Biologic and Regenerative Medicine


Biologic and Regenerative Medicine Overview

At Nebraska Orthopaedic and Sports Medicine, PC, we provide our patients with the latest treatments available.  In the past few years, the area of biologic joint preservation and stem cell therapy has become a dominate treatment alternative to surgery.  

We understand that patients want the most innovative procedures available, and our providers strive to select options that have been tested in clinical trials and have demonstrated effective results.  While many biologic procedures are not yet FDA approved, our physicians have years of orthopaedic experience and knowledge to ensure these procedures are done correctly and safely.  When choosing to undergo alternative therapies to manage joint pain and orthopaedic conditions, patients should put their trust in orthopaedic surgeons who have the expertise and board certification to manage your care. 

BIOLOGIC AND STEM CELL PROCEDURES

Stem Cell Therapy Overview

Stem cells have the potential to reduce inflammation and provide important proteins that may promote healing.  Stem cell therapy is predominantly used for conditions of the shoulders, hips and knees; however any joint or tendon can be treated using this procedure.  Stem cells can also be used to help reinforce a surgical procedure because of the cells’ ability to assist the healing process.

Stem cells are acquired either though a patient’s own body or potentially from donated human tissue.  At Nebraska Orthopaedic and Sports Medicine, we use the patient’s own (autologous) bone marrow blood or adipose (fat) tissue.  Allograft tissue/fluid cells can also be used if desired and determined to be indicated for your condition.

In bone marrow aspiration, bone marrow blood is removed from the pelvis using a local anesthetic to ensure patient comfort.  The aspirated bone marrow blood is then minimally processed by a licensed perfusionist using a special centrifuge to concentrate and separate the cells.  The harvested cells are then injected into your target area(s) using ultrasound-guidance.  

Stem Cell Therapy is not FDA approved and is not covered by insurance.  

We understand there are a lot of questions surrounding the practice of stem cell therapy, particularly regarding the origins of the stem cells themselves. Below is an explanation of the different types of stem cells we use:

  • Autologous/autograft: If the product comes directly from the patient, it is an autograft. 
  • Allograft: If the product comes from donated tissue, it is an allograft.
  • In some cases, procedures require a combination of synthetic, autogenous (your own), and allogenic (donor) biologic materials.

Bone Marrow Aspirate Concentrate (BMAC)

Candidates: Patients with arthritis of the hip, knee or shoulder or those patients with a soft tissue injury who have seen a physician for their condition and have exhausted conservative therapies including, but not limited to: rest, medication, physical therapy.

  • Bone Marrow Aspirate Concentrate, or “BMAC,” contains some stem cells, a higher concentrations of cells than PRP, in addition to anti-inflammatory enzymes and growth proteins.
  • BMAC can be harvested from many areas of your own body, including the hip/pelvis, knee, ankle or shoulder. 
  • BMAC is concentrated in a manner to provide the important cells for the treatment of your injury or condition.
  • BMAC can be performed as an in-office procedure or in conjunction with surgical procedures to augment (assist) and leverage the healing response.

Platelet Rich Plasma (PRP)

Candidates: Those who have a tendon injury, ligament injury or osteoarthritis and have exhausted all non-surgical therapies (rest, medications, physical therapy).

  • PRP is used primarily in joint arthritis, muscle tendon injury, cartilage preservation, rotator cuff repair, and tennis elbow.
  • Platelet-Rich Plasma (PRP) is a concentration of a portion of your blood called platelets. These cells contain specialized proteins and growth factors that enhance healing and leverage the immune system in response to injury and disease.
  • PRP is produced by taking a small amount of your own blood during an office visit and spinning it in a centrifuge. Blood components (ex. red blood cells, white blood cells, platelets) are separated and then injected into the location of injury or painful joint.

Lipogems

Candidates: Patients who desire a minimally invasive alternative to surgery for tissue injuries or joint pain or for those patients where a physician determines Lipogems may be used in addition to surgery to improve post-operative healing.

  • This process offers patients a minimally-invasive option to surgery and may also improve post-operative healing for those patients who require surgery. 
  • The technology works to aid in the repair, replacement, reconstruction, and support of damaged or injured tissues.  
  • The procedure uses cutting-edge technology to process a patient’s own fat tissue to cushion and support areas of injury or damage as the body heals itself. 
  • Micro-fragmented fat is injected precisely into areas of the body to help support tissue in healing and repair.
  • Your physician will make a tiny skin puncture and take a small section of fat from your midsection.  Your collected fat will be  micro-fragmented, during which your fat is washed, rinsed, and resized into smaller clusters while maintaining the natural beneficial properties of your fat.  Impurities in your fat such as blood, cell debris, and oils are removed as the desirable remainder of your fat is concentrated.
  • Your physician then will use a small needle to inject the micro-fragmented tissue into the treatment site. 
  • Only a local anesthesia is required and the procedure can be performed in approximately one hour.
  • There is minimal recovery time from the Lipogems procedure.

