What are stem cell injections, and how do you explain the different types to patients?
That’s a really important question because there are different kinds of stem cell injections. At our clinic, we strictly follow FDA-guidelines: same-day procedures using your own cells, called autologous stem cells. These are harvested from your bone marrow or fat and re-injected into the injured tissues in the same procedure. The FDA permits this under the same-day surgical exception rule.
The stem cells you hear about from umbilical cord or amniotic tissues and exosomes are no longer FDA-approved for use in clinics without going through a formal new drug approval process, due to safety concerns like infections and a lack of outcomes data. Unfortunately, some clinics still use them, but I think patients deserve to know what’s regulated and what isn’t.
Another option some providers offer is taking your stem cells, growing them in a lab/stem cell bank over several weeks, and then later injecting them back into your body. While this sounds great in theory, the FDA also considers that kind of lab-alteration and growth of cells as a new drug. It’s currently unapproved by the FDA for clinical use in the U.S. unless it’s part of a trial or approved under strict protocols.
So our approach is simple: we follow the FDA guidelines by harvesting your own bone marrow or fat tissues (including their stem cells), concentrate the desirable parts of your cells and tissues in-house, and precisely inject them into the injured tissues under Ultrasound-guidance the same day. The tissues are fresh, whole, and includes not just the stem cells, but other supportive elements that work together in your natural healing ecosystem. We have perfected techniques to optimize stem cell viability and cell counts while at the same time are experts in anatomy and ultrasound guidance to ensure that the stem cells and supportive tissues are delivered MOST accurately to the injured areas.
Is more always better when it comes to stem cell counts?
That’s a common misconception. More doesn’t always mean better. I have a veterinarian colleague who studied this over 15 years ago in dogs. He found that fresh, whole bone marrow performed better than lab-expanded stem cells—even with lower stem cell counts. That’s most likely because healing is complex and the fresher and more holistic the tissue, the better your healing and immune system can make use of the injection. It’s not just about one magic cell in maximal numbers—it’s about the right mix of cells working together. Our bodies are communities, not isolated systems, and unsurprisingly work better as a team than as individual cells.
Which type of stem cell do you use most often—and why?
For soft tissue injuries, I use microfragmented adipose tissue (MFAT) grafts with fat-derived stem cells most often. Fat acts as a bio-scaffold which provides structural support to the soft tissues such as tendons, ligaments, muscle and fascia—with ultrasound we can visualize the MFAT actually fill gaps in torn tissue while at the same time delivering a rich mix of regenerative cells. MFAT is semi-solid, contains tissue collagen, adipocytes and stem cells, so it stays where we inject it, unlike PRP, BMAC or prolotherapy, which are more fluid and thus are unable to fill in the tissue tears like MFAT.
It’s especially great for big muscle, fascia and tendon tears, ligament injuries, and in particular SI joint instability. MFAT acts like spackle—it fills the void and provides a structural scaffold upon which the tissue healing response can occur. PRP, BMAC and prolotherapy are more like the paint that follows the spackle, supporting the regenerative process once the foundation is in place.
BMAC is particularly useful in bone, bone-tendon junction and arthritic joints, where MFAT is perhaps not as ideally suited, although both BMAC and MFAT are terrific in most applications.
Conditions We Treat with Stem Cell Injections:
Patients can benefit from same-day, FDA-compliant bone marrow (BMAC) or fat (MFAT) stem cell injections for a wide range of musculoskeletal conditions, including:
- Knee pain & knee arthritis
- Meniscus tears
- Rotator cuff tears & shoulder pain
- Elbow pain (tennis and golfer’s elbow)
- Hip pain, arthritis, labral tears and SI joint dysfunction and instability
- Foot & ankle pain (e.g., Achilles tendinitis, plantar fasciitis and ankle instability)
- Wrist pain, arthritis and carpal tunnel syndrome
- Back pain & sciatica
- Ligament injuries, hamstring strains, sprains & strains (shoulder and ankle instability)
- Tendonitis, tendinosis and tears
- Sports-related injuries
Can you share a few examples of patients you’ve treated successfully with stem cells?
Sure. One woman I treated five years ago had a rotator cuff tendon tear and arthritis in her shoulder. We used BMAC with bone marrow stem cells, and she hadn’t needed another treatment until she came back recently with a new issue in her back. When her university doctor dismissed regenerative treatments as “anecdotal,” she simply pointed to her shoulder and said, “This shoulder has been perfect for five years.”
