Platelet Rich Plasma versus Stem Cells
How does PRP compare to a stem cell treatment? First, one must be very clear about what is needed to ‘fix’ a given problem, and this is where some of the common diagnostic misconceptions in the medical community come into play. For instance, in a knee that has significant loss of cartilage (bone on bone), are the symptoms actually due to ‘bone ends rubbing together’, and to an inflammation (arthritis), or are the symptoms in knees where cartilage loss is noted primarily coming from the ligaments and tendons around the knee, and is the cartilage loss due to mechanical abrasion due to ‘loose ligaments’? (Read More on Prolotherapy and Connective Tissue Damage Syndrome).
A pure Stem Cell treatment ONLY grows new tissue, like cartilage. It DOES NOT add new collagen to ligaments and tendons, which is the way that pain and joint instability are successfully treated and resolved. Research studies have clearly shown that addressing ‘bone on bone’ knees by simply treating the cartilage surface and trying to grow new cartilage, does not give as good, or as enduring, symptom relief as treating the ligament and tendon structures in conjunction with treating the joint surface. Dr. Johnson is personally convinced that a significant percent of the symptoms in such knees, and other joints, are in fact coming from stretch-induced small fiber nerve damage in the damaged ligaments and tendons, NOT from the cartilage loss, and our treatment strategy targets both issues. He is also convinced that the loss of cartilage is in fact due to ‘loose’ ligaments, which are in turn caused by a lack of collagen molecules in these ligaments (unhealed damage). So, stem cell treatments address only one of the two major causes of joint pain in ‘bone on bone’ joints, and probably the more minor of the two causes, while PRP addresses both causes. The excellent results obtained by basing our treatment strategy on thoroughly treating both causes of pain in patients in whom total joint replacement has been recommended, lends supports this idea.
While stem cell treatments do produce good clinical results in patients with ‘large joint’ cartilage loss (knee, hip, shoulder), there are two concerns about using this treatment strategy: First, THE COST. If equivalent, much less better, results can be obtained by using a treatment strategy that is a fraction of the cost, why not fully explore the much less expensive option? Secondly, in a situation where cartilage has been lost, and the primary effort is to provide a nice, shiny new layer of cartilage, one must also ask what is likely to happen to this new, expensive layer of cartilage going forward? I would gently suggest that in all likelihood, the same thing will happen to this new layer that happened to the original cartilage. Unless the ligament laxity that caused the initial cartilage loss is successfully addressed, results will likely not be long-lived. Dr.Johnson would simply point out that he has not seen a single patient with significant cartilage loss (and over five hundred of his patients have fallen into this category) who does not also have demonstrable ligament laxity of the anterior cruciate ligament, and likely other ligaments. It is emphasized that most Orthopedic surgeons and other physicians who offer stem cell treatment, and PRP treatment, are apparently not aware of the role of the ligaments in causing either pain or cartilage loss (they assign the cause of the damage and the pain to an inflammatory process called ‘arthritis’…which has largely been discounted by recent research), and their treatment strategy—simply inserting either stem cells or PRP in the joint capsule, in conjunction with treatment with anti- inflammatory medication—reflects the belief that all of the symptoms are arising from a combination of cartilage loss and joint inflammation. This treatment strategy would be likely to produce results with far less than 100% relief of symptoms—which research studies clearly confirm—and the results that are produced will probably diminish over time— which research studies also confirm.
Again, simply putting stem cells into the knee capsule will have no effect on ligament length, strength, or symptom production, and to the extent that this ligament mechanism for symptoms remains unrecognized by the practitioner, the patient’s actual pain sources will remain untreated.
Let us hasten to add at this point that Dr. Johnson does stem cell treatments, and he does believe that they have a role in certain patients, particularly those in whom the connective tissue healing system is functioning poorly or is unavailable due to other medical conditions. But he also believes that PRP, and even Dextrose Prolotherapy, which does an excellent job of treating a very high percentage of these patients, would reasonably be ‘first line’ therapy, with stem cell treatment, or total joint replacement, reserved for the small percentage of these patients—less than 5%—that do not respond adequately to these ‘first line’ options.