There have been many evolutionary changes in modern orthopaedics, but not so many truly revolutionary breakthroughs. Among the latter is the emergence of orthobiological methods for treating injuries and chronic musculoskeletal conditions.
Orthobiology: what is it?
Surgical repair of damaged musculoskeletal structures has not been a major problem for a long time. However, the situation is very different when it comes to biological repair. Orthobiology, a branch of medicine based on the use of biological (natural) substances for the treatment of acute, traumatic and chronic diseases of muscles, tendons, ligaments and joints, is to solve this difficult problem.
In orthobiologic therapy, growth factors and inflammation-suppressing medicines are produced from the patient's own biological substances using special technologies, which are then used to treat the same patient. The procedure does not require hospital stay, therapies are administered on an outpatient basis. In certain cases, the technique is also applied directly during surgery.
Thanks to the targeted use of the body's own physiological capabilities, orthobiology has become a real step forward towards healing in the true sense of the word.
Autologous cell therapy
One of the most common types of orthobiologic therapy is the so-called autologous cell therapy. It uses preparations derived from the patient's own biological substances. By way of injections, they are delivered to the affected area, where they produce an anti-inflammatory and analgesic effect, supporting the healing process.
Mechanism of action
The autologous cell therapy method in orthopedics is based on natural physiological laws.
The body responds to any damage with a whole cascade of complex processes aimed at rapid healing and recovery. This is accompanied by the release of various growth factors. They stimulate cell regeneration, increase collagen production and improve blood supply to the tissue. At the same time, anti-inflammatory factors, the so-called “good” cytokines that reduce inflammation, are released. It is this potential for natural healing (treatment without drugs and surgery) that autologous cell therapy methods support and enhance.
How long has this been in use?
Application of the technique in orthopedic practice has an over 20- year history. Over the time, it has been evolving, gaining experience, and becoming more and more individualized. And it continues to develop further, having proven itself as an absolutely safe, reliable and maximally effective therapy method for various acute and chronic orthopedic conditions.
Benefits
The indisputable advantages of autologous cell therapy are, that it:
- by 100% utilizes substances taken from the patient's own body;
- is a 100% natural (biological) treatment method;
- is very well tolerated;
- has minimal side effects;
- accelerates healing;
- makes it possible to cancel or significantly reduce the dosage of medications thanks to its anti-inflammatory and analgesic effect;
- has a positive impact on the quality of daily life;
- has proven its efficacy in numerous studies.
The goal of treating joint diseases with this method is to preserve your joints for as long as possible and allow you to lead an active life, without pain, or to recover from an injury as quickly as possible and lead an active lifestyle.
How does it work?
Autologous cell therapy works due to the physiological laws of regeneration.
In natural conditions, three types of cells are involved in this mechanism:
- red blood cells responsible for the transport of oxygen and carbon dioxide.
- leukocytes regulating immune defense.
- platelets forming the basis for the initial wound healing phase and play a central role in the cascade of healing reactions.
Platelets release growth factors that support healing through a variety of mechanisms. They are proteins, just like the specific cytokines (interleukins) released by leukocytes, that enable communication between leukocytes and play an important role in immune defense. Leukocytes produce a variety of cytokines.
Autologous cell therapy involves isolating and concentrating key regenerative components from the patient's blood. Delivered to the site of injury or damage, they become active,
- triggering and supporting cell division;
- stimulating capillary growth and improving blood flow;
- accelerating epithelialization.
Thus, without the use of artificially manufactured drugs, it is possible to enhance regeneration, reduce inflammatory reactions and significantly relieve pains.
Types of autologous cell therapy
The expression “treatment with one's own blood”, which is sometimes used in relation to autologous cell therapy, is not quite correct, since only a blood component, i.e., plasma (or serum, which is plasma devoid of fibrinogen) is used for the manufacture of such preparations. Therefore, it is more correct to apply the abbreviations ACP, PRP, ACS.
| АСР Therapy | PRP Therapy | АСS Therapy | |
| Acronym meaning | Autologous conditioned plasma | Platlet rich plasma | Autologous conditioned serum |
| Method of preparation | Separation of the necessary blood component by centrifugation | ||
| Medicine | Plasma with a high content of | ||
| platelets and growth factors | platelets |
useful signaling proteins (“good” cytokines and growth factors) |
|
In all cases, the separation of blood components takes place under the influence of centrifugal forces in the centrifuge.
Autologous cell therapy also includes treatment with stem cell preparations. These can be derived from adipose tissue or bone marrow, and are so-called mesenchymal stem cells, which play an important role in the regeneration of damaged tissue.
In particular, AMFAT (autologous micro fragmented adipose tissue) technology involves the use of one's own fat, which is obtained in small quantities, for example, from the abdominal area. It is purified and finely ground using a special machine, to be further delivered to the desired area, such as the knee or thigh, using a thin syringe.
When injected in such a high concentration into a diseased joint, this drug acts like a biological reactor, reducing inflammation and stimulating regenerative processes. At the same time, the joint cartilage receives additional protection.
Each diagnosis is to have a customized therapy
Depending on the diagnosis, disease stage and other individual circumstances, the doctor decides what type of autologous substance will be used, in what form it will be administered, how long the course of therapy will last, etc.
Arthrosis
With all the various forms of osteoarthritis, the number one goal is to control inflammation as early as possible. ACS injections can be used for this purpose. The conditioned serum is injected into the diseased joint or, for example, into a compressed spinal root to produce its specific positive effect there. It consists in the fact that the body's own protective proteins act against inflammation and preserve the cartilage.
