Regenerative Medicine in Sports, a potentially important tool for the Physician.
By Dr. Matías Fernández Viña.
Medical Director Stem Cell Therapy Argentina.
Many doctors and athletes use stem cell therapy to treat sports injuries, such as Achilles tendinopathy or damaged knee ligaments. Stem cell injections, platelet-rich plasma (PRP), prolotherapy, and cartilage regeneration techniques are examples of regenerative medicine treatments that doctors use to treat sports injuries. While its popularity is growing, stem cell therapy is not considered standard practice by sports medicine physicians and is not covered by most insurance companies. As more scientific evidence emerges regarding the use of these biological therapies, the benefits seen in sports recovery are increasing.
WHAT TYPES OF SPORTS INJURIES ARE TREATED WITH STEM CELLS?
Doctors use stem cells to treat a wide variety of sports injuries, including damage to:
- Tendons
- Ligaments
- Muscles
- Cartilage
These injuries can result from a single trauma or chronic overuse. Stem cells can be applied to an injured area through: Injection. A doctor can inject stem cells directly into the affected area. Direct surgical application. A surgeon can apply stem cells directly to the torn ligament, tendon, or bone being repaired. Stem cell-carrying sutures. A surgeon can stitch a torn muscle, ligament, or tendon using a thread-like material coated with stem cells. When administering injections, many doctors use ultrasound or other medical imaging techniques such as fluoroscopy or computed tomography (CT) scans to ensure the cells are delivered precisely to the site of the damaged tissue. Regenerative medicine treatments can be used independently or in combination. For example, platelet-rich plasma (PRP) can be used alone in a therapeutic injection or applied during cartilage regeneration surgery. All of these treatments are outpatient procedures and may not be covered by insurance. It may take more than one treatment session before you feel the results, and as with any treatment, results are not 100% guaranteed.
1. STEM CELL TREATMENTS
A stem cell doesn’t have a specific bodily function, but it can develop into a cell that does, such as a cartilage cell or a tendon cell. This is evidenced in various laboratory models. Most importantly, a stem cell will function according to the local environment it is exposed to. In this way, various essential biological benefits are achieved.
Doctors who use stem cell therapy believe that, when placed in a specific environment, stem cells can transform to meet a particular need. For example, stem cells placed near a damaged Achilles tendon are supposed to become healthy Achilles tendon cells. This doesn’t happen 100% of the time; the mechanism is a bit more complex, but the goal is to recruit as many progenitor cells as possible from that tissue to enhance its activity.
Doctors typically collect the stem cells used for treatment from the patient’s fat, blood, or bone marrow. Some companies sell doctors stem cells derived from amniotic fluid, placenta, or umbilical cord tissue, but without close monitoring, these cells generally die during storage and transport, rendering the product ineffective. The growth factors contained in these latter cells are the true effectors of the therapy, as are exosomes (microfragments or nanoparticles of RNA).
2. Platelet-Rich Plasma (PRP)
Many experts believe that the natural healing properties found in platelets and blood plasma can be used to facilitate the healing and repair of sports injuries. PRP can be injected or applied to the injured area, for example, during surgery.
To make PRP, blood is drawn from the patient and then processed, often using a centrifuge, to create a concentrated solution of platelets and plasma (PRP). The goal is to recruit as many platelets as possible.
When blood is centrifuged once, the resulting plasma is called PDGF, which is plasma rich in growth factors. To obtain a good PRP count, at least two centrifugations are necessary. Not all PRP is the same. PRP therapy varies depending on factors such as differences in patients’ blood types, the blood processing method, and the use of other substances, such as anesthetics (for example, lidocaine).
3. PROLOTHERAPY
Inflammation increases blood flow and attracts cells (granulocytes, monocytes, macrophages, and fibroblasts) that can repair and improve damaged tissue. Sports injuries typically cause inflammation, but in some cases, the inflammation subsides before the injury has healed. During prolotherapy, a doctor injects an irritant into the injured area, which temporarily increases inflammation. The hope is that the additional inflammation will facilitate further healing. Prolotherapy sometimes uses platelet-rich plasma (PRP) as the irritant, but prolotherapy is not, by definition, a cell therapy. In fact, the most commonly used irritant is dextrose, a simple sugar. Substances such as glycerin or saline solution may also be used.
Note: Compared to other regenerative medicine treatments, such as stem cell injections and PRP, there is not much clinical research on prolotherapy and its effectiveness.
The goal that a doctor should have when treating an athlete is not to shorten recovery times, although that is often the desire of the entire team.
The primary objective is to achieve tissue regeneration, in order to prevent future recurring injuries to that damaged tissue.
