The book examines recent developments in regenerative medicine and the use of musculoskeletal ultrasound. Musculoskeletal regeneration has become a prominent research topic, no doubt due to the sociological and economic pressures imposed by the current ageing population. The ever expanding role of regenerative medicine and the identification as well as characterization of stem cells have introduced a major paradigm shift in the field of musculoskeletal and sports medicine as well as orthopaedic surgery. Whereas in the past, diseased tissue was replaced with allograft material, current trends in research revolve around regenerating damaged tissue.
Specifically, regenerative medicine stands in contrast to the standard treatment modalities which impair the body’s natural abilities to facilitate endogenous repair mechanisms such as anti-inflammatory drugs; or destructive modalities (e.g., radiotherapy, nerve ablation, injections of botulinum toxin) and surgical interventions that permanently alter the functioning of a joint, bone or spine. When compared to other allopathic options (including knee and hip arthroplasty with a 90-day mortality rate of 0.7%), regenerative medicine treatment modalities have a lower incidence of adverse events with a growing body of statistically significant medical literature illustrating both their safety and efficacy.
Focusing on the major values of regenerative medicine, this book with its 21 chapters is expected to fill an important void in the current literature. It will take that extra step to guide you in your day to day clinical practice. Featuring contributions from a large international group of leaders in regenerative medicine and musculoskeletal ultrasonography, this book is an authoritative reference for rheumatologists, physiatrists, sonographers, radiologists, physiotherapists and orthopaedic specialists.
Author(s): Yasser El Miedany
Publisher: Springer
Year: 2022
Language: English
Pages: 553
City: Cham
Foreword
Preface
Contents
Contributors
Part I: Regenerative Medicine
1: Fundamentals and Applications of Regenerative Medicine
Introduction
Standard Forms of Therapy vs. Regenerative Medicine
Standard Pharmacotherapy
Basics of Regenerative Medicine
Local Tissue Metabolic Changes
The Potential of Regenerative Medicine in Achieving Metabolic Balance
The Induction of Self-Regeneration
Phases of the Regenerative Medicine
The Importance of Image Guidance
Fundamentals of Cell Therapies
The Mesodermal Embryonic Stem Cells
Stem Cell-Microenvironment Communication
Existing and New Cell Sources
Standard Interventions for the Treatment of Major Musculoskeletal Diseases and Their Limitations
Osteoarthritis
Osteoporosis
Myopathies
The Convergence of Regenerative Medicine and Rehabilitation
Transforming Healthcare Through Regenerative Medicine
Controversies in Regenerative Medicine
Ethics in Musculoskeletal Regenerative Medicine
Regenerative Medicine Curriculum for Next-Generation Physicians
Maturity of the Regenerative Medicine Field
References
2: Regenerative Options for Musculoskeletal Disorders
Introduction
Basic Science of Orthobiologics
Selected Orthobiologics to Treat Primary MSK Conditions
Rotator Cuff Tendinopathy
Lateral Epicondylitis
KOA
Orthobiologics to Augment Current Orthopedic Surgical Procedures
Rotator Cuff Tears
ACL Tears
Meniscal Tears
Cartilage Repairs
Quantifying Outcomes of Orthobiologics
Future of Orthobiologics
Bibliography
3: The Nuts and Bolts of Regenerative Medicine as It Pertains to the Joint
Articular Cartilage
Ligaments and Tendons and Their Effects on Joint Problems
Platelet-Rich Plasma (PRP)
Macrophages: A Secret Weapon in a PRP
Matrix Metalloproteases (MMP) A2M
Stem Cells: The Drivers of Regeneration
Some Generalities
Stem Cell Niche
What Are the Major Stem Cells
Embryonic Stem Cells
Induced Pluripotent Stem Cells (IPS CELLS)
Multilineage-Differentiating Stress-Enduring Cells (Muse Cells)
Very Small Embryonic-Like Stem Cells (V Cells)
Mesenchymal Stem Cells
MSCs Sources
Hematopoietic Stem Cells
Techniques for Obtaining HSCs From Bone Marrow
What Cell Combinations Seem to Work Best for the Joint?
Avascular Necrosis and Ligamentous Problems
Why Does There Seem to Be Differences in Success Between Different Joints?
What Else Is Used to the Stem Cell Procedures for Better Efficiency?
