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Feb 11, 2021

How to Choose the Right Orthopedic Regenerative Medicine Provider?

The science of regenerative medicine is progressing rapidly. Many “bad actors” have co-opted “stem cells” preying on unsuspecting patients and their families. Advertisements for stem cells treatments and patient centered seminars are showing up everywhere, often with claims that are too good to be true. Don’t believe everything you hear about stem cells and don’t be misled by deceptive marketing from unqualified physicians.


How do you know what to believe?

The first step is as a consumer understanding the difference between the various orthobiologic treatments.

There are 3 major groups of orthobiologic treatments that are typically offered in orthopedics. What is injected is critical as these treatments are not all the same.

Platelet rich plasma (PRP)

  • PRP uses a patient’s own blood to concentrate platelets and growth factors induces downstream signaling pathways that play important roles in cell proliferation, migration, and differentiation. PRP injections are NOT STEM CELLS, but PRP has been shown to cause proliferation of adipose derived stem cells (Lai et al. 2018) and bone marrow mesenchymal stem cells (Oliva et al 2005) in basic science studies.

Autologous stem cell or mesenchymal stem cell

  • Autologous stem cells are commonly derived from human adipose or bone marrow, and they can differentiate into multiple cell types (chrondrocytes/cartilage cells, tenocytes/tendon cells, etc). Stem cells have been widely used in the field of regenerative medicine, and are autologous meaning they are obtained from the patient at the time of the procedure.

Amniotic products

  • Amniotic tissue products are NOT STEM CELLS and likely have a similar effect as PRP. These products may have a role in orthopedics, but there are fewer studies on amniotic injections in orthopedics. Despite studies from Cornell and UC Davis showing that amniotic products DO NOT contain live stem cells, some clinics advertise that they are stem cell injections. This should be a red flag.

Beware of:

Claims that stem cell treatments can treat a wide range of diseases? This is untrue.

  • Clinical trials are testing the safety and efficacy of stem cell-based treatments for blindness, spinal cord injury, heart disease and Parkinson’s disease, but the treatments are still unproven for many the diseases being studied
  • Our Advice: If interested in regenerative procedures for an orthopedic problem see someone with musculoskeletal, sports or orthopedic training.


Patient testimonials used to validate a particular treatment.

  • In orthopedics there is level 1 evidence for platelet rich plasma (PRP) for knee osteoarthritis and elbow tendinopathy. There is level II-IV evidence for many other applications of PRP and stem cells. Make sure your provider can discuss the scientific evidence for the regenerative medicine treatments and not only rely on patient testimonials.
  • Our Advice: See a provider who can discuss the scientific evidence for these treatments even when the evidence is limited. Physicians who have published book chapters and peer-reviewed articles is one indication they are up-to-date with the evidence.

How do you know who know your physician has the appropriate medical credentials?

Regenerative medicine is a relatively new field and most physicians receive limited training in orthobiologics. If you have an orthopedic condition, then your physician should not only be comfortable with orthobiologics, but also have specialty training in physical medicine & rehabilitation (PM&R), sports medicine or orthopedics. These specialties understand the musculoskeletal system.

In addition to training in orthobiologics and musculoskeletal medicine, your physician should be skilled in ultrasound or x-ray guided injections. There is the evolving field of Interventional Orthopedics, and your physician should be comfortable with these advanced techniques.


Being skilled with using these advanced guidance techniques is the only way to ensure that the injection is being placed in the correct place. Intravenous or IV injections will not get these cells to the injured tissue and the majority of IV ad cells get trapped in the lungs before they can get to the injured tissue (Fischer et al 2009).

  • Our Advice: Whether you choose Boston Sports & Biologics or another reputable clinic you want to:
  1. Understand who is going to be performing the procedure and what their experience is with orthobiologics.
  2. Understand what they will be injecting.
  3. Understand how they will ensure the biologic injection is getting to the right area.

Why Boston Sports & Biologics?


Not everyone is a good candidate for orthobiologic treatments. The treatment must fit this disease, and the outcomes may vary depending on the severity of the problem. In some cases, the best treatment maybe surgical, but as a patient you should understand your options. If the treatment sounds too good to be true it probably is.

Dr. Sussman board certified in PM&R and sports medicine, and regularly contributes to publications on stem cell and platelet rich plasma therapies. He has written book chapters and peer-reviewed articles on orthobiologics and is an editor for a textbook on Interventional Orthopedics to be released in 2021.

In addition, Boston Sports & Biologics is one of only 43 clinics in the country to work with Databiologics to collect outcome data on orthobiologic treatments. Our objective is to provide the highest level of care and continue to promote a greater understanding and advance the field of regenerative medicine. We will spend the time to discuss your underlying cause of pain, your treatment options and whether you maybe a candidate for orthobiologic treatments.

Whether you seek care at Boston Sports & Biologics or elsewhere, we encourage you to do your homework.

REFERENCES:

Fischer UM, Harting MT, Jimenez F, Monzon-Posadas WO, Xue H, Savitz SI, Laine GA, Cox CS Jr. Pulmonary passage is a major obstacle for intravenous stem cell delivery: the pulmonary first-pass effect. Stem Cells Dev. 2009 Jun;18(5):683-92.

Lai F, Kakudo N, Morimoto N, Taketani S, Hara T, Ogawa T, Kusumoto K. Platelet-rich plasma enhances the proliferation of human adipose stem cells through multiple signaling pathways. Stem Cell Res Ther. 2018 Apr 16;9(1):107.

Oliva A, Passaro I, Di Pasquale R, Di Feo A, Criscuolo M, Zappia V, Della Ragione F, D'Amato S, Annunziata M, Guida L. Ex vivo expansion of bone marrow stromal cells by platelet-rich plasma: a promising strategy in maxillo-facial surgery. Int J Immunopathol Pharmacol. 2005;18:47–53.

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