Regenerative Medicine: A Complete Guide for Musculoskeletal and Spine Disorders

Preface
Contents
Contributors
Editors
Section Editors
Contributors
Part I: Basics of Regenerative Medicine
	1: Introduction to Regenerative Medicine
		Fate of Transplanted Cells
		Precipitation Viewed as a Nonsolute Quality
		Mechanical vs. Medical
		References
	2: Prolotherapy
		Introduction
			Prolotherapy vs. Platelet-Rich Plasma (PRP)
		Indications
			Lower Extremities
				Knee Osteoarthritis
				Patellar Tendinopathy
				Anterior Cruciate Ligament (ACL) Laxity
				Osgood-Schlatter Disease
				Achilles Tendinopathy
				Plantar Fasciitis
			Upper Extremities
				Rotator Cuff Tendinopathy
				Glenohumeral and Acromioclavicular Joint Osteoarthritis
				Lateral Epicondylosis
				First Carpometacarpal Joint Osteoarthritis/Hand Osteoarthritis
			Axial
				Lumbar Ligament Sprains and Facet Joint Capsule Laxity
				Sacroiliac (SI) Joint Dysfunction
				Cervical Ligament Sprains and Facet Joint Capsule Laxity
			Head & Face
				Temporomandibular Joint (TMJ) Disorder
		Microanatomy and Biochemistry
			Hypertonic Dextrose and Neurolysis
			Animal Studies
				Rat Achilles Tendon and Prolotherapy
				Rat Medial Collateral Ligament (MCL) and Prolotherapy
				Rabbit Femoral Cartilage and Prolotherapy
		Basic Concerns and Contraindications
		Preoperative Considerations
		Radiographic Guidance
		Equipment
		Technique
		Post-procedure Considerations
		Potential Complications and Pitfalls
		Clinical Pearls
		Suggested Reading
	3: Blood Products
		Platelet-Rich Plasma
			History
			Preparation and Obtaining PRP
			PRP Types and Classifications
			Proposed Mechanisms of Action
			Applications in Musculoskeletal Medicine
		Platelet-Poor Plasma with Alpha-2-Macroglobulin
			Introduction
			Properties
			Indications
		Orthokine, Regenokine, Interleukin Receptor Antagonist Protein
			Introduction
			History
			Properties and Relation to PRP
			Role and Applications
		Commercially Available Products
			Introduction
			Available Products and Vendors
		References
	4: Bone Marrow-Derived Stem Cells and Their Application in Pain Medicine
		Introduction
		Microanatomy and Biochemistry
			BMC vs. Adipose
		Indications
		Safety Profile and Contraindications
		Preoperative Considerations
		Radiographic Guidance
			Ultrasound
			Fluoroscopy
		Equipment
		Technique
			Harvesting Risk
			Processing
			Dosing Bone Marrow Concentrate
		Post-operative Considerations
		Potential Complications and Pitfalls
		Clinical Pearls
		References
	5: Adipose-Derived Stromal Stem Cells
		Introduction
		Indications
			Musculoskeletal Conditions Treated with Adipose-Derived MSCS
			Chronic Conditions Treated with Adipose-Derived MSCS
		Microanatomy and Biochemistry
		Regulatory Status
		Basic Concerns and Contraindications
		Preoperative Considerations
		Equipment
		Technique of Lipoaspiration
			Preparation of Tumescent Anesthetic Fluid
			Infiltration of Tumescent Anesthetic Fluid
			Collection of Lipoaspirate
			Post-Procedure Care
		Adipose Processing: Enzymatic and Mechanical
		Reintroduction of the Adipose Stem Cell Product
		Post-Procedure Care and Potential Complications
		Clinical Pearls
		References
	6: Intra-annular Fibrin Discseel®
		Introduction
		Background
		Discography & Annulograms
		Discseel® Procedure vs. Intranuclear Fibrin
			Microanatomy and Biochemistry
		Indications
			Patient Selection
			Prior Nonsurgical Treatment
			Prior Spine Surgical Treatment
			Anatomic Exclusion Criteria
			Absolute Contraindications
			Relative Contraindications
		Equipment
			Staff
			Pre-Procedure
				History and Physical Examination
				Informed Consent
				Premedication
				Allergy
		Technique
			Selecting Disc Levels to Test and Treat
			Target Identification
			Technique Needle Placement
			Post-Procedural Care
		Conclusion
		References
	7: Allograft Therapies in Regenerative Medicine
		Introduction
			Overview
			Guidelines for Allograft Therapy
		Amniotic Tissue
			Potential Indications
			Experimental Clinical Application
			Concerns and Contraindications
