Magnetic resonance Cartigram® T2 wetmap sequencing (General Electric®, Chicago, IL) has the capability to diagnose appendicu- lar degenerative joint disease with greater sensitivity and specificity than any other imaging modality. This diagnostic advantage has become particularly advantageous with the advancement of autologous orthopedic immunobiologics (AOI) in the orthopedic surgery over the last decade. No studies have been published where diffusion weighted sequences have been used in the setting of autologous biologic therapeutics. T2 wetmapping studies may perfectly compliment the screening process in orthopedic and neurosurgical pa- tients who could be candidates for signaling cell procedures.
Musculoskeletal biologic therapeutic technologies have emerged as safe, viable, disease modifying options for primary (RA) and secondary (OA) inflammatory arthritis patients who often have had no option other than a potentially complicated surgery with uncertain outcomes. Understanding the basic science of immunologic cell signaling pathways and tissue response will continue to lead to more specific, targeted biologic treatments. We present an easy to follow, infographic that we believe serves as a reasonable baseline to help patients and surgeons understand the principles of biologic treatment in orthopedic surgery and neurosurgery.
Osteoarthritis causes a heavy disease burden globally and treatments are continually evolving. We introduced an autologous cell therapy protocol in 2006 that has continued to demonstrate promise clinically and on advanced imagin
Cannabis and endocannabinoid agonists have been safely used for decades by a large segment of the United States population for both recreational and medicinal purposes [1]. The medical use of cannabis products has been legislatively restricted for decades in the United States [2]. Due to widespread enthusiasm for cannabis in American Society, no authority can deny the wide margin of safety that exists, even for chronic use [3,4]. Newly enacted legislation over the last several years has decriminalized cannabis con- sumption and even legalized its use in some states for both recreation and medicinal purposes [5]. Most recently, clinicians’ guides to cannabidiol (CBD) and hemp oils have moved to the front seat of many prestigious clinical publications [6]. The translation of cannabinoids from herbal preparations into highly regulated prescription drugs is progressing very rapidly and healthcare practiti- oners must become familiar with its mechanisms and possible clinical applications [7]. These drugs and supplements may provide an unmet need in the management of patients with osteoarthritis and other musculoskeletal ailments. It may be time for a new gold standard in our approach to the clinical condition of arthritis where these pharmaceuticals play an important role.
Treatment of partial thickness tears of the rotator cuff is controversial in orthopedic surgery and the optimum treatment strate- gies continue to evolve. Recommendations vary widely across the spectrum from benign neglect with physical therapy, to surgical in-situ repair or takedown of the partial thickness tear to create a complete tear, followed by arthroscopic or open reconstruction.
In 2006, we developed an experimental, autologous orthobiologic treatment for partial thickness tears of the rotator cuff with the goal of restoration of tissue biology and function using autologous bone marrow nucleated cell concentrate suspended in a fibrin matrix growth factor concentrate. The technique includes autologous bone marrow injectate modification within the legal limits of human tissue and cell product transplantation. The technique also includes low intensity pulsed ultrasound and tailored physical therapy depending on tear size, morphology and patient specific issues.
This report details the treatment technique and posits mechanisms of treatment action responsible for the clinical success of treatment and includes a case presentation for discussion.
Signaling cell treatments, often referred to erroneously as “stem cell treatments” and “regenerative therapies” are not uniform between clinics and often do not even represent scientifically justified management strategies. In fact, a recent article in the Journal of Bone and Joint surgery illustrated that of the more than 895 clinics claiming to offer “regenerative treatments”, 96% were in violation of both ethical and legal professional standards by making false treatment claims [1]. Sadly, widespread provider unfamiliarity with molecular mechanisms over the last decade has led to widespread patient exploitation with appropriate treatments delayed and patient trust defeated in many settings. Gaining a better understanding of the immunological signaling basis for autologous orthopedic immunobiologics provides the knowledge to make sound clinical decisions where signaling cell treatments are considered.
Musculoskeletal biologic therapeutic technologies have emerged as safe, viable, disease modifying options for primary (RA) and secondary (OA) inflammatory arthritis patients who often have had no option other than a potentially complicated surgery with uncertain outcomes. Understanding the basic science of immunologic cell signaling pathways and tissue response will continue to lead to more specific, targeted biologic treatments. We present an easy to follow, infographic that we believe serves as a reasonable baseline to help patients and surgeons understand the principles of biologic treatment in orthopedic surgery and neurosurgery.
Bone marrow concentrates for knee arthritis have received much attention over the last decade as a viable treatment for osteoarthritic knee pain and disability [1]. In spite of the availability of these bone marrow concentrates, few authors have suggested a gold standard treatment protocol [2]. We first introduced our signaling cell procedure to orthopedic surgery in 2006 [3]. The procedure has undergone multiple iterations since that time. In this article, we introduce our seventh-generation technique for signaling cell treatment in the setting of osteoarthritis of the knee and discuss the role of tumor necrosis factor stimulated gene six protein in our signaling cell product.
Bone marrow concentrate cell procedures have been used frequently over the last decade in the setting of osteoarthritic knee pain and catabolic knee pain syndrome. In this study, safety and therapeutic benefit were assessed for treating knee osteoarthritis using Bone Marrow Concentrate (BMC) with an intra-articular approach. We sought to determine the short-term outcomes of patients treated with this modality over an average ten month follow up period (range 3-36 months) using validated and accurate outcomes assessments including the SF-12, IKDC, LEFS and the visual analogy score for pain. On average, there was improvement in all outcomes analyses over the time period studied. Study patients were uniformly pleased with their outcome and only one patient had gone on to have a total knee replacement during the study period at two years.
The prevalence of osteoarthritis (OA) is increasing and projected to affect one in four adults in the United States by 2040. Limitations associated with recreational and vocational pursuits is expected to increase substantially, resulting in a large impact on individuals and the healthcare system. Conservative treatments for knee OA have traditionally focused on ameliorating symptoms through non-invasive and minimally invasive procedures. While conservative treatment modalities are considered the “gold standard” in clinical practice, preventative and restorative therapies are desperately needed to improve quality of life in those suffering from symptomatic OA. A large body of literature exists regarding the mechanisms responsible for the pathogenesis of OA and has enabled the development of alternative treatment modalities, including optimized cell-based therapies (CBTs) and new systemic and intra-articular disease modifying OA drug (DMOAD) approaches. Bone marrow and adipose CBTs offer significant translational advantages in that progenitor cells and bioactive factors can be harvested using minimally invasive technology without the need of in vitro expansion. Enhancing the therapeutic efficacy of these CBTs via senolytic agents also offers a promising new treatment modality. Senolytic agents are considered DMOADs that target senescent cells which release senescenceassociated secretory phenotype (SASP) factors. Attenuating cellular senescence and their secreted constituents via senolytic drugs may offer a novel disease modifying approach for the treatment of OA. In this review, we will briefly summarize OA etiology of the knee, discuss limitations of current treatments of CBTs and DMOADs, and highlight emerging strategies on targeting cellular senescence.
Scientists have deciphered the inflammatory pathways and we now have a better understanding of the disease’s spatiotemporal sig- naling complexities that have identified gene products tuned by epigenetic modifications. Advances in single cell proteomics and MR spectroscopy now lead the charge in clarifying master protein regulators during inflammation and organic joint disease. Defining major players in both canonical and non-canonical pathways led researchers to the conclusion that inflammatory and osteoarthritis follow the same biological signaling pathways. This has led to an explosion in the development of human biologics and biosimilars that remain to be tested in the osteoarthritis population. We just don’t know and we definitely cannot afford it.