Regenerative medicine is an area of medicine that deals with a “process of replacing, engineering or regenerating human cells, tissues or organs to restore or establish normal function”. This field holds the promise of engineering damaged tissues and organs via stimulating the body’s own repair mechanisms to functionally heal previously irreparable tissues or organs. The term “regenerative medicine” was first found in a 1992 article on hospital administration by Leland Kaiser. Kaiser’s paper closes with a series of short paragraphs on future technologies that will impact hospitals. One paragraph had ‘‘Regenerative Medicine’’ as a bold print title and stated, ‘‘A new branch of medicine will develop that attempts to change the course of chronic disease and in many instances will regenerate tired and failing organ systems.’’
It’s use in musculoskeletal conditions has just begun to be researched and has limited applications. Most of the available materials have limited FDA approval and most often used “off label” which REQUIRES a medical professional to obtain specific consent for their use and explain the indicated uses, consent for the “off-label” use and record outcomes over extended periods of time for both success/failure and complications. Here you will find some basic information on the use of injectable and surgical regenerative medicine technologies we currently use in special circumstances. Many of these are investigational or “off label” and NOT COVERED by insurance plans. As the science of regenerative medicine is rapidly changing, especially with regard to stem cells, it is important to learn as much as you can before undergoing any treatment, by any medical provider, using these technologies.
There are many new biologic companies and “regenerative medicine” practitioners touting the “miracle cures” of stem cells and other regenerative medicine products. These technologies are being heavily marketed as they are a “cash” business (only hyaluronic acid is covered by insurance). Many of these “regenerative medicine” clinics have minimal to no expertise in the areas they claim. Before we discuss the current state of this technology, it is important to understand WHO is out there using it and advertising the service.
Orthopedic Surgeons are the true experts in musculoskeletal care. There are many non-Orthopedic physicians (and even non-physicians) treating Orthopedic injuries. Orthopedic Surgery training, and specifically Orthopedic Sports Medicine, is very long and extremely competitive. An allopathic program (MD) requires 4 years of a top medical school after college, then 5 years of an ACGME accredited residency, where the entire focus is on Orthopedic (musculoskeletal) conditions. Allopathic Orthopedic residencies are the most competitive of all specialties in medicine. Most Orthopedic residents graduate after 5 years and then choose to do a fellowship – an additional 1 year of intensive training in a specific subspecialty of Orthopedic Surgery. The most competitive of all of these is Orthopedic Sports Medicine (others include hip/knee replacement, shoulder/elbow, foot/ankle, spine, pediatrics, oncology, hand/wrist). There are many non-accredited fellowships and “apprenticeships” that are not qualified by the ACGME. The programs do not meet the standards of the ACGME. During this entire process, anatomical dissections occur frequently and complete study of the musculoskeletal system centers around bone/cartilage/muscle/tendon anatomy, histology, physiology, biomechanics, biochemistry and surgical and non-surgical repair/healing. In addition, the it take 6 years to master the art of diagnosis and treatment and, more importantly, the understanding of how to analyze new information presented/published on a daily basis. There is simply not another single medical professional who even comes close to understanding the musculoskeletal system as well as an Orthopedic Surgeon. Other “sports medicine” physicians have minimal training and experience, yet claim to be equal to Orthopedic Surgeons. They simply do not have the same level of education and training and essentially know the “basics”. They have expertise in some areas of nonsurgical/noninvasive management but often do not even understand the anatomy of a joint which they often inject. If you seek out treatment for a bone/joint/tendon/ligament problem, it is recommended that you seek out a Board Certified, Fellowship trained Orthopedic Surgeon for, at the minimum, an opinion, before you have any treatment.