The use of orthobiologics is expanding at a rapid pace in the field of bone and joint surgery, tendon and wound healing. Orthobiologics are considered to be naturally occurring elements that are used in order to initiate, augment or modulate healing of the bone, joints, tendons, ligaments, muscles and/or skin imperfections.
Among the biological compounds currently considered as orthobiologics are bone grafts of various origins, autologous blood and conditioned serum, platelet rich plasma (PRP), growth factors and stem cells. Some of these factors such as bone grafts or the autologous blood (patient’s own blood) have a long history of use in orthopaedics and/or rheumatologic treatment.
The PRP or stem cell treatment was initiated in the beginning of the third millennium and is currently in different stages of use and administration in clinical practice. Orthobiologics are processed or engineered to respond to specific medical need, taking advantage of cutting edge research and using advanced technology.
The modern use of orthobiologics has been divided by some authors in three stages of increasing complexity. The first generation is represented by viscosupplementation with hyaluronic acid; the second stage involves the use of PRP, while the third and most advanced stage consists in cell-based therapies and the use of growth factors.
Basic science motivates the use of PRP in orthopaedic practice in the field of cartilage, tendon and bone healing.
In this way, fractures, as well as tendon, muscle and cartilage lesions, are treated more and more often with PRP. Countless studies have evaluated the efficiency of PRP in diminishing inflammation and pain, improving and accelerating the scarring process and in increasing joint mobility and muscular function. It can be applied in acute situations such as torn muscles or ligaments, accelerating recovery and thus reducing time off sports/work, as well as in more chronic situations, such as tendinitis of the Achilles tendon/quadriceps, epicondylitis and even in the early stages of osteoporosis.
Platelet Rich Plasma is derived from the patient’s own blood (autologous) which is prepared and centrifuged to obtain a high concentration of platelets (3 to 5 times more) in a limited volume of plasma. The platelets contain growth factors and bioactive proteins that regulate specific cells, modulating growth and activity, resulting in tissue recovery. A large quantity of highly concentrated growth factors is administered near the lesion. The preparation is administered either in the consulting room or operating theatre, with or without the use of ultrasound equipment.
Some uses of PRP:
1. Chronic tendinitis (elbow, knee, hip, ankle, and others)
2. Partial tendon ruptures (Achilles tendon, rotulian tendon, quadriceps, etc.)
3. Muscle injuries
4. To assist in delays of fracture consolidation (known as pseudoarthrosis)
5. Alternative intra-articular treatment in early arthritis
6. In reconstructive surgery of tendons and ligaments
7. As an ancillary in the treatment of cartilage injuries
8. Plantar fasciitis/calcaneal spurs
This treatment is now available in the HPA Group.
By Dr. Maria Miguel Carvalho
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Dr. Maria Miguel Carvalho is specialist in orthopaedics and traumatology, holds consultations in pathology of the shoulder and is also a specialist in sports medicine.
