Regenerative Treatments In Sports And Orthopedic Medicine Pdf

regenerative treatments in sports and orthopedic medicine pdf

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Regenerative medicine offers physicians new tools to help repair damaged tissue, alleviate pain, accelerate healing, and improve function for patients with degenerative conditions or sports injuries. Regenerative Treatments in Sports and Orthopedic Medicine is the first comprehensive book devoted to orthobiologic treatments for orthopedic conditions.

Regenerative medicine offers physicians new tools to help repair damaged tissue, alleviate pain, accelerate healing, and improve function for patients with degenerative conditions or sports injuries. Regenerative Treatments in Sports and Orthopedic Medicine is the first comprehensive book devoted to orthobiologic treatments for orthopedic conditions.

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Regenerative Treatments in Sports and Orthopedic Medicine (English Edition)

To browse Academia. Skip to main content. By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. Log In Sign Up. Download Free PDF. Biological Therapies in Regenerative Sports Medicine. Isabel Andia. Download PDF. A short summary of this paper. Sports Med DOI MSC products appear safe in the short- and mid- 30 8 which will restore lost tissue functionality. Controlling and term, but studies with a long follow-up are scarce.

We first describe PR ies is low, stem-cell products may have therapeutic 33 11 the main biological technologies to boost musculoskeletal potential. However, these regenerative technologies still 34 12 healing, including bone marrow and subcutaneous fat- need to be optimized.

We provide some infor- 41 37 42 38 15 mation describing possible mechanisms of action. We Key Points ED 16 performed a literature search up to January searching 39 17 for clinical outcomes following the use of cell therapies for Biologics, including adult cells, platelet-rich plasma, 43 18 sports conditions, tendons, and joints. The safety and effi- and conditioned media, are under investigation for 44 19 cacy of cell therapies for tendon conditions was examined regenerative purposes in sports medicine.

A total of 54 studies Cell therapies under clinical assessment include 46 22 investigated the effects of mesenchymal stem-cell MSC dermal fibroblasts, tenocytes, chondrocytes, and 47 VI 23 products for joint conditions including anterior cruciate various products containing stem cells, mainly bone 48 24 ligament, meniscus, and chondral lesions as well as marrow concentrate, stromal vascular fraction, bone 49 25 osteoarthritis.

In 22 studies, cellular products were injected marrow-derived mesenchymal stem cells, and 50 26 intra-articularly, whereas in 32 studies MSC products were adipose stem cells. The The use of adult cell therapies is safe. Andia, N.

Maffulli 62 and multiple injuries. Major injuries in athletes result in a mechanisms of action. We also review the current literature 63 high incidence of chronic problems such as osteoarthritis about clinical outcomes following the use of cell therapies 64 OA , for which effective treatments are not yet available in sports medicine for tendon and joint conditions.

Both acute and chronic sports lesions have promoted a 66 surge of novel biological therapies aiming to improve the 67 quality of life of athletes and active individuals.

For example, platelet-rich plasma culoskeletal injuries are delivered locally. This is in con- 77 PRP , an autologous regenerative technology, is based on trast to the systemic route of administration in some other OO 78 the delivery of a pool of growth factors and cytokines with pathologies, such as systemic lupus erythematosus [9].

In this context, regenerative medicine seeks Cell therapies include a broad range of subtypes, from 83 to enhance these endogenous resources to help tissue injectable mixtures of cell populations, as is the case with 84 homeostasis prevail over hostile microenvironments. Despite these specific features, there are not 88 Orthopedics and sports medicine are among the areas that unequivocal markers of cell quality and functional effi- 89 will have the greatest applications.

Athletes professional cacy in vivo. Furthermore, comparability between inter- ED 90 and recreational seek novel regenerative medicine inter- trial clinical outcomes can be hindered because of vari- 91 ventions to heal injuries, and to rapidly resume their ability in the quality of MSCs associated with fabrication 92 desired sports activities.

Cell therapies are offered in sev- reagents and procedures. Central to progress in the field is 93 eral stem-cell centers around the world, not only for sports a description of manufacturing procedures and the 94 injuries [5], but also to treat devastating illnesses including development of products based on standardized parame- S 95 cerebral palsy, Alzheimer disease, or multiple sclerosis, ters.

Therefore, for laboratory-expanded cells, authors are 96 among others. Also, a set of basis to avoid any host immune responses. A simple adipose graft has and the assumptions or paradigms on which to base their been injected in joint conditions as an adjuvant to BMC.

In , Rodbell [11] isolated SVF for the first time using prote- olytic enzymes and centrifugation. SVF can be obtained in a few hours using kits and following commercial protocols, without altering the relevant biological characteristics of the cells.

