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General

We no longer offer PRP and Stem Cell procedures until further scientific evidence of its efficacy. We do PROLO Therapy for specific orthopedic conditions.

A2M: The next generation of non-surgical treatment for arthritis

Stem cell therapy and Platelet Rich Plasma (PRP) therapies are becoming increasingly popular for the treatment of many musculoskeletal degenerative disorders. While appearing promising as a means of decreasing pain and in some cases reversing disease, there remains many unknowns in regards to the ideal concentrations, treatment protocols, and long term effects of these treatments.

Add Alpha-2-macroglobulin to the short list of treatments that fall under the umbrella of regenerative medicine. Alpha-2-macroglobulin or A2M is a naturally occurring protein in the body that inhibits proteases (enzymes) that cause deterioration of cartilage which leads to arthritis.

Three protein classes which include cytokines, matrix metalloproteinases, and ADAMTS that have been identified as the culprits that cause the breakdown of cartilage cells leading to damage of joint surfaces. A2M has been shown to inhibit or inactivate these chemicals. Researchers have found that natural concentrations of A2M in the body may not be sufficient enough to protect the joints from the development of osteoarthritis. In response, a super concentrated form of A2M has been developed which can be injected into the joints. In fact, clinical trials of A2M (phase I/II) were approved by the FDA and began in May 2015. Data from this double blind, efficacy and safety study was recently reported and phase III trials are soon to begin.

At present, A2M is only being tested on patients with osteoarthritis of the knee. Unlike cortisone treatments, A2M does not appear to have negative side effects. Furthermore, A2M protects the joint surface and decreases inflammation.

As a new biologic treatment, targeted at treating osteoarthritis, A2M therapy has the potential to one day replace conventional treatments.

References:

Wang S et al. Identification of alpha2-macroglobulin as a master inhibitor of cartilage degrading factors that attenuates the progression of posttraumatic osteoarthritis. Arthritis Rheumatol. 2014 Jul; 66(7): 1843-1853.

http://cytonics.com/news/

http://finance.yahoo.com/news/cytonics-announces-recombinant-a2m-variants-194916921.html

Rotator Cuff Tendinopathies: A case for regenerative injection therapies?

 Rotator Cuff Tendinopathies: A case for regenerative injection therapies?

A painful shoulder is one of the most common complaints seen by orthopaedists.  Athletes who participate in repetitive overhand throwing sports such as baseball, basketball, and volleyball are at increased risk for shoulder injuries.  The same holds true for those who work in an occupation requiring overhead activity.  Pain and dysfunction to the shoulder(s) can also arise from normal aging.  The term rotator cuff syndrome is often used when referring to tearing within the rotator cuff tendons.

 

Anatomically, the rotator cuff is made up of four tendons: supraspinatus, infraspinatus, subscapularis and the teres minor.  These tendons originate along the scapula and attach at various points along the head of the humerus.  Within the shoulder there are several bursa which normally facilitate smooth gliding of the tendons and muscles.

Many painful conditions related to overuse that encompass the rotator cuff tendons and surrounding soft tissues, are commonly referred to as rotator cuff tendinopathy.  Rotator cuff tendinopathy is a very complex, multifactorial process involving both intrinsic (within a tendon) and extrinsic (outside of a tendon) factors.  Clinically, patients often complain of pain with specific motions such as reaching overhead, with lifting, and often at night when sleeping on the affected shoulder. Loss of normal range of motion may also be present with forward elevation of the shoulder and with abduction (moving arm away from the body).  Weakness and further loss of motion often result from disease progression. These symptomatic complaints may be caused by underlying degenerative changes within the tendons resulting in mechanical overload. Additionally, compression on the tendon(s) caused by bony structures may also accompany the forementioned intrinsic factors.

 

The combination of a good detailed patient history of complaints, a sound physical examination, and an MRI of shoulder can help the physician provide the proper clinical diagnosis and direct treatment.  Traditionally, treatment for tendinopathies has included NSAIDs, physical therapy, and corticosteroid injections.  Many can be successfully managed utilizing these non-surgical treatments.  As previously mentioned, rotator cuff tendinopathy is a complex condition and in some cases traditional treatments fail to help improve symptoms.   While there are varying surgical options depending on the specific underlying issue(s), the risks of the procedure and outcomes must be weighed.

In the last decade, the use of regenerative injection therapies for rotator cuff tendinopathies, has been developed and continues to evolve. Prolotherapy, Platelet-Rich Plasma (PRP), and even stem cell therapies have been applied.  Presently there is limited data to support regenerative injection therapies as a part of a standard medical treatment plan for rotator cuff tendinopathies.  However, its use has been reported with increasing frequency by the media among professional athletes.

A few randomized controlled trials and prospective studies utilizing Prolotherapy and/or PRP have been published in the last few years. Outcome measures have focused on pain scales, patient satisfaction, and disability indexes (Western Ontario Rotator Cuff Index, Shoulder Pain and Disability Index).  The results for the most part have been positive.  Further studies to show efficacy are needed.

 

References:

Bertran H, Reeves KD, Bennett CJ, Bicknell S, Cheng AL. Dextrose Prolotherapy versus Control Injections in Painful Rotator Cuff Tendinopathy. Arch Phys Med Rehabil. 2015 Aug 21.

Scarpone M, Rabago D, Snell E, Demeo P, Ruppert K, Pritchard P, Arbogast G, Wilson JJ, Balzano JF. Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study. Glob Adv Health. Med. 2013 Mar;2(2):26-31.