What is Adipose Cellular Concentrate?
Adipose Cellular Concentrate (ACC) is a cutting-edge treatment for acute or chronic sports and musculoskeletal injuries. It continued and expanded the revolutionary thinking of prolotherapists throughout the last half of the 20th century: that the body has the ability to heal itself when directed correctly. Adipose Cellular Concentrate adds to the arsenal of regenerative agents that began with prolotherapy and PRP, expanding the efficacy and range of conditions that can be treated with minimally invasive procedures. Professional and recreational athletes along with lay persons with degenerative pain conditions credit Adipose Cellular Concentrate treatment for enabling them to follow their passions. It is much less invasive than traditional surgeries for the same conditions, with much less down time from work/play/sports.
Adipose contains at least 2 types of stem cells (mesenchymal, “pericytes”). The mesenchymal stem cells (MSCs) are well supported in the literature for their healing and chemical modulating effects. Pericytes are not as well characterized, but appear to be part of a family of very versatile stem cells that act as replacements for cells like MSCs while coordinating local effects on their own. The stem cell fraction in adipose tissue is much higher than bone marrow, with studies showing 10-100 times the number of MSCs. Having the ability to minimally process and concentrate healing cells from adipose improves its potency and versatility. Having a source of stem cells in the injections drastically improves the efficacy of procedures and decreases the total number of times procedures need to be done. Stem cells act as the central organizers of the healing response, calling other cells and coordinating the building of tissue and removal of damaged tissue.
First, we begin by preparing the patient for Platelet-Rich Plasma (PRP) Therapy creation, as we always combine ACC with PRP. This will augment the function of the stem cells in the adipose concentrate and help them to grow via the 13 different growth factors in PRP.
For patient preparation to do a simple liposuction procedure, first, we offer oral sedation to help create relaxation. Though far from a spa, we do have music, oxygen, and aromatherapy in our procedure room. A large volume of anesthetic is used to create anesthesia from the skin and throughout the layer of adipose that will be aspirated. This is allowed to sit for several minutes to allow the anesthetic to reach full effect. A large needle, called a cannula, is inserted into the adipose in a single location on each side of the abdomen or buttock region to carefully aspirate the adipose. The patient should feel the general movement of the cannula, but not sharp pain.
After aspiration, the adipose can be prepared in 1 of 3 ways:
- Washed, but still in its raw state: This is the preferred form of adipose when large tendon tears need to be filled. Recent studies have shown that certain types of local messengers come from raw adipose only, so it is a consideration for all locations
- Macerated (broken up) & centrifuged to remove oil portion: the oil portion of adipose (80+% of its volume) can be removed simply by breaking up the fat and centrifuging it. This gives a much smaller volume that can now be used to place a higher concentration of the fibrous (or stromal) portion of adipose in the affected area.
- Digestion of the adipose to yield a cellular concentrate: This is the most concentrated form of stem cells available. We use FDA approved devices and reagents to process the adipose. In addition, all patients are followed by a tracking database to help follow the outcomes and adverse events of using this preparation. This preparation is good for all regenerative uses, but particularly highly used by Dr. Hanson for arthritis and neurologic applications.
A very unique feature at OrthoCure Clinic is that we measure the number of cells in the volume of fluid that we inject. We can vary this number based on location, the number of structures to treat, and the type of tissue to optimize healing. We believe this is a critical step, otherwise, there is no way to know how many cells are being “dosed” in your injections.
The entire treatment, from blood draw to solution preparation, to injection, takes 2-4 hours in the clinic, also a unique experience at OrthoCure Clinic. To prepare you, complete an arterial blood draw, complete liposuction, process your sample, measure your sample, create a final concentration for the injection and to do the procedures under both ultrasound and fluoroscopy takes time, patience and precision. We treat every procedure as if it was being done in an operating room.
ACC treatment works best for arthritic conditions and torn or severely deteriorated tendons and ligaments, as well as fibrocartilage such as discs and meniscus that have failed other conservative treatment. In addition, it is the agent of choice for significant neurologic dysfunction. Areas treated include:
- Neck injuries such as whiplash, arthritis & chronic instability.
