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Trendy knee injections: potential cures or orthopedic snake oil?

For years athletes have done whatever it takes to get back in the game: playing through pain, taking medications and even undergoing surgery. Recently, new treatments for early arthritic changes have created a buzz in the professional sports world as well as the medical field.

Trendy knee injections: potential cures or orthopedic snake oil?

Philadelphia 76ers´ AndrewBynum walks off the court at the end of the first day of NBA basketball training camp Tuesday, Oct. 2, 2012, in Philadelphia. One day before training camp was set to open, the Sixers announced Monday they would shut down their new franchise All-Star for three weeks as a precaution after he received knee treatment in Germany. (AP Photo H. Rumph Jr)
Philadelphia 76ers' AndrewBynum walks off the court at the end of the first day of NBA basketball training camp Tuesday, Oct. 2, 2012, in Philadelphia. One day before training camp was set to open, the Sixers announced Monday they would shut down their new franchise All-Star for three weeks as a precaution after he received knee treatment in Germany. (AP Photo H. Rumph Jr)

For years athletes have done whatever it takes to get back in the game: playing through pain, taking medications and even undergoing surgery. Recently, new treatments for early arthritic changes have created a buzz in the professional sports world as well as the medical field.

Novel treatments like Orthokine, stem cell therapy and platelet-rich plasma (PRP), and have changed the landscape of sports medicine.

Orthokine, known commonly as the “Kobe Procedure,” has been used in professional athletes like Kobe Bryant, Brandon Roy, Greg Oden and even Alex Rodriguez. This procedure, developed in Germany, has been used for over a decade but has not yet been approved for usage in the United States by the FDA.

Orthokine focuses on treating the inflammation as opposed to mechanical problems in the joints. Its minimally-invasive nature is attractive to patients, and it is advertised as having virtually no recovery time.

About two ounces of blood are drawn from the patient, then spun at body-temperature in a centrifuge with special glass spheres to isolate a material to counteract an arthritic agent in the knee. The blood is then injected back into the patient’s knee (or other affected joint) in six separate injections over a two week period.

If this procedure is being used in Germany, why is it not available to our patients in the United States?  For one, there is no long-term data to show that it works. In fact, there are no studies on Orthokine at all when looking at the most prominent Orthopedic and Sports Medicine journals.

Secondly, patients are currently paying thousands of dollars cash for these treatments. Many professional athletes have traveled to Germany to have these procedures done, but with high cost and no data as of yet to suggest long-term benefit. This is not currently a procedure recommended for the general public.

Unlike Orthokine injections, platelet-rich plasma (PRP) use skyrocketed in the USA after its usage in prominent athletes. Now after the dust has settled, few good studies have supported it as providing benefit. PRP, a quick office procedure involving spinning down your own blood cells and then injecting them into the affected area, quickly gained footing in the sports medicine landscape before the long-term trials could be conducted. Its applications expanded at the same time studies began to show equivocal benefit.

Stem cell injections utilize cells harvested from bone marrow and are more invasive than PRP or Orthokine. The concentration of platelets and other cells is maximized. Again, this technique has received a fair amount of publicity on television shows such as “The Doctors,” but more research is needed to prove out as a truly beneficial technique.

Our experience with PRP should have taught us a lesson, but we continue to push the envelope with newer technologies like stem cells and Orthokine. As sports medicine surgeons, we do everything in our power to get our patients and athletes back to play, but we must temper our enthusiasm for unproven procedures until we have convincing evidence that we are providing true benefit, not just ‘benefit’ seen through optimistic, rose-colored lenses.

-By David Rubenstein, M.D.

About this blog
Kelly O'Shea Sports Medicine & Fitness Editor, Philly.com
Robert Cabry, M.D. Team Physician for U.S. Figure Skating, Assoc. Team Physician for Drexel; Drexel Sports Medicine
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales, Pa.
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
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