Regenerative therapy for musculoskeletal problems

Most of our body’s tissues are highly capable of repairing themselves. For example, consider how our skin heals after a cut or how our bones mend after a fracture. Regenerative medicine seeks to take advantage of this natural healing ability, especially when our body takes too long to heal or struggles to do so.

Today, there are a variety of approaches to regenerative medicine: some already in use, while others are still being studied [1].

Stem cells are “unspecialized” cells, meaning they do not yet have a specific role in the body. They have the ability to develop into several types of cells such as liver, muscle or immune cells. The most versatile stem cells come from embryos, but each “adult” tissue also has its own small reserve of stem cells. These are less versatile, but they can transform locally to repair damaged tissue. A bone marrow transplant is probably the best known stem cell therapy. This makes it possible to replace defective or missing blood cells and restore our body’s ability to produce new healthy blood cells.

Thanks to scientific advances, it is possible to modify the DNA of certain cells to give them specific properties. This approach has been used for several years to treat certain cancers, particularly with CAR-T cell therapy, which helps immune cells recognize and attack cancer cells. Recently, it has also been used to treat genetic diseases such as sickle cell disease, a form of anemia caused by the destruction of deformed red blood cells [2].

When an organ has a very complex structure, tissue engineering can be used to design a support matrix for creating a partially artificial tissue that can be integrated into the body without causing rejection. Skin grafts for severe burn victims is an example of regenerative engineering [1].

Regenerative medicine can also rely on naturally occurring growth factors in certain cells such as platelets, which are responsible for blood coagulation. In addition to forming a clot, platelets release substances that stimulate the healing of surrounding tissue. Platelet-rich plasma (PRP) therapy is a simple and commonly used tissue regeneration technique [3].

Prolotherapy is a technique that involves injecting an irritant solution, generally a dextrose (sugar) into a joint, tendon or ligament. The dextrose causes a local inflammatory reaction that triggers tissue repair mechanisms [4].

Medical imaging – whether x-rays, ultrasounds, CT scans or MRIs – plays an essential role in regenerative medicine.

In the case of musculoskeletal lesions, imaging is both a key tool for diagnosis and monitoring treatment. Imaging is also essential during guided procedures such as infiltrations. It makes it possible to inject (infiltrate) therapeutic substances such as medications, platelet-rich plasma, dextrose or viscosupplements into the lesion site with great precision [5].

Musculoskeletal disorders (MSDs) are frequent and common. They are a group of injuries that affect joints, muscles, tendons, ligaments, cartilage and sometimes nerves. They cause muscle pain, back pain, knee pain, osteoarthritis, and many other discomforts that impair mobility and reduce quality of life. The two most useful imaging techniques for these disorders are MRI and ultrasound.

Medical imaging helps confirm the type of lesion and guide the most appropriate treatment choice. For example, many conditions, including fibromyalgia, cause symptoms similar to those of MSDs, but do not involve the same structures or require the same care. Imaging can therefore help prevent misdiagnosis and ensure the right therapeutic approach is chosen from the outset.

As MSDs often require several treatment sessions, imaging is also a valuable tool for personalizing follow-up: it enables the dose, frequency or injection technique to be adapted according to the progression of the lesion.

Before undertaking any specific treatments, such as infiltrations, prolotherapy or PRP injections, it is reassuring to rely on an accurate diagnosis.

Regenerative medicine holds great promise. This includes cell therapy, which one day may use cells that are less rare than embryonic cells and which may be produced in unlimited quantities. Gene therapy will be able to use cells capable of correcting an increasing number of genetic defects, while tissue engineering will be able to use 3D printers and biological “ink” to produce organs ready to be implanted. Medical imaging will certainly be involved at each step of these future treatments to provide accurate diagnoses, assist with injection and transplantation procedures and undoubtedly for follow-up.