Stem cells are primarily growth-factor engines. They migrate to the site of an injury in the body and often instruct other cells to perform specific healing activities. (Courtesy photo)

Orthobiologics explode

The orthobiologics field, which merges biological therapies with traditional orthopaedic healing and surgical techniques, is exploding. Why? Because in many circumstances, tissues can be induced to heal — or even re-grow — if the right environment is provided. Here’s the latest ..

We have now entered the Anabolic Era of orthopaedics. In the past, surgeons would resect (cut out) torn tissues and tell patients to come back when they needed a joint replacement. Today, the preferred strategy for treating (or avoiding) arthritis is to repair, regenerate, and replace injured tissues as soon as possible.

Tissue engineering has been around for a long time. I was fortunate to invent the first commercially successful tissue regeneration device — called the collagen meniscus implant (CMI) — in the 1980s. This collagen scaffold was designed to induce meniscus tissue to re-grow into a trellis-like material. It has now been used thousands of times worldwide.

Many tissues, however, require more than just a scaffold to re-grow into; they benefit from a stimulus. Nature’s stimuli are called “growth factors” — like the testosterone hormone that children acquire in puberty to spur their growth. There are more than 1,000 different types of growth factors in human blood, and each plays a role in tissue healing. Along the walls of blood vessels live specialized cells called “stem cells.” These cells are primarily growth-factor engines. They migrate to the site of an injury in the body and release their growth factors, often instructing other cells to perform specific healing activities — such as laying down new collagen fibers or forming new cartilage matrices. As you age, the number and potency of these stem cells declines.

Fortunately, there are now numerous outside sources of growth factors and stem cells. Each has pros and cons in its use for stimulating tissue healing. An entire industry is growing around products to harvest and concentrate these factors for physicians’ use. There are avid proponents of each type, which come from a variety of sources. These include bone marrow (BMAC or bone marrow aspirate concentrate), fat (lipoaspirates), blood (PRP, or platelet-rich plasma) and the amnionic membrane and fluid from C-section births.

My personal bias is to use amnionic sources. Why? Because there are at least 45 times more stem cells in newborns than in adults. My older patients have very few stem cells in their bone marrow, and the amount of growth factors from their own blood varies widely. I get 2 to 50 times the concentration of growth factors from amniotic sources that I would from adult blood. Fat, while very vascular, requires a separate surgical procedure that most people would prefer to avoid.

I collaborate with an independent testing lab to test and confirm that each batch of the amniotic fluid I use has both live stem cells and active growth factors.

Each of these techniques of anabolic stimulation has reported successful outcomes across a wide variety of musculoskeletal disorders including tennis elbow, partial tears of rotator cuffs, partial ACL tears, tendonitis, degenerative disc disease, disc herniations, bone bruises and Achilles injuries. The clinical data is accumulating more rapidly than for any previous new therapy I have seen in the field of orthopaedics.

After surgery, I use stem cells and growth factors, with their potent anabolic properties, to accelerate healing and to drive the healing of tissue toward normal regeneration rather than the formation of scar tissue. But what stem cells don’t do is turn into new cartilage. This means that they don’t actually cure arthritis, though they do mitigate the symptoms— in some patients dramatically, and for periods up to a year. In arthritic joints, stem cells release potent anti-inflammatory agents which reduce pain and may stimulate the production of more lubricating factors. These benefits seem preferable to the use of cortisone, which shuts down healing and injures tissues.

Since all my patients want to heal faster and diminish their downtime, return to sports and daily activities immediately, and jump higher and fly faster, the pressure to find novel ways to harness nature and use her hidden resources to accelerate healing is huge.

We aren’t sure if we can accelerate it, but it sure is worth a try.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

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