Orthobiologics are substances that can be used to accelerate healing of injuries. They are typically derived from biological substances made within the human body and are used to heal injured tissue. Orthobiologics are administered in high concentrations to expedite the healing process. Other names include biologics, cell-based therapy, regenerative medicine or stem cell therapy. This field is relatively new and research findings are still in the process of development, but some findings are promising, prompting many health care providers to implement them in their practice. Orthobiologics may be used to treat various orthopedic conditions, but it is important to note that is not a viable option for autoimmune conditions or chronic widespread inflammation throughout the body. If you are looking for a new and upcoming treatment option for your orthopedic condition, orthobiologics might be something to explore.
These healing substances that classify orthobiologics typically fall into three general categories:
1. Growth Factors
Growth factors are a general term for various proteins that help to regulate healing. Depending upon the protein type, a growth factor signals the body to speed up or slow down healing processes. These proteins utilize chemoattraction, which refers to sending the appropriate signals to regulate healing processes accordingly. By adding it to the body in high concentrations, it can cause beneficial cell signaling to drive cells to perform specific functions that promote cellular recovery and healing.
2. Stem Cells
These cells are precursor cells to all other cells-- they can be ‘influenced’ to become any cell type, dependent upon the function that is needed. When some part of the body is injured, the stem cells are signaled by factor proteins to travel to the injury site and become cells that are used in the repairing process. What is so amazing about stem cells is that they can become repairing cells for bone, tendons or ligaments, whatever is needed.
3. Matrix
This substance provides the material for cells to live in. Matrix also is the foundational aspect in creating bone, tendons and ligaments. When bones breakdown through injury, or everyday normal weight bearing exercises, the matrix provides the building blocks to fill in gaps within the bone.
There are many different types of orthobiologics that people can utilize in order to promote faster healing within the body. Now that we have identified the three main categories, we will list some orthobiologics that are commonly used to expedite healing.
Platelet-rich Plasma (PRP)
With this cell therapy, the physician will draw a bit of your blood and place it in a centrifuge. By spinning the blood, beneficial platelets can be separated, which can then be re-injected into your body. These platelets contain growth factors that influence healing processes within the body.
May be useful for: plantar fasciitis, lateral epicondylitis and Achilles tendinopathy. [1]
Cost: $175 to $4,973
The cost for PRP varies greatly. A study found that PRP is offered more in highly
populated areas, which may mean a lower cost to the patient [2]. So we suggest to ‘shop around’ in order to find the price that works best for your budget.
Bone Marrow Aspirate Concentrate (BMAC)
In this procedure, after you are given local anesthesia, bone marrow is aspirated from your body, typically from the hip bone, in order to procure the beneficial stem cells abundant in bone marrow. These stem cells can then be introduced into the injury site in order to promote healing processes and mediate inflammation.
May be useful for: muscle, tendon or ligament tears, lumbar disc disease, shoulder and
hip injuries, osteoarthritis (as stated here).
Cost: $3,600 for stand-alone procedure, including local anesthesia
Cost will vary, depending upon the type of procedure done.
Adipose Tissue
Adipose tissue is collected and used similarly to BMACs. Once the area is numbed, fat is taken from areas like your thighs or obliques. Fat is rich in stem cells and growth factors that can promote healing processes and influence the regeneration of fat cells. This collected tissue is then introduced via ultrasound to the injury site to expedite healing.
May be useful for: osteoarthritis of the shoulder and knee, rotator cuff tears
While the findings are not highly supported, the research is promising [3].
Cost: $4000 - $8000
Can my insurance cover the cost of orthobiologics?
Unfortunately, most orthobiologic procedures are not covered by insurance, which places the financial cost upon the patient. However, as this field grows and develops, findings that support the use of orthobiologics may prompt change in insurance providers. The hope is to continue to push insurance companies to cover the cost of these procedures in the future. Certainly, don’t hesitate to check with your insurance carrier to see what would be covered for you.
Important things to note:
Due to the emerging nature of this field, research findings have historically not been supportive of the widespread use of orthobiologics. However, some findings are promising, which promotes many health care practices to implement this type of therapy. It is also important to note the wide fluctuations in orthobiologic services that are offered. This wide range of pricing warrants us to suggest to you to do extensive research on the therapy type that interests you. Consult search engines, ask various doctors and compare pricing of therapies offered at different clinics to decide what best suits you. While further research is warranted, orthobiologics may be an important treatment that is endorsed and covered by insurance companies in the future, which may be enough reason for you to try now.
Citations:
[1] Bray, Christopher C. Walker, Clarke M., Spence, David D. 2017. Orthobiologics in pediatric sports medicine. Orthopedic Clinics of North America. Volume 48, Issue 3, Pages 333-342. . https://doi.org/10.1016/j.ocl.2017.03.006.
[2] Ponce, B., McGee, A., Dombrowsky, A., et al. 2019. The Cost Variability of Orthobiologics. Orthopaedic Journal of Sports Medicine. doi:10.1177/2325967119S00285
[3] Shroeder, Allison., et. al. 2019. Use of Adipose-Derived Orthobiologics for Musculoskeletal Injuries: A Narrative Review. American Academy of Physical Medicine and Rehabilitation. Doi: https://dx.doi.org/10.1002/pmrj.12291.
[4] West, Tenaya A., Williams, Mitzi L. 2019. Orthobiologics. Clinics in Podiatric Medicine and Surgery. DOI:https://doi.org/10.1016/j.cpm.2019.06.006
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