This is particularly helpful in severe instability, for the condition Barre-Lieou Syndrome - Rotator cuff injuries, including partial-thickness & full-thickness tears (up to 2.5 cm)
- Shoulder pain & instability
- Knee sprains & instability, including partially torn ACLs
- Patellofemoral syndrome & patellar tendinosis
- Knee, hip, and other joint osteoarthritis
- Degenerated, torn and herniated discs
- Areas of bone necrosis (death)
- Complex regional pain syndrome
- Fluoroquinolone induced neuropathy
- ALS
- Other chronic tendon and ligament problems
ACC is a mainstay for many cases of osteoarthritis (the “wear & tear” kind). ACC together with PRP can help stimulate a “smoothing over” of the roughened and arthritic cartilage, reducing the pain and disability of arthritis. In addition, the healing stem cells in the solution create a powerful local chemical environment modulation/control, helping to avoid a return to a toxic or degenerative chemical niche.
Joints most often treated with the ACC/PRP combination include:
- Knee arthritis
- Hip joint arthritis
- Shoulder arthritis
- Spinal facet joint arthritis
- Sacro-iliac joint arthritis
- Great toe arthritis
- Thumb arthritis
- And other joint arthritis
Adipose Cellular Concentrate Therapy FAQs
This is one of the most common questions we receive—patients’ preconceived beliefs about adipose aspiration definitely comes with some trepidation. From widely spread local anesthetic to oral sedation, oxygen, aromatherapy and music, we do the utmost to help you be comfortable. Going slow and monitoring for your discomfort with adjustments is the primary means to ensure that adipose aspiration is as comfortable as possible.
The level of discomfort of the treatment depends in part on the area being treated. For example, injections given into a joint often are minimally uncomfortable and in some cases painless. Injections given into tendons and the capsules of joints tend to be more uncomfortable. There is usually moderate pain for the next few days. In cases where large numbers of injections will be completed, Dr. Hanson will perform a regional nerve block to reduce pain during and after the injection whenever possible.
We also have a master Reiki practitioner who is available to perform energy healing before/after procedures.
We encourage you to have someone with you for support and to help with paperwork and remember instructions.
On average, most patients start to see signs of improvement anywhere from 2-12 weeks after treatment. There can be less overall pain, an ability to do more activity before pain sets in, and/or faster recovery from pain.
Anytime a needle is placed anywhere in the body, even getting blood drawn, there is a risk of infection, bleeding, and nerve damage. However, these are very rare. Other complications, though rare, can occur depending on the area being treated, and will be discussed by your doctor before starting treatment. Because ACC uses your own blood, you cannot be allergic to it.
Studies suggest an improvement of 80+%, though some arthritic joints, namely the hip, do not respond as well. Some patients experience complete relief of their pain. In the case of tendon and ligament injuries the results are generally permanent. In the case of joint arthritis, how long the treatment lasts depends partly on the severity of the condition. Mild arthritis may not need another round of treatments. More advanced arthritis, on the other hand, typically requires a repeat course of treatment, usually in 1-3 years.
The goal of these treatments is to reduce pain and to improve function. While there is some evidence that treatment occasionally does result in increased cartilage thickness, the important point to keep in mind is that the cartilage lining the joint surfaces has no pain fibers! For example, often we see patients with knee or hip arthritis where the joint that does NOT hurt has WORSE arthritis on x-ray! Pain from arthritis is very complex and involves far more than just how thick the cartilage is.
In the case of mild arthritis, the treatment may halt the development of further arthritic decay. However, in advanced arthritis, as noted above the goal of treatment is to reduce pain and improve function. In some cases, the arthritis is so severe that ACC is not a viable option initially, in such cases Dr. Hanson will usually offer to work with you to improve the chemical niche first. If that is successful, a course of ACC may be warranted. Some patients are not surgical candidates because of other medical conditions. Other patients simply do not want joint replacement surgery under any circumstance. In these cases, ACC may be a viable treatment option, but it is not a permanent solution. In these specific situations, treatments may need to be repeated periodically.