What is Orthobiologic Treatment for Rotator Cuff Tears?
Orthobiologics are natural substances such as cells, blood components, and growth factors that are typically used to speed up the healing of damaged tissues such as bones, muscles, tendons, and ligaments. Orthobiologics may be obtained from your own body or a donor and are usually administered in the form of injections. They can be used in the treatment of many orthopedic conditions including shoulder injuries.
Orthobiologic treatment for rotator cuff tears is the use of orthobiologics for the treatment of rotator cuff tears in the shoulder.
Anatomy of the Shoulder
The shoulder is a ball and socket joint that allows various arm movements. The head of the upper arm bone (humerus) articulates with the glenoid cavity of the shoulder bone (scapula). The two articulating surfaces of the bones are covered with cartilage which prevents friction between the moving bones. A rotator cuff is a group of four tendons that joins the head of the humerus to the deeper muscles and provides stability and mobility to the shoulder joint. Major injury to these tendons may result in rotator cuff tears. It is one of the most common causes of shoulder pain in athletes and middle-aged and older individuals. A rotator cuff tear may occur with repeated use of the arm for overhead activities, while playing sports, or from a motor accident.
Significance of Orthobiologics
Your shoulders are normally used for various activities involving repetitive movements and are prone to wear and tear. Over time, the damage to your shoulder muscles can get worse unless the body’s repair system is somehow enhanced. Orthobiologics can help boost your body’s repair system and ensure fast and efficacious healing naturally.
Your body can repair most injuries by itself. However, with severe injuries or with advancing age, your body’s repair process may find it difficult to keep up with the damage done.
Specialized cells are present in all of us that act like a repair system for the body. The purpose of orthobiologics is to make use of these specialized cells to aid in the natural regeneration of injured or damaged tissues such as bone, muscle, or tendon. When these cells are injected into your injured or torn rotator cuff muscles, they begin to divide, grow, and subsequently develop into the kind of cells needed for repair thus accelerating the healing process.
Types of Orthobiologics
Some of the different types of orthobiologics include:
- Platelet-rich plasma (PRP): PRP is obtained from your own blood after it has been processed to concentrate platelets and certain white blood cells that enhance healing and reduce inflammation. PRP may be injected directly into the damaged tissue during an outpatient procedure or following repair surgery.
- Bone marrow aspiration concentrate (BMAC): BMAC is obtained after processing bone marrow that is removed from your pelvic bone. BMAC is rich in specialized cells, which produce proteins and growth factors necessary for healing and reducing inflammation. Specialized cells are cells that can develop into a particular type of tissue or organ. While there are various types of specialized cells, the ones located in the bone marrow are regarded as the best at promoting musculoskeletal healing.
- Adipose tissue: Adipose tissue or fat cells have remarkable healing and regenerative properties. They are typically obtained from your waist, processed to remove impurities and inflammatory components, and then injected at the site of injury.
- Amniotic products: Amniotic tissue products such as amniotic membrane and amniotic fluid can reduce inflammation and promote healing in tissues due to their cellular content and the presence of hyaluronic acid. They are available as injections or patches. Many research studies have indicated that amniotic products are capable of reducing pain and inflammation in joints afflicted with osteoarthritis.
- Autologous cell therapy: In this type of orthobiologic, a blood sample is extracted from a vein in your arm and a sample of bone marrow is obtained from the pelvis through a needle. Subsequently, platelets are isolated from the blood sample and specialized cells are isolated from the bone marrow sample. After preparation, these 2 components are injected into the affected shoulder region using advanced imaging guidance.
Indications for Orthobiologic Treatment for Rotator Cuff Tears
Your physician may recommend orthobiologic treatment for rotator cuff tears if you have experienced significant trauma to the shoulder that has resulted in severe injury or rupture of the rotator cuff muscles, and conservative treatment measures such as rest, medications, and physical therapy have failed to relieve symptoms and surgery is being considered. Orthobiologics may help rule out surgery and relieve symptoms of rotator cuff tears, such as:
- Severe pain
- Muscle weakness or tenderness
- Decreased range of motion
- Loss of shoulder strength
Procedure for Orthobiologic Treatment for Rotator Cuff Tears
The procedure begins with your doctor extracting orthobiologics or specialized cells from your body. There are many sources of these specialized cells in your body. The most important source is bone marrow located in the center of long bones and the pelvic bones from where they are usually derived as this region has the highest concentration of these cells. However, these cells may also be harvested from natural fat deposits in your body such as the abdomen. Your doctor will choose the right source depending on your requirement and condition.
The procedure usually takes about half an hour depending on several factors. It is performed under local anesthesia. Fluoroscopic guidance or a highly sophisticated ultrasound instrument with enhanced needle visualization is used for the precise delivery of these cells.
During the procedure:
- The area from where the cells are to be harvested is cleaned and numbed.
- Using a special needle and syringe, fluid containing the cells is drawn from the source.
- The fluid obtained is then spun in a centrifuge machine for 10 to 15 minutes.
- This process helps obtain a concentrated layer of the specialized cells to be used.
- The rotator cuff shoulder area is thoroughly cleaned and numbed.
- The specialized cells are then injected into the damaged or torn rotator cuff muscle area under image guidance.
In the event that the orthobiologics are obtained from a donor, the sample is tested and treated to ensure that it will not create an immune or allergic reaction in the patient. You will usually return home on the same day.
Post-procedure care will include the following instructions:
- You will most likely be able to return to work the next day following your procedure.
- You will need to take it easy and avoid any load-bearing activities for at least two weeks following your procedure.
- You will need to refrain from taking nonsteroidal anti-inflammatory drugs (NSAIDs) for a while as this can affect the healing process of your body.
- You may apply warm or cold compresses to the treatment area for comfort.
- Rest, medicines, and support such as a shoulder sling are recommended to relieve pain and swelling, facilitate healing, and for comfort.
- A follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Orthobiologic treatments for rotator cuff tears is a relatively safe procedure; however, as with any procedure, there may be some complications, such as:
- Nerve damage
- Immune reaction
- Pain, soreness, or tenderness at the injection site