Regenerative Medicine

Stem Cell Therapy vs. Platelet-Rich-Plasma Therapy “PRP”

There’s still a lot we don’t know about both treatments. However, what we do know is extremely promising. In the past 20 years, both treatments have produced miracle-like results with consistency. How are these treatments different, and which one is better for you?

New treatments are always a little frightening. Due to a lack of clinical research and long-term trial results, neither patients nor doctors want to dive head-first, risking their health and reputations, respectively.

As opposed to their representation in the media, stem cell and PRP therapies aren’t really that new. Stem cell treatments, for example, had been successfully used since the 1960s and provide consistent results. PRP has been dominant in the professional sports for almost 20 years, yet to most people, it’s still a new—hence, risky—proposition.

What is new is the amount of attention these treatments started getting in the last 5-10 years.

We learned that stem cell therapy is a viable treatment for a range of musculoskeletal problems—such as arthriti, tendonopathies, ligament tears and fractures. Previously, we had thought of stem cell therapy only as a means of treating blood cancers, such as leukemia.

We learned that PRP is effective when used in combination with stem cells. Hence the increased attention to the good-old athlete drug.

Most importantly, we have seen with our own patients how safe and consistent these treatments are in treating musculoskeletal injuries after performing thousands of procedures over the course of 10 years.

What Is Stem Cell Therapy?

After an experiment with two groups of mice sick with leukemia in 1957, it became evident that a bone marrow graft transplant can enable the immune system to fight the cancer. The treatment wasn’t a silver bullet—most of the mice had died either due to a recurrence of the disease or due to the negative body reaction to the graft.

Despite conflicting results, the trial established a few important facts. Most importantly, we learned that a bone marrow transplant can be an effective cure to blood cancers. However, we also learned that the diseases can reoccur after the treatment, or they can cause a reaction in the host.

Bone Marrow Transplantation: From Mice Trials to Global Networks

Despite numerous challenges, pioneers such as E. Donnall Thomas saw the immense potential in the treatment, which encouraged him to pursue its manifestation.

Due to the many risks and lack of data regarding the procedure, bone marrow transplantation was “reserved to the dying.” Only patients with the most acute blood cancers were offered the treatment. It was a last resort option for those who didn’t have many options left.

For the next 20 years, Thomas would perform bone marrow transplantation on hundreds of patients with severe blood cancer. Many of them died from the disease eventually. Few of them, however, found the cure in the treatment, which provided stimuli for the doctor to keep looking for the answer.

Besides the general mistrust and skepticism, Thomas faced many practical challenges. For one, he only had the chance to work with the most acute cases of blood cancers—which limited his research capabilities and skewed the results. Secondly, it was considered at the time that only transplants from siblings were considered viable—due to a similar genome—which significantly reduced the probability of finding a donor.

In 1979, Thomas published a conclusive trial where he reported “a cure rate of 50% in AML patients transplanted in first remission.” It was a breakthrough in the world of stem cell treatments.

Edward Donnall Thomas didn’t discover the silver bullet to all diseases. However, his work provided revolutionary evidence that the immune system has the power to eradicate diseases as powerful as cancers, and that we have the power to influence how well the immune system copes with such diseases. In 1990, Thomas received a Nobel Prize for his discoveries in stem cell transplantation.

Today, Bone Marrow Donors Worldwide “unifies more than 23 million donors registered in 73 countries and 600,000 cord blood units from cord blood banks in 32 countries.” The vastness of donors available has dramatically increased the probability of finding the right donor for blood cancer patients. Since the 1957 mice trial, we’ve learned a lot about the treatment too, which has made it a safe and standard procedure.

The Next Step: Treating Musculoskeletal Diseases Without Surgery

During the last 10-15 years, we learned that stem cell transplants have the ability to treat musculoskeletal problems, such as arthritis in the shoulder, knee and spine. It has been used widely as an alternative or adjunct to surgery.

Treatments have emerged that focus on a wider range of musculoskeletal problems. As opposed to just treating blood cancers, stem cell transplants have been shown to help people reduce pain and heal after musculoskeletal injuries. The term regenerative medicine had been coined, and the world of stem cell treatments has entered into a whole new chapter.

Multiple studies and patient cases have shown stem cell treatments to help people with a range of musculoskeletal injuries and conditions—to reduce pain, increase physical strength, improve flexibility and accelerate healing.

Why is that important?

In most basic terms, the issue that stem cell therapy solves is this:

  • Many people suffer from chronic and acute musculoskeletal pain (for example, caused by osteoarthritis or natural cartilage wear-and tear.) To evaluate the scope of the problem, consider that it costs U.S. taxpayers $19.3 billion a year to treat rheumatoid arthritis patients every year.
  • Such conditions force people to take time off work and reduce the quality of life significantly.
  • Traditionally, patients used to have two main options: physical therapy—which is slow in producing results alone and takes significant effort—and surgical intervention—which can produce results much quicker and in a more significant way, but often is only a temporary solution, while introducing significant health risks to the patients. Alternative treatments—chiropractor, massage, acupuncture—are sometimes effective for patients, but not consistent across the population.
  • Stem cells enable the body’s regenerative properties, and provide the body with the additional resources to heal and regenerate. At CellAxys, 80% of our patients are satisfied with the results. Stem cell therapy does not require surgery or prolonged physical therapy.
  • As a result, stem cell therapy can provide results comparable or better than a surgery would, while doing so quicker and with less effort than physical therapy.

