Over the last 15 years, there has been increased interest in “orthobiologics.” In a nutshell, most commonly, this is the use of our own platelets or stem cells in an attempt to cure – or at least provide temporary relief from – various orthopaedic ailments.
The most common of orthobiologic treatments is Platelet Rich Plasma (PRP). Platelets migrate to a wound to stop the bleeding but platelets have growth factors as well. These growth factors are released in the region of the wound, encouraging healing. The theory behind PRP is that by harvesting pure platelets from the blood, and by injecting the pure platelets into the affected region, this can help encourage healing of the injured tissue.
The literature showing PRP’s efficacy is scant. As a result of this, insurance companies generally will not cover a PRP injection and it is a cash service. Despite the lack of a plethora of medical literature showing its efficacy, PRP has become extremely popular among patients and physicians alike. Since platelets are your own blood product, there is a very low risk for complication (other than post-injection pain and tenderness).
A major difference between cortisone and PRP is that cortisone is an anti-inflammatory while platelets are an inflammatory (inflammation at a wound is part of the healing process). After a cortisone injection, patients can have relief within days. With PRP, patients often find the affected region is more painful than it was prior to the injection, for days or even weeks. This is because the platelets are causing inflammation in the region, in contrast to the anti-inflammatory effect of cortisone.
Patients may not see improvement from a PRP injection for six to eight weeks, if they see an improvement at all. It is important to note that there is no data in the literature that shows that PRP will cure arthritis, meniscus tears or rotator cuff tears, to name a few. It is not a panacea. It is not unreasonable to try it for various orthopaedic ailments but a patient should go into the procedure with tempered expectations.
Stems cells are another orthobiologic treatments that has garnered a lot of press over the last decade. Stem cells are different from PRP. Stem cells are undifferentiated cells (present in all age groups) that can differentiate into various tissues (bone and cartilage, for instance). The theory behind stem cells is that by injecting undifferentiated stem cells into an injured body part, say, an arthritic knee, it will create new cartilage for the degenerated knee. Or it will heal a torn ACL in the knee. Unfortunately, similar to PRP, the data supporting the efficacy of stem cells is scant. It will not cure degenerated cartilage, nor will it heal a torn ACL or rotator cuff. Similar to PRP, there is no harm in trying stem cells.
Stem cell therapy is typically more expensive than PRP. A series of PRP injections can cost several thousands of dollars. A series of stem cell injections can cost far more than that. Stem cells can be harvested from a patient’s bone (usually the pelvis) or from fat (from the abdomen). Once the stem cells are harvested, they are then prepared and injected into the affected body part.
Although neither PRP nor stem cells are a “cure-all” for orthopaedic ailments, with further research and further advances in orthobiologic technology, perhaps there will come a day when scientists figure out a way to cure arthritis and other common orthopaedic injuries with an injection. We are not there yet, but orthopaedic basic science has come a long way in the last decade and only time will tell how much progress will be made in the realm of orthobiologics over the coming decades.