When is regenerative therapy recommended in orthopaedics?

Growth factors are cells with a regenerative role, and in orthopaedic pathology they are used as an adjuvant therapy in both acute and chronic conditions.

Growth factors can be obtained either through simple procedures based on a blood sample, such as PRP and PRF, or through a more complex procedure involving stem cells harvested from the subcutaneous abdominal fat tissue.

PRP is a concentrate of growth factors from platelets, obtained by taking 60 ml of blood from the patient and centrifuging it, which yields 6 ml of plasma enriched with regenerative factors that is injected into the joint or at the site of the injury.

The kit is single-use, and the risks to the patient are minimal. The procedure takes approximately 20 minutes and is carried out during the same visit to the doctor's surgery.

PRF belongs to the new generation of growth factors and is a concentrate of platelet-rich fibrin.

The collection procedure is the same as for PRP – 120 ml of blood is taken – but the preparation method differs in that it yields a smaller but much more concentrated quantity of regenerative factors, which act for a longer period at the injection site with increased effectiveness and additional benefits for the patient. The procedure takes approximately 35 minutes and also takes place during the same visit to the doctor's surgery.

Platelet-rich plasma is produced through a process in which a fraction of blood is centrifuged, after which the plasma and platelets are separated from the other blood components. Together with the stem cells, an increased number of platelets and a wide variety of growth factors are obtained, such as:

• vascular endothelial growth factor (VEGF)
• platelet-derived growth factor (PDGF)
• fibroblast growth factor (FGF)
• insulin-like growth factor (IGF)
• transforming growth factor beta (TGF-β)

Stem cell therapy using cells from adipocytes is one of the most effective regenerative therapies. Fat contains the highest number of stem cells. Stem cells are harvested under local anaesthesia, and the advantage of the procedure is that it can be carried out on an outpatient basis within a limited period of time.

The adipose tissue is broken down so that the adult stem cells (ASCs) can then be separated. For the most effective recovery, the patient is advised to protect the harvest site until it has healed.

Regenerative therapy in orthopaedics is indicated for a number of conditions and procedures:

• degenerative joint conditions such as early-stage knee and hip osteoarthritis, early-stage ankle osteoarthritis
• tendon injuries (Achilles tendon rupture)
• ligament injuries (medial collateral ligament)
• tendinitis (Achilles tendinitis, epicondylitis)
• muscle injuries (muscle tears)
• post-operatively as an adjuvant therapy after ligament reconstruction, meniscal sutures, chondral reconstruction, subchondroplasty, osteotomies, fractures, delayed union or treatment of non-union, aseptic osteonecrosis of the femoral head, talus or femoral condyle.

Regenerative factors act locally at the injection site for a variable period of time; they reduce pain and inflammation, slow down joint degeneration and speed up tissue healing.

The risks of regenerative procedures are minimal thanks to the working conditions and the use of special, very safe kits for collecting and preparing the growth factors.

Following a growth factor injection, the patient may experience minimal pain at the injection site and slight local warmth, which will subside with local cryotherapy and a short period of reduced physical activity.

To gain the full benefit of the regenerative factor injection, anti-inflammatory treatment is not recommended after this procedure.

At Artro Sport clinic, those interested can benefit from regenerative therapy, and the specialist doctor will recommend this procedure only after a specialist consultation and specific investigations.