BIOLOGICS
Orthobiologics is a cutting edge area of orthopedics in which substances made up of viable tissue and cells can be used to promote injury healing. Dr. Bedford is widely versed in this area of orthopedics, and the procedures he performs include everything from stem cells to grafts. Dr. Bedford performs procedures using biologics in both the office and the operating room. Read more below for detail on each procedure and visit the office to find out if biologics can help you.
Bone Marrow Aspirate Concentrate (BMAC)
BMAC, or Bone Marrow Aspirate Concentrate, contains true stem cells found in bone marrow drawn from the hip bone (iliac crest) during a minimally invasive procedure in the operating room. The bone marrow is then spun in a centrifuge machine at a high speed for 20 minutes to separate its components by weight, and the concentrated stem cells are then injected into the affected area. The procedure takes about 40 minutes in the operating room under light anesthesia. BMAC is recommended as a one time injection due to the high concentration of stem cells. The healing effect of BMAC varies based on location of its use, and it can take up to 8-12 weeks following completion of the injection for full effect. Physical therapy following the procedure is often prescribed to enhance healing. During the series of injections, it is important to refrain from using anti-inflammatory medications (NSAIDs) as they can dampen the body's inflammatory healing response stimulated by BMAC. The duration of symptom improvement after BMAC varies; however, BMAC often lasts years at a time, with some patients never requiring a repeat injection.
Platelet Rich Plasma (PRP) Injections
What is PRP?
PRP or Platelet Rich Plasma, is a component of blood which contains plasma, platelets, and growth factors. These components are extracted from whole blood through centrifugation, or separation of the parts of the blood by weight. These useful components of blood found in PRP have been proven to stimulate the body's own healing response to tendon, ligament, and cartilage injuries.
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What does the procedure entail?
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PRP is given via an injection performed at an office visit. Blood is drawn in the office from the front of the elbow (antecubital fossa). This blood is spun in a centrifuge machine at a high speed for five minutes to separate its components by weight, and the plasma portion is then injected into the affected area. The procedure takes 15 minutes from start to finish. A series of three injections, once weekly for three weeks, is the current standard of care.
What can I expect following my PRP injections?
The healing effect of PRP varies based on the location of its use, and it can take up to 8-12 weeks for full effect. Often, physical therapy is prescribed following completion of the series of injections to enhance healing. During the series of injections, it is important to refrain from using anti-inflammatory medications (NSAIDs) as they dampen the body's inflammatory healing response stimulated by PRP. The duration of symptom improvement after PRP varies; however, PRP often lasts years at a time with some patients never requiring a repeat series of injections.
Cartilage Patch
What is a cartilage patch?
A cartilage patch is an implant made up of viable cartilage tissue and cells. This implant can be surgically fixed to a defined area of cartilage loss (think of a pothole in a paved road) to replace the lost cartilage. When the cartilage coating the ends of bones (articular cartilage) is damaged, the affected joint can be painful, swollen, or cause sensations of grinding and friction. You may damage your articular cartilage through a sports injury, a trauma or fall, or through wear-and-tear.
Dr. Bedford routinely performs the cutting edge surgery to place a cartilage patch. The procedure is athroscopically assisted, but involves an open incision and time in the operating room. The area of exposed bone where the articular cartilage has gone missing is cleaned and prepared for the implant, and the implant is cut to a size matching the defect and anchored into place.
Where are cartilage patches used?
Cartilage patches are only useful in small to medium sized areas of focal cartilage. They are not appropriate in a case of osteoarthritis, where the articular cartilage is more globally or generally thinned, roughened, or worn. A consultation with Dr. Bedford in the office as well as x-ray and/or MRI imaging can determine if a cartilage patch is right for you.
Examples of cartilage patches used in surgery:
Coming soon.
Allograft Patches
What is an allograft patch?
An allograft patch, or donor tissue, can be used for chronic or severe tendon tears. The tissue can be added to your native tissue to promote tendon healing through a variety of techniques: it can be laid over your tendon tissue, used to reconstruct your tendon tissue, or can be sewn into your tendon tissue. Dr. Bedford may choose to use an allograft to repair your tendon injury if it is chronic or severe.
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Chronic injuries: When a tendon tear is "old" (happened many weeks or months ago), the torn tissue becomes harder to repair as time passes due to changes in tendon tissue elasticity and tissue blood supply.
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Severe injuries: Sometimes when a tendon tears, the torn end recoils ("retracts") an especially large distance. Tendon tissue is usually elastic, but sometimes the retraction is so great that the tissue cannot be stretched back out to the length needed for proper repair.
Dr. Bedford routinely uses allograft patches to augment healing for rotator cuff tears, quadricep tendon tears, and achilles tendon tears, when they are chronic or severe in nature as above. He will discuss this with you during your surgical consultation if he feels it may be needed to repair your tendon tear.
A Superior Capsular Reconstruction is a procedure in which an allograft patch is used.
In the case of a chronic, massive, or irreparable rotator cuff tear, a dermal allograft patch is used to recreate the rotator cuff tissue. During shoulder arthroscopy, the graft is placed across the top of the shoulder (glenohumeral) joint to act as a structural bridge. It is anchored in place and stretches from the shoulder socket (glenoid) to the ball (humerus).
Intact rotator cuff tendon tissue works to raise the arm overhead or away from the body, and a superior capsular reconstruction uses an allograft patch to replicate this function: superior capsular reconstruction restores normal shoulder anatomy and tension to the shoulder (glenohumeral) joint, and this allows the deltoid muscle and any surrounding intact portions of the rotator cuff to contract and perform the function of the native rotator cuff.
Images coming soon.
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