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New Jersey Stem Cell Therapy
Bone Marrow Aspirate Concentrate (BMAC)
Dr. Marc Silberman has been performing regenerative treatments for orthopedic conditions longer than anybody in New Jersey. Dr. Silberman trained under one of the pioneers in the field of regenerative medicine while a fellow at the Crozer Chester Medical Center Sports Medicine Institute. Dr. Silberman now teaches regenerative orthopedic stem cell treatments to attending physicians, fellows, residents, and medical students from around the country on how to harvest stem cells from bone marrow (bone marrow aspirate concentrate, BMAC) with minimal to no pain for the treatment of orthopedic musculoskeletal conditions and injuries. All injections are performed under Ultrasound Guidance.
Dr. Silberman's novel MARROW-STEM™ method, uses a disposable bone marrow needle specifically designed for orthopedic stem cell procedures that selectively harvest high concentrations of mesenchymal stem cells (MSCs) from BMAC, requiring only a single puncture, 20cc or less of bone marrow aspirate, no manipulation, centrifuge, or addition of any substances, no processing off the sterile field (reducing the risk of infection), and no discarding or filtering of any of your stem cells.
Dr. Silberman delivers pure bone marrow aspirate concentrate, BMAC, direct from your pelvis with no need for any processing, additives, or centrifuge.
Other stem cell bone marrow systems may produce aspirates contaminated with peripheral blood lowering the stem cell count, require multiple puncture sites (or drilling of bone), excessive removal of more than 60cc of marrow aspirate (which has to be manipulated, filtered, and spun with additives), and ultimately, the discarding of most of the aspirate, and hence with it, the discarding of your stem cells.
Compared to Regenexx, no pre-treatment with prolotherapy is required the day before your bone marrow aspiration stem cell treatment, only one needle entry site for your bone marrow aspiration is required versus two, no centrifugation is required, the aspiration may take 10 minutes start to finish compared to 30 to 60 minutes for Regenexx, the complete stem cell procedure (bone marrow aspiration and injection of stem cells) may take 30 to 45 minutes door to door (from the time you enter the office to the time you leave) versus up to 8 hours with Regenexx, and there is no need to return for a third day for PRP injections.
Dr. Silberman's method of stem cell therapy using BMAC means less cost, less time, less pain, less risk of infection, less risk of allergic reaction, less waste, and better numbers.
Dr. Silberman's closed system yields 3290 CFU-f per ml.
Harvest BMAC yields 1270 CFU-f per ml.
Arteriocyte Magellen yields 510 CFU-f per ml.
Biomet BioCUE yields 134 CFU-f per ml.
Traditional trocar yields 356 CFU-f per ml.
Source: marrowcellution.
What are mesenchymal stem cells or multipotent stromal cells (MSCs)?
Mesenchymal stem cells, or MSCs, are multipotent stromal cells that can 1. differentiate into a variety of cell types including: osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes (fat cells), 2. modulate oxidative stress, 3. have immunomodulatory, anti-inflammatory, and anti-aptoptic effects.
(Strioga et al. Stem Cells Dev. 2012 Sep 20;21(14):2724-52).
Osteoarthritis is a mesenchymal disease in which the activity of MSCs are altered leading to an absence of repair and increased degeneration of cartilage. (Jo et al. Stem Cells 2014; 32:1254-1266).
MSCs are known to stimulate chondrocytes to proliferate and synthesize extracellular matrix, to induce anti-inflammatory cytokine production, and to possess immunumodulatory properties, resulting in anti-inflammatory activity, regeneration, and pain relief.
BMAC stem cells are obtained in the office via bone marrow aspiration with a needle inserted in the iliac crest of the pelvis.
Postulated mechanisms of MSCs for the treatment of arthritis are:
1. Direct differentiation into chondrocytes (articular cartilage) or more likely, 2. Paracrine effects of secreted bioactive materials, modulating inflammation and providing an environment for tissue regeneration, by controlling cytokine and growth factor production from endogenous cells or through secretion of bioactive materials.
Conditions that Bone Marrow Aspirate Stem Cells may be used for at New Jersey Sports Medicine:
Stem Cells for arthritis, degenerative or osteoarthritis
Stem Cells for articular cartilage defect, when considering the MACI procedure
Hip joint arthritis
Knee joint arthritis
Ankle joint arthritis
Shoulder joint arthritis
Meniscus tears
Rotator cuff tears
Labral hip tears
Labral shoulder tears
Fractures
Osetochondral cartilage defects (OCD), degeneration, injury or wear of cartilage
Chondromalacia Patella
Ligament Sprains
Tendon Tears, Tendinosis, Tendinopathy
Painful neuropathies and nerve pain
Failed surgeries and chronic pain
Lyme Disease arthritis
Fluoroquinolone induced tendinopathy, arthropathy, neuropathy
Rheumatoid arthritis, Lupus, Psoriatic arthritis
Avascular necrosis and Osteonecrosis of the knee, hip, other joints
What is the cost of a BMAC stem cell injection? The cost of injecting a bone marrow aspirate concentrate (BMAC) stem cell injection in a knee, shoulder, or hip joint or a tendon or ligament at New Jersey Sports Medicine is $2500. Injecting two joints with BMAC stem cells or two different body locations cost $2800. Multiple locations may be more cost and can be discounted.
So the cost for BMAC stem cell therapy for knee pain would be $2500 for one knee. BMAC stem cell therapy for knee osteoarthritis is $2500. BMAC stem cell therapy for both knees would $2800. BMAC stem cell therapy for shoulder arthritis is $2500. BMAC stem cell therapy for a rotator cuff tear or rotator cuff tears is $2500. BMAC stem cell therapy for a meniscus tear is $2500, etc.
