Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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23.2 Applications of Regenerative Medicine to
Orthopaedic Physical Therapy
Table of Contents

INTRODUCTION TO REGENERATIVE MEDICINE

Abstract:

CONTENT: Physical therapists need to keep abreast of the advances in regenerative medicine and how these advances translate to changes in care. These emerging technologies will have a significant effect on patient care. These distinguished and highly credible authors have set the stage for introducing the field of regenerative medicine to physical therapy. This monograph first provides a brief history of the field and defines the major categories of regenerative medicine. These include stem cell therapy, gene therapy, tissue engineering using scaffolds, and organ engineering. A nice discussion on the current state of regenerative science in terms of public policy and regulation adds perspective to the science and governance of regenerative medicine. The authors conclude their work by providing specific examples of the importance of regenerative medicine in physical therapy. These distinguished and highly credible authors have set the stage for introducing the field of regenerative medicine to physical therapy. CASE ANALYSES: The authors provide specific examples of the importance of regenerative medicine in physical therapy.

Keywords:​

rehabilitation, physical therapy, technology

References:

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NEUROMUSCULAR TISSUE ENGINEERING

Abstract:

CONTENT: The monograph introduces clinicians to the many facets of neuromuscular tissue engineering. The authors identify the essential steps in the regeneration process for skeletal muscle and peripheral nerve tissues. The basic biology and methodology that modify cell function are presented. The authors build on this background information to describe how exercise and mechanical loading benefit the development of engineered tissues, cell transplantations and cell function in aging, and in nerve injury and with muscle pathology. Specific conditions in which tissue engineering is being researched as a potential treatment intervention include aging, Duchenne muscular dystrophy, volumetric muscle loss, and peripheral nerve injury. The current state of preclinical and clinical stages of applying neuromuscular tissue engineering therapies and limitations and barriers of tissue engineering for musculoskeletal and peripheral nerve interventions are discussed. The principles covered in this monograph may ultimately guide clinical practice as these technologies move to the forefront of clinical practice. CASE ANALYSES: None.

Keywords:​

regenerative medicine, rehabilitation, physical therapy

References:

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TENDON AND LIGAMENT BIOLOGICS

Abstract:

CONTENT: The rationale and application underlying the future role of tendon and ligament biologics in physical therapy is reviewed and its impact on fostering a new breed of rehabilitation is presented. In the monograph, the authors first provide a basic overview of the structure and function of tendons, ligaments, and the enthesis. The different phases of healing following an injury are then discussed along with the implications of scar tissue formation and their effect on ligament and tendon function. The challenges associated with tissue healing and regeneration following injury is then highlighted. Current regenerative medicine therapies and tissue engineering strategies are described so the reader can understand the function of stem cells and the implications for tendon and ligamentous tissue repair and regeneration. Specific coverage of platelet-rich plasma and stem cell injections and their role in treating common injuries serves to readily apply the current science to clinical practice. CASE ANALYSES: None.

Keywords:​

regenerative medicine, rehabilitation, healing

References:

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BIOLOGICS FOR DISK REGENERATION

Abstract:

CONTENT: The authors introduce the societal burden of disk pathology. Both structure and function of the intervertebral disk are delineated and a presentation of the pathophysiology of disk degeneration provides perspective on the demands placed on the intervertebral disk. The pain generation potential of the disk structure is also presented. Current therapies and their limitations are then elucidated. Therapies include growth factor and gene and stem cell therapies. Current and emerging treatments are highlighted along with limitations and how biologic treatments might be useful in treating low back pain. An informative section on how platelet-rich plasma is obtained and how it differs from other growth factor-based therapies is also included. The limitations and safety concerns of stem cell therapy are also covered. CASE ANALYSES: None.

Keywords:​

regenerative medicine, rehabilitation, healing

References:

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BIOLOGICS IN CARTILAGE, BONE REPAIR, AND REGENERATION

Abstract:

CONTENT: The integration of clinician and researcher create effective knowledge transfer that ultimately benefits the patient who has suffered injury to bone or cartilage. The authors have successfully authored a monograph that will help introduce clinicians to the many facets of neuromuscular tissue engineering. The authors first provide a glossary of terms to orient the reader to the “language” of regenerative medicine. Bone is discussed first with cartilage science detailed in the second half of the monograph. Bone and cartilage are reviewed based on their structure and function, loading (stimulation) response to injury, and then interventions based on regenerative science. Stem cell implications are highlighted for each area. At the end of each section, current applications of presented concepts are addressed according to how they impact healing and rehabilitation. The principles covered in this monograph ultimately guide clinical practice as these technologies move to the forefront of clinical practice. CASE ANALYSES: None.

Keywords:​

regenerative medicine, rehabilitation, healing

References:

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MECHANOTRANSDUCTION AS A TOOL TO INFLUENCE
MUSCULOSKELETAL TISSUE BIOLOGY

Abstract:

CONTENT: In the monograph, the role of mechanical forces (mechanotransduction) on pathophysiology and tissue types is described. The authors detail the steps required to convert external mechanical forces into biochemical signals and identify relevant mechanisms within each step. Specific properties of the musculoskeletal tissue extracellular matrix that contribute to mechanotransduction are also discussed. Application of these processes is then related to the influence of mechanical signals on progenitor cell differentiation, and on emerging cell-based regenerative therapeutics in musculoskeletal tissue. Challenges to the clinical translation of mechanotransductive principles and the influence of exercise on mechanical loading and systemic support for musculoskeletal tissue regeneration are reviewed. The applications of regenerative medicine and how closely it impacts rehabilitation will be appreciated after reviewing this monograph. CASE ANALYSES: None.

Keywords:​

regenerative medicine, rehabilitation, healing

References:

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