In Situ Bone Marrow Prolotherapy Makes the Most Sense
Cartilage exists and grows in a low oxygen environment. The environment in which cartilage exists is a 1-5% oxygen environment compared to the 20% oxygen environment we all breathe!1 While this may not mean much to you, it is significant when it comes to cartilage regeneration. In a recent study it was shown that low oxygen tension significantly inhibited the proliferation of adult stem cells, but induced a twofold increase in the rate of protein synthesis and a threefold increase in total collagen synthesis.1 Low oxygen tension also increased glycosaminoglycan synthesis (extracellular matrix of cartilage) at certain times. In other words, stem cells growing in a low oxygen environment may decrease their numbers, but will increase the amount that differentiate into articular cartilage cells and it will help these cells make parts of the extracellular matrix that makes up cartilage. How this applies to Bone Marrow Prolotherapy (BMP) is important.
Articular Cartilage: Sometimes we forget that articular cartilage functions as a nearly frictionless load-bearing surface in joints, withstanding loads of several times body weight for decades. The cartilage extracellular matrix is maintained by a sparse population of cells (chondrocytes) who often can’t heal cartilage lesions because nutrition just comes through diffusion of joint fluid (no blood supply) and a sparse source of stem cells that can promote healing. Thus, several surgical procedures have been developed to try and promote cartilage repair including drilling, abrasion, osteochondral grafting or microfracture of the subchondral bone. To replace the cartilage some have tried autologous chondrocyte implantation but one controlled study showed that this did not work better than just the microfracture surgery.2 The whole theory behind microfracture is to release bone marrow into the articular cartilage (from the bottom up) to try and initiate articular cartilage repair. This method can typically only repair small cartilage defects (<2cm2). Bottom line is all surgical results are suboptimal. There has to be a better way.
In situ Bone Marrow Prolotherapy at Caring Medical: Our treatment involves the direct injection ofbone marrow cells which contain stem cells into the injured or arthritic joint. Thus, the oxygen tension in that area will be low. The thought is with in situ stem cell injection therapy, the body knows best. The joint in your body provides the environment such that it will know which cells need to proliferate, which cells need to decrease in number, and which structures need to be repaired and rebuilt. You see, more is not necessarily better. When adult stem cells are placed in a low oxygen environment, which simulates the one in which articular cartilage finds itself (because of no blood supply), the actual stem cell numbers decline, but the number of chondrocytes, as well as the cartilage-repairing ability increases (which is what we want). What counts is not how many stem cells are injected into an area, but how many can live and thrive. The low oxygen environment of the joint actually helps with this. This is one of the reasons Dr. Hauser lets the body decide what is best and uses direct Bone Marrow Prolotherapy at Caring Medical. Stem cell therapy derived from bone marrow are highly effective in treating osteoarthritis.Patients are typically seen once every six to eight weeks for direct Bone Marrow Prolotherapy. The number of treatments is individualized, but most patients need four to six visits.
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1Guilak F, Estes BT, Dickman BO. 2010 Nicolas Andry Award: Multipotent adult stem cells from adipose tissue for musculoskeletal tissue engineering. Clinical Orthopedics and Related Research. 2010;468:2530-2540.
2Knutsen G, Drogset JO, Engebretsen L. A randomized trial comparing autologous chondrocyte implantation with microfracture: findings at five years. Journal of Bone and Joint Surgery America. 2007;89:2105-2112.