What to expect for a Bone Marrow Aspirate Concentrate BMAC Stem Cell Therapy at New Jersey Sports Medicine:
A specialized disposable bone marrow harvesting needle for BMAC for orthopedic stem cell therapy is used by Dr. Silberman, for the selective aspiration of mesenchymal cells from the bone marrow which, optimizes the cellular yield and minimizes the contamination of peripheral blood due to a micrometric system for lateral aspiration and the closed distal tip of the Trocar. It is a minimally invasive, high yield, low volume aspiration, with NO manipulation, centrifuge, or addition of any substances. Your skin overlying your iliac crest (pelvis) and the lining of your pelvic bone will be anesthetized with a small injection of lidocaine. An access needle is then inserted through the cortex of your iliac crest into the medullary cavity and with a syringe 10 to 20ml of bone marrow aspirate concentrate (BMAC) will be aspirated. There is no pain with needle entry into your bone. There may be discomfort or "a cramp" sensation in your buttock from the suction and the negative pressure with the aspiration. The site is then covered with a gauze and band-aid. There is no suturing. The bone marrow aspirate concentrate (BMAC) is then injected into your injury, joint, tendon, or ligament under ultrasound guidance. Local anesthesia is given for the injection sites. This system is much less painful then what you might have heard about 'bone marrow biopsies'. Some patients do not feel any pain. A typical patient visit is 30 to 45 minutes.
How to choose between PRP versus BMAC stem cell therapy for arthritis, meniscus tear, or rotator cuff tear?
Clinically PRP is performed more for tendon injuries and BMAC stem cell therapy is performed more for joint arthritis, intra-articular injections (meniscus, labrum), for those who failed or are worse off after having surgery, and for those who desire multiple joint injections or body parts treated at one visit. PRP may require multiple sequential visits for repeat injections (more time and money) whereas BMAC stem cell therapy is usually one and done (one session), with no repeat injection required prior to a year. Both therapies are highly effective at reducing pain and improving joint function and superior to cortisone which is now known to be more detrimental than previously thought.
Can PRP (platelet rich plasma) and BMAC (bone marrow aspirate concentrate) stem cells be injected together?
Yes, PRP and BMAC can be injected together at the same visit. PRP rich in growth factors culture can stimulate the stem cells found in BMAC.
Injectable Platelet Rich Fibrin (iPRF) or PRP may also be injected the same day as your bone marrow aspirate concentrate BMAC stem cell injection. PRF (platelet rich fibrin) has been shown to produce a higher cumulative yield of growth factors than PRP (platelet rich plasma), making it ideal for regeneration and growth stimulation. PRF (platelet rich fibrin) acts as a scaffolding for your stem cells to adhere to and serves as a reservoir of growth factors that may be released for up to two weeks.
Will my stem cells be no good because I am old?
No. While it is true that as we age, our total stem cell count drops and their viability and repair efficiency decrease, it is not age that has the greatest detrimental effect, but comorbidity, such as whether you have illnesses such as diabetes, rheumatoid arthritis, cancer etc. Seventy year olds with no illnesses have had significantly high stem cell counts and viability compared to younger individuals with illnesses. So age is not as much of a factor as comorbidity.
Can BMAC stem cell therapy treat bone on bone arthritis?
Yes BMAC stem cell therapy can treat bone on bone arthritis though it is less successful in severe hip and shoulder arthritis compared to knee arthritis. We have been pleasantly surprised to see success in patients who were not surgical candidates for joint replacement who underwent BMAC stem cell therapy who reported success and were pleased they had it done. We often see patients who are told they have bone on bone arthritis by a surgeon who do not have bone on bone arthritis.
Will BMAC stem cell therapy grow back my cartilage in bone on bone arthritis?
No. BMAC won't grow your cartilage back, but it will change the environment of your joint from one of degradation and destruction to one of healing which gives you long lasting pain relief and slows down the degradation.
Do I have to travel to Panama or Mexico for stem cell therapy?
No. You do not have to spend $20,000 in Panama for successful stem cell therapy. I have seen many athletes and patients treated at oversees clinics who still come here for treatment after failure. We have had patients who had to spend the night in a hospital oversees due to hallucinations after stem cell therapies in foreign clinics. Dr. Silberman has treated failures from the "Kobe" Clinic in Germany where stem cells are cultured outside of the body, patients treated in Columbia, Panama, and Mexico, patients seen at the Hospital for Special Surgery (HSS), and patients from the Cleveland Clinic. Nobody is bigger than medicine so don't be fooled by regenerative institutes and stem cell centers. Be wary of testimonials, as they do not constitute science. There are no guarantees in medicine.
Is BMAC stem cell therapy covered by insurance? BMAC stem cell therapy is not covered by insurance. Initial consultation is covered by insurance.
Studies:
Intra-articular Injection of Mesenchymal Stem Cells for the Treatment of Osteoarthritis of the Knee.
Stem Cells 2014; 32:1254-1266.
http://www.ncbi.nlm.nih.gov/pubmed/24449146
Adult Human Mesenchymal Stem Cells Delivered via Intra-Articular Injection to the Knee Following Partial Medial Meniscectomy
A Randomized, Double-Blind, Controlled Study.
J Bone Joint Surg Am, 2014 Jan 15; 96 (2): 90 -98.
http://jbjs.org/content/96/2/90
Mesenchymal Stem Cell Injections Improve Symptoms of Knee Osteoarthritis.
Arthroscopy April 2013Volume 29, Issue 4, Pages 748–755
http://www.arthroscopyjournal.org/article/S0749-8063(12)01884-1/abstract
A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions.
International Orthopaedics August 2016, Volume 40, Issue 8, pp 1755–1765
http://link.springer.com/article/10.1007/s00264-016-3162-y
