skeleton body with pressure points in red

Regenerative Medicine Talk at the Briargate YMCA

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In conjunction with Fyzical Therapy & Balance Centers, Dr. Martin will be giving a lecture at the Briargate YMCA Community Room on August 13 from 6:15 to 7:15 p.m. This informative talk will focus on non-surgical approaches to pain relief, and Dr. Martin will discuss the role of stem cells and PRF/PRP.

Dr. Martin started in the field of regenerative medicine in 2009, and since 2012, she has regularly used stem cells and PRP/PRF in her treatment of the spine and peripheral joints, ligaments and tendons. Dr. Martin brought stem cells for the musculoskeletal system to Colorado Springs in February of 2015, when she opened Spine & Joint Solutions. If you would like to learn from the local expert in this field, join us!

PRP vs. PRF: What’s the Difference?

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At Spine & Joint Solutions, we are proud to offer the newest and most exciting addition to the field of regenerative medicine. Up to this point, platelet-rich plasma (PRP) has been the only platelet-based product offered for treatment of tissue damage. More recently, platelet-rich fibrin (PRF) has emerged as a more advanced and effective product in the world of musculoskeletal care, as well as within anesthetic medicine.

PRP vs PRF: What’s the difference?
Although there are some basic similarities between platelet-rich plasma and platelet-rich fibrin, it is the differences between these two products that makes platelet-rich fibrin stand out as a superior treatment option. Both of these products require blood to be taken from the patient. PRP requires more blood to be taken than PRF. Both of the products require the whole blood sample to be placed into a centrifuge, where the blood is then processed to help separate the blood into distinct layers. Platelet-rich plasma is spun at a higher speed, which effectively causes all of the heavier cells in the blood, such as white blood cells and stem cells, to collect in the bottom part of the test tube and allows the lighter platelets and plasma to collect in the top part of the test tube. The platelets and plasma are then collected from the upper part of the test tube and injected into the region with tissue damage. However, newer research is showing that a platelet product that has an even higher concentration of platelets, as well as a concentration of some white blood cells and stem cells, is even more effective than traditional platelet-rich plasma. With this new information, platelet-rich fibrin was created. The PRF product is spun at a lower speed so that the layers of the blood do not separate out as distinctly. This allows some of the white blood cells and stem cells to remain within the platelet layer that is collected for treatment. Thus, there are more healing factors within PRF than is typically seen in PRP. In addition, the lower spin speed causes less trauma to the individual cells of the blood, allowing more stem cells to remain in the final PRF product.

Another distinct difference between platelet-rich plasma and platelet-rich fibrin is the concentration of platelets within the final product. Literature states that an ideal concentration of platelets for a platelet rich plasma sample is between 2-5 times the level of platelets typically found within the body. Newer literature now points out that an even higher concentration of platelets may be even more effective in the treatment of tissue damage. Platelet-rich fibrin products contain approximately 10 times the platelet concentration that is found within the body.

A final difference worth mentioning between platelet-rich plasma and platelet-rich fibrin is the fact that with PRF, no anticoagulant is used during the processing of the blood. With platelet-rich plasma, the blood that is collected is placed in test tubes that have an anticoagulant called acid citrate dextrose (ACD), which keeps the blood product from clotting too quickly. In an effort to keep the platelet product as natural as possible, the platelet-rich fibrin test tubes do not have any anticoagulant within them. Without any anticoagulant in the test tubes, the natural fibrinogen within our blood is converted to fibrin by thrombin in the early stages of clot formation. This creates a spongy fibrin matrix that activates the platelets and allows for a slow release of growth factors, which starts the tissue healing process.

The Importance of Ultrasound

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Musculoskeletal ultrasound is an emerging field in medicine. To become proficient at performing musculoskeletal ultrasound in both the diagnostic and therapeutic arenas takes years of practice. In using the ultrasound machine from a diagnostic standpoint, real-time evaluation of the injured region of the body can occur. Damage can typically be clearly outlined and monitored for improvement over time. In using the ultrasound machine from a therapeutic standpoint, a needle can be guided directly into a desired region so that the medication can be placed precisely over the desired location. I would urge anyone who is dealing with a musculoskeletal issue to consider diagnostic ultrasound evaluation with Spine & Joint Solutions of Colorado, prior to more costly MRI imaging for diagnosis of an injury. I would also encourage patients to seek out physicians who will utilize ultrasound as a guidance tool for injection therapy. If ultrasound guidance is not used, studies have shown that even large joint injections can be inaccurate, which significantly decreases the possibility for improvement from that injection.

At Spine & Joint Solutions, Dr. Rebekah Martin frequently uses ultrasound evaluation for joints and soft tissue to develop a more comprehensive diagnosis of an injured area. She also performs all in-office injections under ultrasound so that she can be as specific as possible with medication placement. It is also quite interesting to monitor progress and tissue healing over time, which can be seen clearly under ultrasound.

Joint replacement vs regenerative medicine

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I recently reviewed an interesting article that presented a 54-year-old male with moderate-grade knee osteoarthritis who was healthy and active. The article argued the points for total knee arthroplasty (TKA) versus regenerative medicine therapy. An orthopedic surgeon was making the argument that TKA was a safe and successful surgery and that the patient should be able to return to a high level of functioning, such as golfing and skiing. He also mentions that the joint prosthesis should have a life of about 15 years. The physiatrist made several arguments, instead, for consideration of regenerative medicine therapy, including either platelet-rich plasma (PRP) or autologous stem cells. He states that the process of both blood aspiration (for PRP) and bone marrow aspiration (for stem cells) techniques are efficient and safe. The safety profile for regenerative medicine treatments, a single or limited number of injections, is also extremely preferred to the potential risks that are seen with TKA, such as infection, rejection, deep vein thrombosis and pulmonary embolus. Also extremely important is the cost of these two opposing options. The total cost of a TKA today is said to be around $52,000, and with many new insurance policies, a patient may be responsible for up to 20% of this value. Stem cell therapy provided in the office by SJS typically ranges from $1,800 to $3,000, depending on the product chosen, amount used and number of areas treated. This 54-year-old will require one to two prosthetic revisions due to his age and the average life of a knee prosthesis, and research does not show that individuals are typically able to return to a high level of activity following TKA. Most research suggests that patients return to activities of daily living after a TKA for the most part. In contrast to this, the goal of providing regenerative medicine therapy would be to not only return an individual to do her activities of daily living, but also to most extracurricular activities that would want to be pursued. Bottom Line: It is imperative that the general public be aware of regenerative medicine as a viable treatment option instead of more invasive measures. Any physician treating musculoskeletal and spine conditions needs to be educated, fair and honest with patients regarding their options.