			Preoperative and Operative Considerations
		Umbilical Cord Blood
			Potential Indications
			Experimental Clinical Application
			Concerns and Contraindications
		Preoperative and Intraoperative Considerations
		References
	8: Adult Mesenchymal Stem Cell Collection and Banking
		Stem Cell Applications in Regenerative Medicine
		Mesenchymal Stem Cell Sources
			Bone Marrow
			Umbilical Cord Blood and Tissue
			Adipose Tissue
			Factors Impacting Stem Cell Effectiveness
				Donor Age and Site of Collection
				Effects of Storage
				Stem Cell Yields and Expansion
		Mesenchymal Stem Cell Collection and Banking
			Bone Marrow
			Umbilical Cord Blood and Tissue
			Adipose Tissue Stem Cells
		Rules and Regulations
		Current and Future Directions
		References
	9: Exosomes
		Introduction
		Indications
			Future Perspectives
		Microanatomy and Biochemistry
			Paracrine Expression and Phenotypic Modulation
		Basic Concerns and Contraindications
		Equipment, Techniques, Extraction, and Purification
		References
Part II: Imaging, Guidance, and Planning
10: Basics of Ultrasound
	Introduction
	References
11: Ultrasound: In-Plane and Out-of-Plane
	Introduction
	In-Plane Approach
		Technique
	Out-of-Plane Approach
		Technique
	Suggested Reading
12: Probe Selection
	Probe Selection
		Straight Linear Array Probe
		Curvilinear Array Probe
	Ultrasound Artifacts
		Anisotropy
		Attenuation Artifacts
		Artifacts due to Multiple ECHOS
	Ultrasound Orientation and Handling
	References
13: Diagnostic Ultrasound: Recognizing Musculoskeletal Pathology
	Introduction
	Tendons
		Normal Anatomy and Appearance
		Tendon Pathology
	Muscles
		Normal Anatomy and Appearance
		Muscle Pathology
	Ligaments
		Normal Anatomy and Appearance
		Ligament Pathology
	Bones and Cartilage
		Normal Anatomy and Appearance
		Bones and Cartilage Pathology
	Conclusion
	References
14: Fluoroscopic Safety
	Introduction
		Terminology
		Biologic Effects
		X-Ray Generation and Propagation
	Principles of Radiation Safety
	Summary
	References
15: Pre-procedural Imaging
	Introduction
	Patient Factors and Selection
	Common Soft Tissue Injuries (Sprains/Strains)
		Tendinopathy
		Ligament Sprains
		Muscle Injuries
	Pre-Procedural Imaging and Common Imaging Findings
		X-Ray and Computed Tomography (Ct)
		Magnetic Resonance Imaging (MRI)
			MRI Sequences
			MRI Contrast
			Tendon and Ligaments on MRI
			Tendinopathies and Ligamentous Sprains on MRI
			Muscle Contusions on MRI
			Muscle Strains on MRI
			MRI of the Spine
			MRI Limitations
		Ultrasound
			Ultrasound Basics
			Contusions on Ultrasound
			Muscle Strain on Ultrasound
			Tendons and Ligaments on Ultrasound
			Tendinopathy and Ligamentous Sprains on Ultrasound
	Conclusion
	References
16: Discography
	Introduction
	History of Discography
	Validation
	Positive Discography Criteria
	Disc Anatomy and Physiology
	Pathophysiology
	Patient Selection
	Indications
	Contraindications
	Preoperative Considerations
	Perioperative Considerations
	The Procedure
		Lumbar Discography
		Post-Lumbar Discography Imaging
		Cervical Discography
		Post-Cervical Discography Imaging
		Thoracic Discography
		Post-Thoracic Discography Imaging
	Post-Procedure Care
	Interpretation and Documentation
	Complications
	Correlating Imaging with Discography
	Uses of Discography in Regenerative Medicine
	Conclusion
	References
17: Ultrasound-Guided Injections: Preprocedure Planning
	Introduction
	Equipment
	Ultrasound-Guided Injection Supplies
	Consent, Risk, and Benefits
	Clean, Aseptic, and Surgical Aseptic Techniques
	Procedure Set Up
	Conclusion
	References
18: Effects of Local Anesthetics and Contrast Agents on Regenerative Medicine Procedures
	Introduction
	Local Anesthetics
	Contrast Agents
	Discussion
	Conclusion
	References
		Suggested Reading
19: Medicolegal Aspects of Regenerative Medicine
	Introduction
	Regulatory Framework for Regenerative Medicine
		Public Health Service Act (PHSA), Sections 361 and 351
		21 CFR 1271 Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps)
			1271.3 “How Does FDA Define Important Terms in This Part?”
