Diagnosis and Treatment for Sports Injuries

The process of diagnosis is slightly different at the different centres that offer non-invasive regenerative therapies.

Explaining how the diagnosis and treatment work at Apollo Spectra Hospitals, Dr Gautam Kodikal cites the case of an 84-year-old lady with osteoarthritis. She had severe pain in her joints, particularly the knee region. She revealed that her knee turned red and swollen each morning. Despite physiotherapy and other alternative treatments, her condition did not improve.

A primary consultation was followed by an MRI scan as it gave the doctors complete information and allowed for the treatment to be customized. Her treatment was for seven sittings, but she expressed great relief by the fifth. According to Dr. Gautam Kodikal, she has been pain-free since the treatment. Vasishta explains the diagnosis of osteoarthritis is based on clinical features and X-rays of the knees. Based on this information, the doctors can evaluate the extent of degeneration, grade of osteoarthritis, and associated bony abnormalities, after which the treatment is customized for the patient. The treatment is hourly for 21 days, followed by selective strengthening of the muscles. Most patients feel symptomatically better in two weeks and the progress continues for three months.

Osteoarthritis is graded on a universally accepted system into four grades, with 4 being the worst affected. Vasishta says that patients who present early with grade 3 or early grade 4 osteoarthritis do very well and they are able to regain their quality of life.

Contrary views
Not everyone believes regenerative therapies can help, especially people with advanced musculoskeletal problems. "Only patients at stage 1 or 2 may benefit from such therapies,” says Dr. Rakesh Nair, consultant knee replacement surgeon, Mumbai. "Especially those within 40 to 55 years of age may find this form of therapy workable if the cause of trauma is an injury or fall. It may not be for problems that arise due to wear and tear."

He goes on to say that for every form of treatment, non-conventional options are available. "Regenerative therapy plays a role only if there is no mechanical deformity. It might help only younger patients with selective cartilage loss. This constitutes only 10 to 15per cent of patients but may not necessarily have good long-term results. It may not be a viable option in severe cases," he says.

Invasive vs. non-invasive
Apollo Spectra Hospitals offer invasive regenerative therapy, which they believe is a better option than the non­invasive ones. Dr. G. Thiruvengita Prasad, consultant, trauma and orthopaedics, Apollo Spectra Hospitals, Chennai, says, "We have had procedures to regenerate cartilage cells for a long time now, ever since arthroscopy (a minimally invasive surgical procedure on a joint) came into the picture. Non-invasive procedures have been found to encourage the growth of fibro cartilage, as opposed to the necessary hyaline or joint cartilage which is of better quality, when you are looking at the regeneration of cartilage in the case of osteoarthritis."

With technological support from Mumbai-based Regenerative Medical Services (RMS) Regrow, Apollo Spectra Hospitals, among other Apollo Hospitals, uses invasive regenerative therapy for osteoarthritis. This process involves steps. First is a bone marrow cartilage biopsy to harvest precursor cells from the patient. The step involves culturing the progenitor cells in a centralized laboratory setting for four to five weeks to obtain the tissue cells. In step three, the cells are implanted into the patient in the affected part of the body.

"In the invasive technique, the cells taken from the person's own body depending on the area of the defect, culture sufficient number of cartilage cells," says Prasad. "From small to the large area can be covered with cartilage cells that are cultured. This form is much more effective because, one, you cover much more and, two, you can identify specific of cartilage needed and grow that. This does not happen in other techniques." People of all ages can benefit from this stem cell therapy, but it has to be understood that the cells needed for ligaments, tendons and bones vary and have to be harvested from the bone marrow or blood.

While many doctors feel invasive procedures and surgery are better treatment modalities, Mahajan believes that non-invasive therapies should be further explored to capitalise on their positive aspects.

Vasishta points out that since regenerative therapies are new, most required patients are advised knee surgery, which they often refuse because of the fear of surgery, and they end up going through life in pain. "They come to us are in advanced stages of arthritis. But these patients also benefit from the therapies we offer. There are no side effects of MRT as the field strength and small frequencies used are extremely low and have been certified safe for human use by the international commission. The process is comfortable because it is non-invasive and safe and the patient has no pain and discomfort during treatment," he says.

Dr. Gautam Kodikal adds that there is no age bar for the treatment and that it is particularly useful for osteoarthritis, osteoporosis, sports injuries and degenerated bones disc and spinal diseases.
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