Which Problems Can Stem Cell Therapy Treat?
Currently, stem cells can address a number of musculoskeletal issues and conditions:

  • Knee therapy. Issues and pain in the knee area are extremely common as our patients age. Reduced mobility and reoccuring pain affect their everyday life.
    • Knee conditions treated:
      • Chronic conditions (recurring acute or subacute pain):
        • Osteoarthritis
        • Cartilage Injuries or thinning
        • Chronic inflammation
        • Degenerative articular deterioration
        • Patellofemoral Pain
        • Patellofemoral Chondromalacia
        • Tendonitis of the Patella or Quadriceps Tendon
        • MCL and LCL Injuries
      • Overuse of the joints:
        • Bursitis
        • Tendonitis
        • Inflammation
  • Elbow therapy. Being one of the most complex joints in the body, elbow injuries and conditions are extremely difficult to operate surgically, which makes stem cells a primary treatment option.
    • Elbow conditions treated:
      • One-time injuries causing pain (dislocation, old(er) fracture, ligament strain), defined by sharp, reoccuring pain
      • Golfer’s elbow (tendons attached to the bony bump in the elbow)
      • Tennis elbow (tendon overload)
      • Stress fracture (caused by repetitive, mechanical tension)
      • Articular cartilage damage (caused by degeneration or tear)
  • Foot & Ankle therapy. Surgical intervention with foot problems can cause months of downtime. Most of our patients can’t afford that.
    • Foot and ankle conditions treated:
      • Plantar Fasciitis (caused by a variety of reasons—from a misstep to a heavy object dropped onto the foot), more common than many think
      • Achilles Tendonitis/Tear (common among runners and athletes), usually surfaces as mild pain after a high-intensity workout
      • Ankle Arthritis
      • Tendon Tears of the Peroneal, Posterior Tibial and others of the ankle
      • “Turf Toe” or Flexor Hallucis Longus tear/tendonitis
      • Sprains and strains healing slowly (diagnosed by swelling, limited mobility and muscle spasms)
  • Shoulder therapy. An intersection of several joints that combine tendons, ligaments and muscles, shoulders are responsible for an incredible range of motion.
    • Shoulder conditions treated:
      • Rotator Cuff Tendon inflammation and tear (which can lead to serious conditions, such as bursitis and tendonitis)
      • AC Joint pain (usually caused by general overuse or sudden trauma)
      • Arthritis (osteoarthritis is the most common form of the condition found in the shoulder)
      • Biceps Tendonitis or partial tear (symptoms include sharp pain, bruising and swelling)
  • Hip therapy. There are two distinctive types of pain in the hip: pain inside the hips or groin area usually indicates joint problems; pain that radiates towards the outside of the hips is likely caused by a strained muscle.
    • Hip conditions treated:
      • Arthritis (rheumatoid arthritis and osteoarthritis are particularly common in the hip area)
      • Labrum Tears (usually caused by sudden traumas)
      • Inflammation (that could eventually lead to bursitis and tendonitis)
      • Femoral Head Cartilage thinning or injury (“OCD”) (the “pillow” between two bones that reduces friction and add stability deteriorates with age, or can be injured due to trauma)
  • Neck therapy. Neck injuries and natural wear-and-tear usually go unnoticed for long periods of time, since there’s no usual pain right after trauma or injury. However, they could be a part of a larger upper spine problem.
    • Neck conditions treated:
      • Cervical spine wear-and-tear (cervical spondylolisthesis usually surfaces with age, causing severe chronic pain and stiffness in the neck)
      • Ankylosing spondylitis (an aggressive form of arthritis that attacks your spinal bones)
      • Sprains and strains (soft tissues around the spinal joints are subject to overstretching and tear)
      • Whiplash Injuries
  • Lower back therapy. Due to its interconnection with the nervous system, lower spine issues can be—quite literally—paralyzing. There are many factors that make up back pain, and just as many options available non-operatively. As a general rule, cortisone will eventually weaken and degrade the spinal tissues. Although they give you temporary relief, there are more long term minimally invasive options now available.
    • Lower back conditions treated:
      • Degenerative and herniated discs (a spongy tissue of cartilage between the spinal discs that may wear away and rupture)
      • Facet Joint pain and arthritis
      • Nerve Pain or “Radiculopathy”
      • Spondylolisthesis (dislocation of the spinal bones)
      • Sacroiliac Pain, “Sacroiliitis”

Where do stem cell come from?
Currently, we use three types of stem cells in therapy, with a heavy emphasis on your own or “Autologous.”

