STEM CELLS OR MESENQUIMAL CELL
What are Stem cells?
They are undifferentiated basic human cells, with the potential to give different types of cells. They are obtained from adult living tissue.
The stromal cells of the bone marrow are mesenchymal stem cells that, in the right environment, can differentiate into cells that take the form of the musculoskeletal system. They help create new cells in existing healthy tissues and can help repair tissues in structures that are damaged, be it trabecular bone, tendon, articular cartilage, or ligaments.
How are mesenchymal cells obtained?
They are obtained from the bone marrow of the iliac crest. Through a trocar inserted into the iliac crest we aspire bone marrow, to then make the preparation and its subsequent application.
These cells can be concentrated or cultured:
Bone marrow concentrate: they are obtained immediately after the centrifugation, being able to apply it in the same surgical act.
Mesenchymal cell culture: in this case it takes 3 weeks to process them. With this method it is possible to select and multiply the number of stem cells that will be implanted, activating and differentiating to cells with the same characteristics as the recipient tissue.
In what situations can we use mesenchymal cells in Traumatology?
Fractures, Absence of consolidation and Osteonecrosis: Stem cells can stimulate bone growth and promote healing of injured bone. These are placed together with the bone graft to stimulate and accelerate healing.
Cartilaginous lesions: The lining of the joints is constituted by articular cartilage. Articular cartilage injury can cause osteoarthritis and cause pain. Currently, transplants and cartilage grafts can be performed to fill these defects and thus improve pain symptoms.
Tendon or ligament injuries: They allow a faster healing, acting as a coadjuvant in the acute treatment of tendons, muscles and ligaments.
Column pathology: Mesenchymal cells are used to help spinal fusion and also for the repair of degenerated cartilage.
GROWTH FACTORS IN SPORTS TRAUMATOLOGY
Growth factors are proteins present in our platelets, which modulate functions such as angiogenesis (formation of blood vessels), the immune system or tissue regeneration.
The main pathologies that can be treated with growth factors are:
Acute injuries of tendons or ligaments.
Chronic tendinopathies (patellar, Achilles, …)
Insertional entesopathies (epicondilitis, …)
Chronic tendon ruptures in patients with low functional demand.
Partial tears of rotator cuff in the shoulder.
Muscle fibers ruptures.
Affectation of the articular cartilage.
Degenerative processes of different joints (knee, shoulder, ankle, …)
The growth factors are obtained from a small volume (variable according to the needs) of the patient’s blood after centrifugation. These constitute a set of proteins, including anti-inflammatory and bacteriostatic peptides, with multiple properties that stimulate the regeneration of tissues, in the absence of erythrocytes and leukocytes.
The protocol for obtaining growth factors consists of several well-differentiated steps:
Extraction of initial blood.
Centrifugation
Separation of the different components.
Controlled activation.
Normally the growth factors are injected in the area to be treated, 3 or 4 sessions with a periodicity of one week, although this can be modified depending on the pathology.
Procesos degenerativos de diferentes articulaciones (rodilla, hombro, tobillo,…)
Los factores de crecimiento se obtienen a partir de un pequeño volumen (variable según las necesidades) de la sangre del propio paciente tras una centrifugación. Éstos constituyen un conjunto de proteínas, entre los que se incluyen péptidos antiinflmatorios y bacteriostáticos, con múltiples propiedades que estimulan la regeneración de los tejidos, en ausencia de eritrocitos y leucocitos.
El protocolo de obtención de los factores de crecimiento consta de varios pasos bien diferenciados:
Extracción de sangre inicial.
Centrifugación.
Separación de los diferentes componentes.
Activación controlada.
Normalmente los factores de crecimiento se inyectan en el área a tratar, 3 ó 4 sesiones con una periodicidad de una semana, aunque esto puede modificarse en función de la patología.
MUSCLE INJURY
It is a break in muscle fibers in a specific area of the body, usually in sports practice.
This produces a bruise, inflammation and limitation for sports activities and daily life.
They are presented mostly in footballers (31%) and other sports such as basketball (18%), athletics (16%) and rugby (10%).
The most affected muscle groups are those of the lower extremities, being the hamstrings mostly the ones that are injured more frequently, followed by the adductors and quadriceps.
Management of these injuries is very important and therefore they must be evaluated by a Sports Traumatologist.
The diagnosis is made through the physical examination of the patient, complemented by imaging studies such as ultrasound and magnetic resonance. The treatment and management of the lesion depends on the degree of classification of each lesion.
– Grade I: Small tears of muscle fibers producing pain with mild functional limitation. The treatment consists of rest, analgesic, local cold and apply functional bandages.
– Grade II: Partial rupture of muscle fibers producing pain with functional limitation to daily activities and sports. The treatment consists of rest, local cold, analgesics, functional bandages and sometimes it is necessary to drain the hematoma or infiltrate with growth factors.
– Grade III: Complete breakage of the muscle, pain and severe functional limitation. The treatment is surgical and consists of reinserting the muscle to its area of origin.
The treatment of these injuries should be accompanied with rehabilitation sessions guided by a physiotherapist, in order to achieve a quick recovery and a quick return to the sport.
VIDEO ON MUSCLE INJURY
“Ecoguided treatment with biological therapies of muscle injuries”
