Riordan Treatment Protocols
Riordan Medical Institute’s protocols combine the latest scientific advances in bone marrow harvesting with two complimentary cellular technologies: Bone Marrow Aspirate Concentrate (BMAC) and amniotic tissue product. Possible effects of Riordan protocols include:
- shorter healing times
- increased vascularization
- less pain for the patient
- increased safety rate with the harvesting method
- reduced inflammation
- decreased risk of infection
Non-surgical use of Riordan protocols may provide an alternative to surgery using a simple, elegant solution to difficult problems.
Surgical use of Riordan protocols combine advanced orthopedic surgical procedures and cell therapy with the desired objective of superior patient outcomes.
Riordan protocols incorporate:
- Precision bone marrow harvesting using fluoroscopic guidance (C-Arm)
- Bone Marrow Aspirate Concentrate (BMAC™) with Vertical Axis Centrifuge
- Amniotic Tissue Products Developed by Dr. Riordan
- Precision injections with fluoroscopic guidance (C-Arm)
Harvesting Bone Marrow
The entire process takes about 10-15 minutes. Since each patient is under conscious sedation, they feel no pain during the procedure.
The doctor uses fluoroscopic imaging (C-Arm) to ensure that the needle accesses a thick area of bone marrow in order to ensure the highest quality bone marrow sample containing the greatest possible number of stem cells.
Afterwards, most patients don’t even realize where the bone marrow was taken out until they discover the entry point. Some patients might experience a small bruise but it’s not uncommon to have no bruising at all.
Precision Stem Cell and Amniotic Matrix Injections
RMI employs precision guidance using fluoroscopic imaging with a C-Arm. The enables the doctor to administer precise injections to ensure the products enter the joint space or to allow him to get full coverage around a torn ACL for example.
Bone Marrow Aspirate Concentrate™
BMAC comes from your own bone marrow and contains a wealth of cells which can aid the body in its own recovery.
BMAC can be highly effective for bone, muscle, tendon, ligament and cartilage injuries. Bone marrow is an excellent source for the cells and growth factors that are responsible for the healing and tissue regeneration process.
At RMI, we employ a vertical axis centrifuge specifically calibrated to produce bone marrow concentrate (BMAC) in order to maximize nucleated cell yield. Studies have shown that this process can produce a nucleated cell yield percentage over twice that of Arteriocyte Magellan centrifuges and about 20% more than other competing technologies.
How Much Bone Marrow is Needed?
Normally we draw 60 – 120 cc (2 – 4 ounces) of bone marrow.
Is Bone Marrow Safe?
Because BMAC is autologous, meaning it comes from the patient’s own body, the likelihood of any adverse side effects due to the BMAC itself is exceedingly low. To-date, there have never been any reports of adverse side effects.
The Science Behind BMAC
- MSC reduce inflammation, regulate the immune system and secrete factors that stimulate tissue regeneration. The better the blood supply, the faster surgical wounds and orthopedic injuries will heal and the more conducive the environment will be for MSC to flourish.
- CD34+ stem cells are blood-forming cells. They induce blood vessels to grow (angiogenesis). CD34+ stem cells are the most angiogenic cells in the body.
- Growth factors in BMAC are capable of stimulating cellular growth, proliferation, healing and differentiation (changing into another type of cell such as a blood vessel cell).
- Mesenchymal Trophic Factors (MTF) are secreted by MSC. Most of the benefits commonly attributed to MSC (see above), are actually due to the trophic factors they secrete.
Amniotic Tissue Products
Amniotic tissue product is a pliable allograft (transplant) derived from human placental amnion, which functions as a biologic structural matrix to facilitate and enhance tissue healing and repair.
Amniotic tissue has been used since 1910 in the US and is now FDA-exempt for treating wounds and other conditions. It was first used for treating eye problems, primarily corneas and is still widely used in ophthalmology today.
Once the baby is born, the placenta along with the amniotic sack and what’s left of the umbilical cord come out. It’s called afterbirth and is usually discarded.
Amniotic tissue is procured this from contracted hospitals after normal, healthy births. Once it has been fully tested for infectious diseases, sterility and a few other things, the tissue is processed.
Using proprietary technology, the tissue is separated into very small particles that are cryo-preserved in a special way that keeps the integrity of the tissue the same as it was when it came out after the healthy birth of the child.
How do some amniotic tissue products augment a patient’s bone marrow stem cells?
The cells on the left, which were cultured with amniotic tissue product, have the morphology of young, healthy MSCs. No flattening, a red color of mitochondria, and they’re spread throughout the whole cell body. On the right, you’ll notice in cells that were not cultured with amniotic tissue product, the cells are flat and fibroblastic looking. They are becoming senescent, the last step before they stop producing growth signals and can do nothing but basically form scar tissue.
The Amniotic Tissue Product Advantage
- Reduces inflammation and pain
- Provides growth factors
- Supports regeneration
- Enhances stem cells
- Heals wounds
- Reduces fibrosis risk
- Reduces adhesion
- Immune privileged
Amniotic Tissue Product Safety
Other than occasional pain and swelling at the injection site, we have not observed any adverse side effects from amniotic tissue products.
The amniotic membrane is immune-privileged so the patient’s immune system can’t recognize it as a foreign substance.
The Science Behind amniotic tissue products for Inflammation, Pain and Wound Healing
Amniotic membrane provides structural support and a plethora of growth factors. Some products derived from amniotic membrane have as many as 108 growth factors that are cryo-preserved. The two most important are:
Prostaglandin inhibits inflammation, which occurs after injury and marks the beginning of the healing process. The faster we can tame this inflammation, the sooner the body can move on to the next phase of healing, regeneration. The product we use has more than 60 times as much prostaglandin than competing products.
WNT4 is arguably the single most important molecule required for wound healing. The product we use has more than 60 times as much WNT4 as competing products.
The amniotic tissue product we use contains Interleukin-1 receptor antagonists and Tissue Inhibitor of Metallo-proteinase 1, 2, 3 and 4 proteins that suppress and modulate inflammation and subsequent pain.
The Science Behind Stem Cells, Regeneration and Growth Factors
In addition to its pain and inflammation reduction and wound healing properties, the right amniotic tissue product can create an environment that is conducive to stem cell proliferation. It contains important growth factors including PDGF, VEGF, EGF, FGF and TGF-B, which promote collagen matrix formation and cellular proliferation while minimizing the formation of scar tissue.
- The product we use is composed of collagens and other structural proteins, which provide a biologic matrix that supports angiogenesis, tissue growth and new collagen during tissue regeneration and repair.