What You Probably Don’t Know About Orthobiologics

With Bryan M. Saltzman, MD

Orthobiologics -- which you may hear referred to as biologics, cell-based therapy, regenerative medicine or stem cell therapy -- are derived from substances that naturally exist in the body. They may include cells, tissues, growth factors or components of the blood.

Physicians who specialize in orthobiologics are trained to access these naturally-occurring substances in the human body and use them to treat a variety of orthopedic conditions in order to reduce pain and inflammation, stimulate healing or tissue regeneration, and ultimately improve musculoskeletal function.

Helping the Body Heal Faster

Cell-based therapies are composed of a variety of natural growth factors and cytokines which facilitate cell growth/differentiation and recruitment, modulate pain receptors and inflammatory mediators, and stimulate blood vessel growth, matrix synthesis, and tissue maturation/collagen synthesis. Basically, this means that when we talk about orthobiologics or cell therapy we are referring to transplantation of certain kinds of human cells to repair or heal damaged or inflamed tissue and/or cells.  

Depending on the type of orthobiologic treatment, there may be higher amounts of pro-inflammatory mediators or potent anti-inflammatory mediators. It’s important to understand that orthobiologic treatments don’t reverse arthritis or re-grow cartilage, but rather control symptoms and help naturally inhibit pain receptors. 

The Incredible Human Body

There are several different kinds of cell therapies that can be used to promote healing and reduce inflammation, including:

Platelet-rich plasma (PRP): PRP is obtained by drawing a patient’s blood and spinning it in a centrifuge in order to concentrate the clot-forming platelets from the blood with or without white blood cells. The platelets are then injected directly into the affected area to speed up healing.  

Bone marrow aspirate concentrate (BMAC): BMAC is the aspiration of a patient’s bone marrow, typically from the side of the pelvic bone. It is processed to extract a liquid rich in cells, growth factors, and a small percentage of stem cells. This liquid is injected directly into the affected area to speed up healing.

Adipose tissue: Adipose (fat) tissue can be suctioned from the abdomen and processed to remove fat cells. This leaves behind valuable anti-inflammatory mediators and growth factors along with a small percentage of the body’s stem cells, which is injected into the affected area.

Amniotic products: This biologic therapy comes from a healthy donor source after C-section delivery. The amniotic fluid and membrane have hyaluronic acid and unique cells known to reduce inflammation and promote healing. These donor substances are injected into the affected area and are also a type of membrane used during surgeries.

Cartilage transplant: This type of orthobiologic treatment is the surgical transplantation of cartilage to a joint from another part of a joint, or from a donor source. The goal of this type of treatment is to replace an area of bad cartilage and underlying bone in an otherwise healthy joint in order to restore the natural smooth, healthy joint surface.

Be Wary: Avoiding Sub-par Cell Therapy Treatments

I often am asked by patients how orthobiologics at OrthoCarolina differ from highly-advertised treatments that claim to ‘regenerate’ or ‘heal quickly’ without surgery. These companies often market their treatments as cutting-edge stem cell therapy.

The cell-based therapy of orthobiologics that we do at OrthoCarolina are the same products available at what are often referred to as stem cell clinics that are frequently advertised. However, orthobiologics through OrthoCarolina are regulated and backed by extensive orthopedic research. I am working along with other colleagues and research staff to remain at the forefront of basic science and ongoing clinical trial efforts to be leaders in the fields and optimize their use in our clinics.

OrthoCarolina’s Regenerative Medicine Committee oversees and regulates all of our locations and clinics to make sure that orthobiologic practices are responsible and regulated. We also ensure that patients are accurately informed about the therapies including when it comes to standardized cost, which isn’t guaranteed with other clinics. Our physicians are committed to providing patients extensively-researched and fairly price biological treatment options.

Dr. Bryan Saltzman is a fellowship-trained sports medicine and shoulder and elbow surgeon with the OrthoCarolina Sports Medicine Center. He specializes in complex knee reconstruction, cartilage restoration surgery, and augmentation with orthobiologics/cell therapy.

Comments

November 07, 2019

It is good to know of different treatment possibilities. Thank you for keeping us posted.
- Jeannette Sheila Barrell
Reply From: OrthoCarolina

November 07, 2019

Thank you!

