Regenerative medicine seeks to stimulate the body's natural capabilities for regeneration of injured tissues. In orthopaedics, regenerative medicine aims to develop new therapies that will promote tissue regeneration, repairing or replacing diseased and injured bone/soft tissues. This includes the reconstruction of tissues that normally cannot repair themselves; they can be grown in the laboratory, and then implanted back into the patient. This area of medicine is becoming ever more important with the shortage of donor organs for transplant, and the associated risks of rejection when transplanting tissues from an external source.
Although many of these therapies are at an early stage in their development, the results seen to date imply that regenerative medicine will complement, and in some cases, even replace, conventional surgical and pharmacological treatments.
In the field of regenerative orthopaedic medicine there are many areas currently being researched. Amongst these, tissue engineering, the use of physical stimulation (shock waves, neurostimulation, magneto-therapy etc.) and the use of growth factors, have clinical applications that are giving excellent results. Other areas, such as the use of stem cells, will probably require slightly more time before its full potential can be realised.
This therapy was originally used in Urology to break down gallstones. However, it is now being used with great success in orthopaedics to treat various bone and soft tissue conditions, complementing, or in certain cases, replacing surgical treatment.
Shock waves, which are a special kind of acoustic wave, trigger therapeutic biochemical reactions in living tissues – reducing inflammation, pain and swelling, and stimulating the blood supply. They have been shown to cause “neoangiongenesis” i.e. the production of new blood vessels, and they stimulate the activity of the osteoblasts (the cells which form new bone cells). They can also dissolve calcified deposits on soft tissues, such as tendons.
This is a painless, non-invasive therapy, which is normally administered in a course of 3 weekly treatments. The treatment will last 10-15 minutes, depending on the condition. A machine called a lithotripter (see photo) is positioned over the injured area. It then transmits acoustic waves directly into the tissues, at the precise point where they are damaged, even if this is deep within the tissues. It is used on both long-term (chronic), and recent (acute) conditions. It is used most commonly to treat:
• Degenerative conditions of the tendons (eg rotator cuff, Achilles tendon, patellar tendon, plantar fasciitis)
• Inflammatory joint conditions (frozen shoulder)
• Non-healing bone fractures
• Bone necrosis (see osteonecrosis)
• Chronic ulcers, non-healing wounds, and severe burns
This treatment will often produce an almost immediate improvement, even if you may need to wait 4-6 weeks to feel the full benefit of the treatment. In certain cases it may be necessary to repeat the treatment over a period of time.
This is a non-invasive technology which stimulates the nerves using electrical impulses to create an antalgic (pain killing) effect. It can be used to treat a variety of medical conditions:
Typical treatments last from 15 - 30 minutes and your doctor will apply a hand-held device directly to the skin of the involved area, and often also to non-involved areas on the opposite side of the body or the back. This device transmits electrical impulses into the tissues.
The device may be held stationary or moved along the skin in sweeping motions, depending on the chosen mode of treatment. The patient may feel a tickling or vibrating sensation, or it may feel like a prickling or fine "needling" sensation. Some people are more sensitive than others to neurostimulation, and the way your body responds to the treatment may not be the same as the next person. The number of visits and duration of treatment is highly dependent upon the complexity of the patient’s medical history and condition, and whether it is used independently or along with other treatments.
Medical science has made significant progress regarding the study of the processes of cell regeneration and differentiation. These processes are organised in a complex series of events regulated by polypeptides (amino acid chains) which are called growth factors. The current interest in the study of growth factors is due to the expectation that they can assist in these processes to repair tissue damage in bones, cartilage, tendons and skin tissues.
Technology now permits us to isolate the growth factors in a blood sample, concentrating them into a liquid form that can be injected back into the patient in the area where they are needed. As the therapy uses the patient’s own cells, there is no risk of rejection.
A blood sample is taken from the patient, and in the laboratory (under sterile conditions) the growth factors are isolated. They are then injected back into the patient, into the site of the damaged tissue – your doctor will use an ultrasound guide to ensure that the growth factors are injected into precisely the correct position. Your doctor will then assess your recovery at regular intervals.
This is an innovative therapy which has already shown excellent results for the treatment of tendon damage.