Regenerative Medicine
In the vast majority of cases , orthobiologics are combined with other treatments to improve overall outcomes
Orthobiologics can play a role in treating rotator cuff tear in the shoulder
“ Those are two examples where the orthobiologic treatments that we have available to us right now are actually curative ,” said Dr Shapiro .
But since these are relatively new therapies , more studies are still needed to confirm the promising results in the long term .
Orthobiologics are complements , not magic bullets In the vast majority of cases , orthobiologics are combined with other treatments to improve overall outcomes .
“ In most of the things we treat , orthobiologics are not curative nor regenerative , but they are used to relieve pain and maybe alter the natural course of orthopaedic disease ,” explained Dr Shapiro .
Osteoarthritis of the knee , an age-related problem that causes pain due to the wear and tear of the cartilage tissue , is a good case in point . Half of the patients who present with the condition usually end up having a knee replacement , a major surgery to cut away damaged bone and cartilage to replace them with metal and plastic implants .
PRP in particular has pushed the envelope in treating knee osteoarthritis , one of the most studied conditions when it comes to orthobiologics , perhaps because it affects about 30 million Americans and 240 million people worldwide .
“ Our patients are getting one to two years of pain relief from their knee arthritis , and that ’ s a lot more than we usually see from a cortisone or hyaluronic acid injections , which are the standard of care ,” he stressed .
Though the therapy triggers no tissue regeneration and has to be repeated regularly , it can dramatically help patients by sparing them knee replacement , but only if it ’ s complemented by physical therapy , knee bracing , or over-the-counter pain relievers like Tylenol . In other cases , it can put off surgery until patients are old enough to benefit from it .
“ For a lot of people in their 50s , PRP can provide a number of years of solid treatment to delay a costly and invasive surgery until their late 60s or early 70s ,” he said . This is the age group that usually undergoes knee replacement since the implant has a variable shelf life and needs to be replaced after wearing out .
Although in lab experiments stem cells have shown an even stronger therapeutic potential than PRP in relieving pain , there ’ s not as much evidence of their effect in patients to support their use against knee osteoarthritis with a similar degree of confidence .
“ If you ’ re making a recommendation to the patient , you would always say , ‘ we have 10 years of experience studying PRP and we know that works and what it does ,’ therefore it ’ s a good recommendation to tell patients to try that . When it comes to stem cell treatments , it ’ s harder to make that recommendation because they ’ ve not been studied as much ,” he acknowledged .
Another condition where orthobiologics can play a role is the rotator cuff tear , a common injury to the muscles and tendons of the shoulder joint that in about 25 percent of cases requires surgery .
Some studies have shown that adding PRP or stem cells to the site of the injury during surgery speeds up healing of the tendons and lowers the rate of retear in the future . Patients usually face three to four months of recovery and won ’ t be able to play sports for at least eight months , but orthobiologics can reduce healing time in the order of a month or so as well as the risk of retear by 15 to 20 percent .
“ Even a month faster is real value to people ,” stressed Dr Shapiro , who nonetheless cautioned that PRP didn ’ t prove to be an effective standalone approach for the condition . “ PRP is not commonly used for a torn rotator cuff without surgery because it ’ s not an adequate treatment — another example showing that orthobiologics are not a magic cure but are used to complement standard treatments .”
But in addition to tennis elbow , there is another condition where PRP can also help avoid surgery altogether , for example , when a patient has a ligament injury to the connective tissue that connects bones to each other . Lots of baseball pitchers , for instance , get their elbow ligament injured and may require a surgical fix taking almost a year to recover . But PRP , when followed by physical therapy , can promote repairing of a partial ligament tear that has previously failed to heal and get patients back to doing sports in a matter of weeks or months .
“ That ’ s an example of orthobiologics that has revolutionised sports medicine ,” said Dr Shapiro , noting that the approach has not yielded the same results in treating all ligament injuries . Ankle sprains , for example , are a common problem that ’ s not responded well to PRP .
50 OCTOBER 2021 GlobalHealthAsiaPacific . com