Platelet-Rich Plasma and BMCC (Bone Marrow Cell …

What is Platelet-Rich Plasma (PRP)? Platelet-rich plasma or PRP is an "autologous blood therapy" that uses a patient's own blood components to stimulate a healing response in damaged tissues. In response to an injury or tissue damage, your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Modern technology allows us to concentrate platelets and white blood cells from your blood, and induce this growth factor release as we inject the solution directly into injured tissue, simulating this same healing response in a more powerful form. By enhancing the body's natural healing capacity, the treatment may lead to a more rapid, more efficient, and more thorough restoration of the tissue to a healthy state. What is Bone Marrow Cell Concentrate (BMCC)? It is well established that a significant population of our bodies' stem cells are contained within our bone marrow. By harvesting blood and tissue from the bone marrow space of the hip, an injectable product can be produced by concentrating platelets and cells withdrawn through a simple outpatient needle aspiration procedure, done with local anesthetic and light sedation. BMCC contains all of the growth and healing factors in PRP, along with concentrated "pluripotent" or stem-like cells which further contribute to the regenerative process. What conditions can be treated with PRP and BMCC? Knee Pain Tendon Injuries (Patellar Tendonitis, Quad Tendon) Muscle injuries Ligament sprains or tears (MCL, LCL) Bursitis Osteoarthritis Hip Pain Muscle pain or injury Pyriformis syndrome Greater Trochanteric Bursitis Tendon Injuries Sacroiliac joint pain Hamstring tendonitis or tears Osteoarthritis Shoulder and Arm Pain Rotator Cuff tendonitis, tendonopathy or partial tears Bicipital tendonitis Medial and Lateral epicondylitis (golfers & tennis elbow) Ulnar Collateral Ligament sprain or tear Lower Leg and Foot Pain Plantar Fasciitis Shin Splints Peroneal tendonitis Ankle sprains/ligament injury Achilles tendonitis or partial tears Treatment Process: Following a formal evaluation and diagnostic workup, an individualized treatment plan will be discussed with you. A full explanation of the procedure including risks and benefits will be reviewed. Once written consent is obtained, blood is drawn from your arm or from a bone marrow aspiration in the back of your hip region, and placed in a special processing unit, which separates platelets, white blood cells and serum from red blood cells. The platelets and white blood cells (including stem cells) are then concentrated and collected into a sterile syringe. Some of the blood is used to create an "activator" of the PRP/BMCC. The skin and soft tissue is anesthetized with local anesthetic, followed by injection of both the PRP/BMCC and activator into the tissue targeted for treatment. Depending on the size of the injured tissue, one or several needles are inserted to optimize placement of the product. Treatment plan: Depending on the severity and duration of your injury, one to three injections are suggested. Following the initial treatment with PRP or BMCC, a follow up visit occurs 3-4 weeks later. At this visit an evaluation of your response to the initial therapy is performed and a decision is made regarding the need for additional PRP treatments. In general, chronic injuries often require more than one injection. In both acute and chronic injuries, injections may be combined with an exercise or physical therapy program to enhance the success of the treatment. Are PRP and BMCC injections safe? Research and clinical data show that PRP and BMCC injections are extremely safe, with minimal risk for any adverse reaction or complication. Because the injectable products are produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Of note, recent research suggests that PRP may have an anti-bacterial property which protects against possible infection (4). What to expect after your treatment: Often, following the initial injection, an "achy" soreness is felt at the site of injury. This "soreness" is a positive sign that a healing response has been set in motion. This effect can last for several days and gradually decreases as healing and tissue repair occurs. It is important that anti-inflammatory medications such as Ibuprofen, Naproxen and Aspirin be avoided following PRP treatments. These medicines may block the effects of the intended healing response facilitated by the injection itself. It is acceptable to use over the counter pain medication, such as Tylenol and in some cases a prescribed analgesic, which does not have anti-inflammatory properties, to control discomfort as needed. Pain management options will be discussed with you by the physician managing your treatment plan. You will be permitted to resume normal day to day activities and light exercise following injection. We suggest that you avoid strenuous lifting or high level exercise for at least several days after injection. How do I find out if PRP or BMCC is right for me? Questions regarding PRP or your candidacy for the treatments can be addressed to Dr. Karli at the Steadman Clinic in Vail, Colorado. Contact person for the PRP treatment program is Benjamin Dale (970) 479-2706 bdale@thesteadmanclinic.com. We would be happy to review a brief history of your problem via telephone in order to determine if a formal evaluation is warranted. Selected References 1. Anitua E, S. M., Nurden A, Nurden P, Orive G, Andia I. (2006). "New insights into and novel applications for platelet-rich fibrin therapies." Trends in Biotechnology 24(5): 227-234.

