Regenerative medicine uses the natural healing capabilities of stem cells to help repair injured tissues. One of the biggest challenges facing practitioners of this exciting new medical subspecialty is helping patients understand that not all stem cells are the same.
The ABC’s of Stem Cells
Stem cells are unique because they have the ability to renew themselves and become different kinds of cells that are needed by the body. In fact, they are the only cells in the body that are capable of generating new cell types.[i]To better understand what kind of stem cells are used for orthopedic conditions, it is helpful to know that there are several different types.
Embryonic stem cells are derived from an embryo that develops from fertilized human eggs in the laboratory. They are used for research purposes only.There are no FDA approved treatments that use embryonic stem cells.
Stem cells derived from birth tissue products such as umbilical cord blood are approved for use in blood cancers and other blood disorders like sickle cell disease.However, the stem cells from umbilical cord blood and amniotic fluid are not approved by the US Food and Drug Administration (FDA) for any orthopedic indication. The safety and efficacy of these products have not been tested in orthopedic conditions and the FDA does not permit their use.
Mesenchymal stem cells (MSCs) are a specific type of adult stem cell that have the ability to differentiate into bone, cartilage and muscle cells.[ii] These stem cells are found in all tissues of our body in limited quantities, but they tend to exist in higher amounts in the bone marrow and adipose tissue (fat).For orthopedic applications, your physician may obtain these cells from your own (autologous) bone marrow or adipose tissue (fat).These tissues not only contain mesenchymal stem cells, they also contain other cells that are anti-inflammatory and regenerative. Once these cells are injected, they release hundreds of molecules that decrease inflammation, fight infection and repair injured tissues.
The Body: A Constant Work in Progress
There are more than 37 trillion cells in our body which are constantly dying and being replaced. There are more than 200 types of cells in our body and they each have different lifespans. Platelets live for a week, red blood cells live for about four months, bone and muscle cells live about 25 years, while brain cells can live a lifetime.
An injury or disease can hasten the death of cells. But often, the wear-and-tear of the natural aging process cause tissues to become damaged.Stem cell treatments enable regenerative medicine specialists to boost the body’s own natural healing abilities by bringing concentrated doses of these powerful building blocks directly to the site of injured or degenerated joint, cartilage or tissue.
Although regenerative medicine is a relatively new specialty within the field of orthopedics, cell-based treatments have been shown to be an effective non-surgical option for patients who have failed standard treatments or want to avoid surgery.
By combining the body’s own powerful healing capabilities with the latest in scientific and medical technology, orthopedic stem cell therapies provide lasting pain relief and help patients live their life fully.
Drs. Christopher Rogers and Mary A. Ambach have been providing cellular treatments for orthopedic conditions for more than three decades. Their clinical outcome data reveals that the majority of their patients are satisfied and successfully respond to these orthobiologic therapies which also demonstrate excellent safety.
The human body is programmed to heal. Whether it is recovering from a small scrape or from major surgery the body’s initial response to any kind of injury or trauma is to kick into healing mode.
But sometimes it can use a little help. And that is what cell-based therapies offer.
How Cell-Based Therapy Works
Cell-based therapy assists the body to heal injured tissues. This is especially useful for the treatment of injured tendons, ligaments and joints. Cell-based therapy delivers targeted healing factors that are taken from the patient’s own cells to boost the body’s ability to speed healing and recovery.
There are several treatments options available, and each one offers unique benefits that enable your physician to choose the best option for you.
Platelet Rich Plasma therapy concentrates platelet cells from the blood and delivers them to the injured tissues. These cells are rich in growth factors that are needed to initiate the body’s healing and repair processes. Using a patient’s own blood, the platelets are separated and concentrated. They are then placed into the injured area to boost healing.
Prolotherapy delivers a targeted solution of concentrated dextrose and local anesthetic to injured ligaments, tendons or joints. The body responds to the dextrose solution as an irritant which, triggers healing responses that had stalled prematurely.
