At Vail-Summit Orthopaedics, injectable treatments provide expanded care
November 29, 2018
Biologics include Platelet-Rich-Plasma and Mesenchymal stem cells
By Dr. William Sterett
Brought to you by Vail-Summit Orthopaedics
In Sports Medicine, the term "biologics" is commonly referred to when we discuss injectable options for orthopaedic injuries and arthritis. Specifically, we are talking about Platelet-Rich-Plasma (PRP) and Mesenchymal Stem Cells (MSCs).
Sports-related injuries, often consisting of ligament and tendon injuries, are more frequently being treated with biologics as an adjunct to physical therapy, activity modification and surgery. This includes common injuries such as injuries to the Achilles tendon, meniscus tears, ACL tears, rotator cuff tears, etc.
Of the four injectable options at Vail-Summit Orthopaedic's disposal, each has its own risks and chance of success.
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- Steroid Injections & Cortisone
With modern and safer corticosteroids, there is very little risk of further destruction to the joint from the steroid itself. This is very different than the old "cortisone" which was a powerful anti-inflammatory but had some destructive properties to normal tissue as well. We used to hear "no more than 3 injections in a lifetime" because of this risk.
Now we try not to administer more than 3 injections per year. The rationale behind limiting these injections is not because they cause harm, but if 3 injections aren't helping, it may be time to search for other modalities- from arthroscopy to therapy to bigger surgeries such as joint replacement.
You may have heard the brand names: Synvisc, Ortho-visc, Hyalgan, Monovisc, and others. This is essentially injecting pure Hyaluronic Acid (HA) into our knee joints. HA is the normal substance inside of our joints that gives us that gooey, lubricating feel to the synovial fluid.
With Arthritis, HA exists in much lower concentrations in the joint. The goal here is to upregulate the joint lining tissue to start producing more HA. This has been shown to work best with mild to moderate arthritis and only sometimes with more severe wear.
- When Visco-supplementation helps, it seems to help decrease pain for about 6 months.
- We currently stock Synvisc-one at our clinic, however we need to plan ahead for this injection by obtaining authorization from your insurance. If your insurance covers a different brand, we will try to obtain this for you.
Platelets are instrumental in healing processes because they release a number of growth factors and additional bioactive proteins upon activation. PRP is a growth factor therapy in which platelets are concentrated from serum. The procedure consists of blood being drawn from a vein in the arm and then centrifuged to concentrate the platelets and growth factors before being re-injected into the target, or injured area.
PRP is more effective in mild to moderate arthritis and knees that have normal alignment and a healthy meniscus when compared to knees with severe arthritis. Most studies have shown pain relief in about 75 percent of patients, depending upon a multitude of factors.
When effective, PRP can help decrease pain in the arthritic knee for about 1 year.
Stem cells are unspecialized cells that have the ability to differentiate into multiple different cell types or to replicate themselves. Also known as Mesenchymal Stem Cells (MSCs), these can be harvested from abdominal fat or bone marrow.
Minimal manipulation of the MSCs occurs, and is only centrifuged in an attempt to concentrate the most prolific growth factors within the Bone Marrow. Because of this, the injection is often referred to as BMCC or Bone Marrow Cell Concentrate.
When the injection of MSCs are effective at decreasing the pain for arthritis, they tend to improve through the first year and last for about 2 years. If you experience improvements, we may recommend a repeat injection in 6 weeks.
MSCs do not have the ability to reverse the arthritis we see on X-ray as a stand-alone procedure. Think of these as a way to decrease the pain from arthritis for up to 2 years. This procedure requires planning and pre-procedure medication for pain.
Editor's note: Dr. Bill Sterett has had the honor of being the Head Team Physician for the U.S. Women’s Ski Team since 1997. Every winter weekend, Dr. Sterett is poised to react to any situation, from emergency midnight calls to emergency surgeries.