Rope exercise.

Biologics in Rotator Cuff, Meniscus, Cartilage and Osteoarthritis Article

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Rope exercise.

Drs. Anz, Hackel, Nilssen, and Andrews authored an article regarding the application of biologics in sports medicine which was published this month in the Journal of the American Academy of Orthopaedic Surgery.  

The article entitled “Application of biologics in the treatment of the rotator cuff, meniscus, cartilage, and osteoarthritis” reviewed the current status of the use of platelet-rich plasma, bone marrow aspirate, and stem cells within sports medicine.

What can stem cells do?

There is evidence that these technologies are going to influence the way that orthopaedic surgeons practice medicine, and work at the Andrews Institute is focusing on leading the way but also producing proof that these methods are making a difference in the lives of our patients.

If you have questions about platelet rich plasma, bone marrow aspirate, or stem cells please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.

Biceps Anatomy

Biceps Anatomy Study

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Biceps Anatomy

Thank you to Eric Branch for his help with our recent study on the biceps femoris. It was published last month in the Orthopaedic Journal of Sports Medicine. 

This tendon injury can accompany anterior cruciate ligament injuries in football players. The more we learn about it the better we will be at our repairs/reconstructions. In this study we learned exactly where the tendon inserts on the tibia and fibula and its association with the anterolateral ligament.

Read More:

http://www.ncbi.nlm.nih.gov/pubmed/26535398

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Dr. Anz Provides Physician Coverage For Under Armour All-American Game

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photo-5Dr. Anz and a group of athletic trainers from the Andrews Institute in Gulf Breeze Florida provided the event physician coverage for the Under Armour All-American Game on January 2nd.  The event showcased the talents of America’s top High School Seniors.  Many of the players used the event to announce verbal commitments to college teams.  An exciting game was played with no major injuries.

Gym Team Exercise

Bone Marrow Aspirate

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Gym Team Exercise

Bone marrow aspirate contains platelets and a patient’s own stem cells, which have the ability to replicate themselves or differentiate into various tissue types.  

Bone marrow aspirate can assist in treating certain injuries. Sometimes when an injury occurs, the number of stem cells available for tissue regeneration is inadequate.

By using bone marrow aspirate, additional stem cells and growth factors can be placed at a site of injury to improve the overall healing process.

Bone marrow aspirate is a complex mixture of platelets, red blood cells, white blood cells, red blood precursor cells, and white blood precursor cells.  Initially, the white blood precursor cells were thought to be cells that nurtured the growth of red blood cells alone.  These cells were initially termed plastic-adherent cells due to this physical property of the cells.  Later, these cells were found to have the ability to reproduce and change into cells of other types, thus acquiring the name mesenchymal stem cells.  Initially isolated only on their ability to stick to tissue culture surfaces, when scientists studied these cells they found a broad mixture of cells which had the ability to turn into a number of different cell types.   Since bone marrow aspirate and bone marrow aspirate concentrate contains platelets and mesenchymal stem cells, it is a combination growth factor therapy and cell therapy, utilizing the regenerative potential of platelet-rich plasma (PRP) and Mesenchymal Stem Cells.

Bone Marrow

Pictured Above: an artist rendering of bone marrow.

Plasma Blood

Platelet-Rich Plasma (PRP)

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Plasma Blood

Platelet-rich plasma a growth factor/cytokine therapy.  It involves the isolation of platelets from a patient’s own blood and placing it at a given location.  Platelets are found in our blood. 

They contain growth factors and other signaling molecules which are instrumental in the body’s normal healing response.  Growth factors and cytokines are proteins which signal cells in our body.  These molecules tell our body to grow or stimulate our body to heal in scenarios.  When you have an injury, such as a cut on your skin, platelets are some of the first responders to arrive on the scene to stop the bleeding and stimulate other cells in your body to begin the healing process.  Platelet-rich plasma is a tissue product that is made from a patient’s own blood; it is an autograft tissue.

Blood contains red blood cells, white blood cells, and platelets.  These elements are suspended in a fluid called plasma.  Platelet-rich plasma is made by first taking a small amount of blood from the blood stream. The blood is placed into a device that spins, also known as a centrifuge.  The centrifuge separates the blood into layers through spinning. The layer including plasma and platelets is captured.  This solution can then be placed at a site where healing or a response of the body is desired.

A complete evaluation of an injury or condition is necessary before Dr Anz can decide if PRP therapy is a consideration for treatment. If it is determined to be an option, the PRP therapy procedure will be scheduled, potentially on the day of evaluation or at a later date. 

Orthopedics Blood Platelets Research

PRP may not provide instant relief for the patient, as treatment with PRP seeks to improve the biology of healing or reduce inflammation related to a mechanical issue.  During the procedure, Dr. Anz will inject the PRP solution into the injured area. In certain scenarios, PRP is used to augment a surgical procedure.  Dr. Anz will discuss the benefits of using PRP in a given surgical procedure if it will improve the result after surgery.