Stem Cells are found throughout the body and are activated when an injury occurs.Tissue harvested from the patient’s own bone marrow or adipose (fat) contain mesenchymal stem cells (MSCs). They activate healing by producing molecules that direct other cells in the area to form new blood vessels, awaken resident progenitors and stimulate new tissue growth.Cells can be obtained from several sources, however, only bone marrow and adipose (fat) tissue are FDA-compliant for orthopedic indications. Umbilical cord blood products are not approved by the FDA and not supported by clinical research for orthopedic use.
What to Expect While Recovering from Therapy
Unlike major surgery, cell-based therapies do not require hospitalization. They are performed in our office procedure suite with local anesthetic.Recovery usually takes less than 4 days from these minimally invasive procedures.
There may be some swelling and discomfort in the injected area, but these symptoms typically lessen within a few days.Patients begin physical therapy to regain strength and range of motion within the first few weeks. Depending on the extent of the original injury, as well as the specific treatment used, some patients are able to resume their normal activity levels just days after their procedures.
Staying well hydrated and following a nutrient-rich diet are key to overall wellness and are especially important before and after these treatments since the body’s requires high-quality fuel to power their healing efforts.
San Diego Orthobiologics Medical Group is a leader in regenerative medicine therapies and offers a great variety of treatment options depending upon each patient’s unique needs. With decades of experience in the field of minimally invasive interventional treatments, Drs. Christopher J. Rogers and Mary A. Ambach are experts in the field of regenerative medicine. They serve as faculty members and lecturers at national and international medical conferences and serve on the board of directors for several national regenerative medicine organizations.
Anyone considering stem cell therapies should carefully consider their options when researching medical clinics that claim to offer such treatments.You may recall the news stories that were reported last year on cases of infection following stem cell injections.They reported that 17 people in five states were hospitalized with serious infections following injections of umbilical cord blood derived products.All but two of the illnesses were linked to a single company in California [i].
Are All Stem Cell Therapies the Same?
Before consenting to a stem cell injection, we recommend that you ask your physician the following questions:
What kind of stem cells do you use?
Umbilical cord blood products [ii] are not approved by the US Food and Drug Administration (FDA).The safety and efficacy of these products have not been tested in orthopedic applications.However, your own cells can be used when harvested from a patient’s own (autologous) bone marrow or adipose tissue (fat). These cells contain high levels of mesenchymal stem cells (MSCs) and other orthobiologics that contain anti-inflammatory and regenerative properties.
San Diego Orthobiologics Medical Group offers several different treatment options for autologous cell based therapy.These treatments include Bone Marrow Aspirate Concentrate (BMAC), Microfragmented adipose tissue (MFAT), Platelet Rich Plasma (PRP) and Endoret Plasma Rich in Growth Factors (PRGF).Each treatment offers different benefits to suit a patient’s unique orthopedic needs.We do not use donor (allogeneic) products derived from birth waste tissues (like umbilical cord blood, amniotic fluid, exosomes, or placenta) because they have not been tested for safety or efficacy and are not compliant with current FDA guidelines.
How do you process the cells?
Many clinics use basic centrifuges to separate stem cells, but the best method for obtaining the highest concentrations of regenerative autologous stems cells requires specialized equipment operated in a sterile lab setting.
San Diego Orthobiologics Medical Group established a state-of-the-art facility in Carlsbad that contains some of the most advanced Regenerative Medicine technology in the San Diego area.We process autologous same day platelet rich plasma, regenerative cell concentrates and other orthobiologics safely and at a customized dose in our Regenerative Medicine Lab.
How effective are your treatments?
Clinics or practices that sell donated stem cells do so at some risk to your health.These products are not tested for sterility or viability.Independent testing of these products has shown that they do not contain any live stem cells at all. Only live stem cells can exert the sought after beneficial therapeutic effects.These products have not been demonstrated to contain any healing properties in clinical studies.
