Orthopaedic surgeons will tell you that surgery is only half of the battle, and that physical therapy is as important or more important to the patient’s recovery. While this is true for any orthopaedic surgical procedure, the physical therapy, specifically staged weight bearing physical therapy, is paramount to the groundbreaking clinical trial evaluating the use of stem cells to regenerate knee cartilage at Andrews Institute for Orthopaedics & Sports Medicine.
The FDA observed clinical trial, led by Adam Anz, M.D., involves three crucial steps: the surgical procedure, multiple injections of the patient’s own stem cells, and the physical therapy.
“One recurring theme of orthopaedic surgery is that form follows function,” said Dr. Anz. “While we’ve known this for sometime regarding bone maintenance and healing, we’ve also found that with healing tissues such as cartilage you have to stimulate the cartilage with weight bearing so that it heals appropriately as it grows. We’ve found that loading the cartilage (with weight-bearing physical therapy) is the way to get good cartilage to heal (and grow), as we’ve been supplementing it with our body’s own stem cells.”
While the arthroscopic marrow stimulation surgery and the stem cell injections set the foundation for the cartilage regeneration, the specific physical therapy guides the stem cells during cell differentiation (changing from a stem cell into a cartilage cell) and cell signaling.
“If you inject stem cells into a joint without physical therapy, the healing cartilage area may make bone and the joint may become very stiff,” said Tyler Opitz, DPT, SCS. “If you move the joint, the movement will first signal to the stem cells that the location of the injection is a joint. Secondly, the static loading will allow the two surfaces of the bone to come together without shear forces damaging the cartilage and signal to the stem cells to aid in the cartilage healing process, possibly causing the stem cells to differentiate into cartilage cells.”
The static loading (weight-bearing physical therapy) of the joint allows the two surfaces of the bone to come together without shearing (rubbing any of the surfaces off). Without the static loading, the stem cells would not receive the appropriate signals to ensure that they aid in cartilage healing.
While the three aspects of the clinical trial are integral to the success of the research, so is the partnership between the orthopaedic surgeon and the physical therapist.
“In this study, as well as in every day life as orthopaedic surgeons, you need to manage the whole recovery for the patient through the healing process,” said Dr. Anz. “That involves being really plugged in and communicating with your physical therapists.”
The collaboration between physical therapists and orthopaedic surgeons at Andrews Institute is crucial to not only providing patients with positive outcomes, but is paramount to the success of this clinical trial regenerating cartilage.