Many times a prospective patient will come into our office for a consultation and ask if we can do both Platelet Rich Plasma injections and Stem Cell injections at the same time.

Marc Darrow MD, JD. Thank you for reading my article. You can ask me your questions about this article using the contact form below. 

There is much research on the benefit of platelets being the “soil” from which stem cells can grow and begin their healing work. Let’s get to the research.

Let’s start with a 2012 study (1) and make our way up to 2020. Here the research team wanted to determine whether platelet-rich plasma (PRP) could be made into a bioactive scaffold capable of endogenous (using the body’s own healing and response system), growth factor release for cartilage repair. In essence these researchers made a patch of platelets.

Then they took adipose – fat derived stem cells (which we do not use) and they took bone marrow derived stem cells, which we do use, and seeded them into a patch in the laboratory. The patch was then implanted into rabbit knees. What they found was:

  • The stem cells multiplied in the platelet rich patch.
  • The bone marrow stem cells turned into cartilage in the rabbits faster and more efficiently than the fat stem cells did.

The theory that platelets made stem cells work better was now in place but the practicality was not: What you can do in the laboratory you sometimes cannot do in the clinic. For one thing you cannot culture stem cells in the United States.Cultured stem cells were used in this study. Let’s move next to research from 2014

Bone marrow aspirate injections contain plasma rich in growth factors and mesenchymal stem cells

In the Journal of natural science, biology, and medicine researchers wanted to show how effective bone marrow aspirate (containing plasma rich in growth factors and mesenchymal stem cells) injections could be in the treatment of tennis elbow. This research is not a PRP patch or a PRP scaffold, it is a direct injection of bone marrow aspirate into a painful joint.

In this research a total of 30 adult patients with previously untreated tennis elbow were administered a single injection of bone marrow aspirate (stem cells and platelets).

  • This concentrate was made by centrifugation of iliac crest bone marrow aspirate – watch the video below.
  • The researchers concluded: Treatment of tennis elbow patients with single injection of bone marrow aspirate showed a significant improvement in short to medium term follow-up. They suggest that in the future, such growth factors and/or stem cells based injection therapy can be developed as an alternative conservative treatment for patients of tennis elbow, especially who have failed non-operative treatment before surgical intervention is taken.(2)

Let’s point out again bone marrow aspirate contains plasma rich in growth factors and mesenchymal stem cells. No separate PRP treatment was given.

The benefit of the mesenchymal stem cells-PRP mixture is the ability to obtain source cells and growth factors simultaneously, simply, and cost-effectively

A 2018 study published in the medical journal Clinics in orthopedic surgery (3) examined the effectiveness of bone marrow aspirate concentrate on rotator cuff tears following rotator cuff surgery. This research team found comparable results to the researchers in the above tennis elbow study. Bone marrow stem cell therapy alone provided benefits as if the patient was getting two separate treatments. A PRP treatment and a stem cell treatment.

In this study the doctors wanted to see if post surgical bone marrow stem cell treatments could help prevent a high rate of re-tears in the rotator cuff. In fact, it did.  The study conclusion reported: “the local application of bone marrow aspirate concentrate after rotator cuff repair enhanced the mechanical strength of the tendon-to-bone junction. Improved biological healing was also observed  . . . ”

So indeed, bone marrow aspirate concentrate was able to strengthen the repaired tissue. But how? The researchers suggested: “Bone Marrow Aspirate Concentrate contains a high concentration of platelets, but more importantly, it also contains mesenchymal stem cells and progenitor cells* all of which contribute to tissue regeneration. . . The benefit of this combined with the mesenchymal stem cells-PRP mixture is the ability to obtain source cells and growth factors simultaneously, simply, and cost-effectively.”

These are benefits are similar to what we have found for our patients, bone marrow derived stem cell injections contain platelets necessary for accelerated and enhanced healing. When we inject the stem cells into the patient’s painful joints we are providing stem cells and growth factors simultaneously, simply, and cost-effectively.

* Progenitor cells are much like stem cells in that they have the ability to morph into other cells. The difference is progenitor cells have a limited ability to reproduce itself)

Stems cell therapy by itself is not as good as stem cell therapy with platelets

In October 2019, in the journal Stem cells international, (4) researchers examined the regenerative properties of stem cells and PRP to repair damaged skin. Mesenchymal stem cells (MSC) and platelet-rich plasma (PRP) were separately tested in the attempt to regenerate the lost, damaged skin in animal studies. However, these treatments often remained inefficient to achieve complete wound healing. Previous studies suggested that PRP could be used in combination with MSC to improve the cell therapy efficacy for tissue repair. In this study, the researchers showed that PRP improved the efficacy of engrafted MSC to replace lost skin in mice by accelerating the wound healing processes and ameliorating the elasticity of the newly regenerated skin.

As in the 2012 study, this 2019 a study also sought to make adipose stem cells work better by adding PRP. We use bone marrow stem cells because in our research and clinical observations, the bone marrow does not need to be combined with an separate PRP treatments or enhancement because the healing growth factors found in the blood platelets are found in the bone marrow aspirate.

Do you have questions? Ask Dr. Darrow



A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References
1 Xie X, Wang Y, Zhao C, Guo S, Liu S, Jia W, Tuan RS, Zhang C. Comparative evaluation of MSCs from bone marrow and adipose tissue seeded in PRP-derived scaffold for cartilage regeneration. Biomaterials. 2012 Oct 31;33(29):7008-18.
Singh A, Gangwar DS, Singh S. Bone marrow injection: A novel treatment for tennis elbow. Journal of natural science, biology, and medicine. 2014 Jul;5(2):389.
3 Liu XN, Yang C-J, Kim JE, et al. Enhanced Tendon-to-Bone Healing of Chronic Rotator Cuff Tears by Bone Marrow Aspirate Concentrate in a Rabbit Model. Clinics in Orthopedic Surgery. 2018;10(1):99-110. doi:10.4055/cios.2018.10.1.99.
4 Hersant B, Sid-Ahmed M, Braud L, et al. Platelet-Rich Plasma Improves the Wound Healing Potential of Mesenchymal Stem Cells through Paracrine and Metabolism Alterations. Stem Cells Int. 2019;2019:1234263. Published 2019 Oct 31. doi:10.1155/2019/1234263

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