One of our best options to fight the opioid epidemic (in orthopedics) is with orthobiologics. At the Dallas PRP and Stem Cell Institute we use platelet rich plasma and bone marrow derived stem cells for patients with chronic, painful orthopedic conditions like osteoarthritis.
On October 15, 2018 Gina Kolata of the NY Times published an article detailed Harvard University’s retraction of dozens of articles by cardiologist Dr. Piero Anversara. Dr. Anversa has published about 31 studies detailing how mesenchymal stem cells from bone marrow could be injected to regenerative cardiac (heart) muscle tissue. If true, the scientific find would have been revolutionary as a potential new treatment for patients who suffer heart attacks or other cardiac diseases.
On September 28, 2018, the Liveyon company started a product recall of their umbilical cord blood products produced by Genetech in San Diego because of contamination with E. coli. There is no reason to use a riskier allograft orthobiologic when there are more studied, cheaper, safer alternatives that come from our own bodies!
We had a good example yesterday of how important it is to quantify the orthobiologic and also how much variance there can be in the same patient on the same day. Our first draw resulted in 12.43X LP-PRP with a nice shift away from granulocytes(decreased). The patient decided they wanted to treat an additional region so we drew more blood. About a 30 minute time interval max. Exact same tech, same doc, same centrifuge, same hematology machine, etc…. and this time the PRP was 7.29X LP-PRP with a shift away from granulocytes again.
fell off my bike
fell out of a tree
Arthritis in your hand or thumb or wrist? Don’t forget about platelet rich plasma! There are many treatment modalities….medications, bracing, therapy, steroid shots……but only PRP is truly based on using your body’s own healing and anti-inflammatory systems. Here is a 1 minute video showing a recent in office injection….he had an injection 1 year ago and got 80% pain reduction and back to all his activities! (after steroid shots were not working). Results vary of course BUT with PRP the biggest risk is that it doesn’t work….no GI problems, no surgery, no uncomfortable braces, no steroid risk.
Bone marrow derived stem cells for cartilage repair worked in horses 8 years ago…isn’t time we started treating people with state of the art equine care?? In a 2010 article published in the Journal of Bone And Joint Surgery, the authors compared micro fracture of a 15mm chondral lesion in the trochlea with micro fracture plus bone marrow aspirate concentrate injection. Outcomes at 8 months showed that all scoring systems AND histology AND MRI analysis all showed that both the amount of cartilage AND the type 2 collagen content was significantly better in the BMAC treated group.
I like to try to have a thoughtful personalized approach to treating meniscal pathology rather than a less sophisticated approach of “treat them all the same”. After 25 years of surgical experience to use to help interpret often contradictory published papers, I think the best approach is to separate out the acute from the degenerative tears, stable from the unstable tears, and finally to appreciate the vascular anatomy of the tear location. The picture presented is of a patient who had an acute onset of knee pain over the medial joint line and who failed to get better with a month of directed physical therapy.
What about exosomes as an “off the shelf” orthobiologic therapy?
Today I received 4 email inquiries about exosomes.
How much human outcomes data there is on the efficacy of exosomes in orthopedics? …not much at all. Exosomes are produced locally in response to the specific environment…ie. if a joint is inflammed, the exosomes being produced may have an anti-inflammatory nature overall.
We just completed another successful training course…our 25th in 9 years…and now have trained well over 1000 clinicians on MSK ultrasound. Our next Course in January 24-26, 2019 at the Cosmopolitan Hotel in Las Vegas. www.orthosono.com