Lehigh Med Summer 2019 - 23

L C M E D S O C .O R G


rthobiologics, regenerative
medicine, and cartilage restoration have become very exciting
topics in sports medicine and
orthopedics. The technology in these fields
is constantly evolving and often leads to
confusion, skepticism, and unfortunately
false claims. As patients are beginning to
inquire more and more into these treatments,
the importance of physician education and
staying current with evidence-based medicine
is beneficial.

The term orthobiologics refers to treatments
that use our body's own cells to help revitalize,
heal, and/or regenerate tissue. More specifically,
the term refers to platelet rich plasma (PRP)
and stem cells. Both treatments can be used
in a non-operative setting or to augment the
results of surgery.
PRP is obtained by a venipuncture blood
draw and centrifuging the blood to a platelet
concentration above baseline. BMAC, or bone
marrow aspirate concentration, is a procedure
in which stem cells are removed from the
patient's bone marrow. The posterior iliac
crest is the area most commonly used due
to its large reservoir of mesenchymal stem
cells. In general, PRP is used to treat acute
or chronic ligament injuries, tendinopathies
and early arthritis (pathologies with a blood
supply to promote healing). Stem cells, on the
other hand, are used more often for chronic,
diffuse cartilage wear where a robust blood
supply does not exist. For both treatments, 2 years. A level 1 randomized control trial has
it is important to optimize a patient's met- shown PRP to be superior to trephination and/
abolic status for the purpose of healing so or cortisone injections for lateral epicondylitis
checking glucose and thyroid function labs of the elbow. Animal models have shown
are imperative.
the ability for stem cells to regrow cartilage
in the proper conditions. Further research
PRP and stem cells are considered ex- is needed to determine efficacy and the best
perimental in nature by the FDA as more treatment protocols.
randomized controlled trials are needed.
Standardization among clinical trials has
The most ubiquitous injectable treatment
proven to be difficult as many growth factors, are steroid injections (i.e., triamcinolone,
cell concentration, scaffolds, and intrinsic/ cortisone, dexamethasone), which can be
exogenous substances exist. Early literature used to help with both acute and chronic
demonstrates successful application. For pain. However, they do not help with healing
example, a systematic review of intra-articular and function only as an anti-inflammatory.
mesenchymal cells on knee osteoarthritis With repeat use, steroid injections have been
published in Arthroscopy in 20191 showed shown to cause deterioration and fibrosis of
improvement in pain and function at about soft tissue and chondrocyte damage in joints.

Regenerative medicine differs in that it provides pain relief by attempting to heal tissue,
rather than mask the inflammatory cascade.
The surgical counterpart to orthobiologics
is termed cartilage restoration. Surgical solutions exist for focal cartilage defects. For the
complete absence of cartilage associated with
high pain levels and loss of motion, there is no
surgery other than a total joint replacement
which will help the patient.
However, in the presence of a focal cartilage
defect, several options exist. Focal cartilage
defects can exist due to trauma, a sporting
injury, or degeneration. For small cartilage
Continued on page 24
SUMMER 2019 | Lehigh County Health & Medicine 23


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