			1271.10 (a and b) “Are My HCT/Ps Regulated Solely Under Section 361 of the PHS Act and the Regulations in This Part, and If So What Must I Do?”
			1271.15 “Are There Exceptions from the Requirements of This Part?”
	Minimal Manipulation and Homologous Use—Practical Considerations
	Same Surgical Procedure Exception—The Gotcha Section of 1271?
	Handicapping Regenerative Medical Materials and Processes
	Emerging Options in the New Regulatory Environment
	Ethical Considerations
		Options for Physicians to Assess FDA Compliance and Utility of Therapeutic Agents and Processes
		Steps to Take to Ensure FDA Compliance with Regenerative Products and Processes
		Resources for Physicians in Dealing with the Challenging Regenerative Medicine Marketplace
	Conclusion
	References
20: Anti-Platelet and Anticoagulation Medications
	Introduction
	Coagulation and Hemostasis
	The Healing Cascade
	Platelets: Function, Preparation, Activation
	Medications that May Interfere with Platelet Success
		NSAIDS
		Clopidogrel
		Medications that Affect Serotonin
		Anticoagulants
	Discussion
	Conclusion
	References
21: Patient Factors Affecting Regenerative Medicine Outcomes
	Introduction
	Factors
		Exercise
		Type 2 Diabetes Mellitus
		Obesity
		Depression and Anxiety
		Medications
		Nutrition
		Smoking
		Alcohol
	Conclusion
	References
Part III: Treatment Paradigms: Orthobiologics and Additional Utilities
22: Tendinopathy
	Introduction
	Elbow
	Shoulder
	Hip
		Greater Trochanteric Pain Syndrome
		Hamstring Tendinopathy
	Knee and Ankle
	Conclusion
	References
23: Joints
	Introduction
	Indications
		Shoulder
		Knee
	Microanatomy and Biochemistry
		Pathophysiology of Osteoarthritis
		Basic Concerns and Contraindications
		Preoperative Considerations
		Radiographic Guidance
		Equipment and Techniques
			Knee
			Shoulder
		Post-procedure Considerations
		Potential Complications and Pitfalls
	References
24: Axial Spine and Sacroiliac Joint
	Introduction
	Indications
		Intervertebral Disks
			Evidence
				Intradiscal Platelet Rich Plasma (PRP)
				Intradiscal Stem Cells and Allogeneic Grafts
				Fibrin
		Facet Joints
			Evidence
				Intra-Articular PRP
				Intra-Articular Stem Cells
		Sacroiliac (SI) Joints
			Evidence
				Intra-articular PRP
	Microanatomy and Biochemistry
	Basic Concerns and Contraindications
		Axial Biomechanics
	Preoperative Considerations
		Diagnostic Injections
		General Considerations
	Radiographic Guidance
	Equipment
		PRP
		MSCs and Allogeneic Grafts
		Fibrin
	Technique
		Facets
		Sacroiliac Joint
		Intervertebral Discs
	Post-procedure Considerations
	Potential Complications and Pitfalls
	Conclusion
	References
25: Adipose-Derived Regenerative Cellular Therapy of Chronic Wounds
	Introduction
		Commonly Used Treatments
	Indications
		Evidence
	Microanatomy and Biochemistry
		Adipose-Derived Tissue
		Amniotic Tissue
	Basic Concerns and Contraindications
	Preoperative Considerations
		Adipose-Derived Tissue – Enzymatic Versus Mechanical Isolation
	Equipment
		Amniotic Tissue
		Adipose-Derived Tissue
	Technique
		Amniotic Tissue
		Adipose-Derived Tissue
	Potential Complications and Pitfalls
	Conclusion
	References
26: Esthetic Surgery Applications for Adipose-Derived Stem Cells
	Overview
	Applications of Adipose Stem Cells for Esthetic Therapies
		Tissue Volume
		Dermatological Applications (*Pigmentation, Thickness, Elasticity, and Vitiligo)
		Hair (Kerastem STYLE Trial)
		Improvement of Wound Healing and Scarring
	Benefits of Using Adipose Stem Cells for Esthetic Purposes
	Current Limitations and Future Directions for Adipose Stem Cell Treatments
	Conclusions
	References
Index