Biologic Injections

Many patients ask about biologics for their sports injuries and arthritis.  Biologics are not a holy grail, but have tremendous promise for a variety of conditions ranging from acute sprains to chronic tendinitis and osteoarthritis.  While the science is not complete in this realm, and is relatively new in sports medicine, the overwhelming evidence so far shows that the treatments are safe.

In my practice we use a variety of biologic treatments, but always present the science to allow for a comprehensive understanding of treatment options, costs, and expected outcomes.  The most basic type of biologics we use are hyaluronic acid (HA) preparations for osteoarthritis.  There are several brands available and each has pros and cons.  Insurance coverage varies, but the cost to patients from certain pharmacies is reasonable in many circumstances.  The injections are then administered at the doctor’s office.  The effects of these injections is best in earlier stages of arthritis.  Placement in the joint with aspiration of joint fluid, before administration of the compound, using ultrasound guidance has been the most effective means of insuring good outcomes in my practice.  These injections can be used in the knee, hip, and shoulder.  Beyond arthritis, HA injections are sometimes useful in hip dysplasia and hip impingement cases, sometimes obviating the need for surgery.

Derivatives of whole blood can be useful for soft tissue injury.  In years past, and in certain circumstances where people prefer low cost options, whole blood can be utilized for soft tissue injections to propagate healing.  The derivatives used in clinical practice also include PRP (platelet-rich plasma).  Of which there are different varieties.  The concentration and components (specifically white blood cell lines) can have varying impact on immediate and delayed inflammation and healing response rates.  The cost of this procedure is modest in my practice and most patients consider this procedure affordable.  Rotator cuff tendon disease, tennis elbow, hamstring strain, quadriceps and patella tendon disease are examples of areas that respond well to this treatment. Using blood products as a “patch” or graft to partially torn tissues such as the ulnar collateral ligament (UCL) of the elbow is another example of how this type of injection can be used to improve healing.

On the horizon are stem cells.  The most common versions of this are bone marrow derived stem cells and fat derived stem cells.  Osteoarthritis (OA), commonly fairly advanced OA, is a common pathology for which patients will opt for this treatment.  While the hope for cartilage regeneration remains possible, science has not concluded that appreciable cartilage growth with stem cells actually occurs with administration of this remedy.  The cost of these treatments is often 5 times the cost of PRP and I use this judiciously when patients have failed other options.

The most concerning part of this science and practice is the predatory nature of biologic clinics run by non-medical doctors that charge very high rates for unproven treatments.  Often times these procedures are performed by poorly trained medical providers without appropriate image guidance.  Even in some major medical practices there is over utilization of very expensive treatments before ever trying more cost effective, simple measures.  The appeal of “silver bullets” to some people allows the propagation of this practice.  Some sports docs argue that the type of injectable is less important than getting it to the specific target tissue.  This is only possible with image guidance, which is a strong component of my practice, and of other respected sports docs.

 

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