Regenerative Therapies for Joints, Tendons and Ligaments
Approximately 27 million adults in the U.S. suffer with osteoarthritis (OA), and about one-half of all adults will get symptomatic knee osteoarthritis in their lifetime. OA often causes weakness and disability, interferes with work productivity, and may lead to the need for joint replacement. Contributing factors to the increase of OA in adults is the aging baby boomer population, increased longevity of Americans citizens, and the obesity epidemic. This rising prevalence of OA is expected to contribute even more heavily to the severe health and economic effects of aging already present in our society.
OA is a progressive joint disorder caused by painful inflammation of soft tissue, which leads to thinning of cartilage and joint damage, most commonly in the hands, knees, hips, and spine. It is the most common form of arthritis, affecting over 20 million Americans. While there is no known cure for osteoarthritis, there is help for the relief of pain associated with this common condition. OA affects major joints in the body:
Tendonitis is an inflammation or irritation of a tendon, a thick cord that attaches bone to muscle. It is most often caused by repetitive impact or sudden injury to the affected area. Common household activities may contribute to the development of tendonitis—cleaning, gardening, shoveling, raking, painting—as well as participation in such sports as tennis, golf, skiing, and baseball. Other risk factors for tendonitis include poor posturing, insufficient conditioning before exercise, abnormal bone or joint placement, unusual medication reactions, and even infections.Acute or chronic tendonitis conditions include:
Because all of the areas listed above lack an abundant amount of blood flow to facilitate healing, injuries to these areas can take months or even years to fully heal, and re-injury is very common.
SIR is a leader in administering revolutionary regenerative therapies to treat these conditions, several of which are referred to as stem cell therapies because they use human cells for repair, regeneration or replacement of cells needed by the body. SIR also delivers traditional therapies for these conditions when appropriate.
After thorough evaluation of the patient’s condition and degree of progression of the condition, Dr. Grubbs will consult with the patient regarding the best options for treatment, which include autologous and amniotic stem cell therapies, platelet rich plasma, A2M protein, Synvisc, and anesthetic/steroid injections.
Autologous Stem Cell Therapy
Today, a number of chronic health conditions are benefitting from stem cell therapy, a new medical treatment that offers very promising results. Stem cell therapy is currently being used for joint, tendon, and ligament regeneration, specifically to address the common conditions of osteoarthritis and tendonitis.
Autologous refers to the use of the patient’s own stem cells, rather than stem cells donated from another human being. When the stem cells are deployed back into the body, they can change into the type of tissue that is needed for healing. Stem cells can be incorporated into blood vessels, nerves, collagen, fat, muscle, cartilage, and even bone. The natural healing functions within the body accelerate to produce a regenerative effect. This unique and effective form of regenerative medicine is being used by medical practitioners across the country. This therapy does not use the controversial embryonic stem cells, but rather cells that naturally occur in low concentrations in the human body and aid in tissue healing and regeneration every day.
There are many potential benefits from autologous stem cell therapy, and the “closed-system” method used at SIR to harvest the patient’s own stem cells minimizes the risks of side effects, such as infection rejection.
Amniotic Stem Cell Therapy
Amniotic stem cell therapy, also called amniotic tissue allograft, refers to the use of amniotic tissue that comes from the placenta of living, healthy donors who are prescreened during pregnancy, selected according to stringent donor suitability criteria, and have a full-term pregnancy and scheduled Caesarean section. The tissue is not the patient’s own but is an allograft, meaning that the cells are transplanted from a human donor to another human.
Why placental tissue? For over a century, placental tissue has been used as a biologic dressing in a broad range of therapeutic applications, and it has been generally recognized as a versatile wound covering. Placental tissue is an abundant source of collagen, other proteins, growth factors, and cells that support the body’s natural regenerative healing process. Structural proteins and other characteristics of placental tissue used for human body regeneration have been shown to:
support the repair and reconstruction of soft tissue
reduce inflammation and pain
promote cellular proliferation and new collagen formation
minimize scar tissue formation
resist adverse immune response in the human body
SIR is on the cutting edge to use amniotic tissue allograft for the treatment of osteoarthritis, tendonitis, and soft tissue injuries. The donated cells are administered by injection at the site of the injury, after which the patient may feel some discomfort for several days. Because time is needed for the regeneration of new cells, improvement will be gradual and recovery time will depend on the patient’s specific condition.
Platelet Rich Plasma
“Starfish” shape of activated blood platelet
Platelet Rich Plasma (PRP) is platelet-enriched blood plasma used in tissue regeneration therapies. Blood from the patient’s own body (autologous) is used to harvest the cytokine-rich platelets that are the building blocks of growth and regeneration. Using a special centrifuge technique to harvest the platelets and form the concentrate, they then undergo a process of activation and are injected into the site of the injury, thereby stimulating the healing of bone and soft tissue.
With a proprietary technique used at SIR, activated PRP comes from the stimulation of harvested platelets, which immediately releases the 20+ cytokines from the cell membranes that then attract all of the body’s cells to the treatment site to expedite healing. Activation results in immediate degranulation of the cells to release the growth and healing factors, thus improving treatment efficiency.
