Orthobiologic regenerative injection therapy

All areas/joints

Dr. Simon is the leader in state of the art orthobiologic regenerative injection therapy techniques in the National Capital Region, and is one of the most experienced providers in the country, having treated over a thousand patients. The techniques are integral to Dr. Simon’s practice philosophy of minimally invasive joint preservation, while minimizing procedural risk and recovery time. Techniques include hyaluronic acid supplementation, platelet-rich plasma therapy (PRP) and autologous adipose-derived mesenchymal stem cell therapy (concentrated adipose tissue). 

As a surgeon, Dr. Simon’s skill set and experience uniquely positions him to determine when orthobiologics are appropriate versus surgery. 


 

What are orthobiologics?

Orthobiologics are substances that orthopaedic surgeons use to help injuries heal more quickly. They are used to improve the healing of injured or degenerative tissues such as cartilage, meniscus, tendons, and ligaments. These preparations are made in the office from substances that naturally occur in your body. When they are deployed in higher concentrations to specifically targeted areas, they may help promote / speed up the healing process. Patients are often drawn to these types of treatments as they are minimally invasive, very low risk and little / no side effects compared to anti-inflammatory and narcotic strength medications.

Dr. Simon performs 3 types of orthobiologic treatment

  • Platelet Rich Plasma Therapy (PRP)
  • Autologous Adipose-Derived Adult Stem Cell Therapy
  • Viscosupplementation (hyaluronic acid injections)

Platelet Rich Plasma Therapy

What is PRP and how does it work?

Your blood is mainly made up of a liquid called plasma. Plasma also contains
microscopic cellular components such as red blood cells that carry oxygen to tissues, white blood cells that fight infection, and platelets. The platelets are best known for their role in clotting blood but they also contain hundreds of natural proteins called growth factors. These growth factors are very important in the healing of injuries and chronic conditions such as arthritis.

Platelet rich plasma, or PRP, is plasma with many more platelets than what is typically found in whole blood. The concentration of platelets can be 5 to 10 times greater than usual, which means there is also a much higher level of growth factors. Since the platelets are full of intrinsic growth factors and hormones that stimulate healing of damaged tissue, they play a critical role in cell replication, angiogenesis, neovascularization and collagen production. All of these biological activities contribute to the repair and healing of damaged tendons, muscle, ligaments, cartilage and bone.

Examples of conditions that can be treated with platelet-rich plasma therapy (PRP)

  • Shoulder: Rotator cuff tendinitis or small tear, rotator cuff impingement syndrome /bursitis, calcific tendinopathy, acromioclavicular / sternoclavicular joint injuries,bicipital tendinitis / partial tears, labrum tears, arthritis, instability, frozen shoulder
  • Wrist / Hand: DeQuervain’s tenosynovitis, arthritis, other wrist or finger tendinitis, ligament tears or dysfunction of the fingers, TFCC tears
  • Elbow: Medial and lateral epicondylitis (tennis & golfers elbow), ligament injuries, OCD
  • Hip: IIliotibial band tendinitis (ITB Syndrome), psoas tendinitis and bursitis, greater trochanteric bursitis, hip labrum tears, piriformis syndrome, sacroiliac joint dysfunction, arthritis
  • Knee: Patellar tendinitis, patellofemoral syndrome, chondromalacia patella, partially torn or strained major ligaments of knee (ACL/LCL/MCL), meniscus tears, arthritis, patellar instability, cartilage injuries, OCD
  • Ankle / Foot: Achilles tendinitis and tears, peroneal tendinitis, arthritis, recurrent ankle sprains, other foot or ankle tendinitis, cartilage injuries
  • Neck: Whiplash injuries, headaches related to the neck, facet joint arthritis
  • Back: Facet joint arthritis, muscle strains, rib problems, degenerative discs

Autologous Adult Stem Cell Therapy

What are Stem Cells? 

Stem cells are blank slates that can be described as "shape shifters." These cells have the ability to change or “differentiate” into other types of cells. Stem cells are at the centre of a field of science called regenerative medicine. Because stem cells can become bone, muscle, cartilage and other specialized types of cells, they have the potential to treat many diseases such as arthritis, tendon / ligament tears, meniscus injuries and many other degenerative conditions.

What is Stem Cell Therapy and how does it work?  

Stem cell therapy is an intervention strategy that introduces new adult stem cells into damaged tissue in order to treat disease or injury. Many medical researchers believe that stem cell treatments have the potential to change the face of human disease and alleviate suffering. The ability of stem cells to self-renew offers significant potential for generation of tissues that can potentially replace diseased and damaged areas in the body, with minimal risk of rejection and side effects.  

Conditions that can be treated with Stem Cell Therapy

All of the conditions mentioned in the platelet rich plasma section above can also be
managed with concentrated adult adipose-derived stem cells.

