30-2 Regenerative Medicine

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Editorial

Tissue damage from acute injury, “wear and tear” or chronic degradation is a problem that podiatrists see every day.

Tissue damage from acute injury, “wear and tear” or chronic degradation is a problem that podiatrists see every day. However, the fairly recent distinction between musculoskeletal inflammatory changes and tissue chronicity has been a turning point for all who treat musculoskeletal injuries and pathology.

While “tendinopathy” is an umbrella term including non-rupture injury, it’s only within the past 15 to 20 years that we’ve begun to recognize the pathology of tendinosis contributing to the structural and mechanical deficiencies resulting from tendon stress. It’s important to note that there are many areas of tension in the foot and ankle (such as abnormal bony prominences) that directly contribute to tendinopathy due to increased friction. Tendons, as well as the plantar fascia, experience repetitive cycles of injury and repair, which is often left incomplete from continued activity resulting in an accumulation of less-than-optimal tissue. The resulting tissue is thicker, has reduced energy-storing capacity and strains more easily. Understanding the histological, biological and pathological differences between chronic tissue and acutely-injured tissue has given rise to the field of regenerative medicine.

Regenerative medicine involves mechanical, biological or cellular treatments altering the tissue environment and/or providing a foundation for the regenerative process of pathologic tissue for cell attachment, proliferation and/or attraction. Grafts can be used in surgery to preserve tissue plane boundaries by limiting adhesion. By modulation inflammation, the use of regenerative principles is evident in newer treatment approaches for everything from bunion surgery to tendon repair, to bone/ cartilage replacement and treatments for plantar fascial pathology.

Biologics, cellular therapy and the use of amniotic tissues have all greatly enhanced our treatment options. Newer treatments such as platelet-rich plasma injections are based on the premise that platelets create an upsurge in growth factors. Other regenerative treatments including mesenchymal stem cells modulate inflammation. My own personal experience with regenerative medicine began with mechanotransductive procedures such as high-energy shockwave therapy (ESWT). The emergence of ESWT in the 1990s coincided with the understanding that chronicity of soft tissues was an entity distinct from tendinitis, and we now understand the cellular significance. Radiofrequency became available at the same time that ESWT was omitted from insurance coverage, partially due to overuse. I found similar success in my own practice with RF for both Achilles tendinosis and fasciosis as compared to ESWT. Today, many podiatric practices such as mine routinely use amniotic membrane injections as their primary means of regenerative treatment.

With that said, the intent of this issue of Foot and Ankle Quarterly is not to compare competing technologies and products, but to help the reader to understand their differences. Dr. Stephen Brigido’s Audio Lecture explores the healing components that are unique to regenerative healing, and my own Lecture reviews the reasons why traditional cortisone injections are no longer standard for chronic heel pain. More broadly, the Feature Article offers a clearer understanding of how various currently-available biotechnologies work, and gives a comprehensive overview of this rapidly-expanding field.

Marlene Reid, DPM

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The ideas and opinions expressed in Foot and Ankle Quarterly are those of the authors and do not necessarily reflect those of the Editor or the Publisher. Publication of an advertisement or other product mentioned in Foot and Ankle Quarterly should not be construed as an endorsement of the product of the manufacturer’s claims. Readers are encouraged to contact the manufacturer with any questions about the features or limitations of the products mentioned. The Publisher does not assume any responsibility for any injury and/or damage to any persons or property arising out of or related to any use of the material contained in this periodical. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device or of each drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other healthcare professionals, relying on independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient.

Disclosure

Data Trace Publishing Company Continuing Education Mission Statement
Data Trace Publishing Company is committed to providing high-quality print and internet-based enduring continuing education programs, including lectures, feature articles, and condensations and commentaries on current clinical podiatric topics and medical risk management topics which lead to improved delivery of patient care and help reduce the potential for medical errors. These programs are provided to meet the educational needs of the podiatric medical profession and thereby enhance the quality of patient care.

Program Objectives
Foot and Ankle Quarterly (FAQ) is a unique program designed to help today’s podiatric physician manage an ever-increasing flow of information. After completing the Foot and Ankle Quarterly, Volume 30 program, the learner should be better able to: develop and refine a perspective on current treatment recommendations, updates, and advances pertinent to podiatric practice; evaluate the implications of the learned information as it pertains to the diagnosis and treatment of podiatric disorders and societal issues and barriers, and; apply current trends, standards, and best practices into learner’s own practice.