November 07, 2019

I recall Dr. Piasecki being asked about this at a conference and him discussing the poor results. There was also the mention of doctors offering this treatment more for profit motives than outcomes. Has anything changed?
- Frank
Reply From: OrthoCarolina

November 11, 2019

Hi Frank, As a whole, we at OC are trying to remain on the forefront of these therapies, which includes keeping up-to-date with the ever-evolving literature, overseeing/regulating the usage of these therapies across our central and satellite offices, and additionally contributing to these research efforts at large ourselves. Our stance on these treatments is optimistic, with a healthy appreciation that we still do not have many of the answers, and there are a lot of unknowns with Orthobiologics despite their basic science properties having promise. With regards to the literature, there are a lot of supportive level I-IV data available already to reference in the PRP literature where there is proven efficacy in lateral epicondylitis (tennis elbow), early knee OA, and rotator cuff repair for certain types of tear sizes. There are far fewer clinical studies on BMAC, adipose-derived cells, and amniotic products, and so we continue to try to understand these better and research their clinical utility as we try to better understand their optimization and/or efficacy in clinical situations. With regards to the "Cartilage Transplant" genre of biologic treatment - which I mention in the article but which differs from the otherwise discussion of "Orthobiologics injection therapy" (PRP, BMAC, adipose, amniotic) - there are abundant data on its efficacy dating back many years, and several of our Sports center sports surgeons (myself included) routinely incorporate these cartilage restoration techniques in our practice where necessary. --Dr. Saltzman

November 06, 2019

Is any or all of this treatment covered by insurance and if not what is the cost?
- Toni heyward-smith
Reply From: OrthoCarolina

November 07, 2019

In terms of the OrthoBiologic injection therapies (PRP, BMAC, adipose, amniotic), these treatments are not currently covered by insurance. However, for worker's compensation claims related to tennis elbow, these policies are now beginning to cover PRP injections as a first-line option for treatment after several Level I studies have shown its utility in comparison to other injection types including corticosteroid. As more research is done over the years on these therapies and our understanding of their efficacy (and in what clinical scenarios) increases, it will be interesting to see if insurance companies evolve in parallel. With regards to the "Cartilage Transplant" genre of biologic treatment - which I mention in the article but which differs from the otherwise discussion of "Orthobiologics injection therapy" (PRP, BMAC, adipose, amniotic) - these when used are covered under standard insurance policies. --Dr. Saltzman

November 06, 2019

I have been having cortisone injections every 3-4 months with pain relief but have been reading articles indicating that too much cortisone is detrimental to the joint and wonder what I can do as an alternative. I do not wish to have a a knee replacement
- Carmen B. McStravick Patient of Dr. Singer
Reply From: OrthoCarolina

November 11, 2019

Certainly, we generally try to avoid consistently repeating use of corticosteroid injections into the knee (or any joint), because of concerns for the damage it can cause to cartilage cells and the surrounding soft tissues, and risks for infection, etc. In some instances these OrthoBiologic options provide a reasonable alternative to consider. and while they have their own side effect profiles, they are largely considered safe for use. However, the concern I would have is with the degree of arthritis if the recommendation is for a knee replacement; the evidence on these therapies is quite consistent at this point that increasing degrees of arthritic changes in the joint are associated with lesser responses to these therapies. End-stage joint arthritis remains a very difficult pathology for Orthopedic surgeons to combat through non-operative means! --Dr. Saltzman

November 06, 2019

I have seen advertisements for stem cell treatments for neuropathy. Your opinion, please.
- Carol M.
Reply From: OrthoCarolina

November 11, 2019

Carol, As a Sports surgeon, I am less familiar with use of OrthoBiologics for the treatment of neuropathy, but to my knowledge I am not aware of any high-level studies evaluating the use of these injections for the treatment of neuropathy (although that doesn't mean that they don't exist outside of my knowledge!) --Dr. Saltzman

November 06, 2019

I been treating in Orthocarolina for my.leg and my shoulder I'm very happy with all the NR. The Doctors they very professional and nice and good I will recommend any body that know there. What I like before they.any surgery on you they're offer treatments fist if something for surgery they will explaining to you. I'm very satisfied with all they Doctors in Orthocarolina. Thank you for helping me with my problem.
- Carmell Adam
Reply From: OrthoCarolina

November 06, 2019

Thank you Carmell.

