Orthopedic Immunobiologics-Small Molecules, Big impact

Austin Yeargan III, MD, at Carolina Joint and Arthritis in Wilmington, North Carolina, is a leader and pioneer in the field of orthopedic immunobiologics and orthopedic regenerative medicine. He has developed, invented, researched, and improved innovative techniques that he introduced to the field of orthopedic surgery in 2006. He continually advances the field of orthopedic immunobiologics, following his patients clincially for years to determine long-term results and discover ways to improve his therapies.  This work has led to 8 iterations in our therapeutic autologous bone marrow concentrate transplant nanoplasty procedures since inception. His techniques are emulated in over 9000 clinics in the US alone.  His orthobiologics procedures have become the industry standard in some of the best orthopedic sports medicine clinics in the country. Even if you have advanced arthritis, many patients can avoid joint replacement after treatment with orthobiologics.  If you're not appropriate for immunobiologics and would fare better with replacement, we'll tell you that and then refer you to the best possible surgeon for your condition locally or worldwide. 

Orthopedic Regenerative Medicine (immunobiologics)
The human body has the ability to protect itself when you suffer from an injury or degenerative disease. Orthopedic immunobiologic techniques summon the power of nanomolecular cell signaling through direct trophic effects and the immunomodulatory/anti-inflammatory effects of mesenchymal stem cell efferocytosis. Harvesting the signaling power behind orthopedic regenerative medicine procedures that we developed in 2006, we make available to our patients the most cutting edge, scientifically supported applications of autologous cell and protein therapies.  All of our procedures are FDA cleared for safety and if we indicate you for treatment,  we believe they will be effective. Our track record speaks for itself.  If you suffer from an acute musculoskeltal injury, failed surgery or degenerative disease like arthritis or tendonitis, you deserve to know about all of your options.  

Call the office or book online today to learn how orthopedic immunobiologics can ease your pain.  There's nothing to lose by gaining more information.  

Small Molecules, Big Impact

What are the autologous orthopedic immunobiologics we use for treatment?

Also referred to as orthobiologics, orthopedic immunobiologics are useful biological cells and proteins harvested from the patient at the point of care that are used to treat orthopedic conditions, from sports injuries and fractures to chronic diseases like arthritis and tendonitis through nanomolecular cell-signaling pathways that stimulate a healing response. Orthopedic immunobiologic treatments contain natural healing cells from your body’s blood and bone marrow that work through nanomolecular signaling and efferocytotic mechanisms that are both anti-inflammatory and immunomodulatory. The goal in patients who are appropriate for these treatments is clinical organic joint restoration from activating healing pathways and clinical relief from pain, preserving the native joint.

What type of orthobiologic procedure is the Nanoplasty® and Mechanical Axis Deviation Procedure (NAMAD)?

Dr. Yeargan developed and invented the NAMAD procedure for unicompartmental knee joint osteoarthrirtis and it has been frequently duplicated since his introduction because it has been very successful.  The NAMAD is an advanced office procedure, performed under local anesthesia with or without sedation, that decompresses stiff subchondral bone (rate limiting step for the development of arthritis in ANY mammal) and restores the modulus of elasticity to the overloaded compartment. While it can treat cartilage injuries, it’s been especially beneficial for patients with advanced arthritis who want to avoid knee replacment surgery. 

All of our procedures use only cells and biologic proteins that are harvested from the patient at the "point of care" (autologous).  The procedure takes advantage of the biological communication between mesenchymal stem cells (MSCs), often considered an 'injury drugstore' and all other nucleated bone marrow cells.  Effects are both directly trophic and from efferocytosis secretomes from monocytes that line the joint being treated. 

Platelets contain dense granules that are packed with growth factors like platelet derived growth factor (PDGF) and Insulin like growth factor 1 (IGF-1).  The growth factors are liberated from the dense granules using 10% calcium chloride and a growth factor concentrate is engineered in each case to serve as a scaffold for the nucleated cell concentrate.  This is known as the growth factor concentrate.  

Autologous Factor X, or thrombin, is also used in the scaffolding for subchondral injection and turns the GFC into a gel-like structure to hold the biologic in the trabecular subchondral bone.  

Thrombin is only used for the subchondral injection. It is not used inside the joint itself during the intra-articular injection, because it is a serine protease and could damage the articular cartilage that we are trying to preserve. 

The NAMAD process includes the following:

Harvesting nucleated bone marrow cells (in particular mesenchymal stem cells), platelets and isolating thrombin (factor x).  

