What is Biological treatment?
Therapy or treatment using biological substances derived from a patient’s own body tissue that are filled with cells and signaling molecules which has the potential to stimulate and enhance the healing process of the musculoskeletal system are called biological treatment. These can be either musculoskeletal degeneration or injury. This is a treatment aimed to restore body function by embracing the natural healing process of the body. This kind of treatment is also known as regenerative medicine or orthobiologics.

For which Orthopaedic conditions Biological treatment is practiced currently?

There is not enough evidence to suggest that these biological treatment signals or call other cells to initiate musculoskeletal regeneration and tissue healing in different musculoskeletal injuries like tendon, ligament or cartilage. But these biologic concentrates tremendous capability of anti-inflammatory effect due to containing numerous active factors and proteins.

Probably this is the reason biological treatment gives lots of symptomatic relief in different musculoskeletal degenerative conditions and injuries of . Common uses of biological treatment are;

• Osteoarthritis and joint pain
• Tendinosis and partial tear, like tennis elbow, golfer’ elbow, supraspinatus tendinosis (rotator cuff arthropathy), Achilles tendinosis, quadriceps tendinosis, gluteus tendinosis like.
• Muscle sprain and strain, like hamstring injury
• Ligament sprain and tear related chronic painful condition
• Cartilage injury
• Plantar fasciitis
• AVN of hip
• Neuritis
• Metatarsalgia
• As an augment for different tissue graft surgeries like, ACL reconstruction, PCL reconstruction, Meniscal repair.

What are the different types of Biological therapies?

There are different types of Orthobiologics available and are being used currently.

They are mainly serum based or cell based.

• Serum or protein based: Platelet rich Plasma (PRP), Visco-supplement, bone morphogenic protein (BMP), demineralized bone matrix (DBM)
• Cell based: Bone marrow Concentrate (BMC), Stem cell therapy, cultured cell therapy

How does Biological therapy work?

How they will work depends on what type of biological therapy is being used. Theoretically these biological products interact with the body’s own cell and tissue to stimulate the healing process. On the other hand, these orthobiologics are rich in numerous factors which have huge anti-inflammatory potential. It relieves pain by reducing inflammation at the application site. Serum and protein-based biologics probably work as anti-inflammatory only and cell-based biologics initiate tissue healing by promoting new cell growth.

How safe is Biological therapy?

Biologics are derived from patients’ own body so there is very negligible chance of any severe adverse effect but can initiate a local inflammatory response after application. If they are harvested from some other person then there may be a chance of blood borne disease transmission. Safety of Stem cell therapy has not been established yet because of the huge potential of these stem cells to differentiate into any form of mature cell. Currently use of stem cells is restricted only for approved research-based therapy.

How are Biologics prepared?

Procedure for preparing biologics is different for each type of product, but for all baseline materials are harvested from the patient itself and then processed in the laboratory to prepare the product.
PRP: Blood is collected by venipuncture and then centrifuged in a specific protocol and condition to get a layer of plasma that is rich in platelet. To get best preparation there should be a specific spinning cycle, temperature, and amount of blood to be collected.
Stem cell: Bone marrow or adipose cells are collected and then cultured in lab under specified conditions to grow the desired lineage of stem cell for the use. Like stem cells for cartilage regeneration and tendon regeneration will be different and they cannot mix and match. It’s technically a very demanding procedure. Only a few dedicated labs have this facility. More off stem cell therapy is restricted only for research purposes in institution based.
BMC: Bone marrow is harvested from a patient’s pelvic bone and the marrow cells are separated by concentrating in a centrifuge. And then these concentrated bone marrow cells are applied to the desired site to get the healing.
Viscosuppliment: Selective synovial fluid protein; hyaluronic acid is manufactured synthetically by genetic bioengineering. And then stabilized by different techniques and made commercially available for intra-articular injection.

How are Biologics used for therapy?
Most of the time the biologic products are intended to be used locally within the tissue concerned by Injection. Sometimes USG guides are used for precise delivery of the biologic at the site of interest. Most common sites are intra-articular, paratenon area, locally around the injured tissue, likely muscle, tendon, ligament, or bone.
Use of PRP: OA knee, tennis elbow, Achilles tendinosis, peroneal tendinosis, tibialis posterior tendinosis, tendinosis of Gluteus Medius, hamstring bursitis, metatarsalgia.
Use of BMC: for bone regeneration in fracture non-union and AVN, enhance cartilage regeneration in cartilage injury repair, enhance wound healing and healing of tendon injury and degeneration.