November 06, 2019

Would orthobiologics help with inflammation from rheumatoid arthritis? Thanks
- Keith Davis
Reply From: OrthoCarolina

November 07, 2019

There is seemingly overall less evidence on the use of orthobiologics in the setting of RA, but with the physiology of how orthobiologics have their effect in the body, it certainly could have the potential for helping with reducing inflammation caused by RA. --Dr. Saltzman

November 06, 2019

I have both knees that need knee replacement surgery. Would like to know what other alternatives I have besides surgery.
- Cindy palazzo
Reply From: OrthoCarolina

November 07, 2019

Overall, orthobiologics tend to show better efficacy in less severe grades of knee osteoarthritis, so it would depend on the significance of the x-ray findings to help suggest the relative likelihood for whether biologics would be of value in your knee pathology. --Dr. Saltzman

November 06, 2019

Would this type of therapy be helpful for DDD and Disc issues with nerve impingement?
- Kathleen Allen
Reply From: OrthoCarolina

November 07, 2019

Personally I am less familiar as a Sports surgeon with the utility of orthobiologics in the spine, but to my basic understanding, orthopedic spine surgeons are finding success in the use of PRP injections in particular for nerve entrapment and DDD about the spine. --Dr. Saltzman

November 06, 2019

Thank you for providing this service and posting this article to clarify what these procedures actually do. I was skeptical about similar services advertised by competitors. .
- Russell Childers
Reply From: OrthoCarolina

November 06, 2019

Thank you Russell.

November 06, 2019

Interesting, after attending OC Sports conference last year. It seemed OC’s stand was along the lines of literature that these are mostly profit driven treatments that carry a placebo at best for an outcome. Why the shift now?
- Dr. House
Reply From: OrthoCarolina

November 07, 2019

As a whole, we at OC are trying to remain on the forefront of these therapies, which includes keeping up-to-date with the ever-evolving literature, overseeing/regulating the usage of these therapies across our central and satellite offices, and additionally contributing to these research efforts at large ourselves. Our stance on these treatments is optimistic, with a healthy appreciation that we still do not have many of the answers, and there are a lot of unknowns with Orthobiologics despite their basic science properties having promise. With regards to the literature, there are a lot of supportive level I-IV data available already to reference in the PRP literature where there is proven efficacy in lateral epicondylitis (tennis elbow), early knee OA, and rotator cuff repair for certain types of tear sizes. There are far fewer clinical studies on BMAC, adipose-derived cells, and amniotic products, and so we continue to try to understand these better and research their clinical utility as we try to better understand their optimization and/or efficacy in clinical situations. With regards to the "Cartilage Transplant" genre of biologic treatment - which I mention in the article but which differs from the otherwise discussion of "Orthobiologics injection therapy" (PRP, BMAC, adipose, amniotic) - there are abundant data on its efficacy dating back many years, and several of our Sports center sports surgeons (myself included) routinely incorporate these cartilage restoration techniques in our practice where necessary. --Dr. Saltzman

November 06, 2019

This is very interesting, as I am a suffer of a shoulder injury that may require surgery this may be an alternative. Good to know!
- Lakevia Goode-Barber
Reply From: OrthoCarolina

November 06, 2019

Thank you Lakevia.

November 06, 2019

Are any of these treatments covered by insurance?
- Mary Jane Cleveland
Reply From: OrthoCarolina

November 07, 2019

In terms of the OrthoBiologic injection therapies (PRP, BMAC, adipose, amniotic), these treatments are not currently covered by insurance. However, for worker's compensation claims related to tennis elbow, these policies are now beginning to cover PRP injections as a first-line option for treatment after several Level I studies have shown its utility in comparison to other injection types including corticosteroid. As more research is done over the years on these therapies and our understanding of their efficacy (and in what clinical scenarios) increases, it will be interesting to see if insurance companies evolve in parallel. With regards to the "Cartilage Transplant" genre of biologic treatment - which I mention in the article but which differs from the otherwise discussion of "Orthobiologics injection therapy" (PRP, BMAC, adipose, amniotic) - these when used are covered under standard insurance policies. --Dr. Saltzman

November 06, 2019

Very happy to hear that you have options available to try prior to joint replacement.
- Terri
Reply From: OrthoCarolina

November 06, 2019

Thanks Terri.

November 06, 2019

Good to know. Over 5 years ago Ortho carolinas said my cartilage had worn down so bad on my knee that there was little I could do except do pain management and eventually knee replacement. I went to Flexogenics and had lipogems injected in my knees. After careful exercise and rigorous self-administered therapy my knee is better than ever. I wished that Orthocarolinas had offered this therapy at that time.
- Robert Podgurski
Reply From: OrthoCarolina

November 06, 2019

Thanks Robert.

November 01, 2019

Interesting. I trust orthocarolina to do what is best for the patient.
- DonnaYencer
Reply From: OrthoCarolina

November 01, 2019

Thanks Donna.

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