Behind the hype surrounding regenerative medicine in orthopaedics
Its use is limited to certain conditions but its potential is huge
Regenerative medicine is said to be able to regenerate cartilage in the joints and disc tissue in the spine , reduce knee pain , and heal nonunion fractures and inflammation in the Achilles tendon at the back of the ankle
Look up “ regenerative medicine ” online and you ’ d be forgiven for thinking it ’ s a quick fix for almost any orthopaedic condition .
That ’ s because many in the medical profession are now touting the almost unlimited benefits of this new medicine . For example , it ’ s now common to see clinics splash on their websites the powerful effects that both stem cell and platelet-rich plasma ( PRP ) treatments — the two most common regenerative techniques in orthopaedics — can have on a host of problems ranging from Achilles tendinitis , arthritis of the joints , hip , knee , and shoulder pain to ligament sprains , degenerative disc disease , nonunion fractures , and nerve injuries .
Regenerative medicine is said to be able to regenerate cartilage in the joints and disc tissue in the spine , reduce knee pain , and heal nonunion fractures and inflammation in the Achilles tendon at the back of the ankle . In some instances , PRP is hailed as a potential alternative to surgery to treat rotator cuff tears and shoulder arthritis .
While some claims may be true , many are profoundly misleading because they tend to portray regenerative therapies as established approaches that can work effectively on their own to fix a host of orthopaedic problems . Others are outright false .
“ In general , there ’ s too much exuberance about what regenerative therapies can do right now ,” Dr Shane Shapiro , a medical orthopaedist and director of the Regenerative Medicine Therapeutics Program at the Mayo Clinic in Florida , told Global Health Asia- Pacific .
In his view , a minority of patients with orthopaedic conditions could definitely benefit from either PRP or stem cells therapies , but by and large these are still new treatments that can ’ t replace older ones . “ In general , thinking that regenerative medicine is a distinct alternative to conventional standard of care would be incorrect in the current time ,” he said .
The basic idea behind regenerative medicine is to use human cells and tissues to treat diseases , or “ turning the body into its natural drug store ,” in Dr Shapiro ’ s words . In orthopaedics , this translates into injecting platelets ( blood components involved in clotting ) and adult stem cells ( special human cells that can generate multiple types of cells ) into diseased joints and tissues to help them heal .
In fact , platelets are thought to contain growth factors , or substances needed for cells to grow , that might contribute to cellular regeneration , inflammation reduction , or overall health in the joints , the structures that connect different bones in the body . The problem is that these effects are not consistent across the board , meaning that just some orthopaedic issues can be treated with regenerative techniques , and in most instances are far from curative or even wellresearched .
“ The most important thing to recognise is that regenerative medicine is still a field of translational research . Even if we can use some of the treatments in clinical practice , most of it still needs more study , and that ’ s what we , who work in this field , are focused on ,” said Dr Shapiro .
He explained that the term itself can be confusing because not every regenerative treatment actually regenerates tissues . That ’ s why in the orthopaedic community many experts refer to these as ‘ orthobiologics ’ to highlight that they are simply biologic products useful in treating some orthopaedic problems . While experts can debate terminology , what most agree on is that it ’ s an addition to the orthopaedist ’ s toolbox but in no way a one-size-fixall therapy that can reverse tissue degeneration with quick injections .
When patients are injected with their own biologic products without any manipulation , regenerative medicine has shown to be safe , explained Dr Shapiro . But he also cautioned that patients have been harmed after receiving orthobiologics from unknown cell sources and banked cells .
Regenerative medicine at its best The good news is that short-term research suggests that a couple of orthopaedic conditions could be cured by regenerative treatments .
Lateral epicondylitis , commonly known as tennis elbow , is one example . Caused by overuse of the elbow muscles , the condition leads to pain and difficulty extending the arm but can be effectively treated with PRP , which in this specific case regenerates the inflamed tendon , thus improving its health and often sparing patients the discomfort of long-term medications or surgery .
Similarly , stem cells have managed to fix avascular necrosis of the hip , where the bone cells in the hip joint die due to a lack of blood supply often triggered by the use of steroid medications . In such cases , the diseased bone is cut out and the injected stem cells can repair and stabilise it , avoiding the need for a hip replacement .
48 OCTOBER 2021 GlobalHealthAsiaPacific . com