Best Orthobiologic treatment Chennai India, Joint, Bone, Tendon, Ligament treatment

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Orthobiologic treatment Chennai, India.

What is Orthobiologic treatment?

Orthobiologic treatment is defined as any modality which harnesses the healing potential of the body’s own cells, redirecting their use for accelerated healing in damaged and diseased tissues of the musculoskeletal system. In common parlance, the term “orthobiologic” refers to a biologic product used in the orthopedic setting to augment healing or alter the natural course of an orthopedic disease. Orthobiologic treatments are thus disease modifying as they help you to heal better.

Most orthobiologic treatments are performed by injections under image guidance like ultrasound or fluoroscopy. They may be also be done by arthroscopic or open surgery.
The most common condition requiring a biological treatment in India is knee osteo-arthritis.

Which biological substances are used?

I use Hyaluronic acid in early cases.
I use Platelet rich plasma (PRP), Stromal vascular fraction (SVF), Platelet rich stroma (PRS) derived from adipose tissue or fat and bone marrow concentrate (BMAC) routinely.  Fat is considered to be better than bone marrow concentrate for the following reasons.
1) Fat can be easily harvested.
2) Fat has more progenitor cells per unit volume than than bone marrow.
3) Availability of bone marrow decreases due to osteoporosis in the elderly.

1) Platelet rich Plasma (PRP)– Platelets are a type of cell in your blood. They are primarily responsible for clotting. They also contain chemicals known as growth factors which support healing and recovery processes. Platelet rich Plasma is a filtrate of Plasma rich in platelets. In PRP, the plasma contains significantly more platelets than normal, so the concentration of growth factors can be five to 10 times higher. Platelets are known to provide a diverse array of growth factors that have the ability to work independently or with other proteins and cells to improve the healing process.

2) Medicinal signalling cells (MSC). Medicinal signalling cells (MSC’s) were previously known as mesenchymal stromal cells. These are multi potent cells widely present in the body tissues. The main sources of cells in adults is bone marrow and fat.  These cells can stimulate the resident cells inside a joint or bone to differentiate into cartilage and bone. They do this by an action known as ‘paracrine effect” which is basically a signal by chemical mediators (medicines) to the resident cells in a tissue, inducing them to proliferate and repair the damaged tissue. Other possible effects are by immuno-modulation and direct engraftment.  

3) Cultured specialized cells – Chondrocytes are specialized cells present in joint cartilage. Normally these cells multiply slowly and can repair small areas of damage in young patients. In “autologous chondrocyte implantation” these chondrocytes are first harvested and multiplied in the lab. They are then placed by a surgical method over a cartilage lesion.

Some of the common conditions treated by Orthobiologics are discussed below.

1) Osteo-arthritis – This is the commonest condition which can be treated by biologics. Osteo-arthritis of the knee is most prevalent in India. Although PRP may provide short term relief in very early cases, mild to moderate osteo-arthritis often need SVF or bone marrow stem cell treatment. Surgery is reserved for late cases with bone on bone contact. Additional procedures in the knee may often be needed like a meniscal repair, meniscal transplant, osteotomy and ACL reconstruction.

2) Cartilage lesion-
A cartilage lesion is a localized area of damaged joint cartilage. It is the precursor of osteo-arthritis. I treat treated symptomatic cartilage lesions with autologous chondrocyte implantation and one stage cartilage repair  They can be also treated with scaffolds.

3) Bone conditions-  Avascular necrosis of hip delayed and non unions can be treated with stem cell therapy.

4) Bone marrow lesions occur in the subchondral area of joints. They are present in a number of conditions including osteo-arthritis. In osteo-arthritis, they are one of the main areas of pain production. Bone marrow lesions are treated by sub chondroplasty using platelet rich plasma or bone marrow concentrate.

5) Knee injuries– Sprains of the MCL, LCL, Menisci, tendons injuries are treated. See this infogram.

6) Shoulder joint-  Rotator cuff tears, cartilage lesions and osteoarthritis are treated with PRP & stem cells.

7) Hip joint- Augmentation of hip labral repair. Hip labral tears are common in India in young active individuals. This leads to hip pain and is the fore-runner of osteo-arthritis of hip. Hip labral reconstruction is a new area in which biological products like PRP and bone marrow concentrate are used.

8) Lumbar Facet joints – These are the small joints in your low back which allow you to twist and turn. Facet joint arthritis is a disabling cause of low back pain in middle age. When conservative treatments have failed, biological injections can help to alleviate low back pain for a number of years. I offer facet joint injections with MSC’s for low back pain.