Data Trace Publishing Company Continuing Education Accreditation Statement
Data Trace Publishing Company is approved by the Council on Podiatric Medical Education (CPME) as a provider of continuing education in podiatric medicine. Data Trace Publishing Company has approved this activity for a maximum of 8 continuing education contact hours (CECHs). Physicians should claim only the contact hours commensurate with the extent of their participation in the activity.

Estimated time to complete activity: 8 hours
Date of release: October 31, 2019
Expiration Date: October 31 2025 (unless further validated and extended by provider). For amended dates of activity expiration, please see FAQ Activity Effective Dates at www.datatrace.com). (Note: this course was further validated and extended from its original expiration date to now 2025.)

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No commercial interest provided financial support for this continuing education activity.

CECH Note
Participants of Volume 30, Issue 2 will receive a maximum of 8 CECHs for a correctly-completed CME Answer Form. In order to qualify for CECHs, a score of 70% or more must be achieved on the written examination material. Any participant who does not pass the first time may take the exam one additional time (within 90 days of receipt of results). One retake test may be taken for a fee of $15. You will be responsible for notifying your state of the number of contact hours you have received.

Participants are required to complete a course evaluation for use in developing future issues and to meet the unique educational needs of podiatric physicians.

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Article Authors and Lecturers

David G. Armstrong, DPM (n.)
Steven A. Brigido, DPM (n.)
James Cottom (n.)
Lawrence A. DiDomenico, DPM (n.)
Emlyn K. Forsung, DPM (n.)
Colin T. Graney, DPM (n.)
Mohammed K. Hassan, DPM (n.)
Alex Kor, DPM, MS (n.)
Lawrence M. Kosova, DPM (n.)
Patrick A. McEneaney, DPM (n.)
Howard G. Osterman, DPM (n.)
Britton S. Plemmons, DPM (n.)
James W. Ratcliff, DPM (n.)
Marlene Reid, DPM (1. Data Trace Publishing Company)
Laura Shin, DPM, PhD (n.)

FAQ Journal Planning Committee

Sheryl Baum (n.)
Rachel Miller (n.)
Lauren Molander (n.)
Stephanie Wu, DPM, MSc (n.)

30-2 Contributors

 Guest Editor

Marlene Reid, DPM
Family Podiatry Center, Naperville, IL; Past President, Illinois Podiatric Medical Association; Past President, American Association for Women Podiatrists; Past Chair, Podiatric Academy, National Academies of Practice; Fellow, American College of Foot and Ankle Surgeons; Fellow, National Academies of Practice

Contributors

David G. Armstrong, DPM
Professor of Surgery and Director, Southwestern Academic Limb Salvage Alliance, Keck School of Medicine of University of Southern California, Los Angeles, CA

Steven A. Brigido, DPM
Section Chief, Foot and Ankle Reconstruction, Director, Foot and Ankle Fellowship, Coordinated Health, Bethlehem PA; Clinical Professor of Surgery, The Geisinger Commonwealth Medical College, Scranton, PA

James M. Cottom, DPM
Director, Florida Orthopedic Foot and Ankle Center Fellowship; Private Practice, Florida Orthopedic Foot and Ankle Center, Sarasota, FL

Lawrence A. DiDomenico, DPM
Director, Podiatric Residency Training, East Liverpool City Hospital, East Liverpool, OH; Director of Residency Training, Section Chief, St. Elizabeth Hospital, Youngstown, OH; Fellow, American College of Foot and Ankle Surgeons; Certified Wound Specialist; Fellow, Certified Corporate Wellness Specialist

Emlyn K. Forsung, DPM
Resident, East Liverpool City Hospital, East Liverpool, OH

Colin T. Graney, DPM
Fellow, Florida Orthopedic Foot and Ankle Center, Sarasota, FL; Associate, American College of Foot and Ankle Surgeons

Mohammed K. Hassan, DPM
Resident, East Liverpool City Hospital, East Liverpool, OH

Alex Kor, DPM, MS
Private Practice, Witham Health Services, Lebanon, PA; Fellow, Past President, American Academy of Podiatric Sports Medicine; Fellow, American Society of Podiatric Surgeons; Diplomate, American Board of Podiatric Surgery

