Understanding PRP/stem cell injections

I think the term “regenerative medicine” is a bit of a mischaracterization now and a dated statement. 5-7 years ago, based upon animal studies, scientists believed intra-articular delivery could regenerate or regrow cartilage. Certainly the media and public were led to think this, which may have been credited to the marketing of the industry.

Now, the paradigm has shifted to the belief PRP improves the overall cellular metabolic processes occurring in the joint. Basically, there are catabolic processes, or breaking down, and anabolic processes, or building up. Pro-inflammatory processes tend to lean towards catabolism, but the mechanisms are much more complicated than that as negative feed-back mechanisms will attempt to trigger anabolic processes if too much catabolism is occurring.

Basically, these PRP or stem cell injections will improve the catabolic process so that the cellular metabolism is favorable for the knee. This results in improved pain and function on a clinical level. It is doubtful if it occurs on a histological or cellular level to the point scientists would say regeneration occurs.

We just aren’t there yet.

Healthcare in a value-based environment is already here. Value is a function of quality of care over the cost. If cost is high, value goes down.

The implication of these injections, I see, are for patients who: 1) are not interested in joint replacement or surgery, 2) are not candidates for joint replacement or surgery, 3) understand that these injections may not work any more effective than a standard steroid or placebo injection in certain groups of patients.