Marc P Pietropaoli, M.D.
Board Certified Orthopedic Surgeon & Sports Medicine Specialist located in Skaneateles, NY
Soft tissue injuries, joint pain, and sports injuries can benefit from "orthobiolobics" such as Platelet Rich Plasma (PRP) and/or Bone Marrow Aspirate Cells (BMAC) solutions to speed up your recovery process. Board-certified orthopedic surgeon Marc Pietropaoli, MD, offers PRP along BMAC therapy joint injections, and comprehensive orthopedic care for complete treatment under one roof. Located in Skaneateles, New York, the office offers unique and personalized care using the best equipment and evidence-based techniques available for your convenience. To schedule an in-person or telemedicine visit, call or book online today.
What are Platelet Rich Plasma (PRP) and Bone Marrow Aspirate Cells (BMAC)?
PRP is a solution made with your own blood platelets taken from a simple blood draw from your arm that is injected into injured soft tissues or joints to restart, jump start and speed up the healing process. BMAC is fluid removed with a small trochar needle from the posterior (back) part of the pelvis (back part of the "hip") with a relatively simple in office procedure. It does not require going to the operating room or anesthesia. It removes bone marrow fluid which contains stem cells and other cells that help the stem cells as well as growth factors, proteins, fluid, etc. that helps the body heal itself, decreases inflammation and pain, etc. They are NOT "Stem Cell Injections" where stem cells are removed from the patient's body, grown and multiplied in a lab and then injected back into the patient. These type of "stem cell injections" are not FDA approved or allowed in the United States at this time. Some countries do allow these types of injections, but not in the United States. It's a type of regenerative medicine that can be used on its own or along with other injections or procedures, like knee arthroscopy or rotator cuff repair.
Dr. Pietropaoli often combines PRP with BMAC as well as MLS laser and Victory Sports Medicine & Orthopedics Physical Therapy and/or V-Fit, a personalized holaistic strength and conditioning program in syergystic "packages" to further support your healing and speed up your recovery. Dr. Pietropaoli, as well as other institutions, have found that many times, using these treatments together works better, faster and lasts longer than using them individually. In other words, synergistically, i.e. the synergistic package is greater than the would be expected from the individual parts alone.
How does PRP work?
PRP contains blood platelets, which have growth factors in them that stimulate new blood vessels and cells to come in to the area they are injected into to help repair it. The growth factors and signals that are released from the platelets travel through the blood stream and stimulate stem cells in the bone marrow to migrate to the area where the PRP was injected to help with the healing/repair/regeneration.
In injured tissues, the presence of inflammatory chemicals and swelling can prevent normal tissue repair, leading to chronic pain. With PRP, your natural healing response is supported so you can recover more quickly than you can by rest alone.
How does BMAC work?
The bone marrow aspirate contains stem cells, other cells that help and support the stem cells, growth factors, proteins, blood, fluid, etc. These cells all work together with the growth factors to help signal other cells to also jump into action to all work together to help with healing, decreasing inflammation and pain long term.
What conditions can benefit from BMAC/PRP?
BMAC and PRP has been shown to be very safe most of the time to use for a variety of conditions, like:
- Sports injuries
- Golfer’s and tennis elbow
- Ligament sprains
- Muscle and tendon strains
- Rotator cuff injuries
- Knee pain
- Hip pain
- Plantar fasciitis
To determine if PRP is right for you, schedule a consultation with Dr. Pietropaoli. During your consultation, he and his team perform a comprehensive medical history and physical exam to understand the location of your pain and the cause, if known, of your injury.
Dr. Pietropaoli and his team may recommend X-rays or an MRI, which can be performed in the office for your convenience, to determine your diagnosis and the severity of your condition.
Based on his findings, your diagnosis is explained and treatment options, including whether PRP is appropriate for you.
What should I expect when getting a BMAC and/orPRP injection?
PRP injections involve a three-step process. When you arrive for your injection, Dr. Pietropaoli’s nurse or phlebotomist takes a small sample of blood from your arm. You may feel a prick of pain, but it is no different that most blood draws for labs, except more blood is needed for PRP than most blood draws. Next, the nurse processes your blood in a specialized maching (centrifuge) to separate the platelets from your other blood cells and fluids in the blood. The Platelets are separated out into a syringe to be injected into the damaged area(s).
For the BMAC injections, an area of your pelvis (the PSIS; Posterior Superior Iliac Spine) at the "back"/posterior aspect of the "hip" is acurrately identified and marked using an ultrasound. The skin and tissues/bone below it are thoroughly numbed up with lidocaine. A trocar (specialized bone marrow aspiration needle) is utilized to remove and concentrate the bone marrow fluid selectively removing the areas where more of the cells are located. Usually about 3-4 cc is collected for each joint/body part being injected.
Once you’re ready, he injects the BMAC and/or PRP solution into the injured tissues using ultrasound to precisely locate the damaged area(s), which takes less than 5-10 minutes for the injection itself.
There will usually be some expected soreness at the injection site for the first 24-72 hours indicating the healing process has started/restarted. There are, in general, three phases that the body goes through after a PRP and/or BMAC injection.
1) Inflammatory phase (weeks 0-2, sometimes can last up to 4-6 weeks): When the healing process is restarted and normal inflammation starts back up. This is normal and desired. There may be some swelling, warmth, pain as this phase commences and progresses.
2) Proliferative phase (weeks 2-6 on average): The cells that were injected into the area and/or stimulated in the area and/or recruited to the area of damage/pain multiply and "do their work" to "clean up", repair and sometimes regenerate the area of damage/pain. They lay down repair tissue/collagen to help with the repairing/regenerating.
3) Remodeling phase (weeks ~6-up to 3-4 months): With the appropriate load and stress directed by a skilled and well trained Physical Therapist and/or Certified Strength & Conditioning Specialist, of which Victory Sports Medicine & Orthopedics has many, the collagen is oriented along the "lines of stress" generatated by the rehab which strengthens the damaged area that is being repaired/regenerated.
PRP can take up to 2-3 injections to notice the full effect, whereas BMAC can usually attain the same effect with only 1-2 injections.
To set up an in-person or telemedicine consultation to determine if BMAC and/or PRP is right for you, call or schedule through the online booking tool now.
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