Extracorporeal Shock Wave Therapy (ESWT)
Hyperbaric Oxygen Therapy
Photoactivation of PRP and Stem Cells
Prolotherapy
Ozone Therapy
Allogenic Cell Products
Cytokine Therapy
Stem Cell Ageing Pathways May Be the Key to Regenerative Success
Senescent Cells
Supplements to Increase Success
Citations
Suggested Reading
Part II: Diagnostic and Interventional MSK Ultrasound
4: Image Optimization
How an Ultrasound Image Is Generated
The Piezoelectric Effect
Transducers
The Effect of Frequency, Gain and Focus on the Character of the Ultrasound Image
Frequency
Depth
Gain
Focal Zone
Doppler and Its Utility in Identifying Vascular Structures
Orientation Marker
Techniques to Improve Needle Visualization
Probe Manipulation
Ergonomics
References
5: Shoulder
Long Head of the Biceps Brachii
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Injection Approach #1
Injection approach #2
Supraspinatus Tendon
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Injection Technique
One-Needle Technique
Two-Needle Technique
Subscapularis Tendon
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Infraspinatus
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Teres Minor
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Subacromial/Subdeltoid Bursa (SASD Bursa)
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Acromioclavicular Joint
Anatomy and Ultrasound Evaluation:
Pathology
Interventional Procedures
Sternoclavicular (SC) Joint
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Glenohumeral (GH) Joint and Rotator Interval
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Spinoglenoid Notch
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Suprascapular Notch
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Quadrilateral Space
Anatomy and Ultrasound Evaluation
Pathology
Interventional Procedures
Pectoralis Major
Anatomy and Ultrasound Evaluation
Pathology
References
6: Ultrasound-Guided Elbow Injection Techniques
Ultrasound-Guided Elbow Injection Techniques
Elbow Joint Injection
Common Extensor Tendon Injection (Tennis Elbow)
Common Flexor Tendon Injection (Golfer’s Elbow)
Olecranon Bursa Injection
Ulnar Collateral Ligament (UCL)
Ulnar Nerve at the Elbow
Deep Branch of Radial Nerve at the Elbow (Posterior Interosseous Nerve Syndrome)
7: Wrist and Hand
Introduction
Wrist – Sonoanatomy and Interventional Techniques
Hand – Sonoanatomy and Interventional Techniques
References
8: Ultrasound of the Hip/Thigh: Regenerative Medicine Focus
Introduction
Regions of the Hip
Anterior Hip Region
Sonoanatomy
Extra-articular Hip
Procedures
Hip Joint/Labrum Injection/Aspiration
Labrum Injection
Iliopsoas Bursal Injection
Hydrodissection on Lateral Femoral Cutaneous Nerve
Medial Hip Region
Introduction
Sonoanatomy
Rectus Abdominus
Pubic Symphysis
Pathology
Adductor/Rectus Aponeurosis
Osteitis Pubis
Procedures
Lateral Hip Region
Introduction
Sonoanatomy
Ultrasound Technique
Pathology
Gluteus Medius Bursitis
Procedures
Posterior Hip Region
Introduction
Sonoanatomy
Ultrasound
Pathology
Procedures
Ischiofemoral Space/Peri-sciatic Hydrodissection
Hamstring Origin
Hamstring Origin
Conclusion
Thigh
Introduction
Sonoanatomy
Pathology
Muscle Injuries
Hematoma
Morel-Lavallée Lesions/Seroma
Procedures
Hematoma/Seroma Aspiration
Muscle Injections
Conclusion
References
9: Ultrasound Imaging of the Knee Joint
Introduction
Anterior Region
Medial Region
Posteromedial Corner
Posterior Region
Posterolateral Corner
Ligament-Capsule-Menisci Complex
References
10: Ultrasound-Guided Orthobiologics of the Foot and Ankle
Introduction
Ankle Anatomy
Osseous and Ligamentous Anatomy
Muscle, Tendon, and Neurovascular Anatomy
Orthobiologic Use About the Foot and Ankle Interventional Procedures: Joints
Ultrasound-Guided Joint Injections of the Foot and Ankle
