Update on Biologics in

Orthopedics and

Sportsmedicine

Platelet Rich Plasma(PRP)

Adult Chondrocytes

Adult Stem Cells

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

Bennett Orthopedics and

Sportsmedicine

Regenerating the Youth in You!

William F Bennett MD

Orthopedic Surgeon 1250 S. Tamiami Trail

www.Bennettorthopedics.com

www.facebook.com/bennettorthopedicsandsportsmedicine

copyright 2012

Reference List

www.orthodoc.aaos.org/williamfbennettmd/prp%20references.docx

copyright 2012 Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

Biologics In Orthopedics There are materials in your own bodies that can

help heal injuries.

These materials may or may not be manipulated outside the body.

Some are commercially produced need FDA approval

Others are Point-of-Service, do not need FDA approval

This talk is about these.

They include cartilage cells, stem cells, platelets, collagen, bone, amongst others

Bennett Orthopedics and Sportsmedicine

Regenerating the Youth in You!

copyright 2012

Platelets, Chondrocytes, Adult

Stems Cells and More

ALL Yours!

Objective:

• Illustrate how substances that are found in our own bodies can stimulate , accelerate and advance healing and recovery from various orthopedic conditions and injuries

4 Sections of this talk- I will discuss the first 3

1.) Platelets-PRP or Platelet Rich Plasma

2.) Cartilage-Adult chondrocytes-ACI-Carticel

3.) Adult Bone Marrow Derived Stem Cells-

4.) Minimally Invasive Total Knee with PRP

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

copyright 2012

copyright 2012

Section 1

Platelets

Platelet Rich Plasma

PRP/ACP/ACS

Fairy Tale or Fairly Useful?

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

Platelet Biologics

“Spinning Blood” Patients walk in our offices with Information from

the Internet

Wall Street Journal- ”Spinning Blood isn’t Just for Athletes Anymore”!

Spinning Blood is PRP or Platelet Rich Plasma

I will introduce you to some terms, and the objective will be for the audience to leave with a basic understanding of

terms, applications, clinical and scientific outcomes.

PRP is a Concentration of Platelets from your own venous blood

Many Uses in medicine and in orthopedics-

tendon, ligament, cartilage, osteoarthritis

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

copyright 2012

PRP Accelerates Healing!!!!!!!!!

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

copyright 2012

Platelets

Platelets are found in blood

Blood has red blood cells, white blood cells, fibrinogen, clotting factors, over 1,000 assorted cytokines, hormones, amongst other items.

At the time of injury platelets play a role in the inflammatory process and clotting process, more importantly, related to this lecture, they release growth factors-cytokines

Growth Factors-(inflammatory/catabolic or anabolic)

Examples include-TGF-Beta, PDGF, VEGF, HGF, FGF, EGF, IGF1 amongst others.

Growth Factors recruit cells that can make new tissue- both pluripotential cells and adult tissue cells.

Growth Factors stimulate extracellular matrix production and cell differentiation

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You! copyright 2012

Tissue Injury

Tissue repair- relies on an “inflammatory process”, when appropriate, breaksdown and removes damaged tissue and lays down new tissue using adult tissue cells and adult stem cells

Acute Injuries-

-blood escapes and forms a hematoma -Platelets and pluripotent stem cells are in the clot -Cells, adult and stem, respond to the growth factors ( Growth Factors are Bioactive agents in platelets) -Some cells respond differently to the growth factors based upon surrounding tissue.

Chronic Injuries- usually mild chronic inflammation associated with tissue degeneration and can result in granulation tissue, avascular

Bennett Orthopedics and Sportsmedicine

Regenerating the Youth in You! copyright 2012

Literature Sample

Fairly Useful The Positive Effects of Different Platelet-Rich Plasma Methods on

Human Muscle, Bone, and Tendon Cells

Mazzocca, Augustus D. et al.

American Journal of Sportsmedicine

Vol. 40, No. 8

2012 copyright 2012 Bennett Orthopedics and Sportsmedicine

Regenerating the Youth in You!

Literature Sample

PRP Fairy Tale

Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy-de Vos R. JAMA, 2010, January 13 Vol.303 No.2 p144- no data on PRP concentration, wbc concentration or absolute platelet number

copyright 2012 Bennett Orthopedics and Sportsmedicine

Regenerating the Youth in You!

What Is “PRP”?

Platelet Rich Plasma

Fortier, 2011, citing American Red Cross

International Cartilage Repair Society, 10th World Congress, Montreal, 2012 copyright 2012

American Red Cross

Definition of PRP 5.5 x10(tenth power) per 50 mls

About 1,000,000 platelets per

microliter which is 2-5x’s baseline

Depends on initial platelet count

Absolute number should

approach 1,000,000 per microliter

copyright 2012 Bennett Orthopedics and Sportsmedicine

Regenerating the Youth in You!

Not all PRP is PRP

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You! copyright 2012

PRP- What is It?

Not just platelets Concentrations vary in fixed plasma amount

White Blood Cell

Red Blood Cell

Fibrinogen

• Variations

length of Centrifuge time

Force of centrifugation

number of cycles

Laboratory type- Perfusion machines

Commercial Type- single and double spin

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

copyright 2012

PRP not PRP

Fortier, 2011

International Cartilage Repair Society, 10th World Congress, Montreal, 2012 copyright 2012

Are White Blood cells bad?

What Varies?

White Blood cells

Platelets

Fibrinogen

*plasma volume is fixed

copyright 2012

Bennett Orthopedics and Sportsmedicine Regenerating the Youth in You!

copyright 2012

Bennett Orthopedics and Sportsmedicine

The Augmentation of a Collagen/Glycosaminoglycan BiPhasic Osteochondral Scaffold with Platelet-Rich Plasma And Concentrated Bone Marrow Aspirate for Osteochondral

Defect Repair in Sheep Getgood A. et Al.

Cartilage October 3(4) 351-363, 2012

*Leukocyte Concentration did not negatively affect the positive affects of PRP when creating a more normal appearing cartilage, and creating closer hyaline cartilage as evidenced by increased collagen Type 2 with immunohistochemical analysis *Negative relationship between platelet concentrations above 1 million platelets/micro-liter