Many times a prospective patient will come into our office for a consultation and ask if we can do both Platelet Rich Plasma injections and Bone Marrow derived stem cell injections at the same time. The idea comes from visits to other clinics where it is discussed with patients that Platelet Rich Plasma injections either prior to or at the same visit will make stem cell therapy more effective. The answer we give is no, the use of bone marrow concentrate more commonly bone marrow stem cell therapy contains a rich source of blood platelets. Simply, it is getting both treatments at once.
Give me a chance to back this up with some research.
Let’s start with a 2012 study. (1) Here the research team wanted to determine whether platelet-rich plasma (PRP) could be made into a bioactive scaffold capable of endogenous (using the body’s own healing and response system), growth factor release for cartilage repair. In essence these researchers made a patch of platelets.
Then they took adipose – fat derived stem cells (which we do not use) and they took bone marrow derived stem cells, which we do use, and seeded them into a patch in the laboratory. The patch was then implanted into rabbit knees. What they found was:
- The stem cells multiplied in the platelet rich patch.
- The bone marrow stem cells turned into cartilage in the rabbits faster and more efficiently than the fat stem cells did.
The theory that platelets made stem cells work better was is in place but the practically was not: What you can do in the laboratory you sometimes cannot do in the clinic. For one thing you cannot culture stem cells in the United States. Cultured stem cells were used in this study.
This is one of the most cited (by other studies) papers on the subject. We are going to take this 2012 research right into 2021.
Let’s move next to research from 2014
Bone marrow aspirate injections contain plasma rich in growth factors and mesenchymal stem cells
In the Journal of natural science, biology, and medicine (2) researchers wanted to show how effective bone marrow aspirate (containing plasma rich in growth factors and mesenchymal stem cells) injections could be in the treatment of tennis elbow. This research is not a PRP patch or a PRP scaffold, it is a direct injection of bone marrow aspirate into a painful joint.
In this research a total of 30 adult patients with previously untreated tennis elbow were administered a single injection of bone marrow aspirate (stem cells and platelets).
- This concentrate was made by centrifugation of iliac crest bone marrow aspirate – watch the video below.
- The researchers concluded: Treatment of tennis elbow patients with single injection of bone marrow aspirate showed a significant improvement in short to medium term follow-up. They suggest that in the future, such growth factors and/or stem cells based injection therapy can be developed as an alternative conservative treatment for patients of tennis elbow, especially who have failed non-operative treatment before surgical intervention is taken.
Let’s point out again bone marrow aspirate contains plasma rich in growth factors and mesenchymal stem cells. No separate PRP treatment was given.
The benefit of the mesenchymal stem cells-PRP mixture is the ability to obtain source cells and growth factors simultaneously, simply, and cost-effectively
A 2018 study published in the medical journal Clinics in orthopedic surgery (3) looked at the effectiveness of bone marrow aspirate concentrate on rotator cuff tears following rotator cuff surgery. The study was performed to in part see if post surgical bone marrow stem cell treatments could help prevent a high rate of re-tears in the rotator cuff. The study conclusion reported: “the local application of bone marrow aspirate concentrate after rotator cuff repair enhanced the mechanical strength of the tendon-to-bone junction. Improved biological healing was also observed . . . ”
So indeed, bone marrow aspirate concentrate was able to strengthen the repaired tissue. But how? The researchers suggested: “Bone Marrow Aspirate Concentrate contains a high concentration of platelets, but more importantly, it also contains mesenchymal stem cells and progenitor cells* all of which contribute to tissue regeneration. . . The benefit of this combined with the mesenchymal stem cells-PRP mixture is the ability to obtain source cells and growth factors simultaneously, simply, and cost-effectively.”
These are benefits are similar to what we have found for our patients, bone marrow derived stem cell injections contain platelets necessary for accelerated and enhanced healing. When we inject the stem cells into the patient’s painful joints we are providing stem cells and growth factors simultaneously, simply, and cost-effectively.
There is usually no need for the extra PRP treatments.
* Progenitor cells are much like stem cells in that they have the ability to morph into other cells. The difference is progenitor cells have a limited ability to reproduce itself)
There are times when PRP and bone marrow aspirate are used in tandem
Much of the research that surrounds the combined use of PRP and bone marrow aspirate is confined to surgical procedure and the surgeon’s desire to effect a bone healing. A study in the Journal of orthopaedic research (4) from December 2020 gives an example:
“Platelet-rich plasma is autologous plasma that contains concentrated platelets compared to whole blood. It is relatively inexpensive to produce, can be easily isolated from whole blood, and can be administered while the patient is in the operating room. Further, because platelet-rich plasma is an autologous therapy, there is minimal risk for adverse reactions to the patient. Platelet-rich plasma has been used to promote bone regeneration due to its abundance of concentrated growth factors that are essential to wound healing.”
1 Xie X, Wang Y, Zhao C, Guo S, Liu S, Jia W, Tuan RS, Zhang C. Comparative evaluation of MSCs from bone marrow and adipose tissue seeded in PRP-derived scaffold for cartilage regeneration. Biomaterials. 2012 Oct 1;33(29):7008-18.
2 Singh A, Gangwar DS, Singh S. Bone marrow injection: A novel treatment for tennis elbow. Journal of natural science, biology, and medicine. 2014 Jul;5(2):389.
3 Liu XN, Yang C-J, Kim JE, et al. Enhanced Tendon-to-Bone Healing of Chronic Rotator Cuff Tears by Bone Marrow Aspirate Concentrate in a Rabbit Model. Clinics in Orthopedic Surgery. 2018;10(1):99-110. doi:10.4055/cios.2018.10.1.99.
4 Liebig BE, Kisiday JD, Bahney CS, Ehrhart NP, Goodrich LR. The platelet‐rich plasma and mesenchymal stem cell milieu: A review of therapeutic effects on bone healing. Journal of Orthopaedic Research®. 2020 Dec;38(12):2539-50.