What can be treated?

Knee Pain - Osteoarthritis, Meniscus Tears (Medial, Lateral), Chondromalacia Patella, Tendon Injuries (Patellar Tendonitis, Quad Tendon), Ligament sprains or tears (MCL, LCL, ACL)

Hip Pain - Osteoarthritis, Hip Labrum Tears, Sacroiliac Joint Dysfunction, Piriformis Syndrome, Greater Trochanteric Bursitis, Iliotibial Band (ITB) Syndrome

Shoulder - Osteoarthritis, Rotator Cuff Tendinitis, Tendinopathy or Partial Tears, Labral Tear, Bicipital Tendinitis

Elbow Pain - Lateral Epicondylitis (Tennis Elbow), Medial Epicondylitis (Golfer’s Elbow)

Wrist/Hand Pain - Osteoarthritis, DeQuervain's Tenosynovitis

Ankle & Foot Pain - Achilles Tendinitis or Partial Tears, Plantar Fasciitis, Ankle sprains/ligament injury

Spine - Facet Joint Arthropathy, Sacroiliac (SI) Joint Dysfunction

Platelet-Rich Plasma (PRP)

What is PRP?

PRP stands for Platelet Rich Plasma. Platelets contain growth factors that help the body's own healing process. Your own blood is drawn just like you have it drawn at a lab. The blood is then placed in a special machine that spins it down and separates it to get the platelets. The platelets are then injected back into you at the place where your problem is, sometimes under ultrasound or X-ray guidance.

Bone Marrow Concentrate (BMC)

What is BMC?

Bone Marrow Concentrate is a rich source of stem cells and growth factors. Stem cells can be  harvested from many areas and tissue types, but bone marrow is an excellent choice.  Stem cells are known to have the ability to differentiate into many types of tissue like muscle, tendon, ligament, bone, blood cells, and others. This gives the potential for a self-renewal process that could improve and heal degenerative and damaged tissue.

PRP vs. BMC

PRP contains platelets and growth factors thought to improve the body’s own healing process. BMC contains stem cells that are thought to provide more of a self-renewal process. BMC also does contain a percent of platelets as well – almost like a “PRP Plus” injection. Think of BMC like seeds in the garden, while PRP is like the fertilizer for the garden. Choosing which injection is right for you will be a decision between you and your doctor based on your individual case. There are many factors to consider including the condition being treated, medical history, current literature and experience that will help determine which treatment might provide the best outcome.

 Bone Marrow as a Source of Stem Cells and Growth Factors

What is Bone Marrow?

Bone marrow is the soft spongy tissue that is found in the center of your bones.  In adults, marrow in the large bones are the producing center of your red blood cell, white blood cells and plasma components.  Since this is the location of production, immature forms of these cells, called stem cells, will be found here. Bone Marrow extractions have been conducted for quite some time now and used in fields such as oncology and hematology. The vital components in bone marrow were initially used for transplant purposes in patients with immune deficiencies, such as those caused by blood cancers or disorders. The skill of extracting has not changed but the Donor is YOU and the recipient is YOU, preventing any rejection or allergic reactions. 

What are Bone Marrow Stem Cells?

The immature stem cells found inside the bone marrow have the potential to develop into various mature cells such as a muscle cell, the cells of a vessel, cartilage cells, or even bone cells.  Two of the main stems cells found in bone marrow include:

-     Hematopoietic Stem Cells – give rise to the three classes of blood cells that are found in the circulation: white blood cells, red blood cells and platelets.  These are the cells that actually drive tissue regeneration and create supportive circulation.

-     Mesenchymal Stem Cells – also know a Marrow Stromal Cells.  These cells have the capacity to form osteoblasts or bone structure, chondrocytes or cartilage, and myocytes or muscles.  

Is the process experimental or new?