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For additional information, or if you would like to schedule an appointment with Dr. Adam W. Anz, orthopedic surgeon and sports medicine specialist, please contact his Gulf Breeze, FL office today.

Biologics Illustration

What are Biologics

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Biologics Illustration

Medical doctors often use the term biologics to refer to natural products that are harvested and used to augment a medical process.  These products include tissues from a patient’s own body (often called autograft) and tissues from another patient’s body (often called allograft).  These products can encompass a wide spectrum of tissues.  

For the purposes of orthopedics, therapies can be classified into three main categories:

  • Growth Factory Therapies
  • Cell Therapies
  • Tissue Therapies

Growth factor therapies involve the harvest and delivery of growth factors to a site, such as in the setting of using platelet-rich plasma to augment healing after a partial tear of a tendon.  Cell therapies involve the harvest and delivery of cells to a site, such as in the setting of cartilage repair with peripheral blood stem cells.  Tissue therapies involve utilizing tissue to repair or augment a repair, such as in the setting of a meniscal allograft transplant.  Many factors have effects on function, the potential for success, and the FDA regulatory concerns related to these treatments.  There is a spectrum of treatments available within biologics.  Similar to golf clubs in a golf bag,  there are different therapies available for different patient problems. 

 

Food and Drug Administration Regulation

It is important to understand the regulatory affairs concerning biologics in order to understand the potential for how they can be used to help patients.  This is especially important for stem cell therapies, as cells are living biologic products. 

Biologics Slide 1

 In 1997, the United States Food and Drug Administration (FDA) set forth in the Code of Federal Regulations Title 21 Part 1271, an approach to articles containing or consisting of all human cells, tissues, and cellular/tissue based products intended for implantation, transplantation, infusion, or transfer into a human recipient.  These articles were abbreviated HCT/P’s, and the FDA employed a tiered approach to regulation of these articles, based on the FDA’s assessment of patient risk.

Low-risk biologics were set to be regulated by the Public Health Service Act 361 which required only that treatments be prepared involving techniques aimed to prevent the introduction, transmission, or spread of communicable diseases.  These products do not require pre-market clinical studies or approval before they can be offered to patients.

Higher risk products are regulated under Public Health Service Act 351, whereby they must also undergo animal and human clinical studies in order to prove that they are safe and worthwhile to be used in patient care.  

This hurdle prevents physicians from offering some stem cell treatments to patients such as cultured stem cell treatments, certain stem cell treatments from fat and blood, and stem cell treatments involving allograft stem cells.

Orthopedic Biologics Slide 2.
Femoralplasty Cam Impengment

Femoroplasty (Cam Impingement)

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Femoralplasty Cam Impengment

Injury Overview 

Femeroacetabular Impingment, often referred to as FAI for short, refers to a condition where there is a abnormality of the shape of the bones of the hip joint. FAI can include an abnormality of the femur, bone in the thigh, where it is shaped like a ball (Femoral Head), or FAI can include an abnormality of the pelvic bone where it is shaped like a socket (Acetabulum). A Cam lesion is an abnormality in the shape of the femur where it changes in shape from a tubular structure to a ball. The transition section of the femur is known as the femoral neck. A Cam lesion is a bump at the junction of the femoral neck and femoral head. With certain hip motions, impingement can occur due to Cam lesions. Over time, this abnormal fit/interaction may result in injury to the acetabular labrum and articular cartilage within the hip joint. Cam impingment can occur in athletes whose sport involves significant rotational motion of the hip, including cyclists, golfers, ballet dancers, and football players. Surgical reshaping the femoral head and neck junction is known as femeroplasty and often involves an arthroscopic burr.

Initial treatment measures for Cam impingement are non-operative and will include rest, activity modification, and physical therapy to strengthen the core musculature area, as well as the muscles around the hip. If a patient continues to have ongoing hip pain, then surgery is usually recommended to correct the bony conflict and address any labral or cartilage problems.

Dr. Anz will use an arthroscopic surgical approach that will consist of keyhole incisions that are made in the skin, which allow a small camera and surgical tools access to the joint. During arthroscopic femoroplasty surgery for the treatment of Cam impingement, the Cam lesion (the bony abnormality) will be removed using an arthroscopic burr. The section of the femur at the head and neck junction is reshaped, creating a smooth transition which eliminates impingment. During this same procedure, Dr Anz will address the labrum and articular cartilage if it is found that damage has occurred to these structures.

Following surgery, physical therapy is very important. A therapy regimen will be prescribed which will work on regaining motion of the hip while protecting repairs. Patients will be required to use crutches for typically 4 weeks and a brace to protect the hip during healing. Physical therapy will be a progressive process incorporating range of motion movements and strengthening exercises.