Dr. Yeargan painlessly and bloodlessly removes a bone marrow sample from your hip using a percutaneous approach, creating the autologous bone marrow aspirate concentrate (ABMAC) used for your treatment.  Through isopycnic separation (based on density), the harvested autologous bone marrow is fractioned out to a plasma component and a cellular component that is further filtered to engineer a growth factor concentrate and a bone marrow cell concentrate. 

Among other unique steps, that are not done by other orthopedic surgeons offering immunobiologics, he harvests autologous thrombin to stabilize the scaffold the cells go into prior to injection. He harvests this clotting protein directly at the point of clear using an FDA cleared device called the Thrombinator™ by Athrex®.  This stabilizes the cell concentrate and encourages cell adhesion with engraftment,  holidng the ABMAC where he injects it into the subchondral bone.

Concentrating healing cells

He separates and concentrates the healthiest healing cells from other bone marrow components. These cells are also called signaling cells or 'injury drugstores' because they activate healing activities in the surrounding cells and can regenerate new cells or tissues.  Our goal is to encourage the stiff subchondral bone to remodel and to restore the modulus of elasticity in the overloaded subchondral bone.

Retaining anti-inflammatory proteins

This is another technique that sets Dr. Yeargan’s orthobiologics treatments apart from the standard procedures. He captures and retains TSG-6 proteins. This is an essential difference from other regenerative practices because TSG-6 is lost in most procedures due to its small molecular weight that approximates the size of most pro-inflammatory mediators. TSG-6 is vital because it fights inflammation, protects healthy cells, and supports signaling cell activities. Indeed it is the only biomolecule that carries a 'chondroprotective' label. 

Injecting ABMAC above and below the cartilage

Most 'stem cell procedures' or injections that are offered by other clinics who have caught on to our success rely on anti-inflammatory and immunomodulatory signaling within the joint.  That's where I started 18 years ago and it's a good place to start.  Much has been learned since then and today we offer a procedure that has undergone 8 iterations since our original description-and we're still learning and contemplating ways to make the treatments even better.

Many providers have stuck with his intial treatment descriptinos of simply injecting ABMAC into your osteoarthritic joint. We have found that combing this earlier procedure with transplant nanoplasty into the subchondral bone is far superior.  After combining your ABMAC with the GFC and thrombin, it is injected into the stiff bone beneath the cartilage using fluoroscopic image guidance to ensure perfect placement of the injection.  This decompresses the stiff bone and encourages haversian remodeling in subchondral bone to restore the modulus of elasticity (Y).  Next, inflammatory cytokines in the knee joint effusion are removed before injection of ABMAC and GFC/HA/TSG-6 into the joint space itself.  

As a result, the damaged cartilage and cartilage matrix is surrounded by signaling cells, and your ABMAC can also promote healing in the damaged bone below the cartilage. At least 20% of the cells lining the knee are inflammatory monocytes that efferocytose the implanted live autolgous mesenchymal stem cells.  This changes their 'secretome', or the biochemicals that they secrete, resulting in a lasting immune imprint that supports tissue health, repair and regeneration. 

What type of orthobiologics are platelet-rich plasma (PRP) plus TSG-6?

Dr. Yeargan creates PRP (a mixture of concentrated platelets and plasma) from a sample of your blood. Platelets are packed with growth factors in their 'dense granules' that accelerate healing, protect healthy cells, reduce inflammation, and support signaling cells.

He puts the plasma through a nanofilter, eliminating unwanted pro-inflammatory cytokines and concentrating TSG-6. Then he draws excess fluid out of your joint, removing inflammatory  and destructive cytokines that have built up, and injects your joint or injury with optimized PRP with concentrated TSG-6.  

Most treatments come with tailored physical therapy protocols that we have designed and modified over the last 18 years and require 4-8 weeks for an ideal outcome.  

Not all patients are candidates for orthopedic immunobiologics and we will tell you if you are not, but we still care about you getting the best managment for your problem.  Our referral network is unmatched and we see a high volume of patients who just want second or third opinions, even just explanations about the pathophysiology behind their problem.

Our patients drive Dr. Yeargan's committment to your health and he cares for patients like family.  If you need relief from pain or need help healing an injury, or just want to talk to him, call the office or book an appointment online today.  He works tirelessly and looks forward to helping you with your issues. 

Orthopedic Immunobiologics

Small molecules, Big impact