Orthobiologics & Regenerative Medicine
Treatment of Musculoskeletal Conditions without Surgery
Orthopaedic Surgery, Sports & Performing Arts Medicine uses all holistic and non-operative measures to keep patients healthy. This includes medications, acupuncture, Pilates, Gyrotonics, yoga, physiotherapy, home exercise programs, weight reduction, and Orthobiologic Regenerative Medicine.
Natural substances in the body that are components of the healing process of injured bones, ligaments and muscles. The healing process involves growth factors, stem cells, morphogenic proteins, and a matrix or “garden” where differentiation, maturation, growth and healing occur. When an injury occurs, the miraculous healing response starts. Research suggests that providing the components of healing in greater than normal concentrations will aid and facilitate healing. These techniques are also being used for cartilage injuries and treating arthritis. For example, patients who have known arthritis of the knee but want to avoid a total knee replacement, are increasingly turning to Regenerative Medicine.
Platelet Rich Plasma (PRP)
Blood contains serum, red cells, white cells and platelets. Platelets are critical to the normal clotting that occurs with bleeding and also with healing after injuries. Platelets are rich in proteins and growth factors. By drawing off a tube of blood and using a centrifuge, high concentrations of platelets can be collected. These platelets are then re-injected into the site of injury (or arthritis).
Adult Stem Cells
Adult Stem Cells are immature cells that change and can differentiate into mature cells of tendons, bone, ligaments and muscles. Millions of these cells are found in bone marrow & adipose (fat) tissue. These cells can be surgically withdrawn in a process similar to drawing blood, or purchased commercially from tissue/blood banks. The cells are then placed in the site of injury to aid & speed up healing. In some instances, the term Prolotherapy is used when injections are focused on ligaments & tendons.
Despite the treatment of many high profile athletes, the growing use and popularity, and numerous published studies; most insurance companies do not cover Orthobiologic techniques. These companies deem this use as “experimental” and not approved. Many patients use their Health Savings Account for reimbursement for these procedures. Discuss this with your provider.
When a patient develops knee arthritis and has tried to relieve pain by activity modification, weight loss, physiotherapy, NSAIDS, other non-operative options & arthroscopy – Visculosupplementation is an option to consider. This is a pharmaceutically manufactured gel made of hyaluronic acid and is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints. The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain. The individual results are mixed, but most health insurance companies cover this modality.
Steroid Injections are widely used to decrease inflammation, especially in chronic situations. It is a delicate balance when to use steroids since the inflammatory response is an important component of healing. Steroid use is not advocated for repetitive use and is not advised for intra-tendinous use. It is commonly used with later stages of arthritis. It is covered by most health insurance companies.