Orthobiologic Therapy and Mesenchymal Stem/Stromal Cells in Trauma & Orthopaedics
DNB Orthopaedics • October 2023 • Paper IV • Question 5 • 10 Marks [2+2+2+2+2]
Introduction
Orthobiologics are biological substances derived from the patient, another human source, or produced using biological/recombinant technology and used to enhance repair, regeneration or healing of musculoskeletal tissues.
Their role is based on improving one or more components of the biological environment: cells, signalling molecules, matrix/scaffold and vascularity. They are used or investigated in fracture healing, nonunion, cartilage disease, tendon and ligament pathology and other regenerative applications.
Orthobiologics do not replace sound mechanical principles. Stable fixation + viable biology + adequate vascularity remain fundamental to fracture healing.
A. Orthobiologic Therapy — Definition [2 Marks]
Orthobiologic therapy is the therapeutic use of biological materials, cells, growth factors or biologically active products to stimulate, augment or facilitate the repair and regeneration of bone, cartilage, tendon, ligament and other musculoskeletal tissues.
It may act by one or more of the following mechanisms:
- Osteogenesis — supplying cells capable of forming new bone
- Osteoinduction — stimulating progenitor cells to differentiate into osteoblasts
- Osteoconduction — providing a scaffold for tissue ingrowth
- Delivery of growth factors and cytokines
- Modulation of inflammation
- Promotion…