Regenerative Medicine
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Many musculoskeletal injuries and painful conditions can be treated with regenerative medicine which can include, but not limited to:
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Spine: Lumbar, thoracic, and cervical pain from degenerative disc disease, nerve root irritation, disc problems, facet arthritis, and ligament instability
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Knee: Osteoarthritis, meniscal tears, ligament injuries, including partial ACL tears, cartilage injuries and chondromalacia
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Shoulder: Rotator cuff partial and complete tears, labral tears, osteoarthritis, avascular necrosis, conditions causing impingement
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Hip: Osteoarthritis, labral tears, tendinopathies, including outer hip pain, posterior hip pain, hamstring injuries, and avascular necrosis
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Elbow, Wrist, and Hand: Tennis elbow, golfer’s elbow (tendinopathies), ligament tears, TFCC injuries, thumb, finger, and wrist osteoarthritis
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Foot and Ankle: Achilles tendon tears and tendinopathy, plantar fasciitis, ankle osteoarthritis, tendon or cartilage injuries, ligament sprains
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Nerves: All nerve entrapments including median and ulnar nerve conditions such as carpal tunnel syndrome
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What improvements can be expected with regenerative medicine?
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Decreased pain
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Decreased need for pain medication
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Improved function
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Increased activity
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Decreased clicking or grinding of a joint
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Improved mood
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Increased exercise tolerance
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Decreased tenderness in the area of pain.
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What information will I get at the initial consultation?
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At your initial consultation, your regenerative medicine specialist will assess your specific condition and determine if you are a good candidate for a regenerative procedure. You will be given an idea of how many treatments you will need, how often they will be required, and what response you can expect.
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What is a realistic expectation of treatment?
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Experiencing occasional pain is part of the normal human condition. The goal of regenerative medicine is to decrease pain and increase function so you can have more good days than bad days. Regenerative treatments can improve body structures for several months after the last treatment.
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What is the success rate for regenerative therapies?
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Taking into consideration the patient’s condition and realistic expectations, the success rate for regenerative therapies is excellent based on our clinic experience and research studies.
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Is it covered by my insurance?
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Much of what we do at PICSM is submitted to your insurance company, but as a general rule, regenerative-type procedures are considered “experimental procedures” by most commercial insurance plans in Montana. Depending on the procedure this is an evolving process. You may be able to use your health savings account (HSA) for payment with some insurance plans. Contact your program administrator to discuss using your HSA. Remember, just because something can be submitted to your insurance, does not mean it's the best treatment for you. Take your health seriously, and think of both short- and long-term consequences, for your health and financially.
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What risks are involved?
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For any needle-based procedure, any time the skin is broken you run a risk of infection. We use sterile techniques for our procedures and have an excellent track record of success. Allergic reactions to medications or antiseptic solutions is the other major risk. Some unique procedures may pose additional risks, but these will be addressed with each patient based on the situation.
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How long do I have to stay for the procedure?
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There is virtually no downtime with these outpatient procedures. The entire process will take anywhere from 1 to 2 hours, depending on the procedure.
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Will I need someone to drive me home?
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Our patients generally can ambulate out of the clinic post procedure. Depending on whether your treatment will require protective bracing, you may feel more comfortable having someone drive you home. If you have light sedation with medication or laughing gas, we do recommend that you have a driver. With winter roads, Montana’s changing weather, and or if you’re driving a significant distance, be sure to allow yourself plenty of extra travel time before and after your procedure. We encourage you to do what feels best for you and consult with your doctor if you have any questions.
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Prolotherapy
Considered one of the first regenerative therapies, prolotherapy has been around for more than 80 years. Prolotherapy is a treatment used to strengthen and heal joints, tendons, and ligaments. It helps the body heal itself. This is accomplished by injecting natural substances (sugar and salt solutions) into the body to help stimulate the body’s own repair system.
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The body heals by reacting to inflammation. When an athlete undertakes a hard workout and experiences pain afterward, this is because the workout has inflamed the muscles. The normal healing reaction is what will repair the damage from the workout and cause the muscle fibers to become bigger, stronger, and enjoy more blood supply. Prolotherapy, like exercise, can cause tendons and ligaments to become stronger and thicker. This can help stabilize the joint. Once the joint is stabilized, pain usually resolves. More traditional approaches, including surgery, may fail to stabilize the joint and relieve pain long term. By focusing on the stability of the joint and not just an area of pain, prolotherapy is commonly used either prior to or during more complex regenerative procedures.
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PRP
Platelet Rich Plasma is a high concentration of platelets made from your own blood. In the simplest of terms, platelets call on your body to start healing itself by amplifying or ramping up your body’s natural healing response. PRP is a great regenerative treatment option because it works well for many different body parts like tendons, ligaments, and arthritic joints. It can be used on new and chronic issues.
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PRP is one of the most widely used regenerative treatment strategies first popularized for treatment of chronic tennis elbow. Use of PRP for osteoarthritis and tendon disease has been extensively studied with numerous studies showing an excellent reduction in pain, improved functionality and quality of life. When compared to corticosteroids and hyaluronic acid to treat osteoarthritis, PRP is clearly superior at 6 months and again at one year post-injection.
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Unfortunately not all PRP is created equal. Depending on which system your physician utilizes, you may be getting other cells in your PRP mixture. Red blood cells (RBCs) and white blood cells (WBCs) are frequently found in some PRP concentrates and can lead to the patient experiencing significant post-procedure inflammation and pain. At PICSM we use a double-spin technique to optimize the reduction of RBCs. PRP should be an amber color and not red-tinged.
