Regenerative Medicine & Orthobiologics

Regenerative medicine is a branch of healthcare that helps the body heal itself by repairing or replacing damaged cells and tissues, such as skin, muscle, cartilage, bone, and more. These treatments are used in many areas of medicine, including wound healing, post-surgery recovery, joint and tissue repair, and even fields like cancer care and gene therapy. The therapies usually come from two main sources: your own body (autologous) or a donor (allogenic). Depending on their origin, they are generally grouped into three categories: blood-based, cell-based, or tissue-based.

Orthobiologic treatments, or Orthobiologics, comprise a subset of regenerative therapies aimed at boosting the body’s natural ability to heal a variety of acute and chronic musculoskeletal conditions. These treatments are delivered in the form of an injection directly to the injured site. The therapies we utilize at Ortho.Boston are blood (PRP, PPP, plasma proteins) or cell (BMAC/stem cell) based, and are all autologous (from you, to you).

We offer autologous blood-based and cell-based interventions.

● Platelet-Poor Plasma (PPP)

- The portion of blood containing plasma, proteins and certain growth factors

- With platelets removed, PPP results in 2-4x less platelet concentration than whole

blood

- Plasma proteins are beneficial in the initial phase of therapy or as a solo treatment for

some conditions

● Platelet-Rich Plasma (PRP)

- The portion of blood containing plasma that has a high concentration of platelets and

growth factors

- 3-12x concentration of whole blood

- Used for various conditions in and around joints (arthritis, bursitis, tendinitis,

tendinopathy,

cartilage tears, sprains, strains, etc)

● Bone Marrow Aspirate Concentrate (BMAC)

- Additional platelets, proteins, mesenchymal stem cells (MSCs, cells that form new

bone/muscle/tendon) and growth factors are concentrated from a sample of your own

bone marrow

- 2-5x MSC concentration of whole bone marrow

- Greatest regenerative potential

Much of our ability to heal is determined by vascularity, or the presence of blood vessels, and their ability to deliver blood to the target tissue. This is not uniform throughout the body or the lifespan. With respect to musculoskeletal disorders, injuries and degeneration commonly occur in areas with limited or no blood supply. For example, articular cartilage (which covers the surfaces of long bones creating joints like the hip, knee and shoulder - three of the largest weight bearing joints of the body) is avascular, meaning it does not have its own blood supply. Synovial joints (defined by their presence of articular cartilage) receive some nutrients from their inner lining and joint fluid, but that is rarely sufficient in healing acute injuries, which is critical in preventing structural and functional changes that result in chronic degeneration. Though slightly more vascular than articular cartilage, tendons (soft tissue structures that fuse muscle and bone) have a limited blood supply as well. Wherever blood flow is limited, so is the healing, or regenerative, potential. Orthobiologic treatments bypass the body’s healing limitations by extracting the nutrients and raw materials (repair proteins, growth factors, stem cells, etc) from one area (usually the blood or bone marrow), condensing them into a supraphysiologic concentration (significantly greater than what our bodies produce on their own), and placing them directly in or onto damaged, injured tissue, promoting healing and repair. Even in tissue that has excellent blood supply (muscle or skin), introducing biologic therapy at the right time can encourage a specific type of tissue healing (like making new muscle cells instead of forming non-contractile scar tissue).

The purpose of orthobiologic therapy is to reduce pain and harmful inflammation by restoring normal joint and muscle function so that you feel, move and perform at your best. Specific goals are individualized and vary from patient to patient. Some patients injure themselves during sports and utilize orthobiologics to return to play faster and stronger. Other patients have trouble completing daily activities because of joint and muscle disorders. Whether your goal is getting back on the field or into the gym, or being able to climb stairs, lift groceries or pick up your grandkids without nagging pain – these therapies are made for you, because they come from you.

We will work together to create a treatment plan depending on your symptoms and goals as well as the number of treatment areas. On average, you will have 2 to 4 visits with us over a 2 to 6 week period. Blood based therapy visits (PPP, PRP, protein) all start with a blood draw from a vein in your arm. Cell based therapy (BMAC/stem cell) involves aspirating (drawing out) your own bone marrow from a superficial location at the back of your hip bone (local anesthetic is used for comfort during this procedure). The volume of blood or bone marrow obtained depends on the size and number of treatment areas. Once the raw materials are obtained, they are processed using our lab equipment (centrifuge, filter), prepared, and injected during the same visit. There is no storage or chemical alteration. The entire process takes about 30 minutes.

The above therapies are considered low-risk and very safe. Because we are essentially hacking our body’s ability to heal by concentrating our own raw materials and targeting their delivery, there is no risk of rejection to the materials alone. The potential risks/side effects of the procedure are the same you would experience following any injection: bleeding, infection, damage to surrounding structures, or localized pain and swelling. The benefits are numerous: reduce or eliminate symptoms, restore mobility, function and independence, and improve your quality of life, all without the need for medications, steroids or surgery (avoiding anesthesia, incisions, and associated downtime).

It's important to know that we do not expect immediate results. Most patients notice initial improvement in the first few weeks, which grows with time. The goal of therapy is not to treat you with a band aid or a quick fix. We want you to achieve long term results, which does not happen overnight. The research in this field is constantly evolving as we continue to learn more and refine treatment protocols. Current publications report relief spanning 6-12 months and beyond, with repeat interventions as needed to compound positive outcomes.

Most patients are excellent candidates for biologic therapy. There are a few exceptions. Patients with the following conditions are generally not considered candidates: acute or chronic infections, active skin diseases (i.e. Lupus, porphyria, certain allergies), active cancer/chemotherapy, severe metabolic and systemic disorders, abnormal platelet function or other bleeding disorders (HIT/thrombocytopenia), chronic liver disease, (some) anti-coagulation therapy, sepsis, or patients who are pregnant and/or breastfeeding. Some contraindications are absolute and others are relative, and will be discussed and treatment determined on a case-by-case basis.

Alternatives to therapy range from conservative to invasive, including but not limited to: activity modification, assistive devices/bracing, home exercise programs, physical therapy, oral supplements, oral medications (over the counter and/or prescription), other injections (cortisone, hyaluronic acid/viscosupplementation, etc), or surgery. Some of the above therapies are not only helpful but recommended adjuncts to biologic treatment and can help in the recovery process, which we will discuss implementing at the appropriate time.