2. Mishra A, A. J., Anitua E, Andia I, Padilla S, Mujika I. (2007). "Treatment of chronic elbow tendinosis with buffered platelet-rich plasma." Am J of Sports Med 34(11): 1774-1778.

3. Moojen D, E. P., Schure R, et al. (2007). "Antimicrobial activity of platelet-leukocyte gel against Staphylococcus anreus." Journal of Orthopaedic Research DOI: 10.1002/jor.20519.

4. Sanchez M, A. E., Azofra J, Andia I, Padilla S, Mujika I. (2007). "Comparison of Surgically Repaired Achilles Tendon Tears Using Platelet-Rich Fibrin Matrices." Am J of Sports Med 10(10): 1-7.

5. Foster, T. E., Puskas, B. L., Mandelbaum, B. R., Gerhardt, M. B., & Rodeo, S. A. (2009). Platelet-rich plasma: From basic science to clinical applications. The American Journal of Sports Medicine, 2259-2272.

6. Fortier, L. A., Potter, H. G., Rickey, E. J., Schnabel, L. V., Foo, L. F., Chong, L. R., Stokol, T., & Cheetham, J. (2010). Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. The Journal of Bone and Joint Surgery, 92(10), 1927-1937.

7. Fortier, L. A., Barker, J. U., Strauss, E. J., McCarrel, T. M., & Cole, B. J. (2011). The role of growth factors in cartilage repair. Clinical Orthopaedics and Related Research, 469(10), 2706-2715.

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Platelet-Rich Plasma and BMCC (Bone Marrow Cell ...

Fox Sports: Platelet Rich Plasma Therapy Big with Athletes

MINNEAPOLIS On December 10, 2011, Portland guard Brandon Roy announced his retirement. He was 27 years old at the time, at the end of just his fifth year in the league. He'd been the NBA Rookie of the Year in 2007 and was a three-time All-Star.

Yet in the face of chronic knee problems, none of that mattered.

Roy retired due to persistent issues in both of his knees. He'd undergone six knee operations, and there was no longer any cartilage remaining in the joints. Trail Blazers team doctors warned him that he should not continue playing and that to do so would have devastating long-term effects.

Not even a year later, and he's announced his comeback. Many teams have expressed interest in signing him, including the Timberwolves.

That's quite the turnaround for a player who was warned that to play basketball any longer might spell difficulties walking later in his life. It's the kind of story where one wonders what detail is missing; the turnaround is too drastic. And in that brief narrative, something was missing: platelet-rich plasma (PRP) therapy.

PRP therapy is a process by which a small quantity of blood is extracted from a patient. The blood is then placed in a centrifuge and spun until it separates into its component parts. Doctors then remove the platelets and inject them back into the patient at the point of injury, peppering the surrounding area with injections for maximum efficacy. The growth factors in platelets are said to promote healing and tissue regeneration, speeding the healing process.

The therapy has been used for nearly a decade, but it's received increased attention in recent years. There's no medical consensus on it yet, and it's still a procedure that's largely relegated to athletes and patients with disposable income. It can cost between $500-$2,000, though prices do vary, and it's rarely covered by insurance.

Dr. Bradley Nelson, a physician at the University of Minnesota School of Medicine, said that the most common use of PRP therapy is for chronic tendinopathy. That's different from the case in Roy's knees, where he's lacking cartilage. Using PRP therapy cases like Roy's, though, is becoming more widespread, but it doesn't have the same healing effects as it does in treating tendinopathy, such as tennis elbow. Recent studies have begun to indicate that PRP can be effective in reducing the pain of arthritis, and using the therapy in such treatments is the newest trend in PRP.

"Some people are injecting (PRP) into the knee joint in patients that have early osteoarthritis, and they can feel better," Nelson said. "It does not grow new cartilage. It does not reverse the course of cartilage damage. It just helps with the pain associated with arthritis."

For a case like Roy's, more experimental stem cell treatments might hold a better chance in actual healing. It's unclear whether Roy has undergone any such stem cell treatments, but he has received PRP therapy in both his hamstring and his knees. In recent years, some of the biggest names in sports have been associated with the therapy, most notably Kobe Bryant. Bryant, who received the treatment in Germany during the summer of 2011, had been suffering from lingering problems with an arthritic joint in his right knee.

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Fox Sports: Platelet Rich Plasma Therapy Big with Athletes