Orthobiologics and Regenerative Medicine
I recently viewed this course on Medbridge for my continuing education, Orthobiologics and Regenerative Medicine: Rehabilitation Implications. I found it to be beneficial and wanted to share. The instructor is John O’Halloran, PT, DPT, OCS, ATC (retired), CSCS (retired), cert MDT, Certified SCTM-1 Practitioner.
As he stated, 560 million people are affected by osteoarthritis (OA) and the number one leading cause of disability worldwide. He decided to do this course due to the rapid emergence of regenerative medicine to treat OA non-operatively and feels PTs today should be highly informed and provide patients with the best evidence available.
Here is what I took from the course:
Platelet-rich plasma (PRP) – blood is drawn, placed in a centrifuge, separate white and red blood cells, left with the platelets. Platelets are the number one factor for healing.
Stem cells – taking from bone marrow or adipose, huge chondral potential to regrow cartilage.
In this course, he presented a Systematic Review and Meta-analysis of PRP clinically compared to other therapies in the Treatment of Knee OA. Comparing PRP to viscosupplementation, cortisone injection, and placebo injection. At 6 months, PRP is as effective, in some studies, more effective for pain, function, and stiffness.
PRP is used to delay the process of the breakdown of the OA. There is a difference on how it is provided. Landmark-based provider vs. ultrasound guided.
Things for the patient to consider when finding their provider: Preparation of the platelets (how many cc’s injected) and how experienced is the provider (sports fellowship trained in ultrasound guided vs. regenerative medicine non-fellowship trained or ultrasound guided trained)
Stem cells from adipose tissue from 2022 study for treatment of knee OA. 2 year follow-up on pain and function at 6 months showed overall improvement, and at 24 months, pain and function plateaued. Mild OA patients did better than severe. Bone marrow – 19 studies, bone marrow group was more effective. Helps you go through the stages of healing to put a stop to the bouts of inflammation and buy some time.
Research so far has not shown that the treatment can rebuild damaged joints in patients with prolonged OA or advanced OA.
More effective: Stem cells or PRP: Bone Marrow Aspirate Concentrate is equivalent to PRP for the Treatment of Knee OA at 2 years: A Prospective Randomized Trial. Both are equally effective according to clinical trials up to 24 months. PRP costs much less.
Protocol for PRP/Stem Cells: comes down to stages of healing.
Week 1: lie low
Weeks 2-6: light stretching and low level exercises, ROM
After 6 weeks: start stressing the tissues
Supplements – Glucosamine and Chondroitin
Limited studies. Things to consider: purity of the product, it is not going to rebuild cartilage or prevent breakdown of articular cartilage, 30% placebo effect.
Viscosupplementation – indication to improve quality of synovial fluid. Systematic Review and Meta-Analysis in British Medical Journal stated that viscosupplementation in the majority is no better than placebo.
Role of Practitioners for treatment of OA: Individualized programs
- Avoid impact loading
- Kinetic chain evaluation
- Unloading braces
- Aquatics
- Avoiding processed foods
- Dropping weight
Lastly, Journal of Orthopedic and Sports Physical Therapy: revealed evidence that pre-hab before TKA, one will have better effects in a positive way after surgery.
Sarah Falvey, PT
