This is Dr. Robert McGrath, the Medical Director at Juventix Regenerative Medical.
Osteoarthritis is a huge health issue not only in the United States but world- wide. The hallmark is a loss of cartilage both articular and the meniscus. Cartilage is a rubber like padding that supports the ends of the bones. It acts as a cushion between the bones. Cartilage is comprised of glycosaminoglycans, proteoglycans, collagen and elastin. Although it acts as a cushion, because of it’s rigid structure, cartilage holds and supports tubes open such as the rings of the trachea. Cartilage is comprised of cells called chondrocytes. These cells produce the matrix for structure.
There are three types of cartilage:
- Elastic cartilage- The most springy and supple type example nose and ears
- Fibrocartilage- The hardest and toughest and able to withstand heavy forces such as meniscus and disc materal
- Hyaline cartilage-Tough but elastic such as the rings of the trachea and rib area
Cartilage does not have a blood or nerve supply overall. However, fibrocartilage such as the meniscus does have a blood and nerve supply but limited. This supply is further reduced by trauma and aging. Nutrition is supplied to the chondrocytes by diffusion and compression of the joint. This generates a fluid flow to the tissue thus generating the diffusion of the needed nutrients to support these structures. Because chondrocytes are bound, they cannot migrate to sites of damage and therefore cartilage damage is difficult to heal.
Platelet-Rich-Fibrin is a leukocyte and platelet rich fibrin material that acts as a binding site for cytokines and growth factors needed for tissue repair. By concentrating these factors at specific tissue sites PRF promotes regeneration and tissue repair. This is especially important at sites where vascularity is diminished or absent such as the meniscus of the knee. Platelet-Rich-Fibrin is a second- generation platelet concentrate that is cost effective, simple and allows growth factors to be presented to target tissue to repair and regenerate. PRF contains platelets, growth factors, cytokines fibrinogen and fibronectin. The activation of fibrinogen to fibrin provides a cross linked fibrin matrix that binds these growth factors serving as a binding site This blood derived membrane is enriched with leukocytes which not only play a significant role in the immune response to fight infection but also play a needed response in the wound healing cascade. This closely mimics the overall wound repair process and unlike PRP continues to release these substances over a prolonged period of time. The overall result is healing and regeneration of tissue. It has also been proven that this fibrin matrix entraps stem cells with high regenerative potential providing an even more important basis for using this process in the regeneration of tissues like cartilage.
Initially, PRF was processed as a clot and used over a wound or in a dental procedure. The PRF was inconsistent due to lack of standardization in the centrifugation. Advanced PRF defined centrifugation speeds that prevented cell loss within the PRF matrix. Now, injectable Platelet-Rich-Fibrin was developed to act as a regenerative agent delivered in a liquid form. The injectible form allows delivery to tissues such as cartilage to release growth factors over an extended period of time. PRF stimulates osteoblastic activity rebuilding the lost tissue while decreasing inflammatory activity in the damaged area. As chondrocytes are the only cells found in healthy cartilage and are responsible for the production of the cartilaginous matrix. PRF provides the materials needed for the chondrocytes for proliferation and differentiation.
Platelet- derived growth factors (PDGF, IGF-1, TGF-B1) all act as potent stimulators of chondrogenesis by regulation cell proliferation, inflammation, angiogenesis and extracellular matrix deposition. Recent studies reveal that cartilage regeneration improves significantly using injectible PRF as opposed to older preparations of PRF.
The positive effects of Platelet-Rich-Fibrin on articular cartilage has been demonstrated on in vitro and in vivo studies and has been proven superior to PRP as in contains different growth factors.
- PDGF- promotes healing by collagen and protein synthesis
- IGF-1- shown to regulate articular cartilage metabolism
- TGF-B1-Mediates the shift from proliferation to differentiation of the chondrocytes
These growth factors and others help repair cartilage defects. Since this area(meniscus) is mostly avascular, there is a limited ability for self- repair. Platelet-Rich-Fibrin has been recognized as a strategy to improve cartilage regeneration by the presence of these bioactive factors. They stimulate the proliferation of the chondrogenic cells and therefore aid in the deposition of cartilaginous material into these damaged areas.
Comparisons between PRP and PRF on the therapeutic effects on cartilage regeneration demonstrated the superiority of PRF. A recently published study comparing placebo to PRP, demonstrated a decrease in the overall pain and better range of motion in patients with osteoarthritis but an increase in the cartilage was not noted. This study used leukocyte poor PRP and not PRF. This demonstrates the lack of uniformity in the overall review of the clinical use of these products. At least 6 other studies demonstrated the efficacy in the uses of these products in osteoarthritic patients with cartilage loss.
Juventix Regenerative Medical has FDA approved kits for the production of PRP. They allow some needed leukocytes in the processing. Juventix has a patented bio-incubator for the production of Platelet -Rich-Fibrin without the use of activation products such as thrombin or CaCl. Juventix products are safe, cost -effective and the results are can be reproduced.
In regenerative medicine, the products make a huge difference in the outcomes.
Restore, Revive, Regenerate trust Juventix.
Dr. Robert McGrath