Regenerative Medicine

Regenerative medicine uses biologic treatments to improve symptoms of certain orthopedic conditions and has the potential to enhance healing in musculoskeletal tissues.

What is regenerative medicine?

Regenerative medicine therapies, also sometimes called orthobiologics, use biological tissues found in the human body, such as blood, fat or bone marrow.

In most cases, this type of biologic treatment is created using the patient’s own tissue to treat an injury. (This is called "autologous" regenerative medicine.) These therapies are generally safe for patients, since they are derived from the patient’s own cells.

What is orthopedic regenerative medicine used for?

Regenerative orthopedics may improve pain and discomfort of the musculoskeletal system and enhance the healing of orthopedic conditions, such as injuries of a tendon, ligament, bone, muscle, spinal disc, meniscus of the knee, cartilage or other musculoskeletal tissue. Most of these parts of the body have a relatively poor ability to heal on their own. The idea behind regenerative medicine is to help these tissues heal better.

Orthobiologics can be used to treat degenerative conditions such as certain forms of arthritis, as well as sports injuries and traumas. Regenerative medicine may help some patients avoid orthopedic surgery completely. Conditions commonly treated with regenerative medicine include:

*Some studies suggest that, for the treatment of osteoarthritis, current cell therapies may be no more effective than a corticosteroid injection. More research is needed in this area. (See Is cell therapy no better than steroid injection?)

Regenerative medicine may also help shorten and improve the healing process following orthopedic surgeries, such as ACL reconstruction or other ligament surgeries, and meniscus repair.

How does regenerative medicine work?

Samples of a person’s own body tissue (or, sometimes, tissue donated by another person) are collected and concentrated to produce a solution that is then injected into the patient.

Some evidence suggests that these prepared concentrates contain not only cells that signal or "call" other cells to gather at the site of injury to assist with healing, but also many proteins and molecules that alleviate the inflammation process and pain symptoms.

How are the "injectables" in regenerative medicine prepared?

The tissue sample (of blood, bone marrow or fat) will be run though a special syringe, "spun down" in a centrifuge and concentrated. This concentrate contains cells and molecules that help injuries heal.

What are the different types of regenerative medicine?

Regenerative medicine therapies include:

• platelet-rich plasma (PRP) injections
• cell-based treatments such as:
  • bone marrow therapy (also known as bone marrow aspirate concentrate or BMAC)
  • cell therapy

Platelet-rich plasma (PRP) treatment

PRP is produced from a small sample of a person’s own blood. The blood is centrifuged (spun down) to isolate and concentrate platelets, which are the blood cells that assist in natural tissue healing processes.

These platelets, along with a fluid portion of blood called plasma, are then injected back into the person at the site of their injury. The injection contains a number of proteins that can potentially decrease inflammation, reduce pain and improve tissue healing. PRP has been used for many soft-tissue injuries, including those in ligaments, tendons, knee menisci, cartilage and muscle. As with all autologous regenerative medicine, PRP is generally safe, since it is a therapy derived from the patient’s own blood.

Cell-based therapies

Other cell-based therapies work very similarly to platelet-rich plasma injections, but involve other types of human cells.

• Bone marrow aspirate concentrate (BMAC, and also known as "bone marrow therapy") is a cell-based treatment produced from bone marrow cells. The bone marrow is usually collected from a person’s hip bones.
• Adipose (fat) tissue therapy uses fat cells taken from a person’s abdomen or thigh. (This process is completely unrelated to liposuction or other cosmetic surgeries performed by plastic surgeons.)
• Other cell treatments are derived from cells in placental or amniotic tissue. Some limited data suggests that these types of cell injections may improve the symptoms of various musculoskeletal conditions. How exactly these effects are achieved is not completely clear. They may result from anti-inflammatory chemicals that these cells produce, rather than from the cells themselves.

Both PRP and cell-based therapies are often injected using imaging assistance, such as ultrasound. Ultrasound-guided injections help doctors visually pinpoint specific areas for injection, such as the tendon.

What is the difference between regenerative PRP and BMAC?

The two processes are very similar, but they differ in the type of tissue of the body from which the samples are taken. In the case of PRP, a sample of your own blood will be taken with no need for anesthesia. For BMAC, the sample is taken from the inside of your hip bone (pelvis) using a needle. This requires a local anesthestic to help numb pain.

Can PRP or cell-based therapies regrow cartilage, tendon or muscle?

The current available research is still very limited and has not yet demonstrated whether musculoskeletal tissues can be regrown by directly injecting PRP, BMAC or adipose-tissue concentrates.

However, some evidence suggests that these concentrates contain not only cells that signal or "call" other cells to gather at the site of injury to assist with healing, but also that these concentrates contain many proteins and molecules that alleviate the inflammation process and pain symptoms.

Who should get regenerative medicine treatment?

This is dependent on both each individual patient and their particular condition. In order to assess whether you are a good candidate for a regenerative medicine procedure, you will need to visit a physician who will evaluate your symptoms, medical history and current condition.

Which regenerative medicine procedure is best for me?

Although all PRP and cell-based regenerative medicine therapies have been shown to improve symptoms in patients with many different musculoskeletal conditions, there is only limited research on which treatment is best for each patient. You will need to visit a physician who, after evaluating your symptoms and current condition, will recommend the best approach for your case.

Do regenerative medicine injections hurt?

In most cases, the injury being treated is "inside" of a joint, so using a needle in your injured area will produce temporary discomfort. This is usually relieved by the anesthesia applied before the injection.

If you are having a cell-based therapy, the first step will be the removal of your bone marrow or fat, which will be done under local anesthesia with an injection to numb the skin. Your physicians will provide you more details on the different options of anesthesia for these procedures. After the procedure, you will experience some discomfort in the area where your bone marrow or your fat were extracted. Marrow is usually extracted from the back of the hip, while fat is usually drawn from the abdomen.

How long does regenerative medicine injection therapy take?

If you are having a PRP injection, the whole procedure usually takes around 30 minutes. For cell-based therapies, the procedure can take between one and one a half hours.

I’ve already had orthopedic surgery. Am I still a good candidate for regenerative medicine?

Many of these procedures may be used after any orthopedic surgery. You’ll need to consult with a physician who will recommend the best approach for your case after evaluating your symptoms and current condition.

What is the recovery time for regenerative medicine?

Most patients are able to resume normal daily activities within two to three days after treatment and are usually able to resume exercise a few weeks after treatment. However, every case is different.

Does insurance cover regenerative medicine?

Unfortunately, insurance companies do not yet cover regenerative medicine therapies. However, if you are having any of these treatments in combination with a surgery or another treatment (for example, getting PRP injections while also having an operation to repair a ligament tear), those other treatments will be likely covered by your insurance. Check with your insurance provider, as every case is different.

How much does regenerative medicine cost?

The total cost of the procedure varies depending on what type of therapy you are getting. If you are considering a regenerative medicine procedure, you should discuss financial options with your doctor.

To learn more, visit the HSS Center for Regenerative Medicine.

Updated: 1/29/2024

Reviewed and edited by Scott A. Rodeo, MD, and Jessica Andres-Bergos, PhD