Another patient had a massive rotator cuff tear plus arthritis. Surgeons disagreed on whether to attempt a rotator cuff repair or just do a total shoulder replacement. He came to me first for stem cell injections. I treated the arthritis and partially torn tendons with bone marrow and fat stem cells. Five years later, he’s still roofing and building retaining walls—no surgery needed.
For SI joint instability, we’ve found PRP often isn’t strong enough for highly unstable ligaments/joints. So we use MFAT with fat stem cells, sometimes combined with PRP, to stabilize the ligaments and treat the surrounding muscle and fascia attachments to the SI ligament. We’ve done extensive research on SI ligament laxity and SI instability and providing truly life-changing treatments for patients with chronic low back pain and SI/lumbar instability from childbirth, trauma, or hypermobility.
How long do stem cell injections last? Are repeat treatments needed?
If it’s a soft tissue injury and it heals well, you may not need another treatment at all—especially if you rehab properly and stay strong. We have seen hundreds of examples of tendons healed (rotator cuff, tennis elbow, Achilles tendon, plantar fascia) as well as muscle/fascia tears especially in the core and low back, so these are much more than pain-modulating injections, although they do that as well.
With arthritis, it is more likely that repeat treatments are necessary as we haven’t cracked the code on healing cartilage injuries yet. We are lowering inflammation and joint degradation enzymes in arthritic joints while slowing down the rate of joint destruction with these treatments but we are not growing significant amounts of new cartilage. A single injection of PRP for arthritis might last one to two years for significant improvements in pain and function. Adding MFAT or BMAC might give longer relief like three to five years. Most people will eventually need more joint injections in the case of arthritis, as we have learned that these treatments are not curative but do slow down the rate of arthritis progression. The sooner we treat them the better and more durable the results.
One of the most compelling BMAC studies I reference is from Dr. Hernigou in France. He compared patients who had a knee replacement on one side and a BMAC bone marrow injection into the bones of the other severely arthritic knee. After 15 years, 80% of the BMAC stem cell-treated knees were still doing well—and most patients preferred the BMAC injected knee over the surgically replaced one. When he compared BMAC bone marrow injections into bone versus into the joint, the difference was even more stark. Bone marrow stem cell injections into the bone lasted significantly longer than injections just into the joint.
That’s why we treat into the bone directly when appropriate. Not every provider does that, but we’ve made it part of our protocol based on Dr. Hernigou’s compelling data.
How are your protocols and approach different from other providers in Colorado?
We follow FDA-approved practices using your own same-day stem cells. We’ve invested heavily in our internal lab protocols and quality control testing—spending thousands of dollars to ensure the viability and effectiveness of the stem cells we use. We also perform bone-targeted injections when appropriate, which is a more advanced and precise approach, that many clinics do not offer.
Most importantly, we view healing as a holistic, systemic process. We’re not just injecting a product—we’re working with your body to stimulate long-term repair. That mindset sets us apart.
What does the future of stem cell therapy look like to you?
I’m excited about the potential for FDA-approved, off-the-shelf products that combine safety, consistency, and potency—especially if we can regain access to amniotic and umbilical cord stem cells. Those have a unique balance of regenerative and anti-inflammatory properties that I used to rely on prior to FDA restrictions against their use.
There’s also emerging interest in peptides, exosomes, and IV stem cell delivery. Some of these are early in development, but the direction is promising. While they are not yet FDA-approved for use, we are keeping an eye on the science and the regulatory guidance. The more tools we have, the more customized and effective we can make each treatment.
What should patients expect after a stem cell injection?
It depends on the injury and the treatment type. For tendon, ligament, or muscle injuries, we typically ask for four to six weeks of activity restriction. That gives the new tissue time to develop and integrate before it’s overly stressed. You’ll likely have a period of bracing, limited movement, and guided physical therapy rehab.
With arthritis, we usually allow more activity sooner since we’re mostly reducing inflammation in the joint and not expecting significant structural healing per se. However, in the cases when we treat into the bone under the joint surface—say, in severe arthritis—we’ll ask you to use crutches for about a week to unload the area and help the cells do their work.
And if you overdo it and flare things up? The good news is the cells are still there for months. You can rest, recover, and continue healing.
Ready to Explore Stem Cell Injections for Your Condition?
At Breakthrough Regenerative Orthopedics, we offer FDA-compliant, same-day stem cell injections using your own bone marrow or fat—no gimmicks, no shortcuts, and no unapproved biologics. Whether you’re dealing with a tendon tear, arthritic joint, or SI instability, we create personalized treatment plans built around your body’s unique healing potential. Schedule your 90-minute evaluation today to learn if stem cell injections are the right fit for you.
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