The term, “orthobiologics” is a combination of ortho (referring to the bones, joints, muscles, and tendons) and biologics, which in this context refers to substances that are naturally derived and can heal orthopedic tissues.
The use of the word “biologics” differs here when compared to how it is used in the pharmaceutical industry and in particular, rheumatology where it often refers to prescription drugs that are made by living organisms or contain a component of a living organism.
What are Orthobiologics?
Common orthobiologics include platelet-rich plasma, bone marrow concentrate, certain fat grafts, and birth tissues. These substances are either autologous or allogeneic and they can help bones, joints, muscles, or tendons heal if they are precisely injected or placed. However, to fully understand the scope of what is meant by the term “orthobiologics”, let’s break it down further into categories.
Categories of Orthobiologics
Orthobiologics can be broken down into two main categories:
- Where it originates from
- What type of tissue is being used and how
Let’s look at each of these individually.
Where do Orthobiologics Come From?
As previously mentioned have two categories of orthobiologics, autologous or allogeneic.
Autologous refers to the substance that comes from the same person in which it is being used. For example, the physician may draw blood, produce platelet-rich plasma (PRP) and then re-inject that PRP into a damaged tendon in the same patient that the blood was drawn from. Allogeneic means that the orthobiologic comes from another patient. One example would be a product derived from birth tissues and used in another adult.
What Type of Tissue is Being Used and How?
We break orthobiologics into these major tissue categories, blood-derived, stem cell-containing products, extra-cellular matrix, and conditioned media.
In the blood-derived category, we have substances like PRP which is made from concentrated platelets taken from a patients’ own blood. These platelets produce growth factors that can assist in healing. Serums and plasmas made from blood are also included in this category. For example, platelet-poor plasma (PPP) is PRP without as many platelets, which also contains different cytokines and growth factors that may aid healing.
Stem Cell-containing Products
Orthobiologics that contain stem cells are those that likely work through their stem cell content. For example, bone marrow concentrate is produced from a bone marrow aspirate taken from the back of a patient’s pelvis. This is then centrifuged so that the stem cell portion is concentrated. There is a body of research that shows that BMC or BMAC (Bone Marrow Aspirate Concentrate) works better if it has a higher stem cell content. Orthobiologics that have stem cells derived from another person (allogeneic) would also fall into this category. These would include isolating and culturing stem cells from bone marrow, fat, or birth tissues, which is not permitted in the U.S. at this time.
Extra-cellular matrices or ECMs are orthobiologics that act as a scaffold. This means that they can fill voids in torn tissue so that cells can grow across that area. Cells usually need something to grow on as they conduct their repair work. Many ECM orthobiologics also contain growth factors that act like espresso shots for repair cells, meaning that these substances can make cells work harder. Examples of ECM orthobiologics include fat grafts or birth tissues derived from amniotic or umbilical cords. Other examples include products such as demineralized bone matrix (DBM). DBM is cadaver bone that has had the calcium removed and is often placed through injection or surgically into a non-healing fracture where there is a larger gap. Some ECM orthobiologics are derived from animals. For example, pig bladder can be used to help your tendons and/or muscles heal.
You may be surprised to learn that birth tissue products derived from umbilical cords aren’t in the “stem cell” orthobiologics category. Despite what is often marketed and sold at seminars across the U.S. promising that these tissues have millions of young and vital stem cells, multiple research studies have shown the opposite. These are dead cell products with NO live or functional stem cells. However, they do have some growth factors and as such may help tissue in that way.
The conditioned media category of orthobiologics includes products currently being marketed as “exosomes.” These are tiny packets of cell-to-cell instructions which are usually purified from the media in which stem cells are grown in culture. They can have their own tissue repair effects, but since this product generally relies on tissue culture, these are not yet legal to use in the U.S. at this time (despite many companies avoiding the regulatory risk and marketing them illegally).
Common examples of orthobiologics in daily medical practice include:
- An injury to the neck joint “facets” from a car crash that won’t heal on their own. We are able to use PRP and precisely inject into the tear, damaged facets, and surrounding areas using X ray and Ultrasound guidance.
As orthobiologics get more sophisticated, it’s likely that we’ll see more invasive orthopedic surgeries move to less invasive injections. Why? Because when we have substances that can heal, less invasive injections can be used to place those substances into damaged tissue without surgery. This type of approach is often called “interventional orthobiologics” or “interventional orthopedics.”
Orthobiologics are revolutionizing orthopedic care. Despite this, many patients don’t realize that these substances exist and can help them recover from orthopedic injuries, often without surgery.
At Hurford Interventional Pain, Orthopedics & Rehabilitation we specialize in the use of Orthobiologics for the treatment of Neck, Back and Musculoskeletal injuries. To discuss if Orthobiologics are right for your injury, call us today at 314.499.6888 to schedule a consult.
Can Pain Medication be used Long Term?
- Chronic pain should primarily be treated with nonpharmacologic and nonopioid therapies. Consider opioids only if there are benefits for pain and function. If opioids are used, it should be in conjunction with aforementioned therapies, not in lieu of them.
- Informed (verbal or written) consent and opioid management plans (written) are part of good practice. Opioid agreement templates can be found through various organizations.
- Realistic treatment goals should be discussed with patients, including opioid use and reasons for discontinuation and expectations of medical management. Reassessment of opioid therapy benefit and risk should be performed within one to four weeks of initiation and at least every three months for continued use.
- Strict and organized monitoring of pain intensity, function, aberrant behaviors using drug testing and PDMP, and adverse effects.
- Continuously reassess the need/indication, dosage, route, and mode of pain management.
- Monitor all patients regularly and pay particular attention to those who score high on opioid risk assessments. If aberrant behaviors are observed, discuss organized tapering and/or rapid detoxification; be mindful of withdrawal and manage this appropriately. Offer or arrange medication assisted treatment and behavioral therapy for opioid use disorder.
- Optimize treatment of depression, anxiety and other mental health conditions with collaborated treatment with behavioral health specialists.