Amniotic Tissue

Candidates: Patients who have exhausted non-surgical therapies for their joint pain or soft tissue injury.  Non-surgical therapies may include things like rest, medication, physical therapy.  Amniotic products can also be used in combination with surgery.

  • Amniotic tissue and products are typically used in joint arthritis, cartilage damage/degeneration, meniscal repairs, ligament and tendon injuries
  • Mesenchymal stem cells can function in a local environment to assist and leverage the healing process of injured tissues.  Amniotic fluid tissue and fluids are protective tissues that form during pregnancy.  This membrane and fluid is carefully recovered and voluntarily donated after a full-term, healthy delivery by Caesarean section.
  • These cells are rich in growth factors, anti-inflammatory proteins and hyaluronic acid that may aid the healing process. 
  • All fluids are serologically tested to the strictest FDA standards.

JOINT PRESERVATION PROCEDURES

Cartilage and Meniscus Transplantation

Cartilage Candidates: Patients who are physically active and have a healthy joint but suffer some from of articular cartilage damage.  Patients should be of a healthy weight and not have certain contraindications like severe osteoarthritis or rheumatoid arthritis.

  • Many individuals sustain injuries to their meniscus and joint surface cartilage. These two parts of our knee work better together and decrease stress across the joint. A loss of either will lead to an increase in the development of traumatic arthritis.
  • There are multiple options to replace the damaged area with any combination of autogenous (your own), allogenic (donor), and/or synthetic regenerative substitutes.  
  • Fresh cartilage can be transferred from one spot to another.
  • Allograft articular cartilage and meniscii can be replaced at the site of injury.  Options vary between each individual. A structured plan can be developed for each individual who suffers from persistent activity-limiting pain.

FREQUENTLY ASKED QUESTIONS

Why Nebraska Orthopaedic and Sports Medicine?

Nebraska Orthopaedic & Sports Medicine has decades of experience providing the latest in orthopaedic procedures. We offer the entire range of treatments from conservative to surgical.  The doctors at Nebraska Orthopaedic and Sports Medicine can help you choose the best treatment for you.  Many clinics offering stem cell treatments for orthopaedic conditions are not orthopaedic doctors.  When considering a clinic for stem cell treatment, you need to consider a doctor’s training and experience.  Nebraska Orthopaedic & Sports Medicine is one of the few orthopaedic clinics in the region offering these exciting procedures.

For What Conditions Are These Procedures Recommended?

Your physician will conduct a thorough evaluation of your condition before making any recommendations. 

These types of treatments are most commonly used to treat the following conditions:

  • Articular cartilage damage
  • Early stage osteoarthritis or cartilage damage (treatment areas include ankle, elbow, hip, knee, hip, and shoulder)
  • Ligament Injuries (ankle, elbow, foot, knee)
  • Tendon injuries (Achilles tendon, plantar fasciitis, rotator cuff, tennis elbow)

Are These Procedures Covered by Insurance?

  • Many of these procedures are not currently covered by insurance carriers.  As a result, these procedures will be a self-pay (out of pocket) expense.  
  • We believe in price transparency and our physician’s billing team will be happy to assist with any  questions you have once a specific treatment recommendation has been made.

What Results Can I Expect from Treatment?

  • Because many of these services are newer treatment options, the long-term outcomes are not yet fully understood.  As a result, no guarantees can be made regarding outcomes.
  • Generally speaking, patients can expect to feel improvement over the initial 1-3 months post-procedure.  A booster injection may be considered after the initial 8-10 week period. Additional relief may take as long as 6-12 months. 
  • No one person is created the same.  We use these treatments to stimulate your own body to heal itself, but how your body responds is not predictable.

Are These Procedures FDA Approved?

  • No.  Some of these procedures involve devices that have FDA clearance, (Lipogems) but the procedures as a whole are not yet FDA approved at this time.
  • The FDA has taken a strong stance in enforcing the guidelines it has provided to the medical community as it pertains to stem cells and other biologic procedures.  
  • There is still much to be learned about the long-term effectiveness of stem cell therapy.  Clinical trials are ongoing and the American Academy of Orthopaedic Surgeons (AAOS) has released the following position statement about the procedure.  AAOS Policy Statement

What Will My Recovery Time Look Like?

Recovery will vary from procedure to procedure.  

  • Most biologic procedures are performed in-office and have very little downtime.  Patients may experience some pain for a few days following the procedure but can generally return to normal activities after 2-5 days.
  • Joint preservation procedures are more invasive and therefore recovery time is variable.

Who Performs These Procedures?

The following physicians are performing stem cell therapy:

How Do I Schedule an Appointment?

To schedule an appointment, call (402) 488-3322. 

Our physicians will assess you at an initial office visit to determine whether any of these procedures will be right for you.