Page 9 - SMU Spring 2020

TEAM PHYSICIAN’S CORNER

The Use of

Orthobiologics

for Early Knee

Osteoarthritis

BY SETH L. SHERMAN, MD, TAYLOR E. RAY, BS,
AND JACOB G. CALCEI, MD

ORTHOBIOLOGICS is an emerging Non-Operative Treatment one series, an intensive diet and exercise
field of treatments that employ biologically of Early Osteoarthritis program resulted in a more than 10 kg
active therapies in the treatment of Knee OA is a problem that affects over 14 weight loss, over 50 percent reduction
musculoskeletal problems, including million Americans. When combined with in knee pain, and an increase in QALY.
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osteoarthritis. The world of orthobiologics obesity, knee OA accounts for 3.5 quality- Every pound of weight loss can have an
is both exciting and largely unknown. As adjusted life-years (QALY) lost per person. exponential effect on the forces experienced
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with other new and promising treatment When approaching a patient with signs and by the knee joint with everyday activity.
options, the clinical use of orthobiologics symptoms consistent with symptomatic Activity modification protects the joint
has sped past the availability of high-level early OA, it is important that your and gives an opportunity for symptom
research for a variety of conditions. treatment plan is individualized to address recovery. Cross training to avoid impact,
With buzzwords like “stem-cell” and the root cause of their problem. Employing subtle changes in technique, amount, or
“regenerative,” it is concerning that a plan that maximizes non-invasive duration of activity can have profound
hype has the potential to overshadow measures should be the first step. These and early effects. Focused physical
science. While there is growing evidence interventions include weight management, therapy combined with a home exercise
to support the use of orthobiologics activity modification, physical therapy, program is critical. For knee injuries,
for several conditions, many questions icing, anti-inflammatory medications, and we focus on “core-to-floor” flexibility,
remain. These include, but are not bracing. Orthobiologic injection(s) should dynamic stabilization, then strengthening,
limited to, the optimal type of injection, ONLY be considered as an adjunct to this followed by activity specific training.
preparation, dosage, timing, and exact comprehensive treatment strategy. Bracing has proven effective in the
indications. Here, we present an update Fifty percent of Americans with management of early osteoarthritis.
on the current state of orthobiologics in symptomatic knee OA are obese. Weight In a randomized-controlled trial
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the treatment of early knee osteoarthritis loss through diet and low-impact exercise of 149 patients, those patients with
(OA). Our hope is to help guide the sports is perhaps the most effective means of malalignment (i.e., varus or valgus) who
medicine physician or surgeon in their improving symptoms and preventing wore unloader braces demonstrated
use of these promising treatment options. further progression of osteoarthritis. In improvement in all outcome measures.
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Spring 2020, Issue 2 | sportsmed.org 7 