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At PICSM we have been performing PRP procedures since 2008 and have extensive experience with this technique. All of our PRP procedures include ultrasound guidance not only to ensure the correct placement of the PRP into the targeted tissue but also upon initial diagnosis in identifying and isolating the targeted area.
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PDGF
You may be familiar with PRP (platelet rich plasma), which can be used to treat injuries to ligaments, tendons, and osteoarthritis. PRP is a commonly used regenerative technique in the U.S., however a group of orthopedic surgeons in Spain created a special technique designed to treat cartilage and bone defects associated with osteoarthritis called PDGF. The blood draw and processing is similar to PRP, but PDGF cells are activated so we have an immediate release of cytokines, growth factors, alpha proteins and other essential proteins to stimulate healing. If PRP was an extended release medication, PDGF would be an immediate release medication.
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PDGF can be used in many regenerative procedures but has extensive testing for intraosseous injections (into the bone) as osteoarthritis (OA) includes bone and cartilage destruction. Simply injecting into the joint space may not be enough to decrease pain related to OA in some patients. After a comprehensive evaluation, depending on your injured tissue or type of osteoarthritis, we will discuss whether PDGF is the best option for you. As with other regenerative procedures, we will discuss nutritional support, procedure recovery and activity limitations prior to your procedure.
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Autologous Concentrated Plasma (IRAP)
New to PICSM is a specialized spin of your plasma in our centrifuge to help concentrate several very important cytokines the help slow down progression of osteoarthritis (OA). Interlukin-1 receptor antagonist protein (IRAP) has been found to slow progression of cartilage breakdown by blocking Interlukin-1 (IL-1). IL-1 is a pro-inflammatory cytokine that is found in higher concentration in both rheumatoid arthritis and osteoarthritis of joints. Patients with high levels of IL-1 in their joints develop a destructive OA to the cartilage.
By blocking the IL-1receptor with IRAP, progression of joint destruction is significantly slowed down allowing other regenerative forces to promote tissue healing. IRAP is thought to be one of many key cytokines found in PRP and PDGF. Although other important growth factors and cytokines are found in ACP we use concentrated IRAP to help augment muscle and tendon recovery, decrease joint effusions and improve the results of other regenerative procedures for osteoarthritis. Using your own blood, we concentrate about 50 ml or 3 tablespoons of your blood and concentrate IRAP to alter the progression of arthritis.
Adipose Graft
An adipose graft works as a tissue matrix (cushioning) and structural scaffolding for larger defects, such as those seen in rotator cuff tears, fascial tears, etc. It can also be very beneficial for osteoarthritis. Used in conjunction with PRP to augment cellular signaling, the procedure starts off with a blood draw and centrifugation to collect PRP. We then use a lipo-aspiration technique and collect about 30 cc or 2 tablespoons of adipose tissue typically from your buttock. As with other procedures, we utilize ultrasound guidance to accurately and precisely place the adipose graft into the correct location.
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The whole procedure typically lasts about 2 hours. We discuss post-procedural care, rehab and activity level prior to the procedure.
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Bone Marrow Concentrate:
BMA/BMC stands for bone marrow aspirate/bone marrow concentrate. This differs from other regenerative procedures as we are focused on isolating medicinal stem or signaling cells (MSCs) from your bone marrow. It is important to understand that the term “stem cells” is a bit of a misnomer. Dr. Arnold Caplan, who pioneered the term mesenchymal stem cells in the 1990s, and is considered the father of stem cell therapy, recently revealed that he wished he had never come up with the terminology “stem cells” as the term is technically not correct. Based on Dr. Caplan’s work, MSCs should be called medicinal signaling cells.
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Bone marrow is typically harvested from the posterior hip crest using several sites to achieve 30-60 cc of bone marrow. This procedure sounds painful but is generally well tolerated with anesthetic to the bone surface. The main sensation is pressure when drawing out the bone marrow. For those nervous about the procedure, we do offer nitrous oxide (laughing gas) or pain medication prior to the procedure. After removal of the bone marrow, we use a double-spin technique to optimize the purity of MSCs and then re-inject the BMC to your injured tissue.
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Considerable medical evidence and science have shown BMC to be a valuable regenerative technique to improve pain related to osteoarthritis and degenerative causes with minimal down sides. As with other procedures, we utilize ultrasound guidance to accurately and precisely place the BMC into the correct location.
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The whole procedure typically lasts about 2 hours. We discuss post-procedural care, rehab and activity level prior to the procedure.
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Other Regenerative Therapies
A2M
Alpha 2 Macroglobulin (A2M) is a strong anti-inflammatory protein that helps prevent breakdown of cartilage in joints and appears to promote tissue growth and decrease pain in osteoarthritic (OA) joints. Scientific evidence supports that A2M is a key factor in slowing the progression of OA at the molecular level and can be used in conjunction with other regenerative procedures to decrease pain and swelling of osteoarthritic joint disease.
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A2M can be concentrated from your blood through a special process that PICSM offers to our patients to boost the concentration of A2M in an osteoarthritic joint. At this time we feel that A2M is a unique powerful protein that helps to decrease degenerative forces in an arthritic joint and helps with regeneration of damaged tissues.
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IO (Intraosseous)
Intraosseous injections with BMC or PDGF are sometimes recommended based on the evaluation with your physician. Research is finding that edema (inflammation) within the bone seen on MRIs in those with joint pain may be more of the culprit for causing pain than many of the other findings seen. Treating the bone edema via an IO injection may be superior to injecting only into the joint based on some new research.
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