Regenerative Medicine is a branch of medicine that uses techniques and procedures to stimulate cellular repair or healing of damaged tissues. Cellular therapy is the most well-known of the regenerative medicine procedures.
David Price, MD, sports medicine physician at Atrium Health Musculoskeletal Institute Sports Medicine – Randolph says regenerative medicine as practiced at Atrium Health is an evidence-based approach to treating injuries using patients’ own body cells to stimulate a healing response. That’s a far cry from practitioners running commercials and full-page ads promising that knee-replacement candidates simply need an injection to be good as new.
Regenerative medicine encompasses three main types of treatment:
(1) Prolotherapy
Prolotherapy is a procedure using a dextrose (sugar) solution to stimulate natural healing. These injections are placed into the targeted damaged tissue areas and promote a “proliferative” response by encouraging the body’s immune system to flood into the area and trigger the natural healing cascade.
Prolotherapy, with its medicinal roots in Germany, has been practiced in the United States safely for over 70 years. “It creates inflammation and signals the brain to wake up and heal that area,” Dr. Price says.
(2) Platelet-Rich Plasma
Another type of regenerative medicine is platelet-rich plasma therapy (PRP), which might be the most familiar type of regenerative medicine for sports fans.
Tiger Woods, Troy Polamalu, and the late Kobe Bryant are among star athletes who have used PRP to aid their recovery from injuries and avoid surgery. The treatment involves injecting platelets from a patient’s blood into an injured area, which then receives special attention from the high level of restorative benefits platelets offer.
“We have platelets circulating in our blood all the time,” says Eric T. Warren, MD, a sports medicine physician at Atrium Health Musculoskeletal Institute Orthopedics and Sports Medicine – Rea Village. “When we have an injury, platelets release a message telling proteins to gather in that area because there’s a problem. That’s how we get scabs and scars.
“Platelet-rich plasma often has up to 8 times the normal amount of platelets in blood,” he says. “I tell patients to think about blood as orange juice and platelet-rich plasma as orange juice concentrate.”
Dr. Warren says PRP can benefit patients with chronic arthritis (particularly in the knee), and patients with tendinosis, which results from chronic tendonitis. “PRP is literally just from your body,” he says. “It’s not something synthetic or manufactured in a facility. It is a scientifically calibrated concentration of your blood that’s injected back into your area of pain or need.”
He says data from scientific research on PRP is very strong for treating knee arthritis and chronic tennis elbow – another type of painful tissue irritation, and there is good data for treating plantar fasciitis, chronic hip abductor tendinitis, and even for partial thickness rotator cuff tears. “Those are joints and areas that have good literature behind them,” he says. “We extrapolate the knee arthritis data that to support using PRP in other affected joints, too.”
(3) Cellular Therapy
A third type of regenerative medicine is cellular treatment. It’s a relatively new way to treat arthritis and other musculoskeletal problems or injuries. Cellular therapy reduces inflammation (swelling) and helps repair damaged cells and tissue which decreases pain and improves function.
Specialized ”live” cells for this type of treatment are found in adult tissues such as bone marrow, fat and amniotic tissue and are taken from the bone marrow of a patient’s hip or from abdominal (belly) fat using liposuction. These cells can then be injected into the injured tissue to stimulate the healing response.
Dr. Price says some advertising from other clinics leads people to think they’re receiving live cells when instead they’re receiving amniotic and cord-blood products that essentially were freeze-dried and reconstituted. These contain no live or functional cells but do contain some healing factors which can deliver benefits for the right person and condition. “These products usually come in small volumes which are particularly useful for arthritis in small joints, like fingers and toes which can accommodate only a limited amount of volume. Much more research is needed before any further claims can be made,” he says.
Dr. Price also sees a problem in the way some practitioners claim that cellular therapy can regenerate worn-down tissue to make a knee like new. “Actually, we think it mainly reduces inflammation and signals the brain to send out growth factors to try to heal some of the injured tissue” Dr. Price says. “Certain cells do have the potential for self-replication but as far as growing meaningful new cartilage, there’s little evidence to support that yet. More studies are needed to see what these specialized cells do in terms of growing new tissue as opposed to healing tissue.”
He says patients don’t care as much what their cartilage looks like as long as they have less pain and improved function. “Evidence is building that this works really well on mild-to-moderate arthritis,” he says. “We want to catch people before it gets so bad that they need a knee replacement.”
Atrium Health utilizes both fat and bone marrow-based cellular therapy . But no matter which type of therapy is administered, there’s no need to worry.
“The risks are almost negligible,” Dr. Price says. “The safety profiles are excellent going back at least 10 years. These therapies are truly safe if done properly and for the right reasons.”
Hope for now and the future
Dr. Warren says he’s starting to see some insurers begin to include regenerative medicine in their coverage, but there’s still a long way to go and for now it’s primarily a cash pay service (though often a patient can use Health Savings Account for these procedures). He believes ongoing research will continue to validate treatments such as PRP therapy.
“I was slow to adopt PRP, as despite hearing good anecdotal evidence I wanted to see strong evidenced-based studies, but now I’m a believer,” he says. “There are good studies behind it. That’s why with integrity I tell patients it’s going to help and it’s worth the investment if they’re spending their own money on it.”
Cellular therapy in the United States is limited to stem cells drawn from a patient’s own fat and bone marrow. It’s an option for everyone except individuals who are pregnant or have cancer.
“Consult early to discuss options as you age,” Dr. Price says. “Regenerative medicine used to be a last resort, but now it’s being utilized sooner to lessen the progression of arthritis and to improve pain and function. We will make sure to tailor your treatment to what works best for you.”
