Mechanical loading plays a crucial role in the development, maintenance, and health of musculoskeletal tissues, particularly tendons and ligaments. These connective tissues require physiological levels of mechanical loading to maintain proper structure and function. At the cellular level, tendon and ligament stromal cells fine-tune the extracellular matrix in response to mechanical stimuli through mechanotransduction.
However, when tendons and ligaments are subjected to pathological levels of force, this mechanical stress can trigger an immune system-mediated tissue repair pathway. Excessive or abnormal mechanical loading can lead to ‘overuse’ injuries, such as tendinopathy, characterized by pain, inflammation, and degeneration of the affected tendon.
Interestingly, recent research suggests that mechanical stress may also play a role in the development of certain forms of chronic inflammatory arthritis, such as spondyloarthritis and rheumatoid arthritis. The anatomical distribution of these conditions often overlaps with areas of high mechanical stress in tendons and ligaments, indicating a potential link between mechanical loading and the onset of inflammatory joint disorders.
Given the importance of mechanical stress in the health and disease of tendons and ligaments, there is a growing interest in using orthobiologics to treat these conditions. Orthobiologics are substances derived from biological sources that can promote healing, regeneration, and repair of musculoskeletal tissues.
One promising orthobiologic treatment for tendon and ligament disorders is platelet-rich plasma (PRP). PRP is a concentrated source of growth factors and other bioactive molecules derived from a patient’s blood. When injected into the affected tendon or ligament, PRP can stimulate the local stromal cells to initiate a healing response, promoting the synthesis of new extracellular matrix components and reducing inflammation.
Bone marrow aspirate concentrate (BMAC) contains multipotent cells that can differentiate into various cell types, including those found in tendons and ligaments. When injected into the affected area, BMAC can help to regenerate damaged tissue, reduce inflammation, and promote healing.
Using orthobiologics in treating tendon and ligament disorders offers several advantages over traditional treatment methods. Unlike anti-inflammatory medications, which merely mask symptoms, orthobiologics aim to address the underlying biological processes responsible for tissue damage and dysfunction. Additionally, orthobiologics are derived from natural sources and have the potential to promote long-term healing and regeneration, reducing the risk of recurrent injuries.
As our understanding of the biomechanics and mechanobiology of tendons and ligaments continues to grow, so does the potential for orthobiologics to revolutionize the treatment of mechanical stress-related disorders. By harnessing the power of these biological therapies, we can effectively treat and prevent a wide range of tendon and ligament injuries and potentially mitigate the risk of developing certain forms of chronic inflammatory arthritis. Further research into the role of mechanical stress in musculoskeletal health and disease, coupled with advancements in orthobiologic therapies, holds great promise for improving the lives of countless individuals affected by these conditions.
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