What is Platelet Rich Plasma (PRP)?

The blood has been broken down into its three main components: platelet poor plasma (PPP), platelet rich plasma, and red blood cells. It is the platelet rich plasma that is the basis of all PRP therapies. The centrifugation separates the platelets from the other blood cells and increases their concentration. Then the increased concentration of platelets is combined with the remaining blood that was drawn.

The blood is withdrawn from an arm and is spun down in a two-step centrifugation process to separate out the platelets while mixing them with citrate and dextrose using a sterile technique. This provides a super saturated, very high concentration of pure platelets. These platelets, which contain all of the healing factors, are then injected directly into the site of injury.

PRP therapy may be used to manage numerous injuries including muscle injuries (hamstring sprains, biceps and triceps injuries, calf and quadriceps injuries), ligament injuries (ACL, MCL, LCL sprains and tears of the knees), tendon injuries (Achilles tendonitis, rotator cuff injuries, tennis elbow (lateral epicondylitis), golfer's elbow (medial epicondylitis), patellar and quadriceps tendonitis), degenerative conditions such as arthritis (osteoarthritis), degenerative disc disease, plantar fasciitis, shin splints, neck and back pain, nerve injury, plastic surgery, burns, split-thickness skin graft donor sites, and stress fractures. It may also be used after surgical procedures to assist in the healing process in areas of poor blood supply.

One of the main benefits of PRP is that the patient's own blood is used, making this procedure safe, cost effective, and without side effects. The natural healing process may take 3-6 weeks after the injection and the procedure may need to be repeated 1-2 more times in a 6 month period to encourage full healing and regeneration.

PRP Therapy Animation
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Platelet Rich Plasma (PRP) Therapy for shoulder pain
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Difference between Platelet Rich Plasma (PRP) and Stem Cell
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What are Stem Cells?

We use stem cells derived from the patient's own body in order to minimize the risk of allergic reaction or disease transmission. We are able to get your own stem cells from bone marrow aspiration which is a procedure that can be done in the office with minimal discomfort. The two primary sources of bone marrow we use are the posterior iliac crest (posterior hip) and the proximal tibia below the knee. The bone marrow regenerates and multiple procedures can be done over time. After drawing out the bone marrow, the stem cells are then concentrated using FDA approved commercially available machine to create bone marrow aspirate concentrate (BMC) which can then be injected into an area requiring stem cell therapy. The BMC concentrating process takes approximately 15 minutes in the office.

The Drs - Stem Cells for Back Pain Medical Course
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Bone Marrow Stem Cell Treatment (BMAC) for Knee Osteoarthritis from Mayo Clinic
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What is Stem Cell Therapy?
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What growth factors and cytokines are in PRP and Stem Cell - Bone Marrow Aspirate Concentrate (BMC)?

  • Platelet derived growth factor (PDGF)
  • Fibroblast growth factor(FGF)
  • Vascular endothelial growth factor (VEGF)
  • Interleukin 8 (IL-8)
  • Transforming growth factor beta (TGF-b)
  • Insulin like growth factor 1, 2 (IGF - 1,2)
  • Epidermal growth factor (EGF)

What are the clinical indications for using PRP and/or Stem Cell - Bone Marrow Aspirate Concentrate (BMC)?

  • Hip osteoarthritis
  • Knee osteoarthritis
  • Ankle osteoarthritis
  • Shoulder osteoarthritis
  • Elbow osteoarthritis
  • Wrist osteoarthritis
  • Tendonitis (Chronic tendonitis or partial-thickness tears)
  • Rotator cuff
  • Biceps
  • Golfers/Tennis elbow
  • Tendonitis around the thigh (gluteus medius, hamstring, piriformis syndrome
  • Patellar or quadriceps tendonitis
  • Tendonitis around the ankle (Peroneal, Tibialis posterior)
  • Achilles
  • Plantar fasciitis
  • Ligament Injury
  • Ulnar collateral ligament injury of the elbow
  • Medial collateral ligament injury of the knee
  • Degenerative joint disease
  • Symptomatic articular cartilage injury
  • Fracture care
  • Delayed union or nonunion fractures

What happens after the PRP and/or Stem Cell injection in the office?

