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Dr. Stulc Explains PRP and BMAC Regenerative Treatments

PRP and BMAC therapies offer promising options for pain relief and improved function.

Regenerative PRP and BMAC therapies are at the forefront of emerging orthopedic medicine and have been offered at Summit Orthopedics for several years. Although these treatments are already delivering promising results, ongoing research continually adds to what we know about PRP and BMAC treatments. Physiatrist and orthobiologics specialist Dr. Steven Stulc discusses current research about the comparative benefits of PRP and BMAC.

The basics of PRP and BMAC

“PRP is shorthand for platelet-rich plasma treatments,” explains Dr. Stulc. “These treatments use concentrated platelets from the patient’s own blood for regenerative treatments. BMAC stands for bone marrow aspirate concentrate. BMAC also harnesses the healing properties of the patient’s body, but uses a concentrate derived from the patient’s bone marrow.”

The treatment procedures for PRP and BMAC

“We’ve been using PRP treatments for a longer period of time compared to BMAC treatments,” Dr. Stulc points out. “For this reason, we have more published research studies for PRP than we do for BMAC. These studies have established a broader confirmation for the safety and effectiveness of PRP, and that means that PRP is used more frequently. It is also the less expensive option between the two.”

Platelet-rich plasma (PRP)

Platelet-rich plasma is a blood component with three to eight times the concentration of platelets found in normal blood. A PRP solution is made by drawing a small amount of the patient’s blood and then centrifuging it. The centrifuge process separates platelet-rich plasma from the platelet-poor plasma in the blood sample. The PRP is then injected into the injured area under imaging guidance for accurate placement. Tendon treatments are delivered with ultrasound guidance. Spine and joint treatments are delivered with fluoroscopic guidance.

Bone marrow aspirate concentrate (BMAC)

Bone marrow aspirate concentrate is a biologic concentrate of a patient’s own bone marrow. Concentrated bone marrow aspirate is high in adult stem cells known to be critical in processes such as tissue regeneration. The marrow is extracted from the iliac crest of the pelvic bone. “We numb the area around the iliac crest, which makes the procedure relatively well tolerated,” says Dr. Stulc. “Everyone tolerates pain differently, but most people describe the discomfort as fairly minimal.”

There are a number of harvesting techniques for BMAC. “One technique involves using one syringe to aspirate 16 mL of the bone marrow aspirate at a single site,” notes Dr. Stulc. “The concern with this technique is that drawing from a single area gives you one population of stem cells and may deplete all of the stem cells in that area.

“At Summit, we’ve adopted a multiple syringe technique recommended by multiple research studies, including studies done by Philippe Hernigou, an international leader in regenerative medicine,” explains Dr. Stulc. “Using the multiple needle approach, we rapidly aspirate out of different areas of the iliac crest. Studies suggest that this multiple needle, multiple area draw results in a larger overall concentration of stem cells. The BMAC is then injected into the injured area under imaging guidance for accurate placement.”

Choosing between PRP and BMAC treatments

Guidelines for selecting between PRP and BMAC treatments are still being informed by research. In the meantime, because PRP has been around longer, there is more information guiding its use. “To date,” says Dr. Stulc, “we are treating most tendon and muscle issues with PRP. PRP has also been shown to work as a treatment for arthritis. Studies indicate that PRP therapies work better than traditional hyaluronic acid treatments to relieve arthritis pain.

“As we learn more about bone marrow aspirate concentrate, we hope to find that it delivers better and longer-lasting pain relief,” notes Dr. Stulc. “Based on my own ongoing training and experience with BMAC treatments, there are indications that BMAC treatments may provide up to two years of pain relief. That can fill a significant treatment gap for arthritis patients by providing pain relief that delays the need for a joint replacement. The promise of a quick injection that delivers 70 to 80 percent pain relief for two years is a valuable treatment option. We don’t have studies yet that tell us whether we can continue these injections indefinitely. And we don’t know yet if subsequent injections will continue to provide high levels of pain relief. Continuing research will give us the answers to these questions.

“We don’t have all of the answers yet, but the possibilities with PRP and BMAC treatments are promising,” concludes Dr. Stulc. “If we can truly do something that alters osteoarthritis and makes a disease itself better, that’s a fix in my book. And that’s why I’m so excited about this field.”

Expert care

Summit’s team of experts provides orthobiologics, an innovative treatment for those looking for an alternative to traditional treatments. They can treat arthritic joint pain, sports injuries, neck and back conditions—creating an environment to trigger tissue repair and healing.

Start your journey to better function and less pain. Visit our orthobiologics services hub and find your expert, request an appointment online, or call us at (651) 968–5201 to schedule a consultation..

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