Prolotherapy is the original regenerative medicine treatment.  George Hackett, MD wrote the First Edition of Ligament and Tendon Relaxation Treated by Prolotherapy in 1956.  Dr Hackett defined prolotherapy as the rehabilitation of an incompetent structure by the generation of new cellular tissue.  He described prolotherapy as strengthening "the weld of disabled ligaments and tendons to bone by stimulating the production of new bone and fibrous tissue cells...". 

 

Over the years, prolotherapy been done with many different solutions.  The goal is to create a mild inflammatory reaction to jump start the bodies healing cascade.  Dr Garcia has used several different solutions.  For the past 10 years, he has been using a hypertonic glucose solution of varying concentrations.  This has the benefit of being readily available, inexpensive, and relatively safe compared to other prolotherapy solutions.  Hypertonic glucose, of varying concentrations, has become the standard solution used by most prolotherapy physicians.

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David Rabago, MD published a study using prolotherapy for knee arthritis. He showed benefits in pain and stiffness at a one year follow up.  Since then, other studies have shown benefits using prolotherapy for hip pain and sacroiliac instability.

While platelets are most often associated with bleeding, they also play a prominent role in tissue healing.  Injuries tissues attract platelets and the growth factors that they contain.  Soon after an injury, platelets amass at the site and deliver growth factors that initiate formation of new vessels.  The growth factors also attract stem cells which repair tissue and make collagen.  When there is repeated micro trauma associated with overuse injuries, this system becomes ineffective.  We can correct this inefficiency.  We draw your blood and concentrating the platelets by centrifugation.  Then under ultrasound guidance, we inject the concentration, know as PRP, directly into the area of injury.  This provides the needed growth factors to repair the injuries area.

 

PRP appears to be 3 times as potent as prolotherapy during most of the studied treatments.  Some treatment areas take several treatments and the use of PRP rather than prolotherapy, may expedite the treatment course.  Treatment of the sacroiliac joint usually takes 6-9 treatments with prolotherapy and may only take 2-5 treatments with PRP.

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The Hospital for Special Surgeries (HSS) in New York published an article showing the benefits of PRP in treating hip pain.  Please see our section on Reference Articles for additional details.

Stem cells, specifically, mesenchymal stem cells (MSCs), are cells that are found throughout our body.  These cells have the ability to repair tissue.  They have the unique ability to form several different tissues, depending on the environment and substances they are exposed to.  They can form cartilage, tendons, ligaments, and muscles.  They are found in great concentrations in the bone marrow and adipose tissue.  Currently, the FDA allows the use of bone marrow cells harvested from your bone marrow to be injected into the area of your orthopedic injuries.

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Many articles have been published revealing the benefits of these cells and the accompanying fluid for orthopedic injuries.  Dr Chris Centeno recently published an article using stem cells for knee arthritis and Dr Don Buford has an ongoing study using stem cells for rotator cuff tears.  Please see our section on Reference Articles for the exciting details.

 

There is some debate in the regenerative medicine community about the use of amniotic stem cells, adipose derived stem cells and bone marrow derived stem cells.  While this debate is being studied, the FDA recommends avoiding amniotic and adipose derived products for orthopedic treatments.