The name in an advertisement may cover several procedures

Bone marrow concentrate is marrow reduced to a smaller mixed amount

The clinic removes marrow from your pelvis and spins it in a machine. Some liquid is removed, leaving a smaller amount with several kinds of cells and blood parts.

The smaller amount is called bone marrow concentrate. Here, concentrate means the clinic kept more of certain marrow parts in less liquid.

The mixture isn't a pure or measured dose of one kind of cell. Its contents can differ from one person to the next.

A large 2023 knee study compared the marrow mixture with a steroid shot. After twelve months, the marrow product wasn't better on the main soreness scores.

Less soreness is possible after a procedure, but your amount of change is unknown. Ask which result a study showed and which questions the study left open.

PRP is a portion of your blood prepared with more platelets

PRP stands for platelet-rich plasma. A clinic prepares your blood so one portion holds more platelets, which are small blood parts that help clotting.

Concentrated PRP has more platelets than standard PRP. More platelets do not promise more relief, so ask what the clinic expects for your soreness.

PRP and marrow choices are called biologic therapies because they use material from your body. A clinic prepares the blood or marrow for the procedure after an exam.

Cartilage is the smooth covering where bones meet inside a joint. A tendon is the strong band joining muscle to bone, and either area may become sore.

One procedure cannot suit every cause of soreness. Compare the proposed care with exercise, medicine, physical therapy, and surgery when surgery applies.

A study only answers questions about the product and joint it tested

Marrow, blood, fat, and material grown in a laboratory are different products. A result shown for one product doesn't prove the same result for another.

Knees and shoulders also bear force in different ways. A knee study cannot tell you what the same product will do in a shoulder.

Get the treatment name in writing so your doctor can check what was proposed. The written name also makes price and follow-up easier to compare.

Pause before paying if the clinic cannot name the product in plain words. You need its source, how it is prepared, and who performs the procedure.

Sources

1. FDA states in its consumer alert that the only FDA-approved stem cell products in the United States are blood-forming stem cells derived from umbilical cord blood, approved for disorders of the blood-forming system, and that NONE of these products - stem cells, stromal vascular fraction, umbilical cord blood, Wharton's jelly or amniotic fluid - has been approved for the treatment of any orthopedic condition, including osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain or shoulder pain.

   US Food and Drug Administration, Center for Biologics Evaluation and Research — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. , 2020.

2. 21 CFR 1271.10(a) sets the four criteria a human cell or tissue product must meet to be regulated SOLELY under section 361 of the Public Health Service Act: it must be minimally manipulated; intended for homologous use only, as reflected by labeling and advertising; not combined with another article beyond water, crystalloids or a preserving agent; and either have no systemic effect and not depend on the metabolic activity of living cells, or else be for autologous use, use in a close blood relative, or reproductive use.

   US Code of Federal Regulations, Title 21 — 21 CFR 1271.10 - Are my HCT/P's regulated solely under section 361 of the PHS Act. , 2004.

3. A laboratory study of three commercially available amniotic fluid products marketed for orthopedic use found no viable mesenchymal stem cells in any of them when compared against unprocessed amniotic fluid and bone marrow-derived MSC samples - products sold as 'amniotic stem cell therapy' contained no living stem cells.

   Panero AJ, et al. — Are Amniotic Fluid Products Stem Cell Therapies? A Study of Amniotic Fluid Preparations for Mesenchymal Stem Cells With Bone Marrow Comparison. Am J Sports Med, 2019. DOI: 10.1177/0363546519829034.

4. On 27 September 2024 the Ninth Circuit held in United States v. California Stem Cell Treatment Center that stromal vascular fraction produced by enzymatically digesting a patient's own fat IS a drug under the Federal Food, Drug, and Cosmetic Act, and that the same surgical procedure exception does not apply because the removed fat and the implanted SVF are not the same thing. The district court's ruling for the clinics was reversed.

   United States Court of Appeals for the Ninth Circuit — United States v. California Stem Cell Treatment Center, Inc., No. 22-56014 (9th Cir. Sept. 27, 2024). , 2024.

5. On 18 December 2024 FDA approved RYONCIL (remestemcel-L-rknd), the first mesenchymal stromal cell therapy ever approved in the United States - for steroid-refractory acute graft-versus-host disease in pediatric patients 2 months and older, given as eight intravenous infusions. It is not an orthopedic product and does not make any joint injection approved.

   US Food and Drug Administration — FDA Approves First Mesenchymal Stromal Cell Therapy to Treat Steroid-refractory Acute Graft-versus-host Disease. , 2024.