28th Isokinetic Medical Group Conference
During the 28th Isokinetic Medical Group Conference, we held a workshop entitled “Regenerative medicine and multimodal approach to prevent early osteoarthritis onset on late-career and former soccer players”. Our speakers Dr. Andrea Bruno1, Dr. Massimo De Donato1, and Dr. Elisabetta Tibalt2 presented different approaches to manage the trauma and the degeneration of cartilage that can occur in professional and amateur athletes investigating how to ameliorate quality life – not only in sports people – but also in the larger population of former players.
Dr. Andrea Bruno spoke about regenerative medicine approaches, which can be a conservative and preventive approach to avoid major surgeries. Regenerative medicine tools are autologous cell and tissue therapies and involve PRP, bone marrow concentrates, adipose tissue derivatives (rich in mesenchymal stem cells), and mononuclear cells. The latter, due to its minimal invasiveness, was taken as an example showing the good clinical outcome in a case-report of a former marathoner suffering of grade II primary osteoarthritis (abstract and case report available in attachment).
Sometimes surgery is necessary, for example in a cartilage defect of traumatic origin. Dr. Massimo De Donato spoke about cartilage defects treatment, showing the rationale and good results of subchondral stimulation such as microfractures – which are iatrogenic fractures in the cartilage to promove its repair – but evidencing also the existing limits. For this reason, he introduced the argument of II-generation microfractures, namely nanofractures, which are more precise and standard, avoiding subchondral compaction and ameliorating cartilage repair with native type-II collagen and glycosaminoglycans (abstract available in attachment).
Treatment is only one step in the path of healing. Dr. Elisabetta Tibalt spoke about an underestimated but fundamental topic: the preliminary education and rehabilitation program that a patient must face before and after a regenerative treatment. Even if little can be found in the scientific literature, there are several good recommendations, i.e. quadriceps strengthening and neuromuscular joint control in case of knee osteoarthritis. The first phase of a biological activity must go along with protection and joint activation programs. After that, a second phase of progressive loading and functional joint restoration must follow. When there is cartilage repair maturation, it’s time for activity restoration.
1Arthroscopic and Reconstructive Orthopedic Unit of the Knee, Head of unit: Dr. Enrico Arnaldi, Humanitas Research Hospital, Rozzano, Milan, Italy.
2ESW Therapy & Research Center, Rehabilitation Department, Head of unit: Dr. Stefano Respizzi, Humanitas Research Hospital, Rozzano, Milan, Italy