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Melanie Cole (Host): Amniotic placental tissue injections are being found to help resolve acute tendon injuries and are showing promise for regenerative effects on injured, painful joints and back pain without the need for drugs or surgery. My guest today is Dr. Thomas Plut, he’s a sports medicine specialist with the orthopedic program at Lourdes Health System. Welcome to the show Dr. Plut. So, people hear amniotic placental tissue, they hear injection, so speak about what that is a little bit and what does that word allograft mean?

Dr. Thomas Plut, DO (Guest): Okay great. Well thank you for having me. Placenta allograft tissue basically what that is, is taking tissue from a healthy placenta donated to a tissue bank in the United States and from that, capturing growth factors and stem cells and then preserving them. In this case, the product we use is cryopreserved, meaning frozen and then from that sample allograft, if you will, we will then inject that into a diseased tissue, for example a tendon that is damaged.

Melanie: So, why placental tissue specifically?

Dr. Plut: From my understanding, this has been around for many years, more than just the past few years. It’s grown in popularity because of the proper screening that is done now. It fell out of favor when the AIDS epidemic occurred. And at the time, we were not screening for HIV and other communicable diseases. So, that being said, it was helped in wound healing prior to that. But when the HIV and AIDS epidemic occurred, people got scared and, so it was not used because of improper screening, but now that is not the case. As I said before, the placenta allograft, they are from tissue banks in the United States. The mother and the child is prescreened for any communicable diseases such as hepatitis and HIV. So, it’s safe and effective and it has helped a tremendous amount of patients. In my office it has helped a lot of patients, have been able to help people return to running and save their careers. For example, I just saw a patient today, who had severe Achilles tendinopathy; who had surgery and the surgery failed. So, with two injections, he is now back to running and his career is going to be saved with the military.

Melanie: Wow. So, first of all, you know you were mentioning the screenings. So, are there certain set standards now for donation, for these donors?

Dr. Plut: exactly, if there are any health concerns the sample wouldn’t be used. So, that is why there is a ton of prescreening that is done and only samples that are guaranteed – that can be guaranteed to not have those communicable diseases are what are being used. So, it is prescreened for communicable diseases.

Melanie: So, tell us about this injection itself. So, first of all, who can benefit from it? What types of situations are you using it for? In my intro, I mentioned some regenerative effects for painful joints, back pain. What else are you using it for?

Dr. Plut: Correct, so, it falls into the regenerative medicine category. Commonly it is used for tendon problems or plantar fasciosis which is disease thickened plantar fascia tissue that is found in the heel of a patient’s foot where it can be quite painful. So, it is used for places that have diseased tendons or fascia. So, tennis elbow, rotator cuff tendinosis with maybe some tears, it can be used for. So those are some common things that I’m using it for. We have also tried to use it for arthritis management but mainly I am using it for tendinopathy.

Melanie: So, are there any one for whom this cannot be used? Are there any contraindications?

Dr. Plut: Well if they are actively having an infection or at the injection site, there is an infection. That has happened with me. A patient came to get a procedure done and they had a rash, so that would be a contraindication. Obviously, if they are battling with some type of chronic illness that their immune system is depleted, I would be talking with the appropriate specialist to make sure it would be safe to do this. But most of the time, that’s not the case and patients as long as they are on board with proceeding we can proceed without any issues.

Melanie: Dr. Plut, compare for us the use of this amniotic allograft tissue injection versus a steroid injection. Kind of give us a little head to head comparison why one over the other.

Dr. Plut: Yeah so, that’s a great question. So, there is published data that steroids can actually harm tendon when you inject steroids. And so, you obviously don’t want to be doing that if you are causing more harm in the long run. So, that’s the number one thing that I’m concerned about. And a lot of times, unfortunately, patients will come to me for example, I’m thinking of tennis elbow and they have had three or four injections and then once you start getting imaging; you see that the tendon is thickened and in some cases, has partial tearing. So, perhaps there is a possibility that the repeat steroid injections has caused the tearing. So, we definitely don’t like to have continued or repetitive steroid injections done into a tendon because we know that can cause more harm than good. Now, with placenta allograft injection which as growth factors and stem cells; that’s where this injection comes into play. It has potential to bring healing with diseased tissue such as tendinosis as well as tears. So, that being said, in some ways, it’s a lot safer than steroid injections.

