Regenerative medicine is the process of creating living functional tissue to repair damaged and injured parts of the body. Because regenerative medicine uses a person’s own cells to generate the new tissue, the healing process is natural and may allow the individual to avoid surgery.
Regenerative medicine is also referred to as biologic medicine because biologics use the body’s own blood, or progenitor cells, to stimulate healing. An injection of Platelet Rich Plasma (PRP) calls progenitor cells to the damaged area. These cells then turn into the type of cell needed for healing.
PRP stands for Platelet Rich Plasma. “Let’s say you cut your arm. Platelets are released, white blood cells are released, red blood cells are released, because the vein has been opened up. Platelets help stop the bleeding. For a long time that’s all we thought they did. Now we know that platelets release many growth factors that call other cells to the site to help the healing. Some of these types of cells are progenitor cells. Those cells help create whatever is needed, whether it’s veins, arteries, bone, skin muscle, tendon, cartilage etc. It’s all pre-programmed to do that. This is actually an inflammatory reaction that is a healing response. When we
give anti-inflammatories, we actually interfere with the healing process. Inflammation is the process through which the healing begins. So when we take PRP and inject it into an injury site, the inflammatory response starts the healing.” – Dr. Joseph Albano
Advantages of Biologics
Advantages of Biologics
i. All Natural
Because these biologics are coming from your own body and are injected back into you, the procedure is termed autologous – what comes out of you, goes back into you.
ii. Safe
Numerous studies shown that complications are minimal. These are safe enough to do in an outpatient setting. PRP involves simply drawing blood and spinning it down. The fat autograft and bone marrow aspirate are more involved, but are still done in the office on the same day.
iii. Shorter Recovery
Recovery time is shorter than with surgery. Typically, there is increased pain for a few days, which diminishes over 10-14 days. Most conditions have a better recovery if motion is started early. So, with many conditions, motion is started the following day.
iv. No Scarring
There is no scar formed with these biologics. New healthy tissue is formed.
v. Cost Effective
Compared to surgery, it is much less expensive.
vi. Surgery Is Still An Option
If the injury is not fully healed with the use of biologics, surgery is still a viable option. In addition, tendon surgeries may have a better result because the tendon was strengthened with the biologics. If surgery is done, the use of biologics is still an option after surgery, but may be less successful.
vii. Short Procedure Time
The procedure is completed all in the same day in the office, usually within 1-2 hours. There is no wait for cultured growth of cells.
viii. Progenitor Cells
Fat Grafts and Bone Marrow contain mesenchymal progenitor cells, which can turn into the type of cell needed for healing. Platelets release growth factors which call these progenitor cells to the area.
ix. It works!
There are many laboratory and animal studies showing that these biologics work. Human trials have just begun to come out. Over the years, we have had the pleasure of helping many people decrease or resolve their pain, increase function and, most importantly, get them back to the activities that they enjoy!
https://www.youtube.com/watch?v=cI6hSxD5fWE
https://www.youtube.com/watch?v=adWZx-49SIY
https://www.youtube.com/watch?v=OUAMlR3_vOs
Disadvantages of Biologics
Insurance companies typically deny coverage for regenerative medicine procedures.
Injuries that Biologics can help with
i. Tendon Injuries- include tendinosis, partial thickness tears, and full thickness tears that are not significantly retracted.
ii. Muscle Injuries – Chronic muscle fibrosis (scarring) and acute muscular tears or strains.
iii. Ligament Injuries – Include chronic and acute sprains.
iv. Cartilage Conditions
v. Nerve Injuries – Include mild to moderate compression neuropathies.
Diagnostic Ultrasound
Most people are familiar with the use of ultrasound in the obstetrics field to image babies in pregnant women. It can also be used to image superficial musculoskeletal structures. With the advent of improved portable ultrasound machines, this technology has become available for use outside of the hospital setting and in the sports medicine office.
Common uses of Diagnostic Ultrasound
i. Musculoskeletal Ultrasound may be used to help diagnose problems with:
1. Soft Tissue
Tendinopathy/partial tears
Tennis elbow, Achilles tendinosis, plantar fasciosis, patellar tendinosis, rotator cuff tendinosis and partial to full thickness tears
2. Muscle Ligaments
Chronic strains/sprain, muscle fibrosis (scar)
Acute strain/sprain
Cysts (such as a Baker’s Cyst behind the knee), bleeding or other fluid collections within the muscles, bursae or joints
Compression neuropathies, such as carpal tunnel syndrome (wrist) and cubital tunnel syndrome (elbow)
5. Tendons
Tendinosis, as in tennis elbow, patellar tendiand tears, such as in the rotator cuff in the shoulder or Achilles tendon in the ankle
6. Cysts, bleeding or other fluid collections within the muscles, bursae and joints
7. Early changes of rheumatoid arthritis
Benefits of Diagnostic Ultrasound
It is noninvasive and painless
There is no use of ionizing radiation, which is used in X-rays and CT scans, and is potentially harmful if done repeatedly
It is dynamic with images captured in real-time showing the motion of tendons, muscles and joints
It is much less expensive than other imaging methods, such as MRI or CT
It shows soft tissues very well, whereas X-rays do not
vi. It is the choice imaging modality for patients with cardiac pacemakers, who cannot get an MRI
It is an excellent alternative to MRI for claustrophobic patients
Ultrasound may have advantages over MRI in seeing tendon structure, which is better appreciated by ultrasound than MRI
Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as aspiration (withdrawing fluid) and injection
Risk of Diagnostic Ultrasound
There are no known harmful effects on humans
Limitations of Diagnostic Ultrasound
It is unable to see deep tissue structures very well, especially in obese individuals (MRI would be a better choice)
It is unable to “see through” bone. (MRI would be better to image structures deep to bone)
It is very operator-dependent, which means it requires much skill and practice to become good at the evaluations and interpretations
PRP stands for Platelet Rich Plasma.
