In orthopaedic clinic Bisturmed we treat injuries and diseases of joint, tendons and muscles with three different biological treatments:

1. Platelet Rich Plasma (PRP)
2. Amniotic membranes
3. Stem Cells

                     
Platelet Rich Plasma                       Amniotic Membranes                               Stem Cells

Platelet Rich Plasma - PRP

In our outpatient clinic, we perform treatment with PRP, platelet rich plasma by the patient's blood, by the Swiss company RegenLab (www.regenlab.com). The therapy involves collecting patient's venous blood in the test tube and putting it in a special centrifuge. During the centrifugation, we obtain separation of the plasma with high concentration of platelets from the other blood cells. Afterwards, the plasma with platelets is infiltrated into the tissue to treat(articulation, ligament or muscules). The infiltration can be guided under ultrasuond control. The injected platelets start to release different growth factors that accelerate the process of repair and tissue regeneration. For the infiltration of PRP local anesthesia is seldom required. For an effective and complete treatment 3 infiltrations are needed, with the interval between 7 and 14 days between each of them. Normal daily and sports activity are permitted, only anti-inflammatory and corticosteroid drugs are prohibited during the treatment. For the treatment of osteoarthritis, the combination of PRP - Platelet Rich Plasma and hyaluronic acid is also available.

Indications for PRP treatment:

• osteoarthritis (knee, ankle, shoulder)
• Achilles tendinopathy
• rotator cuff tendinopathy
• patellar tendinopathy
• epicondylitis
• plantar fascitis
• muscle and ligament injuries

According to clinical studies, the treatment is effective in 80% of cases.

Very rare copmlications are the following:

• hematoma formation after venous blood collecting
• hematoma and/or swelling at infiltration site
• infection at the infiltration site

Amniotic membranes

The inflammation of the joint in younger patients is due to sports stresses or injuries, and in older patients, as a consequence of minor, sometimes even undetectable injuries. These are imposed and lead to a weak but constant inflammation that does not allow the regeneration of joint cartilage surfaces which begin to disintegrate.
Such inflammation should be stopped or reduced. It can be done by repeated injection of PRP (platelet rich plasma treatment), or with an even more effective injection of micronized amniotic membranes. Amniotic membranes are those surrounding the fetus during the pregnancy, having the role of protecting it. In addition to physical protection, amniotic membranes also contain growth factors that help fetus regenerate in case of injury.
The abilities of amniotic membranes involved in the regeneration of child injuries during pregnancy are used in high-efficiency orthopaedics for medium to long-term reduction of inflammation and stimulation of regeneration. Amniotic membranes are prepared by a special procedure in a tissue bank in the United States, where donors are thoroughly tested, and then amniotic membranes are grinded and dried after a special procedure. The amniotic membranes thus prepared contain intact growth factors that, after injection into the joint, are released from the microscopic pieces of the amniotic membrane, thus ensuring longer release of growth factors than in the PRP injection.
Indications for treatment with amniotic membranes are the same as for platelet rich plasma treatment (joint degeneration, tendon inflammation, muscle injury or strain). The injection procedure is very simple and requires only one application. The amniotic membrane powder is dissolved in saline solution prior to administration and injected into the joint or into soft tissue. After the application, rest is prescribed for a few days and the patient can begin with physical and sports activity after a few weeks.

Stem cells

For now, stem cells are used only in the treatment of joints, and they are not recommended for the treatment of soft tissues (tendons or muscles). Stem cell therapy is used:

• in treating the joint injuries of younger patients, reducing inflammation and accelerating the natural regenerati
• stem cells help very effectively with initial arthrosis, where they are able to stop the inflammation and progression of arthrosis and establish appropriate conditions for limited regeneration;
• in advanced arthrosis, it may delay the need for surgical replacement of the decision for several years.

Mesenchymal stem cells in orthopaedics and particularly in the case of joints can greatly improve the patient's ability and condition. Cells can be isolated from the bone marrow or fat tissue. In addition to the long-term reduction in inflammation that these cells achieve by actively releasing growth factors (with other methods of biological treatment, only growth factors are delivered), stem cells can be differentiated into bone or cartilage tissue, and they also act by stimulating the surrounding tissue towards regeneration. Stem cells are usually injected once, which should be sufficient to relieve symptoms for few years, but they may be re-injected at a further deterioration. Stem cell removal takes place in local anaesthesia and, if necessary, in sedation. Stem cells are taken (aspirated) from the bone of the pelvic bone or tibia through the minimal invasive procedure, or from the fat tissue around the waist. Aspirate is centrifuged and injected sterile in the joint. The procedure is not painful, and it is done ambulatory as one-day procedure. After the application, rest is prescribed for a few days and the patient can begin with physical and sports activity after a few weeks.