Regenerative Therapies

Knee Pain
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Can It Help Me?
Conditions that can be aided by PRP include plantar fasciitis, meniscus tears, osteoarthritis of the spine, hip and knee, ligament sprains, and rotator cuff tears.

Benefit of PRP
The limited blood supply and poor healing properties of ligaments, cartilage and tendons make treatment necessary after injury. Unlike physical therapy or medications that don’t treat the underlying cause of pain, PRP can accelerate the healing process – eliminating the cause of pain.

Collecting the Platelets
The PRP process begins by taking a small sample of the patient’s blood and placing it into Harvest Technologies’ Platelet Concentrate System. The sterile multi-chamber container is spun in a centrifuge to separate the blood into its primary components – platelets and white blood cells, plasma, and red blood cells.

Injecting the Solution
A portion of the plasma is removed. The patient’s concentrated platelets are mixed with the remaining plasma to form a concentrated solution. This platelet rich solution is then injected into and around the injured tissues.

The Body Reacts
The concentrated platelets release many growth factors that help promote a natural immune response. Macrophages – specialized white blood cells – rush in to remove damaged cells and prepare the tissue for healing.

The Healing Begins
Stem cells and other cells multiply, repair and rebuild the damaged tissue. This accelerated healing response reduces pain, promotes increased strength, and improves joint function.

Long-term Outcome
The entire PRP treatment process takes about an hour – the patient will be able to go home the same day. Full recovery from the injection usually occurs within one week of the procedure. Many patients require three to four treatments before the injured tissues are completely healed and they return to a normal active lifestyle.

Ankle Pain
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How it works
First, the physician performs a palpatory exam to locate the area causing the pain. It is important that the injections are inserted into the areas causing the pain, not the areas where the pain is felt.

A proliferant, or mild irritant solution, is injected into the problematic ligament or tendon, where it attaches to the bone, causing a localized inflammation. The inflammation increases the blood supply and the flow of nutrients to the area and stimulates the tissue to repair itself. New collagen, which is the building block of ligament and tendon tissue, is formed and begins to shrink, tightening the area that was injected and strengthening the tissue.

Injections may also be given to injured joints to stimulate cartilage growth and repair injured tissue, as well as to reduce the joint instability that leads to degeneration.

The average number of injections needed is between four and six, though the amount is variable and can be as low as two injections or as high as ten, depending on the body’s ability to heal itself and the technique and skill of the physician.

Prolotherapy techniques

Hackett-Hemwall Dextrose Prolotherapy
With Hackett-Hemwall Dextrose Prolotherapy, the irritant solution contains dextrose (sugar) and an anesthetic (either Procaine or Lidocaine). Multiple injections are given at once, into and around the injured area. Multiple body parts can be treated during the same visit and other proliferants may be added to the base solution.

Platelet Rich Plasma Prolotherapy
Platelet Rich Plasma Prolotherapy requires the patient’s blood to be drawn and processed to extract growth factors. The growth factors are then added to the proliferant and injected into the injured area. Additionally, dextrose is injected into the areas surrounding the injury.

Platelet Rich Plasma Prolotherapy is used for more advanced injuries that require the growth factors’ assistance in stimulating new growth in the injured area.

Stem Cell Prolotherapy
All joints have a limited ability to heal themselves. Stem cell prolotherapy is unique in that it makes joint anabolic (in the process of building).

The stem cells are obtained from bone marrow (from the shin or hip) or fat (from the love handles or stomach) and are mixed into a solution with platelet rich plasma. The stem cells and platelets help generate additional new growth.

Like Platelet Rich Prolotherapy, stem cell prolotherapy is used for more advanced injuries. Treatments are administered every six to eight weeks.

Results
Prolotherapy is typically a permanent solution to chronic pain. It ultimately improves function of the area injected, reduces stiffness, and reduces or eliminates pain. After the first visit, 50-75% of the pain is reduced, and the pain continues to diminish over the remaining treatment period. By reducing pain, prolotherapy also enables patients to improve the strength of the injured area.

Risks

  • Bruising in treatment area
  • Increased pain
  • Swelling
  • Stiffness
  • Joint effusion
  • Infection
  • Puncture of lung if treating spine
  • Tendon/ligament injury

Side effects and outcomes are unique to each patient and will be discussed before any treatment options are prescribed.

Neck Pain
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Goals and Success Rates
The goal of reparative medicine is to reduce pain and improve function without the need for surgery. In some cases, the condition being treated is too severe for these techniques, and surgery may be necessary. Studies in humans have indicated that the treatments are very safe and low-risk. Studies regarding the effectiveness of reparative medicine techniques compared to no treatment or other accepted treatments are still in the early phases and are complicated by the fact that it is difficult to design good controlled and randomized studies in humans. Furthermore, different investigators often use different techniques and have different definitions of success. Nevertheless, many independent investigators have shown evidence of effectiveness in treating orthopedic injuries and disease by reducing pain and improving quality of life. Some studies have shown MRI evidence of healing and even regeneration of tissue (including cartilage) that would not have been expected without reparative medicine. Reported success rates are as high as 70 – 90% in some studies. When treatment is successful, pain relief and improvement in function typically begin to occur about six to eight weeks after treatment. The exact mechanism by which reparative medicine decreases pain and improves function is still in the process of being understood.

Alternative Treatment Options
Most diseases and injuries can be treated by a variety of methods, depending on the individual circumstances of the patient. For example, arthritis of the knee might be treated first with modification of activities, weight loss, over-the-counter anti-inflammatory medication, physical therapy, bracing, corticosteroid injections, and hyaluronic (lubricant) injections. In some cases, knee arthroscopy may be helpful, and in the most advanced stage of knee arthritis, total knee replacement is the most reliable method for decreasing pain and improving function. It’s important to weigh the pros and cons of your various treatment options before deciding which approach is best for you. We will help guide you through that process. Currently, reparative medicine techniques and stem cell therapy are rarely the first line of therapy, but that may change in the future.

Precautions and Risks
The risks related to reparative medicine as practiced at SPOC are very low. There is, of course, some mild discomfort associated with the procedure. There is a very small risk of infection whenever aspirations and injections are performed. Nerve damage, vessel damage, and injury to other important structures are exceedingly rare. As orthopedic subspecialists, we use our detailed knowledge of normal anatomy as well as imaging techniques to assure your procedure is done as safely and effectively as possible. You will be given some important pre-procedure and post-procedure instructions that help reduce the risk of complications. Patients with a history of bone marrow disease, cancers of the blood system (leukemia, lymphoma, etc.), autoimmune diseases, and active infections are not normally candidates for this type of stem cell therapy. Patients with bleeding disorders and other chronic medical problems may not be suitable candidates.

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