Caitlin Whyte (Host): Welcome to WakeMed Voices. I'm your host, Caitlin Whyte. And with me is Dr. Chad Greer, a non-operative sports medicine physician at Wake Orthopedics. Today, we're diving into a topic that's changing the way we treat bone, joint, and soft tissue injuries: regenerative medicine. From platelet rich plasma to cell-based therapies, these techniques aim to tap into the body's natural healing power, often helping patients recover faster, delay surgery, or get back to the activities they love.

Dr. Greer, to start us off today, can you tell us what is regenerative medicine and how is it being used in orthopedics today?

Dr. Chad Greer: So, regenerative medicine is a broad term that's being used really with multiple treatments that are not typically considered mainstream or historically used. And some of those can include things like PRP or A2M and stem cell interventions. And these things that are more cutting-edge and more prone to dealing with their body trying to heal itself. Whereas historically, we've tried to combat disease with anti-inflammatories and medications, as well as other interventions.

Host: And what types of injuries or conditions are most likely to benefit from regenerative treatments like PRP or even stem cell therapy?

Dr. Chad Greer: So, there's really a broad range of things we can treat non-operatively with those interventions, including tendinopathies as well as early degenerative change. Anything from, you know, classic tennis elbow that is giving somebody trouble and not able to get better with your historic treatments, as well as early degenerative change of joints, which we're seeing obviously as people age.

Host: So, how do these therapies actually work inside the body to promote that healing or reduce pain?

Dr. Chad Greer: So, the idea, really depending on the treatment of the condition that you're looking at-- so, for instance, we will use tendinopathy as an example. So, someone who has a breakdown of their tendon in an abnormal way that continues to cause chronic inflammation and pain for, say, someone who has tenness elbow, which is a common condition. That tendon has entered into a state where it's unable to be recognized by your body that it needs repair, but it's continued to have some chronic inflammation that causes pain. And so, the idea behind PRP in this case would be to take the healing properties of your own blood, but concentrate them in a way that if we apply them to that area, get your body to recognize that it needs to repair that area or otherwise it's entered into this indolent state where your body just doesn't recognize it.

Host: Wow. Can you walk us through what a typical treatment process looks like for a patient starting with that evaluation through that recovery?

Dr. Chad Greer: Sure. I mean, I think the evaluation, of course, is the most important part because no condition is the same and no two people are the same. And so, I think, having someone evaluate you and see exactly what your condition is and what treatments you've had and what you've failed and not failed is probably the most important first step.

 And then, seeing what condition it is, that will kind of dictate what you may be most responsive to. And so, let's say PRP, for instance, might be something that we think that you'd be responsive to. The process for that would be, once we've established the diagnosis and the treatment plan for PRP, we would bring you in.

PRP is the process of drawing your blood, spinning it in a centrifuge where it concentrates the areas of the blood-- in this case, the platelets and the growth factors-- to a concentration that's higher than circulating in your blood. And we then take that and in a case of a tendon, we inject that into the area to try to stimulate your body to repair that area.

Host: Now, there is so much buzz around regenerative medicine. What does the current evidence say about effectiveness and long-term outcomes?

Dr. Chad Greer: Well, sure. That's certainly the biggest question, right? That because there's over the years, been lots of different devices that concentrate things at different levels and no two pharmaceutical companies produce the same type of engineering that allows us to kind of have a good standard to go by, we've then had to not have as much evidence as we would've liked to have had thus far. But there's enough evidence out there that suggests, particularly with tendinopathy, that PRP is likely to give some improvement, if not give significant improvement. Particularly, the most that's been studied has been lateral epicondylitis, commonly known as tennis elbow, as well as mild to moderate degenerative change of the joint. So, both of those conditions actually have, you know, decent evidence to suggest it's a good tool for us to try. We do extrapolate that to other areas of the body and other tendinopathies, because we don't have the studies to back up necessarily other areas of the body. But I certainly have seen success. But the ability to have a study to quote in other areas of the body can be more difficult because the research just isn't called up yet.

Host: Well, how do you help patients decide whether regenerative medicine is the right option compared to more traditional treatments or surgery?

Dr. Chad Greer: I think that's exactly what we try to do is we evaluate the patient from start to finish, meaning what has been tried so far, what has worked, what's their past medical history, how does that factor in. Then, you'd have to see exactly what condition you're treating, because some conditions are going to be more responsive than others and what's the pathology there. And so, I think whenever you're looking at these things, you really want somebody who's looking at you as a whole person, both considering your other medical problems, other medical conditions, medications that you're on, what experiences you've had with treatments previously, what you're responsive to. And then, putting that all together to give you the treatment plan for whether the regenerative treatments may be beneficial to you.

Host: And looking ahead, Doctor, what advances or innovations in regenerative orthopedics are you most excited about?

Dr. Chad Greer: I think mostly it's just more research in the areas that give us more concrete evidence that go to insurance companies and say, "Hey, we need this approved and for you to pay for these procedures." I think the evidence is getting there, particularly for certain conditions. But I think that's probably been the biggest holdback over the years is that this has all typically been a cash pay, because insurances are not covering this.

I will say the exception has been Tricare has temporarily covered lateral epicondylitis, which is tennis elbow, as well as mild knee degenerative change. So, I think at least we've had some progress there, but I'd like to see more progress with more coverage so that we can get these treatments to more people.

Host: Absolutely. That was Dr. Chad Greer. To learn more about Wake Orthopedic Services, please visit wakeortho.com. If you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm your host, Caitlin Whyte with WakeMed Voices, brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.