because we're better able to debride intra-articular disease."
Smaller scopes and instrumentation also let surgeons operate much
more efficiently, according to Dr. Barp, who says, "We can treat
pathology arthroscopically that we wouldn't have attempted to
address even 5 years ago."
4. Regenerative medicine
Orthobiologics involves using biological substances to help injuries
heal faster. Dr. Morgan says the substances have an anabolic effect,
which increases healing, and an anti-catabolic effect, which decreases
factors that tear down cartilage and cause joint inflammation. There
are two main types of orthobiologics in use today, according to Dr.
Morgan:
• Platelet rich plasma injection (PRP) involves centrifuging blood
taken from a patient to concentrate platelets to 5 to 12 times more
than the normal concentrated volume before reinjecting the blood
into damaged tissue. The platelets contain growth factors and
cytokines, which proliferate and recruit cells that promote healing.
• Stem cell therapy involves harvesting stem cells from the
patient's iliac crest and injecting them into a joint, tendon or ligament.
The stem cells then substitute damaged cells within tissue. Dr.
Morgan says studies involving second-look arthroscopy have shown
that cartilage growth occurs in knees where stem cells have been
injected, but it's unclear if the injected cells turned into new cartilage
or simply acted as mediators to recruit cells that helped regenerate
the cartilage.
The injections can be administered during adjunctive procedures in
the OR during joint surgeries, or during in-office procedure injections
for treating ailments such tennis elbow and knee arthritis.
There are barriers to more widespread use of orthobiologics,
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