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Published byGeorgina Patterson Modified over 6 years ago
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Regenerative Medicine Overview and Indications
Brian Siegel, MD Steamboat Springs, CO
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Biologics used for Regenerative Medicine
Platelet rich plasma Platelet poor plasma Human amniotic cells Bone marrow stem cells Adipose derived stem cells
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Types of PRP High hct, high wbc, high platelet
Low hct, low wbc, high platelet Low hct , low wbc, low platelet
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Indications for PRP injections
Areas of body with lower blood supply Tendinopathies Plantar Fasciitis Sacroiliitis Wound healing Nerve damage Little to no data to support PRP for discs or articular cartilage OA (by itself)
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Indications for PPP injections
Contains a variety of growth factors Muscle tears Joint preparation prior to stem cell injection Volume expansion for injections
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Human Amniotic Cells Anti-inflammatory properties Growth factors
Hyaluronic acid Stem Cell activators HSC’s (hematopoietic stem cells, CD34+) Better in patients with autoimmune disease?
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Indications for Amniotic fluid injections
Tendinopathies Joint pain associated with mild osteoarthritis Allografts used for cartilage defects Wound healing Peripheral neuropathy
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Bone Marrow Stem Cells Contains Anti-inflammatory Immunomodulatory
Mesenchymal Stem Cells MSCs Hematopoietic Stem Cells HSCs Endothelial progenitor Cells EPCs Platelets Anti-inflammatory Immunomodulatory
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Adipose Stem Cells Mesenchymal Stem Cells MSCs T regulatory cells
Macrophages Endothelial Progenitor Cells EPCs Stromal Vascular Fraction SVF
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Bone Marrow Aspirate Adipose derived cells
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Indications for Mesenchymal Stem Cell Therapy
Knee Osteoarthritis – stage 1-4 Meniscal tears DJD of hip, shoulder, ankle, etc. Labral tears Glenoid Type 1 and 2 Hip Intervertbral Disc and Facet Degeneration Chondral defects Avascular Necrosis
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Contraindications for Mesenchymal Stem Cell Therapy
Active infection Active cancer History of lymphoma Certain blood thinner, i.e. Ticlid, Xaralto Major structural defect Impaired ROM
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Complications Transient increase in pain, resolution within 7 days
Transient increase in swelling, resolution within 14 days Rash – secondary to adhesive, topical antibiotic or prep No reported malignancies
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Conclusion Biologics are safe and effective
Good treatment alternatives for chronic musculoskeletal pain More studies are needed to determine: Best biologic for each particular disease Soft tissue Cartilage Disk When to choose PRP, BMAC, Adipose, Amnion
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