In case of knee and hip arthrosis, but also of tendinopathies or epicondylitis, the infiltrations can, in some cases, be beneficial
Maria Elena Perrero
Regenerate bones and cartilages worn by time and physical activity: one possibility comes from regenerative medicine, that thanks to infiltrations of platelet concentrates (PRP, platelet-enriched plasma) and derivatives of adipose tissue and spinal cord (MSC, Mesenchymal Stem Cells) stimulates the restoration of the physiological conditions of tissues worn out by pathologies, aging, trauma, wear. “There regenerative medicine it is a relatively new field of medicine which, as the word itself indicates, should tend to regenerate tissues, something different from a repair or replacement (as happens with a prosthesis). In the case of regenerative medicine, in fact, an attempt is made to restore the organ or tissue involved in the disease or wear of the supports so that it can be regenerated “, explains to Official Active Dr. Laura de Girolamobiologist, Director of the Laboratory of Biotechnologies applied to Orthopedics and of RE.GA.IN (Regenerative Galeazzi Institute) at the IRCCS Galeazzi Orthopedic Institute.
Regenerative medicine and orthopedics
—
Regenerative medicine refers to an intrinsic capacity of the human and animal organism: that of spontaneous regeneration. “This is what happens in the bone following a fracture, which regenerates itself – underlines Dr. de Girolamo -. In some conditions, however, this spontaneous regeneration of the organism fails, due to the age, severity of the damage or comorbidities of the patient, for example. In these cases, regenerative medicine provides elements to support these regeneration processes ”. Specifically, the musculoskeletal regenerative medicine it deals properly with bones and joints, but also with muscles and tendons, which can also be damaged as a result of wear due to sporting activity, as well as age. “In the orthopedic field, regenerative medicine makes use of ortho-biologicals, that is, substances that we can produce from the patient’s own tissues.
Regenerative medicine: PRP and mesenchymal stem cells
—
As reminds ad Active Dr. de Girolamo, there are two major categories of orthobiological products with which regenerative medicine works today in the musculoskeletal field: blood derivatives (such as PRP, i.e. platelet-enriched plasma) and cell derivatives, particularly mesenchymal stem cells. “The PRP it is a blood derivative based on the potential of platelets, which are the first element that intervenes in regenerative processes even in spontaneous conditions ”, explains Dr. de Girolamo. “The PRP is obtained through a minimal manipulation of the blood that allows to arrive at a final product enriched in platelets, which by releasing growth factors favor tissue regeneration. Therefore, this natural high regenerative power is exploited, simply by enhancing it as in the PRP the concentration of platelets is increased compared to whole blood “.
Mesenchymal stem cells
—
Another category of orthobiologicals is that of cell-derived products. “It is a more delicate product than the PRP and can be obtained in a slightly more scrupulous way – underlines Dr. de Girolamo -. There are different types, but the most used cells are the mesenchymal stem cells. However, to obtain them, it is necessary to go through an expensive and strictly regulated processing phase in the laboratory, so it is not always possible to do it. However, even in this case it is possible to prepare a product that contains mesenchymal stem cells through minimal manipulation: starting from the patient’s tissue, cellular concentrates are obtained that contain various cells including mesenchymal stem cells. In this case it is not necessary to go to the laboratory, the product is obtained during the procedure itself, in a few minutes. The most used fabrics are the bone marrow and fatty tissue. Recently, adipose tissue has received great attention because it is very rich in mesenchymal stem cells and easier to collect, with a treatment of liposuction. Through a minimal manipulation of micro-fragmentation, it is possible to obtain adipose tissue cleansed of pro-inflammatory contaminants and oily residues and ready for use also by infiltration “.
Regenerative medicine and sports pathologies
—
Initially, more than thirty years ago, medicine began to find application in bone pathologies: “In some cases of fractures very serious or other very severe pathologies the growth factors gave great results – the biologist remembers -. Today, however, we know that these findings also find application in the orthopedic field among the sportsmen. In fact, among the pathologies most treated with regenerative medicine we find condropatia patulaeathat is a stage of cartilage degeneration with possible evolution into arthrosis, theosteoarthritis (commonly called osteoarthritis) of the hip and knee, muscle and tendon pathologies such asepicondylitis or tennis elbow and theepitrocleitis or golfer’s elbow. But also the Achilles tendon tendinopathy. A study conducted at the IRCCS Galeazzi Orthopedic Institute showed the effects of infiltration of adipose tissue and PRP in the treatment of this disease widespread among runner. The study showed that both treatments are effective in improving the patient’s symptoms, highlighting a faster recovery in patients treated with adipose tissue infiltrations ”, emphasizes Dr. de Girolamo. “The orthobiological they supply the substances that favor the regenerative processes, so they can be applied to a wide range of pathologies affecting the musculoskeletal system “.
Infiltrations and sportsmen
—
“The mechanism underlying the action of orthobiological in the conservative treatment ofarthrosis and tendon and muscle pathologies (both injuries, inflammatory and degenerative states such as tendinopathy) lies in their marked anti-inflammatory activity – underlines de Girolamo -. In the case of injuries surgical treatment is almost always associated, but in the tendinopathy infiltration is sufficient. And this, especially in sports, is a considerable advantage, since there is an almost immediate recovery after a conservative treatment, unlike a post-operative treatment, with very few risks, mainly linked, in the case of infiltrations with adipose tissue, to the collection site, where you can have a hematoma in some cases. It is certainly essential that these treatments are carried out in ad hoc centers, by expert personnel and in surgical clinics or operating rooms with high standards of sterility to avoid infectious complications. But these are minimally invasive procedures: in our Center we have performed more than 1,500 treatments in the last three years without any complications ”, assures Dr. de Girolamo.
© breaking latest news