Overview of Types of Orthobiologics
Orthobiologics refers to substances that are found in humans that have the potential to positively stimulate the healing process of musculoskeletal or “ortho” tissue, such as bone, tendons, muscles, and possibly cartilage. Other than using bone graft materials for fracture healing or to augment a bone fusion, the most used orthobiologics substance is platelet rich plasma, which is harvested from the patient’s own blood. Another orthobiologic is pluripotential cells taken from the patient’s bone marrow or fat and is often referred to as stem cell treatment. These substances can be taken from sources other than the patient, such as amniotic fluid, although their safety and effectiveness is controversial.
Platelet Rich Plasma (PRP)
Using a patient’s own growth factor proteins, such as the one’s found in platelet rich plasma, has been shown in selective studies to improve treatment over other substances or medications. Most promising is the use of PRP for tendon problems, ligament injuries, and to treat the symptoms of joint cartilage loss or arthritis. Although there have been numerous studies that support the use of PRP for selective indications, insurance companies have remained firm on their stance that the evidence is not strong enough for the treatments to be consider routine and covered by medical insurance plans. Dr. Romeo believes that in the right patient and for the right indication, PRP can help heal the damaged area, relieve symptoms, and may delay or eliminate the need for surgery. Therefore, PRP is offered as part of the evidence-based options for treatment, however, the patient is responsible for the cost of the treatment.
An area of intense debate is the use of PRP to treat acute injuries of the tendons, ligaments, and muscles. High performance athletes in the NFL, NBA, MLB, NHL, and MSL have all been documented as proponents of receiving PRP injections for a variety of conditions early in the treatment program to accelerate healing in an effort to avoid more severe injury or surgery. Such treatments have been shown to be successful in limited studies with hamstring injuries and rotator cuff strains, ligament injuries of the knee, ankle, or elbow (baseball), and sprains of some joints. This investigational treatment is available and recommended to high level athletes, competitive recreational athletes, some work-related athletic injuries, and for those patients who want innovative treatments that have not yet been scientifically proven.
Pluripotential Cells (Stem Cells)
Cells that can differentiate into various types of cells are often referred to as stem cells. However, most of these so-called stem cells that are typically harvested from the bone, or sometimes the fat, and are destined to become a connective tissue cell. They are therefore best referred to as pluripotential cells. These pluripotential cells harvested from the bone marrow, the fat, or the bursa, hold the promise of not only providing growth factor proteins, but also a more sophisticated and potentially sustained improvement to the healing response due to the continuous cellular activity that supports additional cell migration, formation of extracellular matrix, and increased vascularity. Many studies in cell cultures outside the human body have suggested tremendous promise with these pluripotential cells, as well as some human studies. However, in general, the human studies have not been overwhelmingly positive to the point that insurance companies and government health insurance is willing to pay for this treatment.
NOTE: Since the harvesting of the cells is more involved than drawing your blood, some physicians in Dr. Romeo’s practice have become experts at providing this nonsurgical treatment. Dr. Romeo will refer you on one of his non-surgeon partners who will give more details and let you decide if stem cell/pluripotential cell treatment the right answer for your problem.
There is another area of Orthobiologics that is showing promise, and that is the use of scaffolds or grafts to help support and even augment repairs of torn tissues or loss of cartilage. Dr. Romeo does use scaffolds in surgery to help with tendon healing when the overall environment is compromised and healing is more difficult, which includes repeat or revision surgery. This is particularly valuable in rotator cuff surgery where the chance of healing of the tendon to bone in revision surgery can be below 50% in some patients who need the surgery for pain relief and the potential of improved function. Also, with cartilage defects, scaffolds may play an important role.
The Goal of Orthobiologics
Finally, a comment about the concept of regenerative medicine. There are some tissues that can regenerate and function as the normal tissue did before injury or disease, including blood and bone. However, tendons, cartilage, and ligaments are not truly regenerated with orthobiologic treatments. The primary value of orthobiologic treatments for these tissues is relief of symptoms by reducing or eliminating inflammation, which can be over a long period of time if the treatment also results in the development of healing tissue or scar tissue that does not allow for the inflammation to return. Claims that cartilage can be regrown to cover arthritic joints, or tendons can consistently heal with the same attachment to bone that was present before the injury are not supported by well-performed scientific studies at this time. We are getting better, and maybe the future of truly regenerating normal tissue in appearance and function will be an option soon.
Want to learn more? In this video, Dr. Romeo discusses the use of Platelet Rich Plasma and Stems Cells for Rotator Cuff Tears:
For more information about orthobiologics related to the treatment of Shoulder, Elbow, or Sports Medicine conditions, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call our office today to schedule your visit. Please remember that most of these treatments are not covered by your insurance and that payment will be the responsibility of the patient.
Dr. Romeo is on the cutting edge of determining where Orthobiologics can help shoulder, elbow and sports medicine problems heal faster and better. Here are some recent articles he’s written on the topic:
- Does the Use of Platelet-Rich Plasma at the Time of Surgery Improve Clinical Outcomes in Arthroscopic Rotator Cuff Repair When Compared With Control Cohorts? A Systematic Review of Meta-analyses
- The positive effects of different platelet-rich plasma methods on human muscle, bone, and tendon cells
- Bone marrow stimulation decreases retear rates after primary arthroscopic rotator cuff repair: a systematic review and meta-analysis
Anthony Romeo, MD
Dr. Anthony Romeo is one of the nation’s leading orthopaedic surgeons specializing in the management and surgical treatment of shoulder and elbow conditions. His state-of-the-art practice employs minimally-invasive arthroscopic techniques to accelerate the recovery process for a range of challenging conditions.