Approaches
Long Axis to Joint, in-Plane with Td
Out-of-Plane with Td
Ultrasound-Guided Subtalar Joint Injection
Posterior Subtalar (Talocalcaneal) Joint Injection
Approaches
Posteromedial
Anterolateral
Interventional Procedures: Soft Tissue Structures – Regenerative Introduction
Plantar Fascia: Regenerative Evidence
Platelet-Rich Plasma
Amniotic Membrane Derivatives
Prolotherapy
Regenerative Technique: Ultrasound-Guided Plantar Fascia Procedures
Regenerative Medicine/Orthobiologic Injection With or Without Fenestration
Approaches
Medial to Lateral, in-Plane with Td
Achilles Tendon: Introduction
Ultrasound-Guided Achilles Tendon Procedures
Achilles Tendon Injection Technique
Achilles Tendon Neovessel Ablation: High-Volume Injection and Tendon Scraping
Ultrasound-Guided Achilles Tendon Neovessel Ablation (Scraping) with HVI
Procedure
Achilles Tendon Intra-tendinous Platelet-Rich Plasma (PRP) Injection with or Without Needle Tenotomy
Key Recommendations
Tendon Sheath Injections: Regenerative Evidence
Posterior Tibial, Achilles, and Peroneal Tendon Injection Technique
Approaches: Posterior Tibialis Tendon
Posterior to Anterior, in-Plane with Td
Tibialis Anterior Tendon
Medial to Lateral, in-Plane with Td
Peroneus Longus and Brevis Tendon
Posterior to Anterior, in-Plane with Td
Ligament Injections: Regenerative Evidence
Anterior Talofibular Ligament and Anterior Inferior Tibiofibular Ligament PRP Injection Techniques
Anterior Talofibular Ligament
Distal to Proximal, in-Plane with Td
Anterior Inferior Tibiofibular Ligament
Medial to Lateral, in-Plane with Td
Distal to Proximal, Out-of-Plane with Td
Deltoid Ligament
Anterior to Posterior, Out-of-Plane with Td
Anterior to Posterior, in-Plane with Td
Post-procedure Rehabilitation Protocol
Conclusion
References
Part III: Back and Spine
11: Ultrasound-Guided Regenerative Injections for the Spine
Introduction
Neck Pain and Regenerative Medicine
Anatomy and Sonoanatomy of the Cervical Spine
Clinical Pearls of Specific Structures
Cervical Facet Joint
Thoracic Back Pain and Regenerative Medicine
Anatomy and Sonoanatomy of the Thoracic Spine
Clinical Pearls of Specific Structures
Thoracic Facet Joint
Costotransverse Joint (CTJ)
Low Back Pain and Regenerative Medicine
Anatomy and Sonoanatomy of the Lumbosacral Spine
Clinical Pearls of Specific Structures
Lumbar Facet Joint
Thoracolumbar Fascia (TLF) and Paraspinal Muscles [52]
The Iliolumbar Ligament (ILL)
The Sacroiliac Joints (SIJs)
Conclusion
References
12: Spinal Regenerative Medicine
Introduction
Regenerative Medicine by Spinal Target
Regenerative Facet and/or Paraspinal Injections
Regenerative Epidural Injections
Regenerative Intradiscal Injections
Regenerative Subchondral Intravertebral Injections
Conclusions
References
Part IV: Dentistry
13: Regenerative Medicine in Dentistry
Introduction
Sources of Dental Stem Cells (DSCs)
Dental Pulp Stem Cells (DPSCs)
Stem Cells from Human Exfoliated Deciduous Teeth (SHED)
Periodontal Ligament Stem Cells (PDLSCs)
Stem Cells from Apical Papilla (SCAP)
Dental Follicle Precursor Cells (DFPCs)
DPSCs vs SHED vs DPSCs vs SCAP
Oral Mucosa Stem Cells (OMSCs)
Alveolar Periosteum Stem/Progenitor Cells
Salivary Gland Stem Cells
Adipose Stem Cells (ASCs) from Orofacial Tissues
Scaffolds and Tissue Bioengineering in Dentistry
Regenerative Medicine Versus Regenerative Dentistry
Tooth Banking
Collection and Processing for Tooth Banking
Transporting of Dental Stem Cells
Isolation and Preparation of Dental Stem Cells
Cryopreservation of Dental Stem Cells
Low-Level Laser Therapy (LLLT) and Bone Bio-stimulation
Low-Intensity Pulsed Ultrasound Applications in Dentistry
Conclusions
References
Part V: Musculoskeletal Ultrasound in Regenerative Medicine
14: Regenerative Medicine Procedures Under Ultrasound Guidance