San Diego Orthobiologics Medical Grouponly uses your own bone marrow or fat tissue and is able to process them using state-of-the-art technology.Same-day treatments maximize the healing potential of the fresh (not frozen) regenerative cells.
Is there scientific evidence to support your claims?
Clinics that use autologous cell based treatments are not afraid to participate in clinical trials—in fact they welcome the opportunity to do so—because they know it is important to study these treatments for safety and efficacy.
Based on our extensive experience treating orthopedic conditions with regenerative medicine therapies, San Diego Orthobiologics Medical Group is one of only six clinics in the United States selected to participate in FDA-approved clinical trials to treat knee osteoarthritis.Visit our website (Research section) for an extensive list of peer-reviewed published articles from prestigious medical journals about the different kinds of cell based therapies we offer.
It should be clear that the answer to the question “Are all stem cell therapies the same?” is a resounding “No!”.Anyone considering treatment should understand what works and what does not work.What is safe and what is risky.What is FDA compliant and what is illegal.We believe that patients deserve honest answers to these tough questions.
With decades of experience in regenerative medicine, Drs. Christopher J. Rogers and Mary A. Ambach are recognized experts in the field of Regenerative Medicine. They continue to advance the field by participating in clinical trials and serve as faculty members and lecturers at national and international medical conferences. They also serve on the board of directors for several national regenerative medicine organizations.
Your body has an amazing ability to heal itself. Over the last decade, significant advances in Regenerative Medicine have led to a greater understanding of healing. This knowledge allows us to stimulate healing using your own stem cells and other orthobiologics. The new science of Regenerative Medicine supports and enhances your body’s natural abilities in ways never before thought possible.
More and more scientific articles are published each year demonstrating the effectiveness of Regenerative Medicine. For example, there is now validated scientific evidence that platelet rich plasma is more effective than surgery for certain forms of tennis elbow, lower back pain, and knee osteoarthritis. More importantly, our patients have shared their life-changing results with us every day.
Scientific studies have demonstrated the safety of using your own cells to treat many different kinds of orthopedic conditions. Unlike prescription medications, Regenerative Medicine therapies do not cause side effects or allergic reactions. Unlike surgery, we do not disrupt healthy tissue which minimizes the risk of injury or infection.
Actual Healing, Not Just Pain Relief
Many traditional forms of medical care simply mask pain. Regenerative Medicine actually leads to healing. Once the injury is healed and rehabilitated, no further treatment is necessary.
More Comfortable than Other Forms of Treatment
Most Regenerative Medicine treatments involve office based procedures and do not require anesthesia. To minimize discomfort we use local anesthesia and, rarely, mild sedatives. Our doctors are experts in interventional procedures and can perform your treatment quickly and comfortably.
Evidence Based Therapy
Researchers are making new discoveries every week. But those advances don’t always translate into clinical solutions. Our physicians are knowledgeable in the field of Regenerative Medicine and do not leap recklessly to offer unproven treatments. We only offer medical treatments that are deemed safe and effective.
Many professional athletes have turned to Regenerative Medicine therapy as a way to quickly recover from a sports injury. Unlike surgery which may require several months to completely recover, Regenerative Medicine treatments require only a few days of down time.
Safe to Repeat
Corticosteroid injections and surgery can result in difficulties when repeated. Most patients improve from a single Regenerative Medicine treatment, however it is safe to repeat if necessary.
Saves Time and Money
Regenerative Medicine therapies are cost effective and save time. Most of our patients have alreadly tried multiple forms of other treatments such as chiropractice care, physical therapy or surgery. These forms of therapy can be time consuming and expensive. After a Regenerative Medicine physician has made an accurate diagnosis, treatment often results in resolution of the problem without the need for additional costly therapies.