“Let’s say you cut your arm. Platelets are released, white blood cells are released, red blood cells are released, because the vein has been opened up. Platelets help stop the bleeding. For a long time that’s all we thought they did. Now we know that platelets release many growth factors that call other cells to the site to help the healing.
Some of these types of cells are progenitor cells. Those cells help create whatever is needed, whether it’s veins, arteries, bone, skin muscle, tendon, cartilage etc. It’s all pre-programmed to do that. This is actually an inflammatory reaction that is a healing response. When we give anti-inflammatories, we actually interfere with the healing process. Inflammation is the process through which the healing begins. So when we take PRP and inject it into an injury site, the inflammatory response starts the healing.” – Dr. Joseph Albano
Steroid Injections
Short-term relief is possible through steroid injections. However, additional articular cartilage damage will occur with each injection.
Viscosupplement Injection
Viscosupplement Injections, also referred to as “Rooster Comb” shots, are another option for osteoarthritis treatment. Supartz, Orthovisc, Hyalgan, Euflexxa and Synvisc are examples of these medications. These hyaluronic acids are a viscous substance that mimics the normal synovial, or joint fluid. They feel like motor oil.
Pros
Most patients will experience short-term relief for up to 6-12 months, with more prolonged relief compared to steroids
No articular cartilage damage occurs
The knee joint is generally covered by insurance
If this treatment is unsuccessful, other options are still available
Cons
Articular cartilage regeneration is not possible
Insurance generally does not cover joints other than the knee
A series of up to 3-5 injections is required
If osteoarthritis causes you pain or keeps you from fully enjoying daily activities you normally love, call Comprehensive Orthopedics and Sports Medicine right away for an appointment and consultation with Dr. Albano. Dr. Albano’s wide range and length of experience can get you back to doing what you love, sooner.
Biologic Injections
Platelet Rich Plasma (PRP) Pros
Articular cartilage may regenerate
Platelet Rich Plasma is completely natural
Shorter recovery time than surgery
Typically combined with fat and/or bone marrow to further enhance the regenerative effects
If unsuccessful, other options are still available
Cons
Typically not covered by insurance
Usually requires a series of three injections
Structural Autologous Fat Graft
This procedure is done using your own fat. The fat is mixed with PRP and/or Bone Marrow and acts as a matrix (scaffold or “spackling”) to which other injected cells attach. A multitude of progenitor cells are in the fat. These cells have a tremendous potential to regenerate the body’s articular cartilage.
Pros
Long-term relief may be possible
Articular cartilage may regenerate
Autologous fat is completely natural
Shorter recovery time than surgery
Many progenitor cells are in the fat. These cells have a tremendous regenerative potential and may be able to regenerate the articular cartilage
If unsuccessful, other options are still available
Cons
Typically not covered by insurance
Usually requires a series of three injections
If osteoarthritis causes you pain or keeps you from fully enjoying daily activities you normally love, call Salt Comprehensive Orthopedics and Sports Medicine right away for an appointment and consultation with Dr. Albano. Dr. Albano’s wide range and length of experience can get you back to doing what you love, sooner.
Autologous Bone Marrow Concentrate
This procedure uses your own bone marrow and has similar pros and cons as to that of the Structural Autologous Fat Graft, although it is more invasive. Your bone marrow and/or PRP may be combined with fat to further enhance the regenerative effects.
Surgery
Surgical options may include joint resurfacing, total or partial joint replacement. When undergoing surgery, pain is often relieved. However, recovery time is prolonged, usually lasting a few months. In addition, younger patients may need further replacements as the prosthetics wear out. If, for whatever reason, the surgery is unsuccessful, other options are no longer possible.
Foot and Ankle
Hip
Knee and Shoulder
Wrist
Platelet Rich Plasma (PRP)
What is PRP? Platelet Rich Plasma is a form of regenerative medicine which uses blood with high levels of platelets that contain growth factors. It is used to heal injuries by regenerating tissues such as bone, ligament, muscle, tendon, cartilage, or other elements. PRP is sometimes implemented as an alternative to knee replacement or an alternative to hip replacement. Platelet Rich Plasma is rapidly becoming a more popular cutting edge therapy.