The National Institutes of Health defines regenerative medicine as “the process of creating living, functional tissues to repair or replace tissue or organ function lost due to age, disease, damage, or congenital defects.” The hope is to restore damaged tissue that will not adequately heal on its own. The primary goal is to replace damaged, diseased, degenerating or aging tissue with new tissue. Regenerative medicine in the musculoskeletal medicine arena can be used to treat ligament or tendon injuries, aid in healing of cartilage damage, or slow arthritic progression.

Regenerative Medicine may involve cellular therapies, tissue engineering or other therapies that trigger the body’s natural ability to heal. Examples include platelet rich plasma therapy, alpha 2 macroglobulin therapy, amniotic tissue allografts and exosomes. Most regenerative medicine therapies are currently non FDA approved. Early studies show great promise and specific treatments may be an appropriate alternative to more traditional treatment options such as surgery or where injections have provided temporary relief of pain.

Regenerative medicine treatments have potential to relieve pain either by repair or replacing tissue. While some forms of regenerative medicine treatments can relieve pain within days to weeks by shutting down inflammatory substances in the body, others may take months to repair or replace tissue.

Types of regenerative treatment options available for musculoskeletal medicine

Several options may be available to patients seeking regenerative medicine treatments. FDA regulations and laws are constantly changing as the field evolves. Certain regulations may limit certain types of treatments from being done in the United States, while other countries may have more liberal regulations. The more permissive the regulation doesn’t mean the outcome will be better. Current regenerative medicine applications include a wide variety of orthopedic applications including helping heal tendon, ligament, cartilage or joint problems. These treatments also can turn off the degenerative cascade in arthritic processes and provide more sustainable pain relief than injections of cortisone.

Exosomes

Discovered more than 30 years ago, exosomes are vesicles secreted by most cell types already found in the body. Over the past several years, evidence indicates these secreted vesicles are so small in size they are formed inside the cell and act as messengers. Exosomes actually carry and transfer information to neighboring or distant cells.

Exosomes securely carry this information and are guided, similar to GPS, by exterior molecules that target the recipient cell. The action of microRNA is widely accepted as an essential driver of the regenerative process and immune modulation through its impact on multiple downstream biological pathways.

Exosomes are commercially available for use in regenerative medicine and have vast potential to treat many difficult to treat diseases.

Platelet Rich Plasma (PRP)

You may have heard of famous athletes such as Tiger Woods, Steph Curry, Rafael Nadal, Alex Rodriguez, Kobe Bryant having treatment with PRP to treat various injuries such as sprained knees or chronic tendon injuries. Several of these athletes credit earlier return to their sport for various injuries.

Your blood is mainly made up of liquid called plasma. Plasma contains red blood cells, white blood cells, and platelets. Although the platelets are commonly known for their ability to clot blood, platelets also contain hundreds of proteins called growth factors. Growth factors are naturally occurring regulatory molecules that influence cell division and migration and thus have the ability help heal tissue.

Platelet rich plasma is prepared by taking your own blood from a vein and then platelets are concentrated to 5-10 times the normal concentration found in blood through a process of centrifugation. Other blood cells are also removed through this process.

PRP can be injected into a number of musculoskeletal areas to help aid in healing tendon injuries, ligament injuries, muscle tears, joint or cartilage damage, or even into spinal discs or joints. PRP can be used to reduce pain and rejuvenate joints from arthritic problems.

Amniotic Tissue Allograft

The healing effect of fluid and tissue surrounding a newborn baby has been known for more than a thousand years. Amniotic fluid and the amniotic sac as that surround the baby as well as umbilical cord tissue have high concentrations of beneficial substances including collagen, hundreds of growth factors, cellular components, amino acids, carbohydrates, and cytokines. These materials are important in the healing process. These materials are important in the healing process. Purified amniotic tissue products have been shown to support soft tissue repair, reduce inflammation, minimize scar formation and have antimicrobial properties.

Amniotic tissue allografts are typically injected into the diseased area needing repair. They may aid in treatment of a wide variety of orthopedic tendon injuries, painful joints due to cartilage abnormalities or arthritic joints.

Substances within the allograft to help your body to repair or rejuvenate tendons, ligaments, cartilage within a variety of musculoskeletal areas including but not limited to: spine, shoulders, elbows, wrists, hands, ankles and feet (including plantar fasciitis).

Amniotic tissue allograft injection may be done more than once for best effect although many patients require one injection. The response may take up to several months for full effects to be seen. Amniotic or placenta are considered “immune privileged” and produce very little rejection response when placed another individual’s body.

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