Healing a trail to the future — Dr. Luga Podesta on regenerative medicine

Orthopedic Sports Medicine

Regenerative medicine is infiltrating sports medicine and has the potential to change the industry completely, once fully studied.

Becker's Spine Review spoke to sports medicine and regenerative orthopedic specialist Luga Podesta, MD, at Bluetail Medical Group in Naples, Fla., about biologics and their immense potential.

Dr. Podesta has been using biologics to treat primarily upper arm injuries, in particularly partial tears of the ulnar collateral ligament.

In 2013, he was the lead author on a study, published in The American Journal of Sports Medicine, which demonstrated the effectiveness of platelet-rich plasma. He is currently in the process of repeating the study with a combination of platelet-rich plasma and bone marrow derived stem cells.

The primary fix for partial UCL tears was reconstruction or Tommy John surgery, which carries with it a lengthy rehabilitation process. However, through the use of PRP injections, the ligament responds faster and can heal itself.

Dr. Podesta said this is because platelets have robust tissue stabilization properties that have proven to be quite effective. In his 2013 study of 34 patients of varying ages, 88 percent managed to return to play with no complaints after 12 weeks. The patients were able to throw at the same level as prior to the treatment 70 weeks later, without any complaints.

"[The platelets] were able to cut the healing time," Dr. Podesta said. But still the question of longevity remains. Concerning UCL reconstruction, the repaired ligament will wear down if the athlete continues to put excessive strain on it. Given how new PRP treatment is, the industry is still unsure of how long a regenerated ligament will hold up.

Yet, Dr. Podesta said regenerative medicine has loads of potential.

Last year, Jeff Dugas, MD, of Andrews Sports Medicine and Orthopaedic Center in Birmingham, Ala., and George Paletta, MD, of the Orthopedic Center of St. Louis made headlines for performing UCL repair with internal brace construction. In this procedure, a physician can repair a partially torn UCL by repairing it at the ligament and placing a strut across the repair site to hold it to the bone. PRP is then injected around the repaired site to allow the body to heal the muscle naturally.

Repair of the UCL has been around for decades, appearing in a paper by the late Frank Jobe, MD, the same paper that documented Tommy John. Repairs were unsuccessful due to the lack of viable remaining native tissue.

Dr. Podesta believes biologics have the potential to permanently change sports medicine.

"We're starting to see the clinical support," he said. "I think we're going to see a paradigm shift on how injuries are initially treated. With partial tears, we may be able to treat them nonsurgically with those regenerative techniques.… I think that's the way of the future."

However, regenerative medicine is not without controversy. The FDA cracked down on several regenerative medicine clinics in 2017 that were performing treatments legally, but were promising unproven results. The media is also quick to write off successful cases, while dwelling on failed cases.

Dr. Podesta said despite the recent controversies, plenty of physicians are performing the procedures legally, and although the occasional procedure may fail, he urges the industry to take more time, especially concerning recovery.

"[Teams] are quick to pull the trigger, and say [the procedure] didn't work," Dr. Podesta said, "But what if we gave [athletes] more time. I think they'd see the difference in what takes place."

As research advances and physicians have a greater well of knowledge to draw on, Dr. Podesta is optimistic for the future of biologics.

"I think we're going to see we can treat more severe injuries than we initially thought we could treat, and hopefully my research can pan that out," he said.

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