1. Regenerative Medicine Overview and Indications
Brian Siegel, MD
Steamboat Springs, CO

2. Biologics used for Regenerative Medicine
Platelet rich plasma
Platelet poor plasma
Human amniotic cells
Bone marrow stem cells
Adipose derived stem cells

5. Types of PRP High hct, high wbc, high platelet
Low hct, low wbc, high platelet
Low hct , low wbc, low platelet

6. Indications for PRP injections
Areas of body with lower blood supply
Tendinopathies
Plantar Fasciitis
Sacroiliitis
Wound healing
Nerve damage
Little to no data to support PRP for discs or articular cartilage OA (by itself)

7. Indications for PPP injections
Contains a variety of growth factors
Muscle tears
Joint preparation prior to stem cell injection
Volume expansion for injections

8. Human Amniotic Cells Anti-inflammatory properties Growth factors
Hyaluronic acid
Stem Cell activators
HSC’s (hematopoietic stem cells, CD34+)
Better in patients with autoimmune disease?

9. Indications for Amniotic fluid injections
Tendinopathies
Joint pain associated with mild osteoarthritis
Allografts used for cartilage defects
Wound healing
Peripheral neuropathy

13. Bone Marrow Stem Cells Contains Anti-inflammatory Immunomodulatory
Mesenchymal Stem Cells MSCs
Hematopoietic Stem Cells HSCs
Endothelial progenitor Cells EPCs
Platelets
Anti-inflammatory
Immunomodulatory

15. Adipose Stem Cells Mesenchymal Stem Cells MSCs T regulatory cells
Macrophages
Endothelial Progenitor Cells EPCs
Stromal Vascular Fraction SVF

17. Bone Marrow Aspirate
Adipose derived cells

19. Indications for Mesenchymal Stem Cell Therapy
Knee Osteoarthritis – stage 1-4
Meniscal tears
DJD of hip, shoulder, ankle, etc.
Labral tears
Glenoid Type 1 and 2
Hip
Intervertbral Disc and Facet Degeneration
Chondral defects
Avascular Necrosis

20. Contraindications for Mesenchymal Stem Cell Therapy
Active infection
Active cancer
History of lymphoma
Certain blood thinner, i.e. Ticlid, Xaralto
Major structural defect
Impaired ROM

21. Complications Transient increase in pain, resolution within 7 days
Transient increase in swelling, resolution within 14 days
Rash – secondary to adhesive, topical antibiotic or prep
No reported malignancies

22. Conclusion Biologics are safe and effective
Good treatment alternatives for chronic musculoskeletal pain
More studies are needed to determine:
Best biologic for each particular disease
Soft tissue
Cartilage
Disk
When to choose PRP, BMAC, Adipose, Amnion