The science behind the newer biologic treatments for orthopedics, including advanced platelet and stem cell treatments, is still a work in progress. In part that is because these treatments are new, but also because the conditions that are treated, osteoarthritis and tendonitis, are poorly understood by not only the lay public but by physicians as well.
The old and persistent model of understanding of arthritis and tendonitis is that these are purely structural conditions. Cartilage or tendon cells break down either over time or via trauma. Like a house that has a damaged roof, once damaged, this can only be repaired by placing new tiles in place of the old ones.
The problem with this purely structural model of understanding of arthritis/tendonitis is that it’s incomplete. On a macro level progressive degeneration or significant trauma may not be correctable by your normal repair mechanisms. But pain and dysfunction is driven by more than structure alone. If you X-ray the knees of everyone over the age of 70, the vast majority have arthritis. MRI images would likely find arthritis in almost all those people. If you perform a high resolution ultrasound scan on all people who have played competitive tennis at any level, you will find at a minimum small changes in their rotator cuff tendons indicative of prior mild stress or injuries. Yet despite these structural changes, all these people do not have pain. Conversely, mild imaging findings can be found in people who have tremendous disabling arthritic pain where their purely structural imaging findings do not account for all their pain. A more modern model of understanding arthritis and tendonitis is a biologic one.
Any tissue in the body goes through a normal moment by moment process of stress, repair, and recycling. For example, after a full day of work or a recreational golf outing, the joints in your body that have been stressed go through this process. Cells that have been stressed are repaired if possible, or replaced if needed by your body. This process of breakdown and rebuilding is a normal process. It’s more than a structural process. It’s a biological one that includes various cell types, growth factors, and other chemical components. If an injury is too severe, or a process of wear and tear too prolonged, the biological components within that joint are no longer optimally set to help repair and rebuild.
In someone whose X-rays show significant arthritis yet they have no pain, the biologic makeup of that joint is one that is compensating at some appropriate level. Someone whose imaging is mild but has significant pain and dysfunction, their biologic makeup in that joint is failing.
So how do cellular treatments such as platelet rich plasma and stem cells work? Can they repair the structural damage in a joint or tendon? In some cases possibly, the scientific literature certainly has cases of this occurring. But that may not always occur. Instead, these treatments do a much better job of pushing the biologic makeup of a degenerative or damaged joint or tendon back into a healthy mode. This on its own can improve pain. This primarily works on a biologic level and unfortunately will not make sense to patients and physicians who only follow the antiquated structural model of orthopedics.
If the goals of cellular treatments are to reasonably reduce pain and improve function, this is possible in even more advanced orthopedic conditions, and can be understood by the biologic model of arthritis and tendonitis. If you’re stuck on the structural model of orthopedics and are hoping for reversal on X-rays/MRIs back to a perfectly normal looking joint, not only are you focused on the wrong outcomes that matter, but you may need to find a time machine rather than a physician to help you out.