Most patients will have some soreness for up to 48 hours that should decreases. Patients should not take aspirin or other NSAID medications after the procedure because they block the inflammatory response necessary for the procedures to help with healing. Patients can use Tylenol and other pain medications that don't block the inflammatory process. Patients should refrain from significant physical activity or sports activities for about a week after the procedure. Patients are re-evaluated about 6 weeks after the procedure to evaluate their progress and to make further treatment recommendations.

What are adult stem cells?

Adult stem cells are unspecialized or undifferentiated cells, capable of two processes: self-renewal and differentiation. They are vital to maintaining tissues in the body such as internal organs, skin, and blood.

What is Regenerative Medicine?

Regenerative Medicine is a new and advancing scientific field focused on the repair and regeneration of damaged tissue utilizing stem cells.

What is the difference between adult stem cells and embryonic stem cells?

Adult stem cells are found in mature adult tissues including bone marrow and fat, while embryonic stem cells (ESCs) are not found in the adult human body. ESCs are obtained from donated in vitro fertilizations, which raises many ethical concerns. Because ESCs are not autologous, there is a possibility of immune rejection. Adult stem cells do not raise ethical issues nor pose any risks for immune rejection.

Are there ethical issues associated with harvesting adult stem cells?

No, adult stem cells do not raise ethical questions as they are harvested from the patient’s body.

Are there cancer-causing risks associated with adult stem cell treatments?

No. Where embryonic stem cells have been shown to form teratomas (germ cell tumors), there is no data that suggests adult stem cells have the same potential to promote the development of tumors.

Where do adult stem cells come from?

In adults, stem cells are present within various tissues and organ systems, the most common being bone marrow and adipose or fat tissues. Other sources include the liver, epidermis, retina, skeletal muscle, intestine, brain, placenta, umbilical cord and dental pulp.

How do we obtain adult stem cells for use in cell treatment?

We currently have a system that uses adult stem cells from bone marrow and these stem cells are obtained through aspiration during your procedure.

How are adult stem cells used in surgical procedures?

Adult stem cells are used to treat patients with damaged tissues due to age or deterioration. During a procedure, stem cells are isolated from the patient, concentrated and delivered back to the site of injury to assist in the healing process.

How are adult stem cells used in surgical procedures?

Adult stem cells are used to treat patients with damaged tissues due to age or deterioration. During a procedure, stem cells are isolated from the patient, concentrated and delivered back to the site of injury to assist in the healing process.

Are there different types of adult stem cells?

Yes, there are many types of adult stem cells found in the body, which have variable differentiation potentials. The adult stem cells that aid in the repair of damages tissue are multipotent, mesenchymal stem cells. These are located in bone marrow and adipose (fat) tissue.

Are the harvested adult stem cells expanded in a laboratory setting prior to delivery back to the patient?

No, we do not use in vitro expansion. The cells are harvested, processed in the operating room and delivered back to the patient at point of care.

How do stem cells know what type of tissue to develop into?

The differentiation of stem cells is dependent on many factors, including cell signaling and micro-environmental signals. Based on these cues, stem cells are able to develop into healthy tissue needed to repair damaged tissue. For example, multipotent stem cells delivered to damaged bone will develop into bone cells to aid in tissue repair. The exact mechanism of lineage-specific differentiation is unknown at this point.

Will my body reject the stem cells?

No, adult stem cells are autologous and non-immunogenic.

Is stem cell therapy safe?

Yes, and ask your doctor what clinical studies have been done to show that stem cells are safe and effective.

What is the difference between autologous and allogeneic cells?

Autologous cells are taken from the same patient, typically at point-of-care. Allogeneic cells are taken from another patient and are often manipulated before they are given to another patient.

What is the difference between autologous and allogeneic cells?

Adult stem cells are from the body and generate natural proteins and therapeutic biochemicals, decrease inflammation, are anti-bacterial, and recruit other cells to heal the injured site. Pharmaceutical treatments only provide drugs with minimally effective dosages that may cause unwanted side effects. Over dosage can be dangerously toxic or even carcinogenic. Genetic therapy is still unproven and serious concerns exist about it causing cancer due to genetically manipulated cells.

How much will it cost?

Most insurance plans and Medicare/Medicaid do not currently cover PRP therapy. Patients interested in having PRP therapy are responsible for the full payment for the procedure. Please call our office for any questions on cost or payment plans.