Regenerative Medicine therapy fills a critical gap in the conventional medical model. Many patients have not responded to conservative care, but are not candidates for surgical care either. In the past, these patients were told to “just live with the pain”. Regenerative Medicine therapy has offerred new solutions and real hope for these patients.
Stem cell therapy augments your body’s natural healing capacity to reduce pain and improve function after a tendon, joint, disc or ligament injury. Stem cell therapy may also reduce the pain from inflammation of osteoarthritis.
At San Diego Orthobiologics Medical Group, we use the latest in cellular biology and orthopedic clinical research to optimize your care. We use advanced technology to harvest, process and administer stem cells to maximize your results. Because we use your own cells to stimulate healing, each treatment is unique and must be customized to your personal situation.
QUESTIONS FOR YOUR DOCTOR
Regenerative Medicine is an exciting new field that will forever change the way we treat orthopedic injuries. Many physicians are excited to leap into this field with varying levels of knowledge and experience.
So how do you, the patient, decide if you are a good candidate for this therapy. And who should you decide to use as your treating physician? We suggest that you ask your doctor the following questions to help you understand your care.
How much experience do you have treating musculoskeletal injuries?
Musculoskeletal injuries are best managed by specialists in the field of sports medicine. These include board certified physical medicine and rehabilitation physicians (physiatrists), orthopedic surgeons, and fellowship trained sports medicine physicians. It takes years to gain the experience and knowledge necessary to appropriately treat these kinds of injuries.
Accurate diagnosis is essential to successful treatment. And, in many cases, it is necessary to exhaust all conventional forms of treatment before even considering PRP therapy.
Dr. Rogers graduated as chief resident of the University of Texas, Health Science Center in San Antonio, Texas Physical Medicine, and Rehabilitation program in 1997. He completed a nonsurgical interventional spine fellowship in 1998 before joining the University of California, San Diego Orthopedic Surgery Department as an assistant clinical professor. He has practiced nonsurgical musculoskeletal medicine in private practice since 2000 and has treated more than 80,000 people just like you.
How much experience do you have with Stem Cell Therapy?
Stem cell therapy is a relatively new technology to orthopedics and our field is learning more about it all the time. Dr. Rogers was the first physician in San Diego to use an FDA compliant adipose stem cell transplant technique for his patient with knee osteoarthritis. The protocols and algorithms that he uses have been shaped by his experience and the current medical literature to produce the best results possible. Dr. Rogers has been teaching stem cell therapy to physicians at the Regenerative Medicine Therapy Institute, the BREG musculoskeletal ultrasound course and The Orthobiologic Institute (TOBI) courses since 2014.
It is not a bad idea to ask your doctor how he or she stays up to date on Regenerative Medicine. As this is a new field, most physicians did not receive any specialized training in medical school. Doctors advance their knowledge by participation in continuing medical education, reading medical journal articles or attending Regenerative Medicine conferences. This discussion will give you an idea of the commitment your doctor has made in this emerging field. Dr. Rogers has attended more than two dozen Regenerative Medicine conferences and met with physicians from all over the world.
How much experience do you have with diagnostic musculoskeletal ultrasound and fluoroscopic (digital x-ray) guidance?
Administration of stem cell therapy with high precision and comfort leads to better outcomes and reduces the likelihood of additional expensive or risky procedures. Diagnostic ultrasound has radically changed the practice of orthopedic medicine allowing for better diagnostics and improved comfort with office based treatments.
For more than a decade, Dr. Rogers has trained his fellow physicians in the proper use of diagnostic musculoskeletal ultrasound. Dr. Rogers currently teaches musculoskeletal ultrasound at the BREG ultrasound courses, the American Academy of Physical Medicine and Rehabilitation workshops, and the OrthoBiologic Institute (TOBI) courses. He utilizes the most advanced diagnostic ultrasound equipment for his patient care.
All stem cell therapy of the spine should be performed with fluoroscopic guidance (x-ray). Dr. Rogers completed a fellowship in fluoroscopic guided spinal injections in 1997. Since that time he has performed tens of thousands of spinal injections and trained physicians from all over the world.
