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Health Information Repairing and Replacing Shoulders, Biologically

When people think of joint replacement, they tend to think mostly of knees and hips. But like knees and hips, the shoulder can sustain traumatic damage or be ravaged by osteoarthritis when the articular cartilage (the glistening, white cartilage that coats the ends of bones) wears down, causing pain, swelling and limited range of motion that eventually leads to shoulder replacement surgery. While replacement is often a good option for patients over the age of 50, it doesn't always offer the long-term relief that younger, active patients need because the implants can loosen over time, requiring an additional procedure to replace the implant.

That's why orthopedic surgeons at Rush University Medical Center, such as Brian Cole, MD, MBA, are among those looking at ways to biologically repair or rejuvenate the shoulder joint and stave off the need for a replacement. This includes treatments that are borrowed from other joints, such as osteochondral allograft transplantation, in which a fresh graft made of donor cartilage and bone is implanted to replace a localized, or contained, area of damage in the patient's joint. While the procedure has been used to patch cartilage in the knee for the past 20 years, it's relatively new to shoulder repair. But Cole says it holds tremendous promise for helping patients regain full, pain-free use of their shoulders after an injury.

Another novel approach being explored at Rush involves the use of stem cells. It's similar to platelet-rich plasma — which is also being used in the shoulder to enhance the healing of small rotator cuff tears — in that it augments the body's own ability to heal, but different because the stem cells aren't injected into the joint. Rather, the surgeon helps the body access its own stem cells by drilling holes in the ends of the bones and penetrating down to the stem cell-packed bone marrow. This gives the stem cells direct channels to travel to the injured area. The surgeon then puts a collagen membrane over the joint surface to seal it off and hold the stem cells in place so they can do their job: stimulating the growth of healthy new cartilage cells.

"These types of biologic approaches are really taking off," Cole says. "We're getting closer to being able to biologically modify the environment of diseased joints so outcomes can be improved and we can spare patients from having surgery, which is our goal."

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