Biologic approaches are increasingly recognized in Orthopedics to stimulate of the body’s ability to heal itself. Regenerative Orthopedics is focused on the biologic treatment of a wide variety of acute or chronic orthopedic conditions and can present an effective way to repair and preserve musculoskeletal tissue. Orthobiologic treatments can be used as sole therapy method or can supplement surgical procedures with the goal of facilitating the postoperative healing process and recovery. The most effective regenerative treatment option may vary depending on each patient’s individual condition and activity spectrum. To achieve the best possible outcomes, it is important that treatment should be determined by an experienced regenerative specialist that understands and frequently uses the entire spectrum of regenerative orthopedics including both surgical and non-surgical options.
Dr. Mithoefer has been at the forefront of Regenerative Orthopedics for more than 15 years and is an internationally recognized expert in the field of Regenerative Orthopedics. He has been a member of the general board of the International Cartilage Restoration and Joint Preservation Society (ICRS) as well as the scientific chair of the World Congress of the ICRS. He is an active member of the American Academy of Regenerative Medicine and has published many articles and book chapters in this specialized area of Orthopedics. Dr. Mithoefer regularly utilizes the broad spectrum of established and innovative biologic treatment options specifically designed to achieve the best result for each individual patient:
This approach uses intra-articular injections of Hyaluronic Acid (HA) into the affected joint. HA is an important natural component of articular cartilage and responsible for the resilience of this cushioning tissue. In addition, HA presents an important lubricating component of the joint fluid and facilitates smooth gliding of the joint surfaces. HA injections have been shown to decrease joint pain and stiffness. Typically, improvements may be observed up to 6 months, but efficacy of these injections can vary depending on the individual type of injection used as well as depending on the severity of the joint degeneration at the time of injection. HA injections can be done alone or can be combined with other biologic treatments such as platelet-rich-plasma (PRP).
Platelet-Rich Plasma (PRP) Injections
Platelet-rich plasma therapy uses injections of a high concentration of patient’s own platelets derived through a special centrifugation process of the patient’s own blood. PRP injections have been used to treat and accelerate healing of injured tendons, ligaments, muscles, and joints. The concentrated solution of activated platelets is the injected directly into the area of the patient’s injury, and can be performed under ultrasound guidance. Following the targeted injection, the local release of growth factors from the PRP results in a local stimulation of reparative cells and molecular pathways that can facilitate local tissue regeneration and recovery. High-level clinical evidence of PRP injections used for joint preservation of osteoarthritic knees increasingly demonstrates the efficacy of PRP for reducing pain and improving function inpatients with osteoarthritis. Besides its use for joint osteoarthritis, PRP has also been described for augmentation of other joint preservation procedures such as ligament repair, meniscus repair, and articular cartilage repair, as well as tendon disorders such as tennis elbow.
Stem Cells Treatment
When the articular cartilage starts to break down from injury or overuse, osteoarthritis gradually develops with joint pain, stiffness and limited mobility. Stem cell therapy presents a novel regenerative treatment option for osteoarthritis and can be applied to any joint. Stem cells help decrease joint inflammation, reduce joint damage from arthritis and can delay or prevent knee replacement. Stem cells work in the body is to maintain and heal tissues by replenishing damaged and dying cells. Stem cells can be extracted from bone marrow or fatty tissue through simple minimally invasive procedures. They are then be concentrated and injected into the affected joint with ultrasound guidance. Scientific evidence suggests that these injections can improve joint function by stem cells developing into articular cartilage cells, by reducing joint inflammation, and by releasing proteins that slow degeneration of cartilage and reduce pain. Besides its promising role in treatment of osteoarthritis, scientific evidence also supports a role of stem cells in augmenting surgical procedures for articular cartilage repair. While initial scientific results are promising for this new regenerative joint preservation technique, further high-quality research is currently being conducted to better define the efficacy of different techniques, optimal cell source and dosing of stem cell therapy. Besides use for joint preservation stem cells are currently also evaluated as adjunctive treatments for other musculoskeletal conditions such as tendon tears and ligament injuries.
Alpha-2-Macroglobulin (A2M) is a protein contained in blood that has been identified as a potent inhibitor of 3 different classes of proteins called proteases. Proteases are powerful chemicals highly concentrated in joints with osteoarthritis and promote progression of arthritis by degrading the joint cartilage. These proteases include cytokines, matrix metalloproteases, and ADAMTS. A2M is naturally present in blood and can be concentrated from blood in patients with osteoarthritis. The concentrate then injected into the affected joint. Clinical trials in collaboration with the National Institute of Health (NIH) have indicated that A2M injection can reduce protease activity with resultant reduction of joint pain and progression of osteoarthritis. Randomized-controlled clinical studies are currently ongoing to further define the clinical results after A2M therapy.
Regenerative Treatment for Osteonecrosis
Regenerative treatment of bone pathologies resulting from acute or chronic injury, such as bone marrow lesions associated with insufficiency fractures, osteoarthritis and avascular necrosis have gained significant clinical interest. Novel regenerative treatment options for these subchondral conditions combine surgical core decompression of the affected bone with application of the patient’s own Stem Cells and growth factor concentrates. This innovative procedure called “Intraosseous Bioplasty” presents a biologic treatment of bone marrow lesions that encourages physiologic bone remodeling and repair and associated joint preservation.
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