At SIR, this new minimally invasive biotechnological procedure to use PRP is performed with imaging guidance for the treatment of tendonitis and osteoarthritis of major joints. It turbocharges the body’s natural healing processes and enlists the body’s own biochemistry for rapid repair of the damage, usually taking only weeks instead of months or even up to a year.
In some cases, PRP may be combined with adult stem cells, from either bone marrow (BMACs) or fat tissue (ADSCs), to create additional healing properties. The effects of stem cells taken from adipose and bone marrow are comparable, but method of harvesting the cells may be a determining factor in deciding which source to pursue.
PRP with Bone Marrow Aspirate Concentrate (BMACs)
Bone marrow contains abundant cells that may be used as the source of stem cells to aid the body in recovery, but the process of extracting stem cells from bone marrow requires general anesthesia due to pain associated with this procedure. Also, because the quantity of stem cells is drastically reduced as a person ages, the yield of stem cells in older patients may be low.
PRP with Adipose Derived Stem Cells (ADSCs)
Adipose refers to fat tissue in the body, which is extracted from the patient with a mini-liposuction method, broken down to remove the stem cells and separate them from the fat cells, then activated and injected back into the body or applied topically. At SIR, we have found that it is better to use ADSCs because they are more accessible, and it is a safer procedure that requires only liposuction with local anesthesia. Our top-of-the-line technology carefully handles the fat that is extracted to protect the patient and avoid infection. We use “closed system” technology, which means that the extracted tissue does not come in contact with the outside environment. Also, this system allows us to gain access to high numbers of stem cells that are viable to use, thus increasing the potential success of the treatment.
A revolutionary new biologic treatment for OA is a protein that is present in the liver and is carried to other organs in the body thru the bloodstream. This protein, ALPHA-2-MACROGLOBULIN (A2M), is one of the largest and heaviest proteins made in the human body and has the capability to break down the body’s unneeded chemicals and molecules. Scientists at Cytonics Corporation discovered that A2M can capture and neutralize the chemicals created in an arthritic joint that cause destruction of the joint cartilage, thus halting the progressive damage that occurs in the osteoarthritic joint.
The process of harvesting A2M developed by Cytonics is the only system currently available that concentrates A2M to a level nine to ten times the concentration normally found in the blood stream and minimizes the collection of other proteins, platelets, and white blood cells. Other systems currently on the market leave in a high concentration of platelets and white blood cells in their preparations, with the white cells being very inflammatory in nature and destructive to the joint cartilage. The concentrated A2M is delivered directly to the knee or other affected joint via injection to slow or halt the progression of joint deterioration.
The Cytonics system marks the beginning of the era of targeted osteoarthritis therapy. In the first rollout to the public, Cytonics is allowing access to its proprietary process to selected physicians, and Dr. Grubbs at SIR is one of these selected physicians. At SIR, we have named this procedure the PLATELET + PLASMA + “PLUS” or the “3P” injection for osteoarthritis of the knee to signify that it is in the FDA-designated category of Platelet Rich Plasma but is truly more of a specialized protein “PLUS” injection. Again, this is truly unique among the others in this classification.
For more information about A2M, click here.
Synvisc for Knee Osteoarthritis
Advanced knee osteoarthritis
Knee osteoarthritis is a common joint disorder that occurs when the cartilage in the knee deteriorates and the joint (synovial) fluid breaks down. When the natural cushioning wears away, the bones in the knee begin to rub against each other and result in pain, inflammation, and stiffness. Knee osteoarthritis may be hereditary or it may be caused as a result of an injury, infection, or even obesity.
At SIR, a minimally invasive technique called the Synvisc injection is used to treat knee osteoarthritis. (Synvisc has not been tested to show pain relief in joints other than the knee.) During Synvisc, a gel-like fluid is injected into the knee. This gel is made of a natural substance in the body called hyaluronan and acts as a lubricant in the joint. Synvisc is an outpatient procedure performed under CT guidance and takes about 30 minutes.
Inflammation is one of the body’s first reactions to injury and serves several important purposes, the first of which is to set off a series of bodily reactions to trap and remove bacteria, foreign particles, and tissue debris from the injured area. The pain and tenderness that accompany inflammation are strong reminders to the patient to protect the injured area, but the inflammation must be stopped to avoid counterproductive body effects, such as retarding blood flow to the injured area and delaying healing.
Injections of anesthetics and corticosteroids are used for fast-acting, short-term relief for inflamed joints, ligaments, and tendons. Corticosteroids (cortisone) are strong anti-inflammatory substances that offer significant relief with minimal discomfort to the patient. They are commonly administered into tissue around a ligament (especially the elbow, knee and ankle), tissue around a tendon (especially elbow, shoulder, and wrist) and directly into joints of the ankle, elbow, hip, knee, shoulder, spine, wrist, and even the small joints of the hands and feet.
SIR’s patient will receive consultation regarding the estimated term of relief with these injections, the role of these injections in a comprehensive treatment plan, and possible side effects and potential risks.