments for Orthopedic Conditions
There are two types of cell-based therapies that can be used to treat orthopedic conditions:
Bone Marrow Aspiration Concentrate (BMAC): Bone marrow-derived cells are collected from the back of the pelvic bone. The marrow contains mesenchymal stem cells which have the ability to renew themselves and differentiate into bone, tendon, cartilage and muscle cells. These make them an ideal therapy for treating orthopedic injuries such as tendon tears, worn cartilage, and degenerated disc disease. BMAC also contains important therapeutic cells, growth factors and proteins that stimulate the body’s natural ability to improve circulation, decrease inflammation and heal injured tissues.
Micro-fragmented Adipose Tissue (fat) Cells: Adipose-derived cells are collected from a fat sample usually from the buttock or abdomen. There is minimal manipulation of the tissue with no enzymatic digestion or addition of other biological or pharmacological agents. Fat or adipose tissue is rich in healing cells like mesenchymal stem cells or MSCs, growth factors and other proteins that can assist in healing tissues.
Why Consider Cell-Based Therapies?
There is increasing body of clinical research that demonstrates the safety and efficacy of Cell based therapies. A recent comprehensive report 1 based on actual clinical data collected from 65 physicians at 43 clinics in 25 states revealed that seventy percent of the patients treated with adipose tissue therapy reported a meaningful reduction in pain at 12 months following treatment and sixty-one percent of the patients treated with bone marrow aspirate reported a meaningful reduction in pain at12 months following treatment.
Micro-fragmented adipose tissue or bone marrow aspirate concentrate is a non-surgical treatment option that does not involve incisions, general anesthesia, hospitalizations or lengthy rehabilitation stays. This is an outpatient procedure performed in a doctor’s clinic using only local anesthesia.
Patients considering cell-based therapies should do their research in ensuring they get the best treatment. There are several important factors that can impact the effectiveness of these treatments. These include:
- Cellular product preparation: The patient’s bone marrow or fat tissue must be processed using FDA compliant devices and protocols. It must be prepared in a safe and sterile environment by medical personnel who are trained in the proper handling of these tissues.
- Delivery: The procedure must be performed by skilled physicians who are properly trained in this field. They must be able to perform these highly specialized injection techniques using imaging guidance to ensure that the cellular products are delivered to the site of injury.
- Experience: The field of regenerative medicine is changing daily and there are a limited number of specialists around the country who have the experience and technology to perform cell-based orthopedic treatments safely and effectively. Dr. Mary A. Ambach and Dr. Chris Rogers have decades of experience in using regenerative therapies and are nationally recognized experts in this field.
1Databiologics. An Overview of Regenerative Treatments for Orthopedic Conditions. 2021 Outcomes Report.
Join our free webinar to learn about non-surgical treatments and therapies for rotator cuff tendon injuries. Gain information on cutting edge treatments like platelet-rich plasma (PRP) and other cell-based therapies. Get answers to your questions from experts in the field of Regenerative Medicine.
Dr. Mary Ambach specializes in non-surgical orthopedics, regenerative therapies and interventional pain management. As a key thought leader in the field of Regenerative Medicine, Dr. Ambach conducts research, trains physicians and lectures at international medical conferences.
Dr. Christopher Rogers is one of the world’s leading experts in orthopedic regenerative medicine and a renowned speaker at national medical conferences. He has developed new approaches for the treatment of tendon injuries, osteoarthritis and disc degeneration which provide a safe and viable alternative to surgery.
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Platelet rich plasma therapies and cell-based therapies derived from bone marrow and adipose tissue are giving hope to patients who suffer from conditions such as arthritis, low back pain and sports-related injuries for treating their chronic pain.
Regenerative medicine treatments involve the injection of healthy cells derived from the patient’s own body, known as autologous therapies, to the site of injury. These therapies deliver a concentration of the body’s own unique healing cells, including platelets and adult stem cells, to help repair and support formation of new healthy tissue.
Currently, the U.S. Food and Drug Administration (FDA) does not allow physicians to use stem cell products derived from another person for orthopedic clinical use. Practitioners who follow FDA guidelines only use the patient’s own cells derived from blood, bone marrow or adipose (fat) tissues with nothing more than minimal manipulation to treat orthopedic conditions such as spine and joint pain.
The patient first undergoes a comprehensive medical evaluation to confirm the diagnosis. This includes taking a complete medical history, performing a detailed physical examination and obtaining diagnostic tests such as MRI, X-ray, or any necessary blood tests.
The physician will review the patient’s overall health including medication intake, nutritional status and exercise level. Because the cells used are from the patient’s own body, it is important to ensure optimal health of these cells. Medications that can interfere with cellular function may be discontinued temporarily.
Regenerative cell-based therapies are typically performed in a doctor’s clinic. The first part of the procedure involves collecting the cells from the patient’s body through the following:
- Platelet rich plasma is obtained through a simple blood draw from the arm.
- Bone marrow-derived cells are drawn from the back side of the pelvic bone. A local anesthetic will be used to keep the patient comfortable. Pain medication or anxiety reducing medication may be used if necessary.
- Adipose-derived cells are collected by obtaining a fat sample, usually from the abdomen or buttocks. This is also done using a local anesthetic to keep the patient comfortable.
For more detailed information on the different steps involved in these procedures, you can watch our YouTube channel on how PRP, bone marrow and adipose cell based therapies are prepared.
After the collection, the blood or bone marrow are transferred to a centrifuge machine to isolate and concentrate the cells and healing molecules. Adipose tissue is washed, rinsed and resized using a special FDA-cleared device. When the cellular product is ready for injection, the physician will use an ultrasound or fluoroscopic (X-ray) guidance to precisely deliver the healing cells to the injured area in a safe and comfortable manner.
After the procedure, we observe our patients in the clinic to ensure there are no complications before they leave for home. A responsible adult is required to drive the patient home. As an outpatient procedure, there is no need for hospitalization or lengthy stay in rehabilitation facilities.
Soreness in the injection site can be expected for up to four days after the procedure. Ice, or mild analgesics can be used to ease the discomfort. Wearing a brace may help as well. Patients can continue their regular medications except for non-steroidal anti-inflammatory medications such as ibuprofen and blood thinners. These medications may need to be temporarily discontinued, so it is important that you inform your physician if you are on any of these medications.
Most patients are able to resume normal activities within days. Patients will be prescribed a course of physical therapy to help assist the body in healing.
Healing takes time. Pain may be reduced after a few weeks, however most patients will notice slow, gradual improvement within 3-4 months.
Minimally invasive regenerative cellular treatments using the patient’s own healing cells such as platelets or stem cells are being used to treat conditions that are traditionally managed with medications or surgery. When performed by a qualified regenerative medicine specialist, patients can enjoy years of pain relief and increased activity.
Drs. Christopher J. Rogers and Mary A. Ambach of San Diego Orthobiologics Medical Group together have successfully treated thousands of patients with PRP and cell-based treatments for more than three decades. They are published authors and stem cell researchers. Their facility in Carlsbad contains the most advanced Regenerative Medicine technology in San Diego and offers same day treatments with the highest level of safety and efficacy.