Lawrence M. Kosova, DPM
Family Podiatry Center, Naperville, IL; Fellow, American College of Foot and Ankle Surgeons; Fellow, American College of Foot and Ankle Orthopedic Surgeons

Patrick A. McEneaney, DPM
CEO/Owner, Northern Illinois Foot and Ankle Specialists, LLC, Cary, IL; Head, Section of Podiatry, Department of Surgery, Northwestern Memorial Hospital/Centegra Health Systems, McHenry, IL: Staff Wound Physician, Northwestern Memorial Hospital/Healogics; McHenry, IL; Fellow, American College of Foot and Ankle Surgeons, Associate, American Professional Wound Care Association

Howard G. Osterman, DPM
Partner, Foot and Ankle Specialists of the Mid-Atlantic; President, American Academy of Podiatric Sports Medicine; Team Podiatrist, Washington Wizards, NBA

Britton S. Plemmons, DPM
Partner, Longview Orthopaedic Clinic Association, Longview, TX; Associate, American College of Foot and Ankle Surgeons

James W. Ratcliff, DPM
Private Practice, Los Gatos, CA; Diplomate, American Board of Foot and Ankle Surgery; Fellow, American College of Foot and Ankle Surgeons; Fellow, American Academy of Podiatric Sports Medicine

Laura Shin, DPM, PhD
Assistant Professor of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA


In This Issue

  • FEATURE ARTICLE: Podiatric Applications of Regenerative Medicine: Where We Came From, Where We Are and Where We Are Going
    Marlene Reid, DPM
  • CONDENSATIONS/COMMENTARIES
    • Direct Radiofrequency Application Improves Pain and Gait in Collagenase-Induced Acute Achilles Tendon Injury
      Commentary by Alex Kor, DPM, MS
    • A Biomechanical Assessment of Tendon Repair after Radiofrequency Treatment
      Commentary by James Ratcliff, DPM
    • The Effects of Irreversible Electroporation on the Achilles Tendon: An Experimental Study in a Rabbit Model
      Commentary by Britton S. Plemmons, DPM
    • The Placenta: Applications in Orthopaedic Sports Medicine
      Commentary by Howard G. Osterman, DPM
    • The Use of Decellularized Human Placenta in Full-Thickness Wound Repair and Periarticular Soft Tissue Reconstruction: An Update on Regenerative Healing
      Commentary by James M. Cottom, DPM and Colin T. Graney, DPM
    • The Bio in the Ink: Cartilage Regeneration with Bioprintable Hydrogels and Articular Cartilage-Derived Progenitor Cells
      Commentary by Stephen A. Brigido, DPM
    • Topical Review: MACI as an Emerging Technology for the Treatment of Talar Osteochondral Lesions
      Commentary by Lawrence A. DiDomenico, DPM and Mohammed K. Hassan, DPM
    • Matrix-Associated Stem Cell Transplantation (MAST) in Chondral Defects of the First Metatarsophalangeal Joint is Safe and Effective: Two-Year Follow-Up in 20 Patients
      Commentary by Britton S. Plemmons, DPM
    • Sports Medicine and Platelet-Rich Plasma Nonsurgical Therapy
      Commentary by Patrick A. McEneaney, DPM
    • Synthesis, Development, Characterization and Effectiveness of Bovine Pure Platelet Gel-Collagen-Polydioxanone Bioactive Graft on Tendon Healing
      Commentary by Lawrence A. DiDomenico, DPM and Emlyn K. Forsung, DPM
    • Regenerative Rehabilitation: Applied Biophysics Meets Stem Cell Therapeutics
      Commentary by Lawrence M. Kosova, DPM
    • Adipose-Derived Stem Cells in Orthopaedic Pathologies
      Commentary by Stephen Brigido, DPM
    • Lipofilling for Functional Reconstruction of the Sole of the Foot
      Commentary by David G. Armstrong, DPM and Laura Shin, DPM, PhD
  • AUDIO LECTURE 1: Plantar Fascia Treatment Options in the 21st Century
    Marlene Reid, DPM
  • AUDIO LECTURE 2: Regeneration vs. Repair: What’s the Difference?
    Stephen A. Brigido, DPM