Orthobiology: using one’s own body as a treatment

Traditionally, orthopedic surgeons operated to restore biomechanics only, relying on Mother Nature and luck to do the rest. In this way, they looked for the bone to consolidate or the tendon to heal over the suture or within the cast.
However, it is important that the healing is not imposed, but that there is an internal work of the body. Regenerative Medicine seeks to enhance the body’s ability to restore or regrow a body part that has been damaged by an accident or aging.
Orthobiology is Regenerative Traumatology, that is, a part of Regenerative Medicine that deals with restoring the vitality of musculoskeletal tissue: bones, tendons, joints, muscles, ligaments, vessels and nerves. It seeks to enhance the body’s natural healing capacity.
However, different tissues have very different capacities for self-regeneration, so that a bone has a much greater capacity to heal than a tendon, and a tendon has a much greater capacity to heal than articular cartilage. In the same sense, the capacity of a very young person is much greater than that of an elderly person, since the ability to regenerate is lost with age.

What type of patients is Orthobiologie aimed at?

Orthobiologics has application in injuries and chronic degenerative processes, such as osteoarthritis, ligament injuries and tendinitis. That is, in those cases in which the damage cannot be completely resolved by the body’s normal healing mechanisms.
These treatments can benefit both athletes, who need to recover from their injuries in the shortest possible time, as well as patients with fractures that are difficult to consolidate.
Orthobiologics is mainly applied to people with very frequent problems such as osteoarthritis of the knee or hip or tendonitis in shoulders and elbows. These pathologies affect the patient’s quality of life, since they cause pain even at rest. What is sought with the techniques of Regenerative Medicine is to avoid aggressive surgeries such as prostheses or delay the need for prosthesis for years. In addition, it reduces the need to take medicines for pain and inflammation that have detrimental effects on health.

What do orthobiological treatments consist of?

Both medical and surgical techniques are used to stimulate the regenerative potential of tissues. The most common therapies are:
-Growth factors and cytokines: these are proteins that are obtained from the patient’s blood and facilitate the work of cells to generate healthy tissue and control inflammation.
-Mesenchymal cells (also called “stem cells”): cells are obtained from the patient’s own bone, fat or blood. These are able to reproduce and differentiate into cells of different tissues: bone, cartilage or tendon, and are activated when the tissue has been damaged and needs to be repaired.
-Biomaterials: molecules that make up our tissues, such as hyaluronic acid or collagen, are used. These are modified to form meshes or gels that serve as “scaffolds” on which repair cells grow. In addition, they promote the multiplication of regenerative cells, which in turn secrete growth factors.
In most cases these treatments only require a blood draw and an injection in the damaged part. In some cases, less aggressive surgery, such as arthroscopy, is also used to implant them. Generally, a combination of the different types of regenerative therapy is applied to achieve a personalized treatment and maximum benefit for the patient.

Are they really safe?

Orthobiologic treatments are proving to be very effective and safe: by using biological material obtained from the patient himself and reimplanting or injecting it, after processing it to enhance its healing capacity, the risk of rejection and adverse effects is minimal.

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Are they effective treatments?

There are currently multiple scientific studies that prove the efficacy of this type of treatment for osteoarthritis and sports injuries. The scientific evidence is increasing, since the more research there is, the more the indications are refined.

However, we must not lose sight of the fact that Orthobiologics is a specialty in constant development, so it is expected that in the near future there will be better and better results.

On the other hand, there are also “professionals” who control only one technique and apply it to all cases, achieving disappointing results. It is advisable to choose and adapt the personalized treatment for each patient, taking into account the limitations of Orthobiologics: if there is an older patient with advanced deterioration, great bone deformity and joint stiffness, it will not help to implant stem cells. In this case the joint will have to be replaced by a prosthesis.

On the other hand, if a tendon is torn, it will always have to be reinserted with surgery as a first step, although regenerative therapies can also be used as a complement.

In conclusion, Orthobiologic therapy complements surgery, it does not replace it.

When does the patient notice the improvement and how long does the effect last?

To answer this question it is necessary to understand a little the physiopathology of the injuries and to take into account that Orthobiologie acts on the different phases of healing of the body.

In the first phase, which lasts a week, inflammation and cell aggregation are generated. These secrete molecules that will attract platelets and other cells such as macrophages and immune cells to “clean” the area and eliminate the damaged tissues.

The second phase, which lasts about 3 weeks, is the proliferative stage, in which repair cells are attracted to form new tissue.

In a third phase, which lasts for months, the tissues are molded and adapted to their function. This last stage is known as the remodeling phase.

If the initial inflammatory phase lasts too long, if not enough reparative cells are attracted, or if these cells do not act correctly and form a tissue with a different structure to the original one, the lesions will not heal. On the contrary, they will be destroyed or scars will form that make the body not function properly.

The application of Regenerative Medicine therapies are aimed to:

– Modulate the initial inflammatory phase, since it generates an attraction through cytokines of cells that eliminate pathogens and cellular detritus and platelets containing granules with growth factors that act on cells involved in tissue regeneration.
– Stimulate the proliferative phase at the cellular level so that abundant extracellular matrix of similar composition to the original one can be produced.
– To favor the remodeling phase, favoring the organization of extacellular matrix and avoiding or minimizing the formation of fibrosis.

Thus, although the treatments are effective within hours of application, the effects take longer to be noticed. While the results of hyaluronic acid begin to be evident from the third day, and last about six months, infiltrations with growth factors, cytokines and stem cells are noticeable several weeks after their application. However, the effects last much longer, and sometimes even a definitive healing of the tissues is achieved.

In conclusion, what is really important is not to achieve a very rapid improvement, but to ensure that the effects are long lasting, and to apply combinations of therapies that enhance each other, achieving a great functional improvement.