Advances in Non-surgical Regenerative Techniques

Ashwin Badu, MD, is a sports medicine physician at Massachusetts General Hospital, a team physician for the New England Revolution and USA Paralympic Soccer and associate program director of the Spaulding/Harvard Physical Medicine and Rehabilitation Residency Training Program. He conducts research to evaluate various new non-surgical, regenerative medicine treatments and finding out why patients respond, or don't respond, to these new therapies. Here, he explains the use of these new techniques, including platelet-rich plasma, bone marrow aspirate and lipogems, to treat various orthopedic injuries.

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Transcript

One of the exciting new things that's coming down the pipeline, in terms of non-operative sports medicine, is the development and refinement of this regenerated medicine treatments. Specifically, figuring out exactly which patients benefit most from a PRP/lipogems-type injection, and which patients don't necessarily do quite as well.

One of the most common regenerative medicine treatments that we do nowadays, particularly for some of our athletes with tendinopathic problems, would be PRP, or platelet-rich plasma. This basically involves drawing the blood from the patient, spinning it down to the platelet-rich fraction. The platelets effectively are the healing cells of the body. They undergo a process called degranulation where they release a large number of growth factors in a very predictable curve. We use that growth factor surge to best heal patients with problems that don't necessarily heal well themselves--specifically, tendinopathy in areas that don't have great blood flow. An example of this would be in the patella tendon, for instance, the gluteal tendons or in the lateral epicondyle.

That's one of the more basic treatments that is done very commonly. This seems to have a great effect in cases where physical therapy and other common treatments don't work quite as well.

The other time when we typically use PRP is in cases where we're a little nervous to use steroid medicines. And as many folks are aware, a steroid, while very effective in the short term, doesn't quite have great long-term outcomes and in fact can be degenerative and can actually accelerate degenerative changes in joints and in tendons. So, as a result, we use PRP in those instances to try to give some benefit without some of the degenerative effects of the steroid medicine.

One of the other things we do is something called bone marrow aspirate, and this is a related technique. It's something referred to as a stem cell-like treatment. We draw blood from the iliac crest, typically, get bone marrow aspirate, and we'll use it for its healing properties. This technique is commonly done in orthopedics, mostly in the OR. We've adapted its use in the office setting.

The main focus here is to create a healing environment as best as we're able. The best treatments tend to be in more early-arthritic conditions. In folks who are a little bit older … sometimes the bone marrow aspirate and the actual stem cell or growth factor curves from these patients aren't quite as high as we get older. And so, we use some other treatments. Specifically, one of the newest ones being lipogems, which is a fat grafting technique. The rationale behind this is in the fat cells, the blood vessels which feed the fat cells have what are called parasites, which live on those blood vessels. They actually are very effective in modulating local environments with growth factor manipulation. And the thought is that we use these parasites and inject them into the areas of concern to try to kick-start a healing cascade.

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