SVF is a fresh product prepared at the point of care but qualifies as an advanced therapy medicinal product ATMP because it involves the use of proteolytic enzymes to obtain a cell suspension. This cell suspension is then centrifuged and the cell pellet is termed SVF. Vascularization is crucial in early healing mechanisms to provide oxygen and nutrients for the metabolic needs of activated cells but it is downregu- lated in the later stages of healing.

However, ASCs from aged ditioned culture media CM , which contain biologically active people are less proliferative, and can be of lower quality, molecules secreted by cells in vitro; these molecules affect cell because of telomere shortening and DNA damage, com- functions. Common steps to process cells from CD ASCs adipose weeks of ex-vivo expansion. Common steps to process cells from bone marrow include centrifugation and cell-culture expansion of plastic-adherent cells.

S marrow aspirate concentrate. Most cells are CD34? Center for Biologics Evaluation and Research. CSF [21]. In addition, Since cells are isolated from the niche that controls their PBSCs can be harvested and cryopreserved.

This product is phenotype i. PRP contains a complex molecular mixture including signaling and adhesive pro- A less investigated product to be used for regenerative teins. At present, it is evident that the therapeutic effect of purposes is the conditioned culture media CM. While PRPs in tissue healing is not only attributed to growth growing in vitro, cells release to the extracellular milieu a factors, but also to a myriad of chemokines and other pool of cytokines, chemokines, growth factors including cytokines actively involved in tissue-repair processes, transforming growth factors [TGF-a, TGF-b], hepatocyte including cell proliferation, differentiation, migration, growth factor [HGF], epidermal growth factor [EGF], angiogenesis, and the synthesis of ECM [22].

The source of CM is cells cultured in vitro OO trolled milieu for cells. In addition, PRPs can function as under specific consistent protocols. CM is composed from both cell carriers and cytokine delivery systems.

In fact, the soluble molecular components of cell secretome, which upon plasmatic fibrinogen cleavage and polymerization by can be tailored for specific therapeutic actions.

Actually, thrombin action, the newly developed fibrin constitutes a the therapeutic potential of CM is based on one of the suitable adhesive scaffold for cell delivery [24]. Platelets paradigms of MSC actions: the trophic and paracrine embedded within this fibrin scaffold slowly release the effects on local cells. The therapeutic value of the stem-cell CM is under The molecular characterization of PRPs is challenging research [34, 35].

Numerous patent applications have been and varies quantitatively from one individual PRP to filed in recent times i. For ED another and from one formulation to another [26].

Up to example, an ongoing clinical trial [36] in OA is assessing now, it has been impossible to establish quality criteria for the safety and feasibility of trophic factors from umbilical PRP products, because there is not enough information cord mesenchymal stem cells. For example, it this topic. Consistent with the complexity of these prod- RE was recently shown that PRP could favor stemness, and ucts, extensive literature from the past decades indicates prolongs survival of transplanted cells [28—30].

In addition, that regenerative medicine products modulate almost every PRP can control secretory function [31] in different man- facet of repair mechanisms Fig. In addition, ASCs were re-suspended [37, 38]. Site-directed implantation i. Maffulli F Fig. Differentiated cells are indoleamine 2,3-dioxygenase, IFN interferon, IGF insulin growth injected or implanted within tissue lesions to 1 engraft, synthesize factor, IL interleukin, MCP monocyte chemotactic protein, MSCs ECM molecules, integrate with the surrounding tissue, and return mesenchymal stem cells, PDGF platelet-derived growth factor, PGE2 tissue to homeostasis conditions and full functional capabilities.

Several authors [40, 41] modulators of excessive inflammation [51, 52]. MSCs speculate that cell engraftment is hindered because the host activated by local inflammatory molecules i. This can happen immunomodulatory factors including inducible nitric especially in degenerative diseases such as OA or oxide synthase iNOS , monocyte chemotactic protein 1 tendinopathy, in which the microenvironment could be MCP-1 , interleukin 1 receptor antagonist IL-1Ra , deprived of nutrients and exposed to high concentrations of and prostaglandin E2 PGE2 [53].

Interestingly, when [42], and detrimental pro-inflammatory cytokines such as MSCs are activated by inflammatory cytokines present VI interleukin-1b IL-1b and tumor necrosis factor TNF-a in the local milieu, they secrete TNFa-stimulated gene [43].

Cells can also limit tissue quality and functional efficacy in modulating sterile destruction and enhance repair by means of anti-apoptotic, inflammation [54]. Whether a single allogeneic MSC product can be used The therapeutic potential of MSC secretome is the rea- for all musculoskeletal conditions, and have similar effi- son to believe that CM may mimic the effects of cells. But, assuming that Similar trophic actions are advocated for the pool of aging of MSCs reduces their regenerative capabilities growth factor and cytokines delivered by PRP [49].

