Regeneration instead of repair

The objective of regenerative medicine is to use the body’s own strength to treat the condition long-term. Even in the case of degenerative conditions, such as osteoarthritis of the knee, it can provide opportunities that can be supported by the use of braces.

For decades, the treatment of osteoarthritis has been a challenging and often frustrating task. “In cases of higher-degree cartilage tissue damage, the only last resort of non-surgical treatment was intra-articular cortisone or hyaluronic injections,” Dr. med. Ralf Peter Schnorr remembers. “Bridging the time until surgery and reducing pain were the focus of treatment. Influencing the condition in a sustainable way was not really an option.” About eight years ago, the situation changed for Dr. Schnorr. At that time, the Specialist in Osteoarthritis started orthobiological treatments with other sports physicians and later founded FIRST (Focused Integrated Regenerative Sports Medicine and Treatments) in Zurich, Switzerland, an orthopedic clinic that uses the treatment principles of regenerative medicine.

Biological signals stimulate regenerative processes

From anti-inflammatory treatment to orthobiological stimulation of the body’s own regeneration – this is how FIRST’s approach to cartilage damage can be described. Today, a lot of damage caused by excessive strain as well as conditions caused by wear can be successfully treated in orthopedics and sports medicine using orthobiological treatment, such as PRP (platelet rich plasma), LLLT (low-level laser therapy) and NPT (neural prolotherapy), which all trigger a biological signaling cascade. “The cause of osteoarthritis is multifactorial,” Dr. Schnorr emphasizes. “We support a periarticular perspective, rather than a purely mechanical one. We see the joint as a ‘micro climate’. It is not just the cartilage that must be taken into account but also ligaments, bones, muscles, tendons and nerves.” When treating symptomatic osteoarthritis of the knee, many factors must therefore be considered: axial alignment and loading, static and dynamic axial stability and the muscular guidance of the joint. But also the factors of proprioception, strength and muscular endurance as well as passive stabilizers, neural control and pain generators must be borne in mind.

Orthobiology and braces

“In parallel with regenerative medicine, non-surgical treatment options have also increasingly evolved,” Dr. Schnorr explains. According to him, braces are important pillars of osteoarthritis treatment, which positively complement the orthobiological measures of regenerative medicine. Active and passive factors, such as neuromuscular, proprioceptive movement control and improved joint guidance with reduced impact on the ligaments, menisci and cartilage, are ways to support different treatment approaches. An improved positioning of the joint parts concerned, such as centering the patella in its natural trochlear groove in cases of potential effusion, and patellar control in cases of trochlear insufficiency play a vital role during the treatment using braces. “In specific cases, correction of the leg axis and patellar positioning can be of particular significance,” the physician explains.

GenuTrain OA reduces shear stress

The GenuTrain OA was demonstrated to the sports physician and interventional pain specialist in October 2019. This brace is provided by medical supply retailers and can be individually adapted by orthotists. Meanwhile, the brace has become an established option for Dr. Schnorr. “We use it as an additional tool in cases of unilateral joint destruction. For injuries, we may also employ unilateral relief of the menisci. Studies have shown that a distraction of the joint parts concerned has a positive impact on cartilage regeneration 1. The distraction is also used as a positive element as part of joint regeneration – in addition to the principle of providing the damaged tissue with relief, which is initially considered in a purely mechanical way. We consider this option of axial correction as additional joint stimulation to promote regeneration. The reduction of cartilage shear stress is also an important element within our treatment plan.”

The comfortable system regulates relief

In addition to dynamic axial correction in accordance with the specifications for medial or lateral relief, Dr. Schnorr sees great benefits in the GenuTrain OA when it comes to patient convenience. The adjustment using the Boa® Fit System is very comfortable and easy to use to control the brace’s degree of correction. It also allows simple adjustment of the brace when there is no strain. In addition to the excellent anatomical cushioning, this also results in exceptional wearing comfort between active adjustment of the axis under strain and opening the control mechanism during relief. The physician also reports that, in the case of an elderly lady with extreme axial misalignment who did not receive any physiotherapy because of her Parkinson’s disease, the GenuTrain OA helped her return to increased self-activity. “The brace was the key component of functional treatment. Because it was so well tolerated, we were able to use further medication and symptom therapies without difficulty.” This is a motivating experience, not only for the patient.

1 En L. G. et al.: The role of joint distraction in the treatment of knee osteoarthritis: a systematic review and quantitative analysis, Orthopedic Research and Reviews 2019:11 79–92

Bilder: FIRST/Dr. Ralf Peter Schnorr