Introduction
General Guidelines for Regenerative Intervention
Platelet-Rich Plasma (PRP)
Preparation Methods for PRP
Injection Procedure of PRP
Bone Marrow Aspirate Concentrate (BMAC)
Preparation Methods of BMAC
Injection Procedure of BMAC
Adipose-Derived Stem/Stromal Cells (ADSC)
Preparation Methods for Adipose Aspirate
Alpha-2-Macroglobulin (A2M)
Preparation and Clinical Application of α2-Macroglobulin
Interleukin-1 Receptor Antagonist Protein (IRAP)
Autologous Conditioned Serum (ACS)
Specific Regenerative Interventions uUnder Ultrasound Guidance
Joints
Joint Injection Technique
Tendons and Ligaments
Ultrasound-Guided Injection of the Tendon and Ligaments
Muscle Injuries
Ultrasound-Guided Injection of the Muscles
Regenerative Treatments for Spinal Conditions
Regenerative Treatment for Peripheral Nerve Injury
References
15: Ultrasound-Guided Nerve Hydrodissection for Pain Management: From Anatomy to Techniques
Introduction
Current Methodology
Method 1 (In-Plane Approach, Needle Perpendicular to the Long Axis of the Nerve)
Real Practice of This Technique
Clinical Pearls
Method 2 (Out-of-Plane with Subsequent In-Plane Approach)
Clinical Pearls
Identification of Nerve(s) Indicated for Treatment
Injectate for HD
Downregulation of the Transient Receptor Potential Vanilloid Receptor-1 (TRPV1) Ion Channel
References
16: High-Frequency Peripheral Nerve Ultrasound
Introduction
Integrating Electrodiagnosis and Ultrasound for Diagnosis of Peripheral Neuropathies
Electrodiagnosis
Peripheral Nerve Ultrasonography
Comparison of Electrophysiology and Peripheral Nerve Ultrasonography
Peripheral Nerve Anatomy and Sonographic Appearance
Imaging Strategies
Nerve Measurement
Evaluation of Focal Neuropathies
Identifying Focal Nerve Abnormalities
Evaluation of Generalized Neuropathies
Ultrasound-Guided Peripheral Nerve Procedures
Summary
References
17: Dextrose-Based Perineural Injection Treatment, and Ultrasound Hydrodissection
Introduction
Change in Neuropathic Pain Definition and Introduction of Perineural Injection Therapy (PIT)
Differentiating Dextrose-Based Treatments
Perineural Hydrodissection With Ultrasound Guidance
Historical Relationship Between Neurogenic Inflammation and Pain
Early Concepts of Pain
Valleix Points
Concept of Nociceptors
Hilton’s Law
Twenty-First Century: Pain As a Channelopathy
TRPV1
What Are the Effects of CGRP and Substance P That Produce Signs and Symptoms of Chronic Pain Syndromes and Degeneration?
Potassium Channels
Glucose Transporter 3 (GLUT3)
The Basic Science on Dextrose Algesia Efficacy
Neuronal Energy Deprivation Theory of Pain/Lyftogt Theory of Pain
Early Clinical Evidence of PIT Efficacy Using Dextrose
Discussion
Conclusion
References
18: Ultrasound-Guided Spinal Procedures
Regenerative Medicine for Spinal Procedures
Evidence
Contraindications
Peri-procedural Considerations
Cervical Spinal Nerves
Indications
Scanning Technique and Important Anatomy
Injection Technique
Pearls
Equipment Needed
Cervical Medial Branch Blocks and Third Occipital Nerve
Indications
Scanning Technique and Important Anatomy
Injection Technique
Equipment Needed
Cervical Zygapophyseal Joint
Indications
Scanning Technique and Important Anatomy
Injection Technique
Pearls
Equipment Needed
Stellate Ganglion
Indications
Scanning Technique and Important Anatomy
Injection Technique
Pearls
Equipment Needed
Greater Occipital Nerve
Indications
Scanning Technique and Important Anatomy
Injection Technique
Pearls
Equipment Needed
Lumbar Medial Branch Blocks and Zygapophyseal Joint
Indications
Scanning Technique and Important Anatomy
Injection Technique
Pearls
Equipment Needed
Caudal
Indications
Scanning Technique and Important Anatomy
Injection Technique
Pearls
Equipment Needed
Sacroiliac Joint
