Types

Types of Orthobiologic and Regenerative Medicine Treatments

Stanford Medicine orthopaedic providers offer different types of orthobiologic treatments. They differ in the kind of source of orthobiologics injected to encourage healing.

Platelet-rich plasma (PRP) injections

PRP injections begin with drawing your blood. The blood sample is put into a special machine, called a centrifuge, to separate red and white blood cells, leaving behind plasma and platelets. Then the platelet-rich plasma is injected into the site of pain or injury. Platelets release growth factors to potentially decrease inflammation and pain, and stimulate healing.

Bone marrow aspirate injections
Bone marrow aspirate injections use cells and tissues from the bone marrow, a soft, spongy tissue inside your bones. Your doctor extracts (harvests) bone marrow, usually from the pelvic bone.

After numbing the area where they will extract the bone marrow, the doctor inserts a needle into your hip bone. Your doctor collects a small amount of bone marrow into a syringe, filters the sample, and places it into a centrifuge to concentrate the bone marrow. Then the doctor injects the concentrated bone marrow into the injured area.

Adipose tissue injections
Adipose tissue is body fat. To extract fat cells, your doctor performs a procedure called lipoaspirate, which is similar to liposuction but much less invasive. After numbing, your doctor inserts a cannula (thin tube) into the stomach, buttocks, or thighs to obtain a fat sample. Your doctor processes the fat tissue to separate the blood and oil and injects the cells into the injured or diseased area.

Understanding cell therapies
Regardless of claims and advertisements, stem cell therapies are currently not available for use in standard outpatient clinics. Stem cells are unique and specialized cells that can develop into many different types of cells and are capable of self-renewal. When you are injured, stem cells travel to the injury to help with the healing process.

It takes time for the body to repair damaged bone or soft tissue, and you may need more than one injection. Additional injections may be spaced out over several weeks or months. Patients typically begin experiencing pain relief and improved function within eight to 12 weeks.

While there are many research projects in progress, there are currently no stem cell therapies approved by the FDA to treat osteoarthritis or tendinopathy. Stem cells are extremely hard to produce and studies submitted to the FDA typically involve cell therapies and not stem cells.  

While orthobiologic treatments are commonly referred to as stem cell therapy or regenerative medicine, we recommend against the use of these terms. This is in order to avoid any confusion with true stem cell therapy and to avoid misleading patients about tissue regeneration with orthobiologic treatments. In fact, it is not clear whether current orthobiologics regenerate the damaged tissue back to the preinjury status. Additional research is being conducted to answer these questions.