ORTHOPEDIC REVOLUTION: The science of taking care of our bones, joints and muscles has advanced by leaps and bounds.

• Author: Blake, Kathy
• Position: ORTHOPEDIC CARE

Three years ago, Claude T. Moorman III of Atrium Health's orthopedic department in Charlotte performed the first mesenchymal stem cell procedure in the United States, a process that purifies and isolates healing cells to help with joint preservation. The therapy from fat- and marrow-derived cells is used to help heal cartilage and other tissues. In July, Moorman was the first to use the procedure in Charlotte.

At EmergeOrtho in Asheville, Robert Boykin uses a treatment called PRP injections, which separates the platelet-rich plasma from a patient's blood and repurposes it to help joint cells heal, multiple times per week. Five years ago, he may have done it twice a year. "It's what we refer to as an autologous blood product, and it has high concentrations of growth factors that help in healing while reducing inflammation," he says.

At Carolina Orthopedics' branches in New Bern, Kinston and Jacksonville, physician partner Raymond Jay Bradley Jr. recently added Cartiform to his work, a way to take frozen, articular cartilage from a donor, thaw it and use the resulting living cells to treat cartilage lesions.

"We've figured out how to thaw out Han Solo," he says. "They've figured out how to take articular cartilage from a donor, freeze it in a medium and be able to thaw it out, and the cells are still alive. We can now be in the [operating room], and if we discover a lesion in cartilage in real time, we can remove a living graft from the freezer and I can implant that and use PRP or stem cells to augment that graft and help it take root."

The work these physicians do is called orthobiologics--using substances naturally found in a body, such as harvested blood and stem cells, to improve healing of bones, muscles, tendons and ligaments. Part of this combination of continually evolving scientific research and applied medical treatment is regenerative medicine, the engineering or regenerating of human cells and tissues to return an area to its normal function. Used extensively in Europe for several years, orthobiologics is inching up the ladder of options in the U.S., though regulating forces such as the Food and Drug Administration and insurance companies often are one rung behind.

In the Increasingly complex world of orthopedics, orthobiologics is the pursuit of medically allowing the body to heal naturally.

"I've been involved for over five years with regenerative medicine. In orthopedics, PRP has been the most-studied form," says Moorman, named president of Atrium's new Musculoskeletal Institute in February and a former executive director of the James R. Urbaniak Sports Science Institute at Duke University Medical Center. His research published by the Duke Medical Journal investigates outcomes of regenerative procedures. "However, it is by no means the most promising," Moorman says. "While it has been carefully studied, benefits range based on patient populations. For instance, patients with certain tendon injuries would benefit more than, say, a patient with advanced arthritis in the knee." Moorman says he's performed hundreds of mesenchymal stem cell procedures.

The Andrews Institute for Orthopedics & Sports Medicine in Gulf Breeze, Fla., which researches regenerative medicine, received a $1 million grant from the state of Florida in July to support its research and education foundation. Boykin collaborates with Andrews surgeon and sports medicine specialist Adam Anz, who has called regenerative medicine "a foggy place."

"There are a lot of unknowns and unsupported claims," Anz says...