Dr. O'Donnell Writes: Regenerative Injection Therapy: Healing Injuries Naturally

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Dr. Kevin O'Donnell wrote the article “Regenerative Injection Therapy: Healing Injuries Naturally,” which was featured in the July 2016 edition of the Flagstaff Business News.

Regenerative injection therapy (RIT) is an exciting and emerging option for patients with musculoskeletal injuries who do not respond to traditional treatments and are not ready for or not candidates for surgery. Newer RIT options include platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) therapy, and adipose-derived stromal cell (ADSC) therapy. Compared with surgery, these offerings are minimally invasive and cost effective. Conditions treated with RIT include arthritis and acute or chronic ligamentous, tendon, or muscle injuries. They are particularly effective in knee and hip arthritis, plantar fasciitis, tennis elbow, carpal tunnel syndrome, knee and Achilles tendonitis, and knee meniscus tears.

Once considered experimental, RIT has been called the “the next wave” in the advancement of orthopedics by world-famous orthopaedist James Andrews and has also been endorsed by former Surgeon General C. Everett Koop. RIT and biologic treatments are also gaining momentum in mainstream medical circles. Elite athletes including Stephen Curry, Peyton Manning, and Kobe Bryant all have undergone RIT. Hines Ward of the Super Bowl Champion XLIII Steelers famously used PRP on a ligament torn in the AFC Championship game, which was initially felt to be a four- to six-week injury. Thanks to his treatment, he healed exceedingly fast and was able to compete in the Super Bowl two weeks later.

Unlike many traditional treatments that are geared towards pain or symptom relief, RIT seeks to heal damaged or degenerative tissue. PRP works by harnessing the unique healing power of platelets. Platelets are a component of blood generally recognized by its ability to clot wounds. However, platelets also are rich in growth factors that help to stimulate regeneration and heal injuries. Injecting a concentrated amount into an injury helps kick start and “super charge” the body’s natural healing powers.

Whether harvested from bone or fat tissue, multipotent stromal cells have the special ability to differentiate into several lines including muscle, cartilage, vessels, or bone. They also help trigger local cells adjacent to the injury to begin the reparative process. Cells are considered to be a very powerful and versatile healing option, and we are just beginning to tap into the potential of this exciting treatment.

Regenerative injection therapies are usually performed in an office setting under locally injected anesthesia. PRP is created by withdrawing 60 ml of blood from a vein, much like a regular blood draw. The blood is then processed to create a platelet-rich injection amount between 3-6 ml. This final product (PRP) is then injected under ultrasound guidance into the diseased tissue or joint. The entire process usually takes 30-60 minutes.

BMAC is another form of RIT in which the physician obtains multipotent stromal cells from your hip bone. This procedure is also performed in the office under local anesthesia and ultrasound or fluoroscopic guidance. The procedure is minimally painful and very well tolerated.

Adipose-derived stromal cells are harvested from abdominal fat through a virtually painless procedure done in the office. The cells are collected with a device that performs a “mini liposuction.” The cells are then washed and purified and then injected back into the injured or degenerative body part using ultrasound guidance.

RIT is considered to be very safe. Typically, these procedures require much less recovery and downtime compared to surgery. Patients are often back to full activity within six weeks. In addition, the risk of serious side effects is virtually zero given that the “medicine” is the patient’s own body. With any invasive procedure, there remains a very small risk of infection.

Although not yet considered mainstream, mounting evidence for RIT demonstrates very promising results. Several studies show benefit even in patients with severe disease who have failed traditional treatments. In some cases, the results have been so dramatic that patients have put off or even canceled major surgeries like total joint replacement. Because of the investigational nature of RIT, most insurance companies will not cover the cost of the procedures. Typical out-of-pocket cost for patients ranges from several hundred dollars to a few thousand dollars.