Viscosupplementation (Hyaluronic Acid Injections)

When a joint becomes damaged from trauma or develops degenerative osteoarthritis, the natural level and quality of synovial fluid decreases. The synovial, or joint fluid, is comprised of large molecules called hyaluronic acid. Hyaluronic acid gives the joint fluid its viscoelastic properties, which keeps the joint lubricated and protected through a cushioning effect. Doctors can replenish or augment diminished joint fluid levels with injections of synthetic (manufactured in a lab) hyaluronic acid which can reduce pain and disability related to the damaged / osteoarthritic joint and enhance mobility and quality of life. Hyaluronic acid is also a key source of nutrition for joint cartilage and evidence in the scientific literature indicates that a regimen of 1- 3 annual viscosupplementation treatments with hyaluronic acid injections can slow the progress of degradation within the joint and help patients delay the need for joint replacement for several years, or avoid it altogether. Hyaluronic acid injections work best in mild to moderate arthritis.

Which joints can be treated?

Viscosupplementation treatment with hyaluronic acid injections are appropriate for any joint in the body from large ones like the knee and shoulder to smaller joints like the ankle and wrist.  

But I thought certain treatments aren’t allowed in Canada yet and my other doctor says there isn’t any evidence yet?

Interest in regenerative medicine therapies has increased significantly over the past 5-7 years, first in Europe and Asia, then the USA and slowly in Canada. 

Main drivers of interest in advanced orthobiologic therapies in Canada include such factors:
regenerative therapies have potential to treat almost any musculoskeletal condition

  • patient / physician desire for treatment options that are less risky than surgery
  • patient / physician desire for treatment options that are less invasive than surgery
  • patient / physician desire for treatment options with shorter recovery periods than surgery
  • patient desire / physician to explore all treatment options before surgery (e.g. joint replacement)
  • patient desire to avoid surgery again after experiencing suboptimal outcomes with previous surgery
  • patient desire to explore alternative options to strong pain medications / narcotics while they languish on wait lists for surgery in some instances
  • patient frustration when injury / degenerative disease interferes significantly with their quality of life, but they have been told they are not a candidate for surgery yet
  • patient empowerment when they come to understand and accept that the provincial health care plans do not / will not cover all available treatment options

Although regenerative medicine techniques offer a promising future for musculoskeletal care, the lay press, Dr. Google and under-informed clinicians offer up many conflicting views regarding safety, effectiveness, which specific techniques are available at present and which conditions can be predictably managed.

Dr. Simon only manages orthopaedic conditions that are within his scope of practice and for which there is clear literature support for potential benefit.  Worldwide, stem cell treatments for a wide variety of musculoskeletal diseases have been and continue to be extensively researched.  For example, this link (need to put the pub med “stem cell osteoarthritis” one here) will take you a searchable database of hundreds of published academic studies regarding a single disease – osteoarthritis of the knee – and is easily searchable for other conditions.  There are also hundreds more registered clinical trials underway at the moment (clinical trials.gov).  There have been large academic conferences about regenerative therapies every year that draw thousands of physicians from across the globe (http://www.prpseminar.com/tobi-2018/). 

In my view and experience, when others assert that there is “no evidence” or “no research,” it usually simply means, “I haven’t taken the proper time yet to educate myself thoroughly about the subject.” This a very common phenomenon in clinical medicine where it is actually impossible to keep up with anything but a fraction of developments across specialties. 

Specifically, with respect to the regulation of autologous stem cell preparations in Canada, according to Health Canada’s Safety of Human Cells, Tissues and Organs for Transplantation Regulations (SOR/2017-119) (Health Canada, 2017),  autologous  stem cells in concentrated adipose tissue used to manage musculoskeletal derangement do not currently fall within the regulation. Health Canada’s Application Section, Scope of Regulation, Non-application – various therapeutic products, states:

  1. These Regulations do not apply to any of the following therapeutic products:
    • cells, tissues, and organs that are for non-homologous use;
    • cells, tissues, and organs that are for autologous use.

At present, stem cell therapy, using autologous cells, reinjected on the same day, is legal in Canada. However, Health Canada does not currently specifically regulate cells that are for autologous use (using you own cells).  While this may change in coming years as federal and provincial Colleges of Physicians and Surgeons policy evolves, at present stem cell therapy is technically neither approved nor disapproved.  In the US, Stem cell use in clinical practice has dramatically increased. Concentrated Adipose Tissue (CAT) and Bone marrow aspirate concentrate (BMAC) may represent the safest and most feasible source of these cells as reported by Taylor and Graff in 2015. Additionally, The FDA guidance advises that a same-day concentration of bone marrow (BMAC) without additives is considered minimal manipulation and covered under the Code of Federal Regulations 361 (FDA regulations and Turner, 2015).


For more information

For more information on orthobiologic regenerative injection therapy, or to book a consultation, please see our contact page.