Regenerative Treatments for Orthopedic Conditions

The term “regenerative medicine” has been used increasingly in medical practice during the past decade [1]. It has been applied in broad areas of medicine from plastic surgery to cardiac disease and neurologic conditions. The term evokes the thought of a futuristic fountain of youth whereby the many conditions of aging, disease, and trauma are reversed to a healthy state by the use of cells capable of differentiating into healthy tissue. Various cells sources to achieve this state have been suggested, including embryonic, autologous, and pluripotent-induced stem cells [2]. This treatment has triggered considerable medical, political, and ethical debate among various concerned groups, particularly regarding the use of embryonic stem cells. The potential benefit of most of these treatments have yet to be realized in the daily practice of medicine, although there has been a rapid increase of various groups promising remarkable benefits from these treatments with a paucity of good scientific evidence. At present, these regenerative techniques remain “experimental” when viewed by Medicare and the various commercial health insurance carriers. With all the hype associated with the term “regenerative,” it is interesting to note that we all “regenerate” on a daily basis, as our bodies create new cells that replenish our blood cells, line our gastrointestinal tract, and reform our skin, and maintain our skeletal system. No one is surprised when our skin heals after a cut or a fracture heals after a trauma. Although the potential and rate of healing slows down with aging, it certainly does not disappear. Tissues heal/“regenerate” even in the most elderly patients of our population, for instance, cuts heal, fractures heal, etc. Thus, there is an intrinsic capability of healing in humans that can be harnessed in the treatment of injuries and disease. There are multiple ways this healing can occur, including nutritional approaches, rest with a gradual application of exercise, modalities, invasive measures, and, at times, surgical intervention [3-6]. In the specialty of physical medicine and rehabilitation, there are several methods that have been used to “turn on” or facilitate this regenerative response,