A [58, 59], allogeneic MSCs may overcome this limitation. Similarly, PRP can optimize the local escape immune recognition as they do not express HLA niche, and progenitors within a tendon can be stimulated to class 2 antigens and express moderate detectable levels of proliferate and differentiate [50]. HLA class 1 antigen [60, 61]. The presence of immunogenicity after cell differentiation can decrease their To obtain more precise information about the clinical therapeutic effect. Current knowledge supports the theory S outcomes following cell therapies, we conducted a narra- that MSCs are immune evasive and not immune privileged, tive review, categorizing the studies included in the review an issue that requires further scientific clarification.

We excluded Efficacy doses of regenerative medicine products are studies examining the efficacy of autologous chondrocyte unknown. Regenerative medicine products are biological implantation ACI because they have been recently response modifiers in contrast to pharmaceutical agents or reviewed [64].

For the same reason, we did not review PRP recombinant proteins. This means that they induce further studies [2, 65, 66]. However, because of their perception as drugs, MSC doses for 3. Articles were weight for systemic or intrathecal routes of administration categorized according to condition, and whether the [63]. Intralesional delivery compared with systemic experimental cell product was applied by injection or at administration has the advantage that cells arrive directly at surgery.

Doses of PRP are measured as concentration of procedures or laboratory-expanded cells for 3—4 weeks platelets or multiples of platelets relative to the number in were used. Data relating to experimental design, condition, peripheral blood. Effect maintained at 4. Reduction of hypoechogenicity and tear size in both medium without cells 2 mL groups at 6 months.

PRP[49 12 months showed restoration of normal tendon Alexander structure, improvement maintained at 3—4 years. RE Studies examining the efficacy and safety of cell therapies 3. Cell therapies consisted of culture-expanded tenocytes [70, 71] Nine clinical studies used autologous cells obtained from or skin fibroblasts [67, 74]; also, BMC [68, 69, 72], SVF different sources to treat tendon conditions [67—76] [76], and PBPC [73] have been used in five case series.

No donor-site while stem-cell-derived products were used in 23 studies complication was found at follow-up.

Regenerative Treatments in Sports and Orthopedic Medicine - E-bog

JavaScript seems to be disabled in your browser. For the best experience on our site, be sure to turn on Javascript in your browser. Regenerative medicine offers physicians new tools to help repair damaged tissue, alleviate pain, accelerate healing, and improve function for patients with degenerative conditions or sports injuries. Regenerative Treatments in Sports and Orthopedic Medicine is the first comprehensive book devoted to orthobiologic treatments for orthopedic conditions. Authored by experts in regenerative medicine, this evidence- and experience-based guide is written for clinicians looking to understand and effectively implement these treatments in their practices.

Search for:. Email Address. Your Message. There has been an error, please check the information you entered and try again. Skip to content Now, your second edition to better orthopedics. Unprecedented synthesis of evidence.

Malanga Details. The regenerative medicine offers doctors new tools to help repair damaged tissue, relieve pain, accelerate healing and improve function for patients with degenerative or sports injuries. Regenerative therapies in sports…. Regenerative therapies in sports and orthopedics is the first comprehensive book devoted to orthopedic treatments for bone conditions. This evidence-based manual has been authored by experts in regenerative medicine for physicians who are looking to understand these therapies and apply them effectively in their practices. Extensive and focused coverage of scientific bases, regulatory issues, staff, equipment, food and rehabilitation concerns, and anthropological interventions for specific clinical problems makes this ideal procedural reference for anyone recovering the job for athletes or other patients with musculoskeletal diseases.


Regenerative medicine offers physicians new tools to help repair damaged tissue, alleviate pain, accelerate healing, and improve function for.


Regenerative Injections in Sports Medicine

It seems that you're in Germany. We have a dedicated site for Germany. This book sheds new light on the complex area of regenerative injections used in sports injuries and musculoskeletal conditions, pursuing an evidenced-based approach. Largely ignoring orthopedic surgery, which would involve arthroscopic procedures and scaffolding as they are practiced mainly by orthopedic surgeons, the book instead focuses on injection-based treatments that are particularly useful in sports medicine and for musculoskeletal pain conditions. Including evidence from systematic reviews, meta-analyses, and randomized controlled trials, the book provides a comprehensive overview of regenerative injections such as dextrose, platelet-rich plasma and stem cell therapy, along with their history and scientific basis.

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Biological Therapies in Regenerative Sports Medicine

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