Regenerative Medicine A Fountain of Youth or Marketing Misnomer? By Jordan Know, MD, CAQSM, FAAFP, COPC Sports, Spine & Joint Humans always seem to be looking for the fountain of youth, or just about any way to delay getting older. The field of “regenerative medicine” is one that aims to reverse, or at least slow and delay, the damage and decay of our bodies’ organs and tissues by utilizing the body’s own existing cells, structures and mechanisms for healing and repair. At the moment, however, “regenerative medicine” may be more of a misnomer, or perhaps false advertising. It might be tempting to think that “regenerative medicine techniques” could regrow cartilage in an arthritic knee, build up a thinned and degenerated disc in the spine, or regrow a knee’s anterior cruciate ligament (ACL). While this last example does actually show some promise, with the development of the Bridge-Enhanced ACL Restoration implant, for a patient thinking about “regenerative medicine,” they are more often looking at treatments for chronic degenerative conditions, such as osteoarthritis or tendinopathy. Treatment options such as Platelet-Rich Plasma (PRP), Bone Marrow Aspirate Concentrate (BMAC), stem cell therapies, and extra-corporeal shockwave therapy (ESWT); or even viscosupplementation with hyaluronic acid formulations, are often touted as alternatives for the more classic steroid or cortisone injections. Many of these are more accurately described as orthobiologics, a subset of regenerative medicine that consists of orthopedic treatments derived from biologic materials. PRP In the case of PRP, a volume of the patient’s blood is taken out by venipuncture, processed through a centrifuge to separate the components and the concentrated plasma fluid containing platelets, associated cytokines and growth factors is collected. This fluid is then injected into the target area, often a tendon or joint space, sometimes around a nerve, or into or around an intervertebral disc. Treatment may consist of a single injection, or sometimes two or three spaced a few weeks apart. Best practices and protocols are still in development, and there is some variability in these methods. Typically, insurance will not cover PRP, which may generate a bill anywhere from several hundred to several thousand dollars — much of this comes from the materials used for processing the patient’s blood. A centrifuge may cost $5,000-$10,000, but can be reused, while the non-reusable blood draw and processing kits typically cost $200-$500. PRP tends to be most effective in cases of early knee arthritis or chronic tendinopathy lasting six months or longer, including tennis elbow, Achilles tendinitis, patellar tendinitis and rotator cuff tendinopathy. It can also be particularly effective in treating rotator cuff tears without surgery. BMAC and Stem Cell Therapies BMAC costs are typically even higher than PRP, ranging from $3,000-$10,000 or more, due to the more complicated processing of the extracted materials. Conceptually, it is somewhat similar to PRP, although instead of taking blood, a sampling of bone marrow is taken, typically from the iliac crests in the back of the pelvis, and processed to extract circulating mesenchymal stem cells, which can theoretically differentiate into cartilage, bone and other tissues. However, while there are certainly anecdotes and individual cases where it seems that cartilage and joints have “reversed” their degeneration, the overwhelming body of literature, meta-analyses and randomized controlled trials indicate that the miraculous regrowth of cartilage or reversal of aging are more likely rare exceptions, and those results cannot be reliably expected. Adipose Derived stem cells, essentially a combination of liposuction followed by processing the removed fat cells to extract stem cells from the fat tissue, can then be injected into the target tissue for repair. It is very similar to BMAC, with a similar typical price 20
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