  • Bone marrow stem cells. Bone marrow is a semi-solid tissue which may be found within the spongy or cancellous portions of bones. After the whole introduction into how stem cell therapy evolved over the decades, it is no surprise that bone marrow is a rich source of stem cells.
  • Adipose tissue stem cells. Adipose tissue is a medical term for fat. Stem cell concentration is usually lower in adipose tissue, hence a larger volume needs to be extracted via liposuction.
  • Umbilical cord stem cells. It has recently been established that the blood in the umbilical cord of a newborn is also a rich source of stem cells. It is the only “external” source of stem cells, which means it doesn’t come from your own body. Autologous, or your own stem cells are always preferred for safety and availability reasons—umbilical cord stem cells can only be purchased in limited doses through highly regulated healthcare channels.

Some of our readers are wondering whether embryonic stem cells are used in the treatment.

We’d like to clarify that it is illegal to use embryonic stem cells in therapy. Embryonic stem cells are gathered from an embryo—which leads to the destruction of the embryo—and are only limited to highly regulated research.

How Does the Procedure Happen?

One of the best things about stem cell therapy is the simplicity and quickness of the procedure. Here’s how it goes:

  • Initial consultation. Dr. Otten, Dr. Mohajer or another lead physician evaluates your medical condition through questioning, tests and other diagnostic tools and methods and suggests a treatment plan for your problem specifically.
  • Stem cell extraction. If the doctor decides to use bone marrow stem cells for the procedure, then a bone marrow aspirate will be collected. If it is decided to use adipose tissue (fat) stem cells, then a mini-liposuction procedure will be performed. Our bone marrow system is accepted as the best available, concentrating and harvesting the highest quantity of stem cells. Our liposuction machine is engineered and manufactured in Germany specifically to harvest unharmed, live, viable cells. In either procedure you choose, a combination of local and general anaesthesia will be used to ensure your comfort.
  • Concentration and activation. Gathered stem cells will be purified and concentrated in a special centrifuge and system to ensure maximum efficiency upon transplantation. In most every case, the concentrated cells will be activated and enriched with PRP (which we’ll get to in a second.)
  • Stem cells are transplanted into the problem area. Using X-ray, ultrasound and MRI guidance, stem cells will be transplanted precisely into the problem area. Often this can include 2-5 injections. Here are two examples. For a shoulder procedure, typically the rotator cuff, subacromial bursa, biceps tendon and the glenohumeral joint will be injected for the procedure (this requires both Fluoroscopy and live Ultrasound). For an L5/S1 Lumbar Spine procedure most often the disc, and both the left and right L5/S1 facet joints will be injected (all performed under Fluoroscopy).

What Is Platelet-Rich-Plasma (PRP) Treatment?

Unlike stem cell therapy—which originates from treating immunodeficiency diseases and blood cancers—PRP is deeply rooted in musculoskeletal injury treatment. In function, however, PRP acts similarly to stem cells when addressing musculoskeletal injuries. As such, PRP is often seen as the more modest, less ambitious brother to stem cell therapy.

Compared to stem cell therapy, PRP treatment doesn’t have that much of a controversial and history. In fact, the treatment made its way into the spotlight only after a 2006 study published in the American Journal of Sports Medicine by Mishra and Pavelko, on behalf of Stanford University.

The researchers had concluded their trial with astounding evidence that PRP is effective in treating chronic elbow tendinosis—a common musculoskeletal disease, especially in professional sports. 8 weeks after the treatment, all patients reported a 60% improvement in pain scores. At 6 months, the patients treated with platelet-rich plasma noted a 81% improvement. And, at their final follow-up (12-38 months after the treatment), patients reported a 93% improvement in pain scores.

Such strong and consistent results attracted a lot of attention among professional athletes. Tiger Woods, for example, attributes PRP as the crucial treatment that helped him return to the sport after an injury.

Only after multiple athletes have openly spoken about using PRP to recover from injuries, the treatment has attracted mainstream attention and became available across the world.

How Does the PRP Procedure Go?

In essence, during a PRP the procedure, doctors draw blood, put it in a centrifuge to separate the blood’s plasma (which contains platelets) from the red blood cells and then inject the solution back into the patient’s injury site.

Upon entering the bloodstream, the plasma helps thicken the blood around the injury site. This maximizes the signals sent to the swollen site, redistributing the body’s resources where they’re needed the most, accelerating the healing process.

The procedure itself is almost identical to the stem cell therapy transplantation. The major difference is that it’s not stem cells that are harvested, but instead a blood sample.

How Does PRP Compare to Stem Cell Therapy?

The title of this article suggests that there are significant differences between these two treatments.

Technically, the statement is true. Platelet-Rich-Plasma is not the same thing as a stem cell concentrate, and they help the body regenerate in different ways.

However, from a patient’s perspective, there’s almost no difference between the two treatments. It is up to the doctor to decide from experience and available research what combination of PRP and stem cell concentrate to use. The two treatments complement each other beautifully.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni