There is no miracle or magic in medicine. Most injection therapies are used to treat sport injuries as well as the symptoms of degenerative diseases and disorders such as osteoarthritis (OA). Some injection therapies such as corticosteroids (CS) and hyaluronans (HA) are well documented for their safety and potential side effects. Some such as hydrolyzed collagens (HC) and hydrogels (HG) however are experimented in a limited number of patients and their follow-up outcomes are time limited. Still, they are broadly used to relieve pain and increase function in musculoskeletal conditions. The European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA)-Orthobiologic Initiative (ORBIT) recently supported the safety and clinical efficacy of platelet rich plasma for mild to moderate knee OA. CS are strong anti-inflammatory agents that can be used in inflamed joints however as they have degenerative effects on articular joint cartilage and they are only recommended to patients that are in the waiting list for a joint replacement surgery. There is a critical time window between two injections and/or surgery. In case of CS injections, there is an increased risk of infection if the duration between injection and surgery is less than 12 months. HA is debatable for their effectiveness. About 80% of our patients re-visit the outpatient clinic in about 12 to 24 months for their regular injection. The formulations of HA are improving rapidly. Combinations are frequent however the best treatment option is not well established yet. Their long-lasting beneficial effect is also hardly reported in randomized controlled studies. Recent randomized clinical studies revealed that there is a place for a special formulation of HA in the treatment of degenerative and stable meniscus tears. Selected patients who refrain from forceful rotational knee activities may benefit from these injections. Concentrated HG collagens are recently introduced into injection therapies for musculoskeletal acute or chronic injuries. Relief of pain and increase in function is observed in most patients. HG on the other hand significantly decrease swelling and pain in knee OA patients. They do not recover deformity however they open a window for patients that cannot undergo joint replacement surgery. Platelet rich plasma (PRP), total stromal cells from adipose tissues (TOST) and extracellular vesicles (EV) have the potential to regenerate tissues. In this chapter, we are willing to give insight into orthobiologics and injection therapies that are frequently used in musculoskeletal conditions by including our expert opinions.

Musculoskeletal Injection Therapy: Part 1

章节
发表日期：

2025年

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Feza Korkusuz,
Elif Üstün,
Emine Çiftçi,
Bilge Başak Fidan,
Paul Lee

摘要

There is no miracle or magic in medicine. Most injection therapies are used to treat sport injuries as well as the symptoms of degenerative diseases and disorders such as osteoarthritis (OA). Some injection therapies such as corticosteroids (CS) and hyaluronans (HA) are well documented for their safety and potential side effects. Some such as hydrolyzed collagens (HC) and hydrogels (HG) however are experimented in a limited number of patients and their follow-up outcomes are time limited. Still, they are broadly used to relieve pain and increase function in musculoskeletal conditions. The European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA)-Orthobiologic Initiative (ORBIT) recently supported the safety and clinical efficacy of platelet rich plasma for mild to moderate knee OA. CS are strong anti-inflammatory agents that can be used in inflamed joints however as they have degenerative effects on articular joint cartilage and they are only recommended to patients that are in the waiting list for a joint replacement surgery. There is a critical time window between two injections and/or surgery. In case of CS injections, there is an increased risk of infection if the duration between injection and surgery is less than 12 months. HA is debatable for their effectiveness. About 80% of our patients re-visit the outpatient clinic in about 12 to 24 months for their regular injection. The formulations of HA are improving rapidly. Combinations are frequent however the best treatment option is not well established yet. Their long-lasting beneficial effect is also hardly reported in randomized controlled studies. Recent randomized clinical studies revealed that there is a place for a special formulation of HA in the treatment of degenerative and stable meniscus tears. Selected patients who refrain from forceful rotational knee activities may benefit from these injections. Concentrated HG collagens are recently introduced into injection therapies for musculoskeletal acute or chronic injuries. Relief of pain and increase in function is observed in most patients. HG on the other hand significantly decrease swelling and pain in knee OA patients. They do not recover deformity however they open a window for patients that cannot undergo joint replacement surgery. Platelet rich plasma (PRP), total stromal cells from adipose tissues (TOST) and extracellular vesicles (EV) have the potential to regenerate tissues. In this chapter, we are willing to give insight into orthobiologics and injection therapies that are frequently used in musculoskeletal conditions by including our expert opinions.