Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
Arthroscopy. 2022 Jul;38(7):2350-2358. doi: 10.1016/j.arthro.2022.04.018. Epub 2022 May 21.
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the foot and ankle (including acute traumatic injuries and fractures, tumor, infection, osteochondral lesions, arthritis, and tendinopathy) and procedures, including osteotomy or fusion. Promising and established treatment modalities include 1) bone-based therapies (such as cancellous or cortical autograft from the iliac crest, proximal tibia, and/or calcaneus, fresh-frozen or freeze-dried cortical or cancellous allograft, including demineralized bone matrix putty or powder combined with growth factors, and synthetic bone graft substitutes, such as calcium sulfate, calcium phosphate, tricalcium phosphate, bioactive glasses (often in combination with bone marrow aspirate), and polymers; proteins such as bone morphogenic proteins; and platelet-derived growth factors; 2) cartilage-based therapies such as debridement, bone marrow stimulation (such as microfracture or drilling), scaffold-based techniques (such as autologous chondrocyte implantation [ACI] and matrix-induced ACI, autologous matrix-induced chondrogenesis, matrix-associated stem cell transplantation, particulated juvenile cartilage allograft transplantation, and minced local cartilage cells mixed with fibrin and platelet rich plasma [PRP]); and 3) blood, cell-based, and injectable therapies such as PRP, platelet-poor plasma biomatrix loaded with mesenchymal stromal cells, concentrated bone marrow aspirate, hyaluronic acid, and stem or stromal cell therapy, including mesenchymal stem cell allografts, and adipose tissue-derived stem cells, and micronized adipose tissue injections. LEVEL OF EVIDENCE: Level V, expert opinion.
正位再生被定义为一种针对骨科疾病的解决方案，它利用生物学的益处来改善愈合、减轻疼痛、改善功能，并优化组织再生的环境。选择包括药物、手术干预、支架、细胞产物的生物制剂以及物理和电磁刺激。再生医学的目标是增强肌肉骨骼损伤后的组织愈合，无论是作为单独的治疗方法还是作为手术管理的辅助手段，使用新的治疗方法来改善恢复和结果。各种骨科生物制剂（orthobiologics）已被用于治疗足部和踝关节的疾病（包括急性创伤性损伤和骨折、肿瘤、感染、骨软骨病变、关节炎和腱病）和手术，包括截骨术或融合术。有前途和已确立的治疗方式包括 1）基于骨的治疗方法（例如来自髂嵴、胫骨近端和/或跟骨的松质或皮质自体移植物、新鲜冷冻或冻干的皮质或松质同种异体移植物，包括脱矿骨基质腻子或粉末与生长因子结合，以及合成骨移植物替代品，如硫酸钙、磷酸钙、磷酸三钙、生物活性玻璃（通常与骨髓抽吸物结合）和聚合物；蛋白质如骨形态发生蛋白；和血小板衍生生长因子；2）基于软骨的治疗方法，如清创术、骨髓刺激（如微骨折或钻孔）、支架技术（如自体软骨细胞植入术[ACI]和基质诱导 ACI、自体基质诱导软骨形成、基质相关干细胞移植、颗粒状青少年软骨同种异体移植术和与纤维蛋白和富含血小板的血浆[PRP]混合的切碎的局部软骨细胞）；和 3）血液、细胞和注射治疗方法，如 PRP、富含间充质基质细胞的血小板减少血浆生物基质、浓缩骨髓抽吸物、透明质酸以及干细胞或基质细胞治疗，包括间充质干细胞同种异体移植物和脂肪组织衍生的干细胞，以及微粉化的脂肪组织注射。证据水平：五级，专家意见。
