Regenerative Medicine
Regenerative Medicine is an exciting, expanding field of medicine. Stem cell technology is quickly expanding in the area of musculoskeletal conditions. As physiatrists, we routinely treat musculoskeletal injuries and are therefore, perfectly aligned to be leaders in this new realm of medicine.
In this edition, we meet Dr. Malanga who is involved in stem cell research and clinical application, as well as active in the education of other Rehab Physicians through the AAPMR’s Regenerative Medicine course.
This is an excerpt from the full length article in the AAPMR CORE newsletter, for which I am editor. In this section, Dr Malanga discusses the research and efficacy behind platelet rich plasma and stem cell technology.
Gerard A. Malanga, MD
Founder and Partner; New Jersey Sports Medicine and New Jersey Regenerative Institute Cedar Knolls, NJ
Clinical Professor, PMR, Rutgers University- New Jersey Medical School
Chair, AAPM&R Regenerative Medicine Task Force .
“I believe that PRP (platelet rich plasma) is effective for treating many musculoskeletal conditions. I have personally been able to publish review articles on the topic and feel that the literature is supportive of PRP. Also, I was fortunate to be part of a multi-center study, along with Dr. Kenneth Mautner of Emory University, looking at PRP in the treatment of tendinopathy1. Several factors affect the efficacy of PRP: the absence of red blood cells, the concentration of PRP relative to serum concentrations, and the presence/absence of leukocytes.
Other than tendinopathies, the other area that many clinicians have found difficult to manage is a diagnosis of degenerative arthritis, such as in the knee, particularly in those under the age of 60. This is an ever increasing common problem with very few treatment options. Many patients have tried and failed a variety of nonoperative treatment measures that include: medications, strengthening and physical therapy, various injections and yet remain limited by pain. Many are offered a total knee arthroplasty, a procedure that often requires a reduction of activity level after surgery. It is this population, I believe, that may be better treated with mesenchymal stem cell therapies.
Several years ago, I researched and developed expertise in the use of bone marrow stem cell therapies in the treatment of various cartilage and osteoarthritic conditions as well as for meniscal tears. This involved a great deal of review of various journal articles in journals that I had never before read. I have been fortunate to learn from and exchange experiences with many other physicians around the country who are pioneers in this area.
Thus far, the results from stem cell therapies are promising and each year the techniques and experiences continue to improve. There continues to be a great deal of more work to be done in this area to solidify the scientific evidence for these Orthbiologic treatments and I am excited to be working with physicians across the country who share interest in this area of medicine.”
Dr Malanga is leading an upcoming review of the literature for both techniques in the medical journal PMR; and is leading the task force on Regenerative Medicine for the medical society, American Academy of Physical Medicine & Rehabilitation. Dr Malanga has been a leader for years in the field of musculoskeletal care and I feel quite fortunate to learn from him over the years and I look forward to learning more about this very exciting therapy.
Good Luck!
References:
http://www.pmrjournal.org/article/S1934-1482(13)00003-8/pdf
ys been a blend of science and art. Medical school lays the foundations for the science portion; however, the art comes from the guidance given by established physicians. In fact, you graduate medical school with a Medical Degree but cannot practice medicine until you do an internship where you train under the tutelage of an Attending Physician.