Biologic Supplementation – Stem Cells and PRP

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The field of ortho-biologics is becoming a hot field.

Whether it be patch augmentation during rotator cuff repair used from a dermal donor (skin) from animals (most commonly pig), spun down platelet rich plasma (PRP), or bone marrow concentrate (BMC or BMAC) which contains precursors to stem cells the use of Biologics to supplement healing is a very attractive option to offer patients.

 

This is a controversial subject and for good reason.  The reason is because there is not great evidence to support this and therefore the expense is often out-of-pocket. Additionally I do believe that there are some physicians within the community that are pushing this as a cure all. I do not believe that just merely injecting stem cells into your shoulder is going to magically repair a tendon that is ripped off the bone and retracted from its insertion site or fixed cartilage that is already degenerative and becoming arthritic or repair a torn ligament. Peer-reviewed literature would state that that is fantasy.

 

However approaching this from a practical point of view I believe that supplementing a patient’s surgery with some of these options can be useful and the literature is starting to show some promise. If you are interested in either platelet rich plasma at the time of your surgery, stem cells at the time of your surgery (whether it be rotator cuff surgery, shoulder instabilitylabral tear surgery, or shoulder replacement surgery), or even discussing patch augmentation of your rotator cuff repair please don’t hesitate to schedule a visit with me.

 

What is Platelet Rich Plasma (PRP)

Blood is drawn from your arm and spun down in a centrifuge to concentrate platelets and serum. Platelets contain hundreds of proteins called growth factors, which are very important in the healing of injuries. The platelets degranulate, releasing activated growth factors to migrate to the affected area and promote healing by inducing healing cells. These healing cells are thought to cause increased tenocyte proliferation. Along with increased healing potential, studies suggest that PRP reduces patients’ pain and improve joint stiffness and physical function. Most importantly, PRP is safe and efficacious with level 1 evidence. This healing option is not covered by insurance. Out-of-pocket cost is approximately $800.

Bone Marrow Concentrate (BMC or BMAC)

Bone marrow is aspirated (BMA) from the hip and concentrated with a centrifuge to produce bone marrow concentrate (BMC). BMC contains progenitor cells like hematopoietic stem cells (HPC) and mesenchymal stem cells (MSCs /CFUs), which have the potential to repair damaged tissues. There is a significant reduction in MSC content at the tendon-bone interface in all RC repair patients, which leads to higher failure rates. Some of the factors that contribute to a decrease in MSC content and increase in failure rates include lag time to treatment, number and size of tears, and the stage of fatty infiltration. Literature suggests that BMC helps improve pain and function scores shortly after surgery, which could be due to increased levels of IL-1ra (IRAP), an anti- inflammatory growth factor present in BMC. In one study, results for 10-year follow up for the BMC group are 87% intact versus 44% in the control group. This healing option is not covered by insurance. Out-of-pocket cost is approximately $5000.

Risks of either PRP or BMAC include infection from blood draw, short-term increase of pain, or no benefit.