The Guide to Regenerative Injections
/Dr. Holmes’ Guide to Regenerative Injections
Regenerative injections are those specifically utilized to promote healing of damaged tissue, reduce or eliminate unhealthy inflammation and slow or halt the progression of soft tissue and joint deterioration. We now use them regularly for tendon problems including tennis elbow, golfer's elbow, the rotator cuff, the high hamstring, patellar and Achilles tendons. We also have seen great success in treating osteoarthritis of the knees, shoulders, hips, thumb and great toe joints. Plantar fasciitis, ligament and muscle tears are great candidates for regenerative injections as well.
· Platelet-Rich Plasma Injections
o Blood obtained from an arm vein is centrifuged for 15-20 minutes, isolating the platelet-rich plasma
o Platelets are very rich in our natural growth factors (healing agents), and are concentrated 6-10 times their natural concentration
o Under ultrasound-guidance, the PRP is injected into the damaged tendon, ligament, fascia, joint or muscle
o Great option for tennis elbow, golfer’s elbow, small rotator cuff tears, small patellar tendon tears, high hamstring tendon tears, Achilles tendon tears, plantar fasciitis, etc.
o Widely-used also for osteoarthritis of numerous joints
o PROS: very natural and safe (your blood); used in orthopedics for ~10 years, Dr. Holmes has used for 7 years; numerous medical studies confirm significant benefit; 2-3 areas can be injected at one time; long-term benefit for most patients
o CONS: these work gradually, over weeks to months; increased pain after the procedure for 2 days to 2 weeks; immobilization required with a splint or boot for some injections
o UNKNOWNS: length of benefit (can be months to years); number and frequency of required injections. 1-2 injections initially for most soft tissue problems; 2-3 initially for arthritis/joint problems
· Amniotic Membrane Allograft Injections (brand- AmnioFix)
o Utilize one of the placental membranes (these cover the fetus during pregnancy) to form a product containing numerous types of growth factors
o Intended to reduce inflammation, reduce scar tissue formation and enhance healing
o The membrane undergoes a rigorous purification and sterilization process, and is stored as a dehydrated powder; sterile saline is added to become an injectable solution
o Great option for plantar fasciitis (#1 use), tennis elbow, golfer’s elbow, small rotator cuff tears, small patellar tendon tears, high hamstring tendon tears and small Achilles tendon partial tears
o PROS: very safe, with no significant reportable adverse effects; Dr. Holmes has used for 5 years; no rejection, despite not being one’s own tissue; no blood draw required; typically less post-procedure pain than PRP
o CONS: probably not as effective for joint pain/arthritis; otherwise, same cons as PRP
· Amniotic Fluid Injections (brand- Catalyst PDA-HAF)
o Very similar to amniotic membrane injections, but often stored in a frozen form and thawed immediately before injection
o Contain over 200 different growth factors
o Great option for soft tissue as well as joint problems such as osteoarthritis
o PROS: theoretically, a more powerful amniotic product than a dehydrated membrane
o CONS: more expensive than the dehydrated membrane product
· Alpha-2-Macroglobulin Injections
o A natural substance found in our bloodstream
o Blood drawn from the patient, centrifuged, manually separated and then placed in a separation pump to further isolate and concentrate the A2M
o 45-minute procedure done in one office visit
o Functions as a “protease inhibitor,” binding the inflammatory proteins that cause the degradation of cartilage in the joint
o Utilized to reduce pain, inflammation, halt the progression of osteoarthritis and provide “longevity” to the joint
o PROS: very safe and natural substance; presumed long-term benefit, less post-procedure discomfort than other injections; two to three injection sites can often be chosen with one procedure
o CONS: newest type of regenerative injection; very few medical studies proving effectiveness thus far, but studies are underway; frequency of injections not known at this point (likely every 6-24 months)
With any of these injections, all forms of ORAL and TOPICAL anti-inflammatories must be stopped for 1 week before and 2 weeks after, as to not interrupt the initial healing cascade initiated by the injections. This includes:
· Advil/Motrin/ibuprofen
· Aleve/naproxen
· Aspirin- any doses above 81 mg
· Mobic/meloxicam, Celebrex/celecoxib, Voltaren/diclofenac
· Fish oils/Omega-3 fatty acids
· Turmeric
· Oral green tea
· Glucosamine/chondroitin
· Arnica
COST: Regenerative injections are rarely ever covered by insurance. Although we closely monitor their coverage status, in the current climate of healthcare and insurance companies reducing their coverage of even typical treatment measures, we do not expect these injections to be covered in the near future.
With rising deductibles, many patients pay out-of-pocket for traditional treatment measures as well. Thus, a regenerative injection may ultimately be a similar out-of-pocket cost to traditional treatments but more clinically effective and cost-effective over the long-term.
A patient should view these injections as an investment into the long-term health of their tendons, fascia, ligaments and joints.
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F. Clarke Holmes, M.D.