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For more information on FAI impingement of the hip, Cam impingement, or for additional resources on hip impingement treatments including arthroscopic femoroplasty, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.

Running Exercise

Hip Instability

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Running Exercise

In orthopedics, instability occurs when patients have pain or discomfort due to abnormal looseness of a joint.   When a joint completely comes out of place it is called a dislocation.  When a joint partially comes out of place it is called subluxation.  In almost all cases involving the hip, it takes a great force or special scenario to dislocate, such as a motor vehicle accident.  Hip subluxations may require less force such as in the setting of football or soccer injuries.  With these types of injury, normal stabilizing structures may be compromised, for example ligaments that normally hold the joint securely in place may become stretched or torn. Hip instability may result and in this scenario it is known as traumatic hip instability.  A second type of hip instability is called acquired hip instability.  This type arises from recurrent microtrauma to normal stabilizing structures.  This can occur through normal activities in patients with abnormal anatomy such as in the setting of femoroacetabular impingment or hip dysplasia, or it may also occur in patients who perform certain repetitive activities which involve repetitive extreme movements which may slowly stretch the joint capsule with time.

Symptoms

Hip instability may cause one or more of the following symptoms:

  • •          Pain or the feeling that the hip will dislocate with certain movements
  • •          Deep aching in the hip joint
  • •          A repetitive clicking with certain activities or movements

Diagnosis

Dr. Anz will begin with a detailed discussion regarding previous injuries, surgeries, or activities that may include repetitive motions.  He will then perform a thorough exam of the hip joint and will assess the stability by performing specific movements and a series of stability tests. X-rays will be obtained to evaluate the joint space at the hip and check for underlying bony abnormalities.  If a patient has dislocated or subluxed his/her hip, it is often important to obtain a more in-depth study such as an MRI scan or a CT scan.

Treatment

Non-surgical treatment is almost always the best first step. After an initial traumatic event, a period of rest  to allow the capsule and/or surrounding soft tissue to heal is followed by a period of strengthening with physical therapy.  In patients with acquired instability, activity modification, strengthening methods with physical therapy focusing on pelvic girdle strengthening, and anti-inflammatory medications are the initial treatments. These treatments seek to reduce hip irritation and improve dynamic stabilization (stabilization provided by muscles) for the hip joint.  If these non-surgical treatments are not successful and symptoms continue, Dr. Anz may discuss surgery as an option.

Surgical Treatment

If surgery is necessary, Dr. Anz prefers an arthroscopic approach to treat hip instability.  Arthroscopic hip surgery uses several keyhole incisions, a tiny camera, and special instruments to allow Dr. Anz a complete view of the inside of the hip joint. The exact type of surgery will depend on the condition and/or the nature of the injury. Thus, each surgical treatment will vary from patient to patient. In some cases, Dr. Anz will tighten the hip capsule (inner lining of the hip joint).  The acetabular labrum is a structure important for hip stability. If it has been injured, it sometimes requires repair.  These procedures may occur in isolation, or together, in order to stabilize the hip and improve/maintain hip motion.

joint xray

Post-Operative

Dr. Anz will prescribe a progressive, thorough physical therapy program following arthroscopic surgery.  Working diligently with a therapist after a hip surgery is important to regain motion, strength, and function.  Dr. Anz and his staff will outline a customized therapy regimen to guide patients toward the best recovery possible after their surgery.

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If you have any questions relating to hip instability or any other hip related injuries, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute. 

Stem Cells

Dr. Anz and Dr. Saw’s Publication Highlighted by Arthroscopy Journal

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Stem Cells

The results of Dr. Saw’s recent clinical trial involving peripheral blood stem cells was published in this month’s Arthroscopy Issue. 

Dr. Anz and Dr. Jee among other authors helped to collect, synthesize, and statistically asses the data for this publication.   The results from this trial are a critical step forward in bringing this new technique to patients all over the world.  Further preparations are being made by the team to present information to the FDA to allow trials involving this technique.  The goal is to begin a clinical trial in the United States in January of 2014.

To read the full article, please, click here.

US-Ski-Team

Dr. Adam Anz Provides Physician Coverage for the US Ski Team During World Cup Races in Ofterschwang, Germany

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US-Ski-TeamDr. Adam Anz, orthopaedic knee and hip surgeon and sports medicine specialist in Gulf Breeze, Florida, recently returned from Ofterschwang, Germany where he provided physician coverage for the USSA women’s technical team during the Audi FIS Alpine Ski World Cup.  During this event, ski racers competed in giant slalom and slalom competitions.  Mikaela Shiffrin, the 2013 World Cup Champion in women’s slalom, was among the ski racers competing in Ofterschwang and finished 3rd in the slalom competition on Sunday March 10th.