What kind of stem cells will you use?
There are many methods used to harvest, process and deliver stem cell therapy. The cost and clinical results of each method vary widely as well. The healing response is largely determined by the concentration and quality of the cell harvested and the method used to deliver them to the injury site. Improvements in your condition may be slower or faster depending upon the method used to process your cells.
At San Diego Orthobiologics Medical Group we only use cells from your own body. The cells may be derived from your bone marrow or fat tissue. Your stem cells will not be manipulated or altered with enzymes. The cells are administered on the same day that they were removed.
We do NOT use cells obtained from a donor. We do NOT use cells from embryos or fetal tissues. Some physicians believe that donated amniotic fluid or fetal membranes contain living stem cells. But, at the time of this writing, they do not. When tissue obtained at the time of birth is sterilized with freezing or other techniques, any living stem cells do not survive the procedure. Independent testing has demonstrated that no cells are contained in this fluid.
Nutritional status, hormonal status, exercise, medications, and supplements all influence the quality of your cells and your healing potential. Prior to performing stem cell therapy, we will often need to assess and modify these factors to improve your results.
What system (s) do you use to harvest and process your stem cells?
There are several commercially available products that assist in the harvesting and processing of stem cells. The cost of each system varies and more sophisticated systems are generally more expensive. However, more sophisticated systems will allow your physician to customize your treatment and optimize the results. At San Diego Orthobiologics Medical Group we use four different cell concentrating systems depending upon the goals of treatment. We use closed systems which eliminate the risk of contamination from airborne particles.
Furthermore, we can measure the cell concentration which allows us to better understand why treatment results may vary from one person to the next.
Will you combine stem cell therapy with any other form of therapy?
Stem cell often functions very well as a stand-alone treatment. However, many times additional forms of treatment need to be performed at the same time to maximize outcomes. This may include physical therapy, bracing, nutrition, and supplements, or electromagnetic therapies.
How many treatments will I need?
More than 95% of our patients only require one treatment and will see results for years. More challenging conditions may require repeat treatments or be combined with other cellular-based therapies.
Have you ever had a complication?
Stem cell is considered to be a very safe procedure. It is certainly safer than most other orthopedic treatments and surgery. Potential complications include pain, infection, fever, allergic reaction, swelling, tissue injury, and a failure to relieve symptoms. At the San Diego Orthobiologic Medical Group, we have never had a significant complication with any procedure in more than 20 years.
Do I have any reason to not consider stem cell therapy?
Some people are just not a candidate for stem cell therapy. Their condition may be too advanced and other more conventional therapy such as surgery may need to be considered. Contraindications to stem cell therapy include active infection or cancer, pregnancy, very low platelet count, fever, anemia with symptoms, or use of certain medications.
Will you combine exercise or physical therapy with my stem cell therapy?
This important step is often overlooked by some medical clinics. Exercise is crucial to expedite and maximize healing with stem cell therapy. Stem cells simply address incomplete healing of specific tissues, whereas stretching and strengthening are necessary to restore function to the entire joint. We have developed physical therapy protocols that you can do at home or with your therapist to allow the restoration of mobility, strength, and endurance.
How long will it take for my condition to improve after treatment with stem cells?
This depends on the severity of your injury and your ability to regenerative healthy tissue. Some people heal very quickly and others more slowly. However, on average most people feel some significant improvement within six to eight weeks. Healing will continue for many more months after treatment. Many studies have demonstrated continued healing for up to a year.
What are your clinical results?
Very few medical practices track clinical outcomes. Although there are several clinical outcome studies in the medical literature, consensus regarding the exact types of therapy to use for a specific condition does not exist. Therefore, it is critical that each physician tracks the results of their treatment and share this information with prospective patients. At San Diego Orthobiologics Medical Group we have been tracking our results for years.