Regenerative medicine with orthobiologics can give patients with diseases such as osteoarthritis significant results and help them get back to their favorite activities. (Getty Images)
Over the past decade, interventions with orthobiological agents such as platelet rich plasma (PRP) have brought relief and new hope for tissue and joint damage. Many patients with conditions such as osteoarthritis, degenerative disc disease, and tendonitis find significant, long-term improvement from orthobiologics – the use of natural substances such as platelets and stem cells to aid healing from musculoskeletal injuries.
Dr. Matthew Gnirke, physiotherapist at Vail-Summit Orthopedics & Neurosurgery, specializes in orthobiology. He uses PRP and Bone Marrow Aspirate Concentrate (BMAC) to get people back to the sports and activities they love.
What is it?
PRP and BMAC both use platelets from the patient’s own body.
PRP interventions involve a simple blood draw – about 60 ml, which is anticoagulated (to prevent blood clotting) and centrifuged to separate different cell types. Doctors then collect the platelets, which are the least dense cells, and inject them into a joint or other damaged area.
BMAC interventions also use platelets, along with a small amount of stem cells; These mesenchymal stem cells have the ability to differentiate (or transform into cells) that produce cartilage, tendons, ligaments, and muscles. They are obtained from the bone marrow through a needle. The procedure can be performed in the office or, if a patient prefers sedation, in a surgical setting.
“BMAC is not a surgical procedure, but it can cause pain,” he said. “The response is very different. Many patients describe it as a deep Charlie horse in the buttocks. Some feel it less, some more, but the vast majority of patients tolerate it in practice and sedation is not necessary. ”
BMAC is often used for advanced osteoarthritis and disc disease, while PRP is used for early-stage osteoarthritis, joint problems, and tendon diseases such as tendinosis (the latter due to degeneration of tendon collagen due to chronic overuse, such as “).
Platelets act like microscopic, natural “surgeons,” said Gnirke. They attach themselves to damaged collagen fibers, which are the basic building blocks of tendons, ligaments, and muscles. A platelet contains over 1,200 growth factors, he said. PRP treatment typically releases at least 1 million platelets into an injured area, releasing growth factors that are involved in collagen repair and synthesis.
“These are really wound-healing cells,” says Gnirke.
What can it help?
Orthobiologics are called regenerative medicine because they actually aid healing, not just mask symptoms like steroid syringes do. They are used to treat damaged tendons, ligaments, muscles, joints, and intervertebral discs.
Gnirke has seen how patients with early-stage osteoarthritis of the knee and other joints, as well as diseases such as tennis elbow, have significantly improved. These conditions result from the slow degradation over time as collagen fibers lose strength and density and tend to develop microcracks.
“The sooner you know it, the more likely you’ll see long-term improvement in trajectory,” he said.
He recommends that people come for an exam as soon as symptoms regularly affect them or affect function. Even if you can still ski, bike, hike and do what you love, when you change movements or become aware of ailments, it often indicates a mild to moderate illness, he said. Grinning and bearing pain or stiffness can lead to further breakdown of tissues and joints, which can lead to more severe osteoarthritis (like bone-on-bone knee damage) or severe disc degeneration and associated pain.
Gnirke finds orthobiologics “quite effective for back pain associated with degenerative disc disease,” he said. “Studies show a long-term improvement in back pain in two out of three patients.”
In the past, physical therapy and / or anti-inflammatory drugs, then surgery, were used to treat degenerative disc disease – there weren’t many options in between. Orthobiologics fill this gap.
Originally used in sports medicine for competitive athletes, PRP and BMAC are now available to the general public. Although most insurance companies still view them as experimental treatments, Workers Compensation Insurance and Kaiser Permanente are paving the way for other companies to adopt the procedures. Nobody knows when (or if) this will happen, but it is probably years away. Until then, patients can pay out of pocket (usually under $ 1,000 for PRP).
Studies show that 65 to 75% of patients respond positively to PRP and BMAC.
“Over 2/3 of the patients see a significant, long-term improvement for more than one to two years,” said Gnirke.
Dr. Matthew Gnirke (Photo courtesy Vail Summit Orthopedics & Neurosurgery)
This is how the process works
Once the platelets (and, in the case of BMAC, stem cells) have been collected, Gnirke will deliver injections into the injury site, using ultrasound or X-rays to ensure the exact injection site.
Patients often feel temporarily worse before they feel better: the pain relapses range from mild to severe and can last from a day to two weeks. The longer, heavier reactions usually happen with spinal injections, he said. Within a month, patients usually feel like they are at baseline: no better, no worse.
It usually takes about six to eight weeks for you to feel better; It can take four to six months, with a spinal injection, up to a year for the improvements to take full effect. Of course, regenerative medicine is just one of the procedures Gnirke uses. His practice focuses on the proper diagnosis, prevention, treatment and rehabilitation of musculoskeletal injuries and diseases. He avoids over-treatment and does not believe in preventive orthobiologics where they are not needed. His main interest: getting people back to doing what they love.
from American Chiropractors Directory and News – Feed https://www.americanchiropractors.org/back-pain/regenerative-medicine-gives-new-hope-and-healing/