Melanie: So, now you mentioned the number, sometimes people have two, three, four steroid injections and then a doc says you know what, that’s enough. Is this something that needs to be administered more than once? Does once do the trick? Or what’s the situation for how often they need this?

Dr. Plut: Yeah, so the way you look at an injection therapy, how I look at it is if the patient proceeds to do an injection, basically I say we do one injection and then we reevaluate the patient in six to seven weeks to see how they are doing. If they get absolutely no response, then I have to question is this the right treatment algorithm to keep going down. Because you should get a response. If you are getting a positive response, then you can definitely consider a second and maybe sometimes a third. Earlier on I gave you an example about the soldier that had severe Achilles tendinosis. We did one injection. I reevaluated him six weeks later and he was around 80 – 85% better. And then like I said, after reevaluating him, we thought it was best to proceed with a second injection and I’m glad I did because now and I just saw him today; he is around 95% better and he is ready and he is ready to continue with his running program.

Melanie: So, that really is amazing and certainly stem cells and regenerative medicine is fast becoming an area of medicine with this incredible potential Dr. Plut. So, is this an FDA approved thing because it’s considered an allograft? So, is it regulated by the FDA?

Dr. Plut: Yeah, this is a regulated product. But it is often not covered by insurance.

Melanie: Is it difficult to find? I mean is it like something that there’s a lot of availability? Are many doctors using it? What’s kind of going on in this world?

Dr. Plut: Oh regenerative medicine is growing. There are a lot of doctors in our community that are doing it. From my perspective, it depends on the physician and their comfort level and where they are in their career. For me, you start out using some products and as you grow and learn, you start to see that certain products are not as good as others. For me, I quickly have tried to decrease the amount of steroids I use in my practice because of what I said earlier about how it can cause more harm than good. So, you have to look at each case individually. You have to look at the patient, their current situation, their job and from there, determine the best treatment plan. Once you determine the best treatment plan and they are comfortable proceeding with an injection like this; then you do proceed and then you closely follow them and see where they are at. And from there, based off of their response, is based off of if you continue with the treatment or if they are doing well, you just stop the treatment and continue with their rehab.

Melanie: Now when people get hyaluronic acid, they hear about that and we are talking about steroid injections; sometimes based on the skill level of the provider that is doing it or maybe they are using ultrasound guided or making sure it gets right in the right spot. Is that the same with this type of an allograft injection? Does it need to be a very specific point or do these stem cells kind of go in there and find the injury?

Dr. Plut: That’s a great question. So, for example, whether it be the soldier I saw today with the Achilles tendinosis or I also saw a patient today with chronic tennis elbow that had diseased tendon thickening. You need ultrasound guidance so you can be very specific in injecting the correct tissue. In the case that I did today with the elbow, I was able to visualize the diseased tendon for this case, the tennis elbow, the extensor tendon; visualized it with ultrasound and then I was able to do the procedure with guidance and properly inject the correct tendon with the placental allograft. So, I think it’s very important that with these types of procedures that they be done under some type of guidance. In my case, I use ultrasound which has no radiation and it can be done in the office.

Melanie: Such an important point. So, wrap it up for us Dr. Plut with your best advice or information to educate the listeners on exactly really what it is that you are doing at Lourdes Health System using placenta allograft for regeneration of tissue and possibly really helping so many sports medicine and orthopedic injuries.

Dr. Plut: So, to sum it up, basically, the goal is to get people back healthy and active and being productive in society whether if they are a weekend warrior, competitive athlete or somebody that just has an office job; the goal is to make them productive, decrease their pain and make them more functional. That’s our number one goal. And to do that within reason and that the patient understands the treatment options and that they are comfortable proceeding. So, there’s a lot of education that I do about the various injection techniques that I do, products that I offer, so, another important point is to make sure the patient I educated and that they are comfortable proceeding with the procedure. But ultimately, the goal is to make them – to decrease their pain and improve their function and subsequently, improve their quality of life.

Melanie: That’s great. What a fascinating topic. Thank you so much Dr. Plut for being with us today. This is Lourdes Health Talk and for more information on the orthopedic program at Lourdes Health System, please visit www.lourdesnet.org. That’s www.lourdesnet.org . This is Melanie Cole. Thanks so much for listening.