REGENERATIVE MEDICINE
ORTHOBIOLOGICS
“Regenerative Medicine” refers to procedures that use the body’s own innate mechanisms to heal a certain condition of the musculoskeletal system. This can include prolotherapy, autologous blood injections, platelet rich plasma, “stem cell” injections, shockwave, photo-biomodulation, PEMF etc.
Each of these regenerative interventions and treatments work similarly but also very differently! Choosing a treatment FIRST depends in a CORRECT diagnosis. Other factors then include co-morbid diagnosis, post-treatment recovery timeline, goals of the patient, and finances.
Dr. Black places heavy emphasis on ethically determined treatment options. This is to avoid false claims, unmet expectations, and physical and financial harm. Many regenerative treatments are not FDA approved for most conditions. HOWEVER, Dr. Black only uses FDA cleared devices and evidence based procedures and techniques.
WORD OF CAUTION:
The term “Regenerative” medicine is often used to market and often leads to false expectations. The therapies of Regenerative Medicine help aid in the bodies own ability to regenerate the healing process which may lead to regeneration of tissue BUT it also may not.
At this time, modern medicine does not have the capability to regenerate full thickness cartilage injuries using the bodies own innate healing mechanisms. Also, there are many factors that contribute to tissue healing and ultimately, the tissue being treated will not be “as good as new”….THOUGH, it may function as if there wasn’t an injury!.
WHAT IS REGENERATIVE MEDICINE?
Orthobiologic injections are substances that are derived from tissue in the body or other biologic sources and then used to aid in healing of orthopedic injuries. These injections fall under the umbrella of regenerative treatments.
ORTHOBIOLOGIC SOURCES
Allogenic: donated tissue (placenta, wharton’s jelly, blood, bone, grafts, etc)
Autologous: from the patient’s own body
Bio-fermented: grown in a lab from bacteria
Animal: Tissue obtained from animal source and then purified in the lab
WHAT ARE ORTHOBIOLOGIC
INJECTIONS?
Prolotherapy is a technique that also varies from provider to provider but the main principal is an injection that is used to recruit the bodies’ healing and growth factors in the blood to an area of injury or degeneration. It is not well understood on the exact mechanism of how it works and many different types of injectate have been used under the banner of “prolotherapy”. Prolotherapy is a technique with very little high quality research thus is considered experimental. That being said, prolotherapy, in varying techniques, has been used for >20 years as a treatment option in soft tissue and joint pain relief similar to PRP. The most commonly used injectate is dextrose (typically D25-D50),
PROLOTHERAPY
PRP generally falls under the term “regenerative medicine”. This is somewhat of a misnomer as PRP itself is not regenerating anything but instead is helping the body “jump-start” it’s own healing and anti-inflammatory processes.
In very basic terms, PRP contains concentrated healing and growth factors from the blood that help recruit stem cells and stimulate healing, decrease inflammatory processes and thus improve pain and function.
At Equity Orthopedics we use high quality “PRP kits” that require blood draws of 60-120mL. This blood is then concentrated to it’s different parts using specialized equipment to ultimately obtain 5-8mL of PRP.
We can differentiate leukocyte-rich PRP (LrPRP) for soft tissue injuries and leukocyte-poor PRP (LpPRP) for joints. LrPRP contains some white blood cells to help create an inflammatory reaction to help the body recruit more healing factors to aid in the healing process. You want LpPRP for a joint because you don’t want to create an inflammatory process in a joint because of pain and this may lead to more degeneration.
PRP is an adjunct to a rehabilitation and exercise program and not an “easy button” to pain relief. That being said, we are seeing some fantastic responses for many conditions in decreasing pain and increasing ROM for both acute and chronic injuries and degenerative processes. The research is fascinating and ongoing but not definitive yet and thus most provider’s that provide this treatment have different protocols on preparation, procedure and rehabilitation.
PRP: Platelet Rich Plasma
AUTOLOGOUS BLOOD
This is similar to leukocyte rich PRP in its use and function; as it is the unconcentrated blood. Much less research done but less cost for at least a first time injection. This type of injection should only be used for soft tissue such as muscle or tendon.
Known commonly by many names, “gel shots, chicken shots, rooster shots, visco shot”, viscosupplementation injections are external supplements to a substance made by cartilage cells called hyaluronic acid (HA).
The purpose of HA is to lubricate a joint, naturally decreasing inflammation. As we age our cartilage cells make less HA and as the joint degenerates we have fewer cartilage cells and this leads to less naturally occurring HA. VS injections are also “thick and sticky” and some people feel as though it offers a cushioning effect filling in the “crooks and crannies” of injured cartilage. The purpose of VS injections is to decrease pain and swelling related to arthritis.