What are Stem Cells and Platelet Rich Plasma?

For many orthopedic injuries and conditions, Dr. Daniel Goodman utilizes an alternative in-office treatment known as Regenerative Injection Therapy. This cutting edge therapy is accomplished using either Platelet Rich Plasma (PRP) from your own blood cells, or Stem Cells from your own bone marrow or fat cells. Currently, Dr. Goodman is one of only a few Board Certified physicians in Califonia who is experienced and skilled at performing these treatments.

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• What is Platelet Rich Plasma (PRP)?
• Why use your own platelets?
• What is a Stem Cell transfer?
• Which conditions are PRP/Stem cells used to Treat?
• Are PRP/Stem cells safe?
• How many treatments are required?
• Are PRP/Stem cells right for me?
• Are there any special instructions?
• What should you expect after the injection?

What is Platelet Rich Plasma (PRP)?

Platelet Rich Plasma is a new non-operative procedure that is used to treat chronic pain and injuries. Its use can often obviate the need for surgical repair. This highly advanced procedure provides an option for conditions that have traditionally been thought to be untreatable or require major surgery.

The doctor, or a skilled technician, will draw the patient’s own blood (similar to a lab test). The blood is then sterilely placed in a special centrifuge which spins the blood at high speeds. This process separates the patient's own platelets from the other blood components. The platelets are then concentrated, resuspended and re-injected into the arthritic joint or injured area. Once inside the tissue, the platelets release substances known as growth factors, which lead to initiation of the natural tissue healing process.

Along with initiating repair, platelets act as MAGNETS for undifferentiated, pluripotent "stem cells". Stem cells are attracted to the damaged area by the platelets and assemble in the injured tissue. They are instrumental in the regenerative process by changing (differentiating) into the specific, appropriate tissue that had been previously injured. The stem cells are responsible for remodeling and organizing the damaged area. Regenerative injection therapy works by stimulating ACCELERATED NATURAL HEALING in an injured site or arthritic joint.

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Why use your own platelets?

Platelets are tiny cells that are critical to clotting and healing. They are the body’s primary source of bioactive tissue growth factors. The platelets contain thousands of growth factors, which include:

• Connective Tissue Growth Factor (CTGF)
• Platelet Derived Growth Factor (PGDF)
• Transforming Growth Factor-beta (TGF-β)
• Epidermal Growth Factor (EGF)
• Insulin Growth Factor (IGF)<
• Basic Fibroblast Growth Factor (BFGF)
• Vascular Endothelial Growth Factor (VEGF)

Together, these compounds initiate and regulate your natural healing process in response to injury and degenerative changes. By concentrating these growth factors and injecting them at the site of an injury, a robust healing response is achieved.

Platelet Rich Plasma (PRP) also attracts Mesenchymal stem cells (MSCs). MSCs are multi-potent stem cells that can differentiate into a variety of cell types during tissue repair processes. Cell types that MSCs have been shown to differentiate into include collagen-secreting cells, bone-forming osteoblasts and cartilage-forming chondrocytes. Together these cells have the potential of rejuvenating tissues damaged by injury, degenerative changes, and osteoarthritis.

The Platelet Rich Plasma (PRP) process concentrates platelets and growth factors so that each cubic millimeter of solution contains approximately TEN TIMES the normal quantity of platelets and regenerative growth factors. . Because it is so concentrated, Platelet Rich Plasma (PRP) acts as a potent tissue growth stimulant, amplifying the natural process of tissue repair and healing.

Studies show that Platelet Rich Plasma (PRP) induces the production of new collagen. It grows new tissue…especially ligaments, tendons, bone and cartilage...at the site where it is injected. It heals injured ligaments and tendons. The newly formed collagen is incorporated directly into your existing damaged tissue, making it thicker, stronger and more elastic. PRP actually HEALS damaged tissue….unlike steroids or other pain medicines that mask pain but do not enhance healing.

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What is a Stem Cell Transfer?

Stem Cell Transfer is a procedure done in the office setting, where stem cells from bone marrow or fat cells are extracted, filtered, and concentrated. The concentrated Stem cells are then injected into areas of severe damage... especially large arthritic joints (hips, knee, shoulders). The stem cells differentiate into damaged tissue (eg.- cartilage). Stem cell transfers are being utilized to treat severe arthritis and meniscal tears.

