Biologic treatments for cartilage and sports injuries

Biologic treatments for cartilage and sports injuries

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Description: The Arthritis Epidemic! OA: Not just simple “bone on bone”, Many (1.5 million) with TKR in 50s & 60s, prone to revision and complications, Limited options. Subchondral Bone & Marrow Edema: Why Is Knee OA Painful? “A Disease of Bone”- “The presence or absence of joint space narrowing..was not significantly associated with knee pain”! A Systematic Review Found that Pain Is: Strongly related to large Bone Marrow edema/lesions (seen on fluid-sensitive, fat-suppressed sequences), Moderately related to synovitis & effusion, Weakly related to cartilage volume / thickness.

 
Author: Steven Sampson DO (Senior) | Visits: 532 | Page Views: 915
Domain:  Medicine Category: Therapy 
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Contents:
Biologic Treatments for
Cartilage and Sports Injuries
Steven Sampson DO
Founder, The Orthohealing Center & The Orthobiologic Institute (TOBI)
Assistant Clinical Professor of Medicine, David Geffen School of Medicine, UCLA
Assistant Clinical Professor, Western University of Health Sciences
Adjunct Assistant Professor, Touro University of CA and NY

Collaborating with doctors
and industry to advance the field
We are all pioneers!!! My story…
Understanding Osteoarthritis
Case studies & Promising new technologies

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June 2007: USA Soccer
PRP for MCL Injury
Aug 2007: I tore my own MCL!

Published MSK PRP Review, knee OA pilot study, clinical
trials, textbook chapters etc, lectured around the globe

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Founded
Annual regen med symposium

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The Orthohealing Center,
(PM&R Practice) Los Angeles, CA
Acute Injuries: Los Angeles Clippers and
USA Track and Field athletes
Chronic Injuries:
Offseason athletes, large spectrum
Weekend Warriors

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LA... an Active Community!

― Patients more adventurous than ever!
― Increased risk of OA post meniscus or ACL injury.*
Svoboda, S. J., Harvey, T. M., Owens, B. D., Brechue, W. F., Tarwater, P. M., & Cameron, K. L. (2013). Changes in serum biomarkers of cartilage turnover after anterior cruciate ligament injury. The
American Journal of Sports Medicine, 41(9), 2108–16. doi:10.1177/0363546513494180
*Frizziero A GE, Ferraro C, et. al. Platelet rich plasma intra-articular injections: a new therapeutic strategy for the treatment of knee osteoarthritis in sport rehabilitation. A systemic review. Sport
Sciences for Health. July 2012 2012;8(1):pp 15-22
Filardo et al. Anterior cruciate ligament injury: post-traumatic bone marrow oedema correlates with long-term prognosis. Int Orthop. 2015 Jan 2

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Arthritis: A Silent Enemy
1 out of 4 military Veterans live with OA vs 1/5
in civilian population
Why? Basic training carrying 60-100 lb packs,
ACL & Meniscus injuries and blast trauma

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The Arthritis Epidemic!

― OA: Not just simple “bone on bone”
― Many (1.5 million) with TKR in 50s & 60s,
prone to revision and complications.
― Limited options
Source: Meeting current musculoskeletal health demand through deeper insights into
tissue homeostasis and regeneration. Isabel Andia & Nicola Maffulli. Expert Opin. Biol.
Ther. [Early Online].

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We are cellular beings!
Current estimation of total cells in an
adult human body = 37.2 trillion!
Bianconi et al. An estimation of the number of cells in the human body.
Annals of Human Biology, November-December 2013, Vol. 40, No. 6 : Pages 463-471.

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What If?
Introducing specific cells can alter
communication or “cross talk” between
tissues, to turn on our ability to self repair?
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OA Pathophysiology: What's happening?
Repetitive microtrauma without enough time to heal

Exhausted or Failed healing response = Failed cellular process
Immune response →→ altered synovial fluid homeostasis (GF’s) pro-inflammatory and
catabolic → vicious cycle: chondrocyte death, osteophytes, meniscus changes,
subchondral edema
Andia, Maffulli. Meeting Current Musculoskeletal Health Demand Through Deeper Insights Into Tissue
Homeostasis and Regeneration. Expert Opin Biol. Ther. (2015) 15(6).
Kumar V, Abbas A, Fausto N. Tissue renewal and repair: regeneration, healing, and fibrosis. In: Robbins
and Cotran Pathologic Basis of Disease (7th Edition). Elsvier Saunders, PA, USA, 87–118 (2005).
Witte MG, Barbul A. The process of wound repair. Surg. Clin. North Am. 77, 509–528 (1997)

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Autologous Biologics:
A paradigm shift in modern medicine

Lanny L. Johnson M.D. (MI, USA): Arthroscopy 1970’s
Lucio Buratto M.D. (Italy): Lasik 1989
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3 Domains of joint pain
Intra-articular
Subchondral bone
Extra-articular (soft tissues, tendon, ligament & nerves)

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Subchondral Bone & Marrow Edema:
Why Is Knee OA Painful? “A Disease of Bone”
“The presence or absence of joint space narrowing . . .
was not significantly associated with knee pain”!
OA & Cartilage, 1996

A Systematic Review Found that Pain Is:
― Strongly related to large Bone Marrow
edema/lesions (seen on fluid-sensitive, fatsuppressed sequences)
― Moderately related to synovitis & effusion
― Weakly related to cartilage volume / thickness
Hunter et al., OA & Cartilage 2011

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Subchondral Bone Images
with permission fromDr Henning Madry, Homburg Germany

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Subchondral Bone
Linear micro cracks in trabecular
rods cause pain “microfracture”
Diab and Vashishth, 2005 Bone

Consistent with the Histology of
Fracture Non-Union Taljanovic, 2008
Image courtesy of M Sanchez & S Padilla et al.

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Current Biologic Therapies
Hyaluronic Acid (HA)
Platelet Rich Plasma (PRP)
Bone Marrow Concentrate (BMC)
Adipose Derived Cells
Amniotic Fluid
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Cell Stacking Following Centrifugation

Illustration courtesy of Theodore Sand, Ph.D.

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Case Reports

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Case Study

Elite soccer player from Brazil.
Fibular head pain. Played on injury for 4 wks then diagnosed on MR with fracture.
Rested 4 wks & returned to season & developed distal biceps femoris tendinosis.
After 4 in-season cortisone injections had tearing/partial rupture with non-union fx.
Plan: BMC

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STAR: Surgical Treatment and Regeneration,
Beverly Hills CA
Interventional Orthopedics: where less can be more..

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Summary

OA Epidemic

PRP & BMC may modify
cellular environment to
neutralize OA. More
collaboration & studies
needed!
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More major institutions
& industry are getting
behind biologics

Come to TOBI (The
Orthobiologic Institute)
meeting.

7th ANNUAL
PRP & Regenerative Medicine
Symposium with Cadaver Labs
Breakout Workshops: PRP and MSK Ultrasound Basics, BMC & Adipose basics,
Perph Nerve Hydrodissection
June 10-12, 2016
Wynn, Las Vegas

www.prpseminar.com
PROMO CODE:
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WSCS500