Bone Marrow extractions have been conducted for quite some time now and used in fields such as oncology and hematology for cancers after chemotherapy. The vital components in bone marrow were initially used for transplant purposes in patients with immune deficiencies, such as those caused by blood cancers or disorders. The skill of extracting has not changed but the Donor is YOU and the recipient is YOU, preventing any rejection or allergic reactions. The immature stem cells found inside Bone Marrow stem cells are the regenerative cells responsible for repairing and rebuilding damaged tissue. The concentrated cells accelerate the healing process, promote strength, offer pain relief, and improve overall function. The healing cascade can be active and take place over a 4-6 week period. A follow-up PRP procedure may be recommended if desired relief is not met.

Are There Any Risks?

Bone marrow extractions are relatively safe procedures when conducted by a trained professional in a sterile environment. Complications are rare but can include: Pain, infection or bleeding particularly in patients with a low platelet count or clotting disorder.* Please see informed consent for complete discussion of risks vs benefits and discuss personally with your doctor.

Infection in patients with weakened immune systems. Antibiotics can be given post extraction to decrease risk in this group of patients.  Bone marrow aspiration, amniotic or other sources of stem cells should not be given to patients who have had cancer due to the  risk of the stem cells becoming cancer cells or reactivating the cancer. 

The Healing Process

Bone marrow stem cells are the regenerative cells responsible for repair and rebuilding damaged tissue. The concentrated cells accelerate the healing process, promotes strength, offer pain relief and improve overall function. The healing cascade can be active and take place over a 4-6 week period. A follow-up PRP procedure may be recommended if desired relief is not met and or a second treatment.

How Long is the Procedure? 

 Treatment is in an outpatient setting.  The actual extraction can take up to 10 minutes, but the concentrating process can take up to 30 minutes, during which the patient will be waiting.

What to Expect 

You may receive pre-treatment medication to take by mouth to make you more comfortable if needed. The area of extraction is locally numbed to reduce any pain felt. Bone marrow is extracted from the back of a patient’s pelvis or hip bone from an area called the posterior iliac crest. A suctioned syringe attached to a long needle is used to reach the posterior aspect of the hip, during which most patients experience minimal discomfort due to the local anesthetic and mild sedation. The collected sample is transferred through a filter, then placed into a centrifuge for spinning. Spinning at a high speed and a light separation system isolates and concentrates the specimen to platelets rich plasma also containing stem cells and growth factors. This concentration of stem cells and healing components, collectively known as the bone marrow concentrate, are reintroduced to the injured area. The majority of patients are able to return to usual activities within 1-2 days but some pain may be felt for up to 1 week.

What should I do or not do?

 There are a few recommendation, such as drinking plenty of fluids and eating a good meal.  Please consult with you physician about medication or prior history of blood disorder. Pain control, if needed with be given.  

Why BMC?

• Less side effects when compared to steroid injections or surgery.

• Reservoir of stem cells

• Regenerative properties

• Natural & organic; from your own body

• Speeds up & promotes healing

• Minimal to no down time

• Minimally invasive 

Start Healing and Get Back to Life

Bone Marrow Concentration (BMC) is to be used in the clinical laboratory or intraoperatively at the point of care for the safe and rapid preparation ofplatelet-poor plasma and platelet concentrate (platelet-rich plasma) from a small sample of whole blood or a small mixture of blood and bone marrow. The platelet-rich plasma can be mixed with autograft and/or allograft bone prior to application toan orthopaedic site. For more information, please discuss with your healthcare provider or go to www.orthoillustrated.com to learn more about the process.

Amnion Viscous – Amniotic Injectable Treatment

What is Amnion?

Arthrex Amnion™ Viscous is amniotic fluid rich in growth factors that activate the body’s own healing response. It is derived from donated human birth tissue and fluid. Birth tissue is obtained with consent from healthy mothers during cesarean section delivery. It can be used when patients don’t want to use bone marrow. Since the cells are frozen, most of the activity is due to the growth factors.  Amnion Viscous is indicated for surgical applications associated with soft tissue procedures. It can be applied directly at the site of inflammation or injury.

How does Amnion work?

• Arthrex Amnion™ Viscous is highly anti-inflammatory, improves healing and reduces scar tissue. Injectable amnion can be an effective strategy in treating tendonitis, fasciitis and joint arthrosis.