Indications
Scanning Technique and Important Anatomy
Injection Technique
Pearls
Equipment Needed
References
19: Musculoskeletal Ultrasound-Guided Regenerative Medicine
The History of Ultrasound and Physiatry
The Ultrasound as an Extension of the Physiatrist
Ultrasound in Physiatric Musculoskeletal Medicine
Joint Injections
Tendon and Bursa Injections
Injections in Soft Tissue
Ultrasound in Rehabilitation
Post-stroke Shoulder Pain
Spinal Cord Injury Considerations
Botulinum Toxic Injections
Amputee Limb Complications
Conclusion
References
Part VI: Sports Medicine
20: Ultrasound-Guided Exercises
History of Ultrasound Use in Exercise
Biofeedback in Exercise
Ultrasound-Guided Lumbar Core Exercise
Ultrasound in Neurodynamics
Other Applications of Ultrasound in Exercise
Conclusion
References
21: Evolution of Sports Ultrasound
Introduction
Diagnostic Ultrasound in Sports Medicine
Advantages of Diagnostic Ultrasound in Sports Medicine
Broad and Expanding Applicability of US Beyond Traditional MSK Applications
US in Sports Medicine: Organ System Evaluation
HEENT
Ocular Evaluation
Exercise-Induced Laryngeal Obstruction
Chest
Echocardiography
Rib Fracture and Pneumothorax
Abdomen
Extended FAST (eFAST)
Splenomegaly Monitoring in Mononucleosis
Abdominal Muscle Evaluation
Inguinal and Femoral Hernia Evaluation
Hernia Mimickers: Groin Pain in the Athlete
MSK
Peripheral Nerve Injuries
Median Nerve
Ulnar Nerve
Sciatic Nerve Branches
Lateral Femoral Cutaneous Nerve
Brachial Plexus
Vascular Injuries
US in Sports Medicine: Physiologic Measures
Muscle Glycogen
Body Composition
Tendon Stiffness
US in Sports Medicine: Guiding Return to Play
Interventional Use of Ultrasound for Procedural Guidance
Advantages of Interventional US in Sports Medicine
First-Generation Procedures
Second-Generation Procedures
Calcific Barbotage
Neovessel Ablation
Third-Generation Procedures
Ligament or Retinaculum Release
Tendon, Muscle, or Fascial Release
US in Orthopedics: Use of US in Preoperative Planning and in the Operating Room
Current Limitations and Future Directions
Conclusion
References
22: Use of Musculoskeletal Ultrasound and Regenerative Therapies in Sports
Musculoskeletal Ultrasound in Sports
Musculoskeletal Ultrasound/Regenerative Therapies in Upper Extremity Sports Injuries
Shoulder
Elbow
Wrist and Hand
Peripheral Nerve Injury Secondary to Sports in the Upper Extremity
Brachial Plexus Injury or “Stingers”
Spinal Accessory Nerve
Long Thoracic Nerve
Suprascapular Nerve
Axillary Nerve
Musculocutaneous Nerve
Median Nerve
Ulnar Nerve
Radial Nerve
Musculoskeletal Ultrasound/Regenerative Therapies in Lower Extremity Sports Injuries
Hip
Anterior/Medial Hip
Posterior Hip
Knee
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Lateral (Fibular) Collateral Ligament Injury
Medial Knee Ligaments
Iliotibial Band Injuries
Patellar Tendon Sports Injuries
Meniscal Injuries
Ankle and Lower Leg
Ankle Inversion Sprain
High Ankle Sprain
Medial Ankle Sprains
Achilles Tendon Injuries
New Features in Ultrasonography
References
Part VII: Future of Regenerative Medicine
23: Regenerative Medicine: Challenges and Opportunities
Introduction
Challenges
Clinical
The Evidence Crisis
Augmented Access
Commercial Clinics
Ethical and Governance Crisis
Demand
Finance
Media
Responding to the Challenges: The Opportunities
Is There a Bright Future for Regenerative Medicine?
Driver: Availability of Funding for Stem Cell Research
Restraints: Ethical Concerns Related to Embryonic Stem Cells
Opportunity: Emergence of iPSCs as an Alternative to ESCs
The Allogeneic Stem Cell Therapy Segment Dominated the Stem Cell Therapy Market in 2020
The Inflammatory and Autoimmune Disease Segment Will Witness the Highest Growth During the Forecast Period
Conclusion
References
Index
