Biologics Offer Possibility of Regeneration over Reconstruction in Orthopaedics
Ann B. DeBellis
Published: August 13, 2013
Lyle Cain, Jr., MD (left) and Jeffrey Dugas, MD (right) with James Andrews, MD, founder of Andrews Sports Medicine
Biologics have been used in orthopedic medicine over the past decade to treat a number of injuries using the body’s own tissues. In an effort to learn more about the body’s ability to heal itself, surgeons from Andrews Sports Medicine & Orthopaedic Center are researching this emerging field as a viable therapy for orthopaedic conditions, including regenerative medicine for injured cartilage, muscle or tendons.
“In its basic form, biologics are intended to use the body’s own tissues, in concentrated form, to accelerate the healing process,” says Jeff Dugas, MD. “The research we are doing is cutting edge and has the potential to change the way athletes heal. It could mean an injured athlete has the potential to return to the game faster.”
Lyle Cain, MD, also with Andrews Sports Medicine, says their patient population requires cutting edge therapies. “Athletes have the means to go the Europe or elsewhere to get treatment, so it forces us to be aware of these new techniques,” he says. “We are currently doing studies to determine proper dosing. We started with platelet rich plasma (PRP) a number of years ago and it has become well-known. It has been used to treat ligament injuries of the knee, tennis elbow and arthritis.”
PRP was the first real biologic used that has achieved widespread use in the U.S. “Little research has been completed on this treatment so we use it judiciously because we still don’t know the long-term effects,” Cain says.
Dugas points out that there are a number of biologics that can be used safely. One of these is the patient’s own bone marrow stem cells. “We do bone marrow aspiration through which we take a patient’s marrow from the hip. We are not using manufactured stem cell products or products that have been altered. This autologous treatment falls within approved guidelines of the Federal Drug Administration (FDA).”
These bone marrow cells can be isolated and used to repair rotator cuff injuries. “Rotator cuff surgeries generally have a high failure rate, and we have had success using stem cells in revision rotator cuff repairs. We have also seen good results using this treatment for tendonitis and knee injuries,” Cain says.
The bone marrow aspiration currently is not covered by insurance companies, but Dugas says it is a quick and easy procedure to perform. “We have been using it to treat patients for almost a year, and we will continue to gather information to help assess its effectiveness. While we don’t have a lot of information on it right now, we believe that from a medical standpoint it makes good sense,” he says. “I hope Alabama will be at the forefront of this therapy.”
Non-autologous stem cell treatments also are available, and Dugas says there are commercial products on the market. “The companies selling these products currently have no data that support claims that they enhance healing. Because they don’t have FDA approval, clinicians can’t use them,” he says. “At Andrews Sports Medicine, we are on the cutting edge of what is allowed. We are proceeding cautiously and using approved products, and we will continue to push the envelope safely and legally to apply these therapies.”
One reason the FDA has issues with non-analogous stems cells, Dugas says, is because a person’s body produces antibodies when one of these products is introduced into the body. “If a person receives allograft stem cells, it may prevent them from having a solid organ transplant in the future due to the production of antibodies,” Dugas says. “That could adversely affect the transplant. Long-term data will be needed to determine if these effects prove to be problematic in stem cell recipients.”
Cain clarifies that these treatments use only adult stem cells. “We do not embryonic stem cells, which are taken in vitro from a recently fertilized egg. The cells are extremely potent for creating different types of tissues, such as heart, lung, etc.,” he says. “There are a lot of political issues surrounding embryonic stem cell research, but if we, as scientists, isolate embryonic stem cells in ways that are palatable, we will have even more potential for treatment than we have with autologous stem cells.”
The future of these therapies holds many possibilities, but caution must be applied to new therapies. “In the past 30 years, orthopaedic surgery has been focused on reconstructive injuries. We remove and repair them with different tendons or artificial body parts,” Cain says. “With biologics, we all see a future where we can regenerate instead of reconstruct. There are exciting possibilities on the horizon, but we need to proceed with caution.”