Combining Orthobiologic treatments for a Hamstring tear

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Combining orthobiologic treatments during your regenerative medicine cases. How do we use it, what are some ideas, what are some of the benefits? There’s a lot of value to this because you can take treatment modalities and options that work in one way and may have some synergistic benefit and can get a more pronounced benefit when you combine them together.

As an example, I have a 55-year-old woman who’s a runner who has had a partial thickness hamstring tear at the origin for roughly eight months or so. I ended up treating her with a combination of BMAC or bone marrow aspirate concentrate derived stem cells, platelet-rich plasma, as well as amniofix. Now she’s someone who’s actually had platelet-rich plasma for that same tear originally, with only a partial benefit. And we elected to combine these three different orthobiologics for the following reasons.

The bone marrow aspirate concentrate was going to be stronger than just the platelet-rich plasma, and so that was a no-brainer in terms of going with that. Utilizing platelet-rich plasma and platelet lysate to help augment the main treatment, the bone marrow aspirate concentrate, has a lot of value as well. And then lastly, adding in amniotic fluid, because the amniotic fluid product would help to add some additional extracellular matrix to help the bone marrow aspirate concentrate treatment to essentially stay in place. One of the challenges in a tendon tear is that if you inject a orthobiologic, how to you get it to stay in that place? Now, bone marrow aspirate concentrate does have a greater viscosity and tends to stay more in place than platelet-rich plasma does, but the addition of the amniotic fluid helped that to stay even more in place.

Now obviously she was partially unloaded and partial weight bearing after treatment. That helped as well, and in the end on serial ultrasound scans we have someone who’s not only functionally doing better in terms of getting back to a high level of physical activity, but even on ultrasound she has evidence of healing of that tear as well. Combining orthobiologic treatments, that’s sort of the next level of orthobiologic care and regenerative medicine care, and it’s something that with a good understanding of how these orthobiologic treatments work, can be beneficial to your patients as well.

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