The main indications for anti-inflammatory injections are:
- Osteoarthritis, especially in the active phase, such as in knee joints.
- Spinal degenerative conditions (e.g. spondyloarthritis, osteochondrosis, spondylosis, degenerative spinal canal stenosis).
- Nerve compression syndrome (e.g., intervertebral disc protrusion, intervertebral disc prolapse, degenerative foraminal stenosis).
- Back pain.
The earlier treatment for osteoarthritis is started, the greater the effect and the better the prognosis.
Injuries and inflammation of tendons, ligaments and muscles
In injuries and inflammation of tendons, ligaments and muscles, orthobiologic therapy with PRP helps control inflammation and supports the healing process.
Based on the type of injury, and especially depending on whether the process is acute or chronic, and how long the patient's complaints have lasted, the composition of PRP can vary. In chronic inflammation it is advisable to use PRP enriched with leukocytes. In acute injuries, especially sports injuries, plasma with a reduced leukocyte content is used. In order to ensure that the necessary proteins and cells are actually transported to the defect site, the amount of the injected substance varies depending on the size of the defect. In case of trauma or damage to small joints or other structures where only a small amount of fluid can be injected, more concentrated plasma is used.
Bone Injuries
Bone healing is a special process, with a specific time distribution.
In bone injuries, platelet-rich plasma is also used to support the healing process and prevent complications. In addition to platelets, it also contain the proteins fibronectin, fibrin and vitronectin, which promote cell “gluing” and differentiation of special bone tissue cells, the so-called osteoblasts. This therapy accelerates the bone healing process, but does not lead to calcification.
Back pain
If the cause of the pain is identified, it is appropriate to use injections with anti-inflammatory and analgesic medications. ACS is used for this purpose. The goal is to reduce the intensity of the pain syndrome and suppress inflammation. This treatment is particularly suitable for patients who do not tolerate cortisone well, or want to avoid its side effects.
Post-surgery healing support
Those cytokines that stimulate inflammation play an important role in the body's response to surgical intervention or trauma. The cytokines interleukin-1 (IL-1), tumor necrosis factor-A (TNF-a), and interleukin-6 (IL-6) are mainly released locally after surgery. This is how the body tries to protect itself from injury. But the resulting inflammatory reaction does more harm than good. The cartilage tissue in the joint, which was already damaged, suffers even more. ACS therapy in combination with other postoperative treatment methods helps to suppress inflammation and reduce pain as quickly as possible.
How autologous cell therapy is performed
The treatment process involves several steps:
- First, a small amount of blood is drawn from a vein in the arm.
- The blood is centrifuged and automatically separated for the planned type of autologous therapy.
- The required amount of the preparation is injected into the joint or other affected structure.
- Ideally, the treatment is carried out 3 - 4 times with certain intervals.
The length of treatment and the regimen are determined by the doctor on an individual basis.
For successful healing, a healthy lifestyle with alternation of sufficient phases of movement and rest, with physiotherapy, proper nutrition, etc. should be observed along with injections of these drugs.
Modern perspectives of personalized therapies corresponding to the specific condition of the patient, as well as safe and highly effective treatment of a wide range of diseases of the musculoskeletal system can hardly be overestimated. Orthobiologic methods based on natural, physiologic processes are increasingly being used and will undoubtedly continue to develop.
How do I know if orthobiologic treatment is right for me?
Although autologous drugs are harmless, their use should be taken very seriously. Firstly, you need to be sure that they can really be an alternative to, for example, surgery, in a particular diagnosis and at a given stage of the disease. Otherwise, you may miss the time, and then instead of a relatively minor surgery, you will end up having to undergo more extensive procedures.
In addition, it is very important to choose the right type of therapy and its regimen. Therefore, orthobiological treatment should be prescribed by specialists who have sufficient experience in all existing types of treatment, with a particular focus on the use of natural substances. By the way, they are constantly improving, so the doctor should be aware of the latest orthobiology trends.
The portfolio of medconsonline.com includes recognized orthopedic experts who have first-hand knowledge of all autologous cellular techniques. By selecting the appropriate consultation on our orthopedics page, you will find out whether you can count on the success of the innovative non-surgical approach in your case, as well as receive recommendations on the most optimal drug, method and mode of therapy.
In this case, a remote appointment will also help you plan a follow-up visit to the clinic for your treatment.
References
- Scherer, Jürgen; Seitz, Rainer; Cichutek, Klaus. Autologe Zellpräparate: Wenn Ärzte „Arzneimittel“ im OP oder am Krankenbett herstellen. Dtsch Arztebl 2013; 110(18): A-872 / B-760 / C-756
- Calcei JG, Rodeo SA. Orthobiologics for Bone Healing. Clin Sports Med. 2019 Jan;38(1):79-95. doi: 10.1016/j.csm.2018.08.005. PMID: 30466724.
- Malhotra R, Kumar V, Garg B, Singh R, Jain V, Coshic P, Chatterjee K. Role of autologous platelet-rich plasma in treatment of long-bone nonunions: a prospective study. Musculoskelet Surg. 2015 Dec;99(3):243-8. doi: 10.1007/s12306-015-0378-8. Epub 2015 Jul 21. PMID: 26193983.
- Sherman BJ, Chahla J, Glowney J, Frank RM. The Role of Orthobiologics in the Management of Osteoarthritis and Focal Cartilage Defects. Orthopedics. 2019 Mar 1;42(2):66-73. doi: 10.3928/01477447-20190225-02. PMID: 30889253.
Comments — 0