Recent Research

Dr. Bunyak has read and analyzed the recent research in musculoskeletal stem cell therapies, PRP (platelet-rich plasma), and prolotherapy. Having conducted cellular research at the National Institutes of Health (NIH), she understands the strengths and limitations/biases of data and the resulting study conclusions.

She partners with her patients to development personalized treatments plans based on both the current research and her more than 15 years of experience in the clinic. Below is a selection of recent research and commentary by Dr. Bunyak.

Select a topic to read relevant targeted research:

knee researchPRP researchshoulderstem cell research




An optimised protocol for platelet-rich plasma preparation to improve its angiogenic and regenerative properties
(Etulain, et. al.)
Dr. Bunyak notes this text from the conclusion, “Our findings indicate that PRP pre-incubation at 4!°C, PRPr dilution, and cryoprecipitate supplementation improve the angiogenic and regenerative properties of PRP compared to that obtained by current methods.”

Management of rotator cuff injuries in the elite athlete
(Weiss, et. al)
Dr. Bunyak notes, “Conservative management of rotator cuff injuries continues to be the “gold standard” in the elite athlete. This includes a comprehensive rehabilitation program, anti-inflammatories, and corticosteroid injections. Newer treatment techniques such as intramuscular dry needling and the use of biologics such as platelet-rich plasma and stem cells demonstrate early promising results; however, these modalities require further investigation to determine their effectiveness.”

The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis
(Rahimzadeh, et. al.)
Dr. Bunyak notes this text from the Conclusion, “Results of the present study suggested a significant decrease in the overall WOMAC score of patients who undergo either PRP therapy or PRL (prolotherapy). This positive change in the overall WOMAC score led to an improvement in the quality of life of patients with knee OA shortly after the first injection. PRP injection is more effective than PRL in the treatment of knee OA.”

Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon
(Kim, et. al.)
Dr. Bunyak notes, “BMAC-PRP (bone marrow aspirate concentrate therapy combined with PRP) improved pain and shoulder function in patients with partial tear of the rotator cuff tendon.”

Tissue source determines the differentiation potentials of mesenchymal stem cells: a comparative study of human mesenchymal stem cells from bone marrow and adipose tissue
(Xu, et. al.)
Dr. Bunyak notes this text from the conclusion, “The epigenetic memory obtained from either bone marrow or adipose tissue favored MSC (mesenchymal stem cells) differentiation along an osteoblastic or adipocytic lineage. The methylation status of the main transcription factors controlling MSC fate contributes to the differential differentiation capacities of different source-derived MSCs.”

Mesenchymal stem cell-conditioned medium reduces disease severity and immune responses in inflammatory arthritis
(Kay, et. al.)
Dr. Bunyak notes, “MSC-conditioned media (containing exosomes and signalling molecules) reduces cartilage damage and suppresses inflammation in inflammatory arthritis.”

Circulating levels of proinflammatory mediators as potential biomarkers of post-traumatic knee osteoarthritis development
(Panina, et. al.)
Dr. Bunyak notes, “This study shows that ‘patients with early- and late-stage post-traumatic knee osteoarthritis have increased levels’ of biomarkers which may help diagnose the likelihood of future degeneration and which may help target therapies such as A2M (alpha-2 macro globulin). Scientific note: Serum NO, leptin, IL-6, IL-18, and IL-1B correlate with post-traumatic knee osteoarthritis develpement (and may help select targets for A2M therapy).

Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement
(Vasavilbaso, et. al.)
Dr. Bunyak notes, “HA (hyaluronic acid injections) and PRP (platelet-rich plasma therapy) both help with post-arthroscopy pain and function for arthritis and meniscal tears. In this study, the HA offered more benefit than PRP, and this benefit lasted 18 months.”

Conservatively treated knee injury is associated with knee cartilage matrix degeneration measured with MRI-based T2 relaxation times: data from the osteoarthritis initiative
(Hoffman, et. al.)
Dr. Bunyak notes, “Significant knee injuries, as defined by an injury that limits the ability to walk for at least 2 days, are associated with (permanent) cartilage matrix abnormalities as shown on MRI, even without obvious morphologic abnormalities.”

Optimization of pure platelet-rich plasma preparation: A comparative study of pure platelet-rich plasma obtained using different centrifugal conditions in a single-donor model
(Yin. et. al.)
Dr. Bunyak notes this text from the paper, “In conclusion, while P-PRP obtained using different centrifugal conditions had similar erythrocyte, leukocyte and pro-inflammatory cytokine concentrations, centrifugation at (specific spin speeds) successively captured and concentrated platelets and growth factors more efficiently with preservation of platelet function compared with other conditions. “

Intra-articular injection in the knee of adipose derived stromal cells (stromal vascular fraction) and platelet rich plasma for osteoarthritis
(Bansal, et. al.)
Dr. Bunyak notes this text from the conclusion, “SVF combined with PRP has a great potential as a therapeutic agent in regenerative medicine especially in orthopedic conditions. The high numbers of MSCs in SVF make it a suitable source for cellular medicine. Preliminary studies suggest that it is a safe and effective method for treating osteoarthritis. Both qualitative and quantitative measurements showed statistically significant improvements during the follow up period of 2 years.”