OrthoBiologics Program

The fundamental goal of the OrthoBiologics Program is to provide cutting edge treatments with a sound scientific foundation. The program is an evolution of the Cartilage Restoration Center that was started in 1995 and has grown to include knee preservation and restoration of articular cartilage, ligaments and menisci.

Patients often search for ways to avoid a knee replacement. Typically, the search starts with cartilage restoration options; that is, replacing worn out cartilage with new cartilage. Unfortunately, some patients have arthritis changes and are not candidates for knee biologic restoration. For patients in this situation who still want to avoid a knee replacement, orthobiologic injections may offer an alternative.

With the OrthoBiologics Program, we can now offer a potential “bridge” between biologic knee restoration and (artificial) total knee replacement. We offer platelet-rich plasma (PRP) injections and tissue and/or cell therapies.

Note: PRP injections and ReNu® can be performed the same day and time as your office visit if prior arrangements are made. However, LipoGems® and Bone Marrow Aspirate will require a specific appointment to verify that the harvesting and processing kits are available. Once verified, a procedure time will be scheduled. If you decide the injection is not right for you, the prepayment for the procedure will be refunded. Since the completed office visit is separate and insurance eligible, it is not refundable.

To be clear, MOST INSURANCE PROGRAMS, MEDICARE AND MEDICAID label these treatments as “experimental/investigational” and DO NOT pay for these treatments. Consult with your Health Savings Account (HSA) adviser, as prescribed medical treatments may be allowed for payments from your HSA account.

Prepayment is necessary depending on the injection.

Optional ultrasound guidance for knee injections

While experienced knee surgeons and physician assistants can perform accurate knee injections, the option of ultrasound guidance is available. This noninvasive technique allows visualization of the injection needle precisely within the joint capsule.

Platelet-Rich Plasma (Autologous Conditioned Plasma®) Knee Injection

Platelets are one of the first biologics to reach an injury. Their first function is to participate in sealing the injury with a clot. During the blood clot formation, they release over 1,500 biologically active proteins, including growth factors and “signaling” factors that call in the patient’s own adult cells to aid in the repair process.

Blood is obtained from a peripheral arm vein and then centrifuged to separate the blood components. Red blood cells are removed, resulting in a concentrated number of platelets in the remaining plasma, hence the term platelet-rich plasma, or PRP for short.

There are many ways to prepare PRP. The type of PRP we use, Autologous Conditioned Plasma®, has been shown in a recent scientific study to diminish symptoms of knee osteoarthritis. It is administered in the same manner as other knee injections with local skin anesthetic.

ReNu® Amniotic Fluid Cells and Amniotic Membrane Knee Injection

Human amniotic fluid and tissue are typically discarded at birth. However, the fluid and tissue are rich with cells and biologic factors that have been used successfully for many years to promote wound healing. The fluid and membrane are donated by healthy mothers at birth. The fluid and membrane are then cryopreserved allowing the cells to potentially return to function upon thawing.

Although amniotic fluid with cells and amniotic membrane are promoted by several companies in the United States, ReNu® is the only product that has published articles on safety and efficacy for knee osteoarthritis. We participated in the original study (published in the Journal of Knee Surgery, 2015) and led a multicenter trial of this promising product. The trial was completed with the positive results published in the Journal of Knee Surgery, 2019.

Bone Marrow Aspirate Concentrate Knee Injection

Bone marrow harvesting for reparative cells has been performed for many years. The number of adult tissues and cells actually make up a very small number of the total cells obtained during aspiration. In the past, much of what was aspirated from within the bone was largely peripheral blood.

We utilize a new tool for harvesting, which minimizes the amount of peripheral blood within the aspirate. The device, a Marrow Cellutions® cannula, uses a new patented instrument that allows the harvest to contain a high number of reparative cells without requiring centrifugation. However, bone marrow aspirate can be concentrated. Currently, the most common applications are in the OR to augment bone stress fracture reaction healing and meniscal healing. 

LipoGems® Microfragmented Fat™

LipoGems® is a technique that fragments adipose (fat) tissue. The tissues and cells reside on the microscopic blood vessels within the fat tissues. Some techniques involve enzymatic digestion and centrifugation of fat to obtain the vascular portion. LipoGems®, on the other hand, involves minimal manipulation. Fat tissue is gently harvested by “lipoaspiration” from a small amount of one’s own abdominal fat. This has FDA clearance as opposed to enzymatic and centrifugation techniques.

Through mechanical emulsification (thorough mixing) of the tissue, the size of the fat clusters is reduced. Sterile saline is employed during processing to wash and rinse the tissue, which reduces inflammatory impurities, such as oil residue and blood. This allows maintenance of the native adipose tissue microenvironment containing the microvasculature with attached reparative cells. These small adipose microspheres with their microenvironment can then be injected into the knee using standard injection techniques. 

 

References

Smith PA. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial. Am J Sports Med. 2016;44(4);884-91. doi: 10.1177/0363546515624678.

Riboh JC, Saltzmann BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med. 2016;44(3):792-800. doi: 10.1177/0363546515580787.

Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective double-blind, randomized trial. Am J Sports Med. 2013;41(2):356-64. doi: 10.1177/0363546512471299.

Vangsness CT, Farr J, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. J Bone Joint Surg Am. 2014;96(2):90-8. doi: 10.2106/JBJS.M.00058.

Vines JB, Aliprantis AO, Gomoll AH, Farr J. Cryopreserved amniotic suspension for the treatment of knee osteoarthritis. J Knee Surg. 2016;29(6):443-50. doi: 10.1055/s-0035-1569481.

Xia P, Wang X, Lin Q, Li X. Efficacy of mesenchymal stem cells injection for the management of knee osteoarthritis: a systematic review and meta-analysis. Int Orthop. 2015;39(12):2363-72. doi: 10.1007/s00264-015-2785-8.

Wyles CC, Houdek MT, Behfar A, Sierra RJ. Mesenchymal stem cell therapy for osteoarthritis: current perspectives. Stem Cells Cloning. 2015;28(8):117-24. doi: 10.2147/SCCAA.S68073.

Pers YM, Ruiz M, Noël D, Jorgensen C. Mesenchymal stem cells for the management of inflammation in osteoarthritis: state of the art and perspectives. Osteoarthritis Cartilage. 2015;23(11):2027-35. doi: 10.1016/j.joca.2015.07.004.

Ruiz M, Cosenza S, Maumus M, Jorgensen C, Noël D. Therapeutic application of mesenchymal stem cells in osteoarthritis. Expert Opin Biol Ther. 2016;16(1):33-42. doi: 10.1517/14712598.2016.1093108.

Fodor PB, Paulseth DG. Adipose derived stromal cell (ADSC) injections for pain management of osteoarthritis in the human knee joint. Aesthet Surg J. 2016;36(2):229-36. doi: 10.1093/asj/sjv135.