#6 Biologics in Orthopaedic Repair

Overview

It’s a dreaded injury for athletes and laypeople alike – the all-too-frequent ACL tear. Characterized by a twist and a pop, ACL injuries typically result in rapid swelling and the feeling of instability in the knee. An estimated 300,000 ruptures of the anterior cruciate ligament occur per year in the U.S – with a large percentage in scholastic-aged athletes. Reconstruction for this injury, among other common orthopaedic procedures, can set an individual back months, to years in recovery.

Reconstruction for an ACL tear is fairly standard, and has been refined over time to become less invasive. Although most patients are able to return to sports/daily activities, ACL re-tear rates can be as high as 20%, with approximately 80% of patients developing arthritis 15 to 20 years after surgery. For faster, lower-risk treatment with the potential for better long-term results, specialists are leveraging patients’ own tissue and immune system and exploring the use of biologics in orthopaedic repair.

Biologics are defined as drugs made from complex molecules manufactured using living microorganisms, plants, or animal cells. But in orthopaedic repair, use of biologics refers to cells, blood components, growth factors, and other natural substances that replace or harness the body’s own power to promote healing and decrease inflammation.

Fortunately for the 300,000 individuals suffering an ACL tear each year, the concept of biologic use in orthopaedics is farthest along in ACL repair. Several systems are studying new methods utilizing the biologic of blood to mend existing tissue. Unlike traditional ACL reconstruction – wherein a surgeon removes the ends of the torn ligament and replaces them with a graft – this new technique utilizes nothing but stitches and a bridging scaffold (a sponge injected with proprietary biologic factors in combination with the patient’s own blood) to stimulate healing of the torn ACL. In this procedure, only a minimal incision to insert the scaffold is required, there is no secondary-site graft harvest, and remaining ACL tissue is preserved rather than cut. The method has been tested in 75 patients to date. A pivotal trial for the full efficacy of this procedure starts this October.

The biologic approach is being explored in other common orthopaedic procedures, as naturalistic medicine is of great research interest. For example, there are several early stage trials testing its use in rotator cuff repair. Biologics are also being explored as coatings for orthopaedic implant devices to improve adoption and reduce risk of infection. Leveraging the repair power of the human body, biologics hold the potential to provide every orthopaedic patient a more effective, more natural, speedy recovery.

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