Posts for: September, 2018
Regenerative Medicine V:
Umbilical cord tissue is a soft substance (Warton’s Jelly) within the umbilical cord that provides cushioning and support to the umbilical vein and arteries. As a father of five children I’ve had the opportunity to cut this tissue and get a close up to it’s uniqueness. The cushioning and structural support elements from the soft substance consists of structural proteins, cytokines, chemokines and growth factors.
Hyaluronic acid is the most plentiful component of the glycosaminoglycans found in the umbilical cord matrix.
Hyaluronic acid is a key factor in the viscoelastic properties in the synovial fluid of joints.
Injections into joints can help with a decrease in pain and increase function.
Regenerative Medicine Part IV:
Amniotic tissue is a unique allograft (a tissue from a donor). This graft is taken from placental tissue and amniotic fluid. Amniotic fluid contains growth factors, carbohydrates, proteins, amino acids and essential molecules. The allograft is the preserved cytokines, growth factors and proteins. Amniotic membranes contain a high concentration of cellular scaffolding, cytokines, growth factors and proteins. The fluid is regularly used for injecting painful arthritic joints, degenerative tendons or ligaments and into chronic wounds. The membrane is commonly used for wound care, tendon repairs and large cartilage repairs. Amniotic tissue has played a significant role in allowing the physician and surgeon to optimize healing, decrease inflammation and increase function.
Regenerative Medicine Part III:
Stem cell therapy has many different classifications. Physicians have two different choices with accessing these cells. They can take it from the patient through a bone marrow aspirate or they can get it from companies that use post birth placental tissue and umbilical cord tissue to harvest the cells. In this section we will discuss Bone Marrow Aspirate as a way to harvest mesenchymal stem cells. Mesenchymal stem cells are undifferentiated cells that can turn into a variety of cells including; bone cells, cartilage cells, muscle cells and fat cells. The ability of differentiation decreases with the patients age. In the foot and ankle, a bone marrow aspirate can be taken from the heel bone and this concentrated fluid is then re-injected into the patient.
This has been shown in studies to decrease pain and increase functionality.
Regenerative Medicine Part II:
Platelet-Rich Plasma is one regenerative medicine option that many physicians have used for years. The process is simple and done in the office. Patients have their own blood drawn at the physicians office. It is than placed in a centrifuge, and spun down to separate the platelet poor plasma, Buffy Coat (PRP) and red blood cells. The Buffy coat has the greatest number of platelets and growth factors. This is injected in the joint or soft tissue. PRP has been used to decrease inflammation and pain in joints, muscles, tendons and ligaments. It is often used to optimize healing after surgical procedures, or combined with other biologics to enhance bone healing.
PRP suppresses the inflammatory environment through a locally applied concentrate of platelets, leukocytes, and growth factors. PRP therapy aims to control inflammatory factors in a degenerative environment through the secretion of anti-inflammatory factors and signaling effects.
Studies have shown that PRP can be effective with pain reduction and increased healing.
Regenerative Medicine Part I :
Osteoarthritis (wear and tear arthritis) is something we see on a daily basis. Physicians have multiple choices on how to educate and treat their patients. Some conservative treatment methods are rest, ice, compression, elevation and non-steroidal anti-inflammatories. Steroid injections are a minimally invasive way to decrease the inflammatory response and reduce swelling. I usually give a steroid injection in the joint every six months if needed. I don’t like to inject the same joint earlier than this. JAMA published a study last year about the frequency of injections done in a knee joint. Patients were given a steroid injection every 3 months for two years. An MRI was done prior to the study and one after two years. This was compared to saline injections in patients over two years as well. The patients receiving the steroid injection quarterly, had their cartilage decrease 2 times as quickly as those with saline injections. Steroid injections can be very helpful for immediate pain relief and to specify the location of pathology. The frequency of the injection is what patients need to be educated on. Too frequent of steroid injections according to this study can have a negative effect on the cartilage in the joint. Regenerative medicine like platelet rich plasma, umbilical cord blood, umbilical cord matrix, bone marrow aspirate and adipose extraction are all options to decrease inflammatory factors in the joint and optimize healing without causing an increase in harm to the cartilage. These can be done frequently if needed and have had long term benefits as well. We will learn about different regenerative medicine options in following posts.