What is the procedure protocol?

May 20, 2022
What is the procedure protocol?
If you are a candidate for our joint regeneration procedures, you will be enrolled in a procedural protocol designed to get the most from your treatment using orthopedic immunobiologics.

If you are a candidate for our joint regeneration procedures, you will be enrolled in a procedural protocol designed to get the most from your treatment using orthopedic immunobiologics. Below is the clinical algorithm for our enhanced NAMAD (Nanoplasty And Mechanical Axis Deviation) protocol. Treatment is introduced in a safe, stepwise fashion intended to relieve clinical pain associated with the catabolic knee pain syndrome associated with osteoarthritis. Our treatments go out to two years ensuring you get the most out of your regenerative treatment. Our treatments are scientifically based and proven through our contributions to the scientific literature.

Carolina Joint and Arthritis

Regenerative Joint Procedureb - Nanoplasty And Mechanical Axis Deviation (NAMAD protocol)

Visit 1


Prolotherapy involves injecting a sugar or saline substance into your sore joint or muscle, where it acts as an irritant. It’s thought that your body recognizes the irritant and sends immune cells <https://www.webmd.com/cold-and-flu/ss/slideshow-immune-system> and other biochemicals to the area, which starts your body’s natural healing process. This process is meant to help repair any damaged soft tissue <https://www.webmd.com/pain-management/guide/myofascial-pain-syndrome> in your joint or muscle area, like nerves, blood vessels, and muscle tissue.

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Visit 2

Hyaluronic Acid Treatment/Mechanical axis deviation protocol

Your body makes hyaluronic acid <https://www.webmd.com/vitamins-supplements/ingredientmono-1062-hyaluronic+acid.aspx?activeingredientid=1062&activeingredientname=hyaluronic+acid>. It's a natural part of the fluid that helps lubricate and cushion your joints and keeps them working smoothly. When you have osteoarthritis <https://www.webmd.com/osteoarthritis/default.htm> (OA), the hyaluronic acid in the affected joint thins. Hyaluronic acid injections add to your body's natural supply (and so does platelet rich plasma). You may hear your doctor refer to these injections as "viscosupplementation," which literally means they help the fluid in your joints.

Mechanical axis deviation involves the use of custom shoe inserts with a heel wedge to align your lower extremities and offload the osteoarthritic compartment of the knee. These are custom made by a physical therapist who specializes in gait and they are made the same day as your visit. In some cases a medial unloader brace (Ossur Cartilage Rebound) is recommended for 6-24 weeks while the knee heals. Unloading the stiff bone underneath the cartilage can lead to remodeling of the stiff marrow beneath the cartilage and relieve bone edema that can contribute to clinical symptoms.

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Visit 3


Platelet Rich Plasma (PRP) therapy introduces concentrated platelets and a growth factor concentrate (GFC) we obtain through nanofiltration using a 65 kiloDalton nanofilter. This filter allows us to concentrate TSG-6 and A2M, two chondroprotective molecules that we deliver into the knee joint after harvest from your peripheral blood.

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Visit 4

ABMAC with subchondroplasty. Low intensity pulsed ultrasound treatment (LIPUS)

Autologous bone marrow concentrate comes from a cell harvest done comfortably in the clinical setting. Autologous means your stem cells, or ‘signaling cells’ are harvested from your own marrow. All of our procedures involve the transfer of your own cells and plasma only. We routinely perform a subchondroplasty which involves decompression of stiff bone underneath the diseased cartilage and marrow replacement with autologous bone marrow concentrate. We use a combination of growth factor concentrate mixed with your own clotting factor (thrombin) harvested during the cell capture to engineer a scaffolding for the signaling cells combined with PRP.

Each patient is given a hand-held LIPUS unit that is used for ten minutes twice daily. Low intensity pulsed ultrasound delivers a lower than traditional ultrasound frequency (<3W/cm3) that activates human cell mechanical receptors and enhances cartilage tissue regeneration.

Visit 5-----------------------------------2 years later or when indicated-------------------------------------------

PRP+A2M Booster

We have found that a PRP+A2M booster at two years is valuable to enhance the healing process and to extend the life of the ABMAC procedure and have included that in our procedural protocol. Concentration of peripheral blood for PRP and platelet poor plasma for a growth factor concentrate rich in TSG-6 and A2M is accomplished and administered intra-articularly.

This five-step staged approach is designed to give you the best clinical outcome with your regenerative joint procedure and to help you avoid the need for knee replacement surgery.