9) I treat joints like the ankle, elbow, wrist, hand and fingers with Orthobiologic injections.

Surgical Orthobiologic procedures. – These procedures are done either by key hole or open surgery. Some of the common operations are marrow stimulation, autologous chondrocyte implantation, single stage cartilage regeneration.

I also offer joint preservation procedures of the knee, hip and other joints like osteotomy, ACL reconstruction, Meniscal repair, replacement, cartilage repair, MPFL reconstruction, rotator cuff repair etc.

Let’s look at the evidence for biological treatments.

1)  PRP can offer pain relief for up to nine months in early osteo-arthritis.

2) SVF is more effective in mild to moderate cases of osteo-arthritis.

I have satisfied bone marrow treated patients reporting three year pain relief.
I have got follow up video testimonial from SVF patients.
I also have MRI evidence demonstrating healing of bone marrow lesions following bone marrow stem cell treatment.

Advantages of Orthobiological treatments

1) They are safe.
2) They are effective.
3) They are cost effective.
4) A joint replacement can be postponed or avoided.

Which conditions are treated by orthobiologics in my practice?

Common degenerative conditions of knee, shoulder, hip, fracture non unions and soft tissue injuries can be treated with orthobiologics

How are they done?

Commonly the injection procedures are done under local anesthesia and are quite painless. I use ultrasound and/or fluoroscopic guidance. Sometimes I deliver the treatment through arthroscopic or open surgery under regional or general anesthesia as a day care procedures. See how it is done here .

What are the results?

Results are encouraging in knee osteo-arthritis. Now I have patients with more than two year follow up who are pain free and functional. You can see their latest stories in the blog.
Patients have got pain relief and are able to continue with their daily activities. See this playlist for patient testimonials 

Who are the right candidates for Orthobiologic treatment Chennai, India?

    1. Patients with knee joint pain from mild to moderate osteo-arthritis may benefit from ortho-biologic treatment after trying other conservative measures.
    2. Medically unfit for knee replacement but still suffering from knee joint pain and desirous of pain relief

Who is not suited for orthobiologic treatment of knee arthritis in Chennai India?

    1. Obese patients with BMI > 35.
    2. Bone on bone disease ( IKDC grade D). Total knee replacement is the definitive treatment
    3. Uncontrolled inflammatory arthritis like Rheumatoid arthritis and sero-negative arthritis. You may consult your rheumatologist for medical management. I offer joint replacements for advanced cases. See my website
    4. Young patients with post-traumatic arthritis and gross deformities. A complex knee replacement is necessary.
    5. Uncontrolled diabetes.
    6. Patients with gross deformities. ( They may need an additional reconstructive procedure simultaneously to correct mal-alignment like an osteotomy.

Although patients with knee OA are most common, others with AVN hip, rotator cuff tears, tennis elbow, foot conditions and fracture non unions also seek help.

About Dr.A.K.Venkatachalam

Dr.A.K.Venkatachalam
Dr.A.K.Venkatachalam

Dr.A.K.Venkatachalam FRCS, M.Ch Orth, DNB Orth, MS Orth is an UK board certified orthopaedic surgeon.

He pioneered micro-fracture of knee in Chennai in 2004 . He pioneered autologous ossron implantation ( 2013), autologous chondrocyte implantation (ACI)  in Chennai in 2014. He has now pioneered stromal vascular fraction treatment (SVF treatment) in Chennai, India. He has undergone training for cartilage repair, bone marrow, fat harvesting and guided injections in the USA.  He has done signaling cell & PRP procedures for hip, knee, elbow, ankle, foot and shoulder. He chairs the ethics committee  of a company for development of cellular products.
Our procedures are done only in Chennai after thorough clinical and radiological evaluation.

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Contact Us

Chennai Meenakshi Multi-Specialty Hospital,
Luz church road, Mylapore, Chennai, India.
MJRC clinic- At Guest & Chennai Meenakshi multispecialty hospitals
Phones- 1) CMMH- 044 42938938
Guest hospital- 044 26411656

Mobile : 7824003400
E mail : drvenkat@kneeindia.com

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Disclaimer

Orthobiologic treatments mentioned in this website are medical techniques that may or may not be considered mainstream. As with any medical treatment, results will vary among individuals, and there is no implication that you will heal or receive the same outcome as patients herein. There could be pain or other substantial risks involved. These concerns should be discussed with your health care provider prior to any treatment so that you have proper informed consent and understand that there are no guarantees to healing.