Русский 
English 
Deutsch 
Español 
العربية 
中文 
Türkçe 
Français 
Italiano 
Prof. Dr. med. Arsen Babayan
Regenerative orthopedics offers 4 main types of autologous (from the patient's own tissues) concentrates. They differ in source, composition, mechanism of action, and evidence base. We analyze each method objectively.
1. PRP — Platelet-Rich Plasma
Source
Patient's blood (10–60 ml). Centrifugation > platelet concentration 2–5 times.
Mechanism of Action
Platelets contain growth factors (PDGF, TGF-?, VEGF) that stimulate tissue healing. The effect is short-term: factors are released in the first 1–2 hours and degrade within 5–7 days.
Evidence Base
- Moderate effectiveness in mild osteoarthritis (Kellgren-Lawrence I–II)
- Tendinopathies — good results (epicondylitis, plantar fasciitis)
- Herniated discs — insufficient effectiveness (growth factor concentration too low)
Limitations
Does not contain stem cells. Short-term effect. Requires repeat courses (3–5 injections).
2. SVF — Stromal Vascular Fraction
Source
Adipose tissue (50–100 ml, harvested via mini-liposuction). Enzymatic digestion with collagenase > isolation of stem cells.
Mechanism of Action
SVF contains mesenchymal stem cells (MSCs), pericytes, endothelial cells, and growth factors. MSCs can differentiate into chondrocytes and participate in cartilage regeneration.
Evidence Base
- Knee osteoarthritis — good results in several RCTs
- Issue: enzymatic processing may damage cells (viability 60–80%)
Regulatory Status
?? In the EU, enzymatic SVF is classified as ATMP (Advanced Therapy Medicinal Product) and requires a special license. Many clinics use it illegally.
3. BMAC — Bone Marrow Aspirate Concentrate
Source
Bone marrow from the iliac crest (30–60 ml, aspiration under anesthesia). Centrifugation > MSC concentration.
Mechanism of Action
BMAC contains MSCs, hematopoietic cells, and growth factors. MSC concentration: 500–2500 cells/ml (significantly lower than in SVF or Lipogems®).
Evidence Base
- Good results for nonunions of fractures
- Moderate for osteoarthritis (lower than SVF due to lower MSC concentration)
Limitations
Painful harvesting procedure. Low MSC concentration. In patients over 50 years, the number of MSCs in bone marrow decreases by 90%.
4. CGF — Concentrated Growth Factors
Source
Patient's blood (20–40 ml). Special centrifugation with variable speed (Medifuge, Silfradent) > fibrin matrix with growth factors.
Mechanism of Action
CGF is the evolution of PRP. Key difference: the fibrin matrix provides prolonged release of growth factors over 7–14 days (vs 1–2 hours for PRP). Concentration of PDGF, TGF-?, VEGF is 5–10 times higher than in standard PRP.
Evidence Base
- Osteoarthritis — superior to PRP in direct comparisons
- Disc herniations — effective in combination with stem cells
- Tendon healing — high efficacy
Comparison Table
| Parameter | PRP | SVF | BMAC | CGF |
|---|---|---|---|---|
| Source | Blood | Fat (enzymatic) | Bone marrow | Blood |
| Stem cells | No | Yes (many) | Yes (few) | No |
| Growth factors | Low conc. | Medium | Medium | High (5–10? PRP) |
| Effect duration | 1–2 hours | Weeks | Weeks | 7–14 days |
| Harvest invasiveness | Minimal | Medium | High | Minimal |
| CE Mark | Yes | ?? ATMP | Yes | Yes |
| Best for | Tendinopathy | Osteoarthritis | Fractures | Discs, joints |
Why MIBRAR® Combines CGF + Lipogems®
The MIBRAR® method uses a combination of the two most effective concentrates:
- CGF — powerful growth factors with prolonged release
- Lipogems® — mechanically processed adipose tissue with live MSCs in native matrix (>95% viability, no enzymes = legal status in EU)
Lipogems is not SVF. Lipogems® technology processes adipose tissue mechanically (without collagenase), preserving the stromal matrix — the microenvironment necessary for cell survival. This is a key advantage over SVF.