Autologous stem cells (derived from the patient himself) can be obtained from the bone marrow or from adipose tissue (fat). If Dr. Goodman decides to utilize bone marrow to harvest stem cells, he first "numbs up" the skin over the area he is working on. He then inserts a needle into the hip bone (iliac crest) and withdraws a small amount of the bone marrow. The procedure is fast and relatively painless. The bone marrow collection contains billions of stem cells, far more than are found in peripheral blood.

If adipose cells are chosen as the better site for stem cell harvesting, Dr. Goodman does a "mini-liposuction" procedure. He will first use a local anesthetic solution to "numb up" a region of your body that has excess fat. He then uses a small tube to gently withdraw a small amount of adipose tissue. Fat cells have been proven to have an extremely large number of stem cells, possibly more than found in bone marrow.

After harvesting the stem cells from bone marrow or adipose tissue, Dr. Goodman will concentrate the cells and immediately inject them into a severely arthritic ("bone on bone") joint. The stem cell procedures are especially effective on patients who are told that they need major surgery to cure their painful conditions, as in "total joint replacements" on the knee, hip and shoulder. The procedure is done in the office under mild sedation.

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Which conditions are PRP/Stem cells being used to treat?

Medical researchers are reporting remarkable results using PRP/stem cells in the treatment of common injuries, including:

• Chronic pain: back/neck, shoulder, elbow, wrist, hand, fingers, ankles, feet, knees & hips
• Cartilage regeneration (from injury or arthritis): knees, hips, shoulders, thumbs
• Non-surgical repair of rotator cuff tears, separated shoulder (A-C joint)
• Acute tendon and ligament injuries (eg - tennis elbow, achilles tendonitis, plantar fascitis, patellar tendonitis)
• Erectile dysfunction in males and females
• Eradication of facial wrinkles and unsightly scarring
• Regrowth of premature hairloss in men and women

Published studies show:

• Restoration and smoothing of roughened cartilage.
• Improved range of motion.
• Resolution of pain in osteoarthritis of hips, knees and shoulders.

Many other conditions respond to PRP/stem cell treatment, including injuries to the shoulders, knees, back, neck, jaw, elbows, hands, hips, ankles and feet. Dr. Goodman commonly uses these regenerative injections on tendons and ligaments through the body, including:

• Tennis elbow and golfer’s elbow
• Tendonitis
• Ligament and meniscal tears
• Spine conditions
• Arthritic joints
• Rotator cuff tear of the shoulder
• Labral tears of the shoulder
• Osteoarthritis of the hip, knee, and shoulder
• Overuse syndromes

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Are PRP/Stem cell procedures safe?

Yes. 

Autologous (patient derived) PRP has been used for over 30 years as an aid in recovery following certain surgical, orthopaedic and dental procedures. There are thousands of research articles published on the safety of PRP. Because your own blood is used, there is no risk of a transmissible infection and a very low risk of allergic reaction.

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How many treatments are required?

The response to treatment varies. Most patients require one to three treatments. Patients are evaluated to see how they will respond to the injections. For more severe problems, additional injections may be necessary. Some people respond immediately, but most of the time, it takes approximately 8-12 weeks to get optimal response to the treatment.

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Are PRP/Stem cells right for me?

If you suffer from chronic pain, arthritis, an injured ligament, or tendon, and traditional methods have not provided relief, then PRP/Stem cell therapy may be the solution. The procedure is less aggressive, less invasive and less expensive than surgery. It will heal tissue with minimal or no scarring. It will relieve chronic pain and alleviate further degeneration of the tissues. There will be an initial evaluation with Dr. Goodman to see if PRP/Stem cell therapy is right for you.

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Are there any special instructions?

You are restricted from the use of non-steroid anti-inflammatory medications (NSAIDs) one week prior to the procedure and one month after. Initially, the procedure may cause some localized soreness and discomfort. Dr. Goodman typically orders a mild narcotic for this post-procedure discomfort, however most patients only require some extra-strength Tylenol to help with the pain. Ice and heat may be applied to the area as needed, after the first 36 hours.

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What should you expect after the injection?

After the injection, there is an increasing discomfort for approximately 1-3 days. The positive effects of the injection can occur within one week after the injection. This usually happens with torn tendons/ligaments and bursitis. With an osteoarthritic condition, it takes about 8-12 weeks to respond. We recommend normal activity with no extra exercise for the first 48 hours. After 3-4 days, you will start light exercise (or physical therapy) progressing to full activity in four to eight weeks.

NONE OF THESE PROCEDURES ARE APPROVED BY THE FDA.