What is the screening process for Amnion?

• The Arthrex Amnion™ Viscous was recovered from a qualified donor and processed using aseptic techniques in accordance with federal, state, and/or international regulations and to the standards of the American Association of Tissue Banks. The donor has been screened and tested for communicable disease risks and other exclusionary medical conditions. The results of the donor screening and testing has been reviewed by the Medical Director (or licensed physician designee) of UMTB Biomedical, Inc. and the donor has been deemed suitable for transplantation.

 Are there adverse reactions?

• Short term adverse reactions – the main adverse reaction is pain and discomfort during and after injection. This is because we are stimulating an inflammatory and healing response. It is also possible to develop a low grade fever, body aches, or fatigue.

• Your own cells and tissues are used which reduces risk for contamination or rejection.

• Very low risk of infections, DVT, or neurovascular injury.

• Long term, the only problem that you could encounter is that it is not effective.

Will this just “mask” or “cover up” my symptoms?

• The purpose or theory of biologics treatments is to optimize healing and improve the body’s own framework. Therefore we are trying to induce a healing process rather than just covering symptoms up with something like pain medications.

How many treatments/injections will I need?

• Typically the average patient requires one treatment. Sometimes a patient will need 2 or 3 treatments.

• This is normally assessed at least 6 weeks after the first injection. We usually do not consider a repeat injection if the injection helped completely or did not help at all. A repeat injection may be beneficial in those that get partial relief after the first treatment or if symptoms return after a period of time.

How long is the healing process?

• The body starts the healing process over the first 4-6 weeks, but can take up to 9-12 months to completely heal depending on the problem. Usually symptoms and mobility improve over the first 4-8 weeks.

Contra-indications or cautions with using orthobiologics* refer to consent form for a more complete discussion

• Anemia

• Low Platelet Count

• Abnormal platelet function or diseases

• Ongoing or recurrent infections

• Undergoing cancer treatments

• Pregnant or breastfeeding

Factors that can reduce effectiveness of orthobiologics and healing

• Smoking

• Diabetes (especially uncontrolled diabetes)

• Immuno-compromised conditions

Factors that do not seem to affect outcome

• Body mass index

• Sex

• Mild or controlled diabetes

• Use of immunosuppressive medications

Frequently Asked Questions

When can I return to work or school?

• This is patient dependent. It is ok to return the next day if symptoms are controlled. However, it is acceptable to take a day or two off. A note can be provided if needed.

Does it regrow cartilage?

• Scientific studies are promising, but currently there is nothing definitive that shows this in human studies. Literature currently shows pain reduction in patients with arthritis and cartilage defects.

Does insurance cover biologic treatments?

• There are some cases where insurance will cover treatments. However, most insurances do not cover this procedure and the patient is responsible for out of pocket expenses. If you have questions about your specific insurance you are encouraged to call your insurance company.

• HSA and FSA accounts can be used to pay for the procedure. It is your responsibility to call and check with them ahead of time.

• There may be financing options available for the procedure.

Meet our doctor

Dr KEith Nord, MD, MS 

Dr. Nord is the founder and CEO of Sports, Orthopedics & Spine in Jackson, TN and Nord Regenerative Sports Medicine

Dr Nord is Board Certified by the American Board of Orthopaedic Surgery

He has additional qualifications in Sports Medicine and was the Director of the  SOS Shoulder Arthroscopy and Sports Medicine Fellowship

He is a Master instructor in Shoulder and Knee arthroscopy and was the team doctor for the London Olympics in 2012.

He has developed training programs for Orthopaedic Surgeons at the Masters Course, his presentations are required for all Orthopaedic Residents by The American Board of Orthopaedic Surgery prior to entering the Operating Room and he is currently in charge of the shoulder team for developing a computer simulator for teaching surgery worldwide. 

He has extensive experience and knowledge in Biologics including use of PRP, Bone marrow aspirate, Amniotic and Adipose derived Stem Cells.