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Regenerative therapy treatments in orthopaedic medicine have been shown to help limit the need for pain medications and even surgery for some patients, which is why these noninvasive procedures with little to no recovery time are becoming increasingly popular in sports medicine.
Dr. Matthew Gnirke, whose primary specialty is Interventional Sports and Spine Medicine, is joining Vail Summit Orthopaedics and Neurosurgery in August. When appropriate for patients’ specific conditions and needs, Gnirke provides evidence-based orthobiologic treatments — including platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) stem cells — to manage a variety of musculoskeletal disorders.
“Regenerative medicine focuses on using the body’s own proteins and cells to promote the natural healing process. This helps to limit the need for pain medications and surgery, which carry a more troubling side effect profile when compared to regenerative treatments,” Dr. Gnirke said.
While appropriate for some patients, these treatments might not be a replacement or alternative to surgery for others.
Specific diagnoses
Dr. Gnirke said the first step of a successful treatment plan is the proper diagnosis and localization of pathology.
“I accomplish this by obtaining a careful history and physical examination, reviewing imaging studies and providing real-time musculoskeletal ultrasound diagnostics,” he said.
Specific diagnoses that are particularly well suited for such a treatment include arthritis, disc degeneration, degenerative and traumatic tendon injuries, meniscus and labrum pathology, and nerve injuries. In order to deliver these treatments to the exact site of pathology, Dr. Gnirke utilizes fluoroscopy and ultrasound guidance for all procedures.
“The central focus of my practice is to precisely diagnose and properly treat patients with musculoskeletal disorders,” Dr. Gnirke said. “I perform diagnostic musculoskeletal ultrasound and electromyography to pinpoint exact sites injury and pair this with fluoroscopy and ultrasound-guided interventions to deliver accurate treatments.”
Continuum of treatment options
Regenerative treatments are best suited for musculoskeletal disorders that have failed to improve with activity modification, therapy, and anti-inflammatory medications and can often eliminate the need for invasive surgical procedures.
While regenerative medicine is a new and exciting treatment option for several orthopedic conditions, it is not necessarily the best treatment in every situation or for every patient, Dr. Gnirke said.
“I also enjoy helping patients navigate their recovery with a concentration on injury prevention, physical therapy and exercise-based treatments, conventional anti-inflammatory medications and injections, as well as surgical discussions and referrals when needed,” he added. “My goal is to match a careful treatment plan with a patient’s diagnosis and circumstance that best suits them remaining as active, pain-free, and healthy as possible.”
Always a role for surgery
Dr. Gnirke said there will always be a role for surgery in musculoskeletal medicine. He does not characterize these regenerative treatments as a one-for-one replacement for surgery.
“If surgery is indicated and is the best next step in a treatment plan, I will discuss this and facilitate referral for high quality surgical care,” Dr. Gnirke said. “I have found the best success — in terms of avoiding the need for surgery — with mild-moderate arthritis, meniscus and labrum degeneration, degenerative tendinopathy of the shoulder and hip, and degenerative disc disease.”
Benefits of regenerative medicine
Historically, the treatment for orthopedic conditions has focused largely on treating symptoms and not improving or curing the underlying disease process. Regenerative medicine is unique in that way as it focuses on treatment of the primary issue and not the secondary symptoms. This, coupled with the relatively low side effect profile, short recovery time, and high success rate, has made regenerative treatments a very popular and exciting new advance in medicine.
“There is also limited down time after a regenerative procedure, which is typically one to two weeks and far shorter than surgery,” Dr. Gnirke said.
The success rate for regenerative treatments varies depending on the specific diagnosis and patient. Dr. Gnirke said success rates are difficult to discuss broadly, which is why a consultation to determine the proper diagnosis, severity, and associated health related issues is so important for prognostication with regenerative medicine. That said, regenerative treatments generally provide significant long-term improvement in pain and dysfunction in 50 to 90 percent of patients.
“I have been particularly impressed with the results of regenerative treatments for the management of knee osteoarthritis, tendon disorders, and degenerative disc disease,” he said.
Regenerative medicine offers many gratifying results for physicians, such as returning patients to their favorite physical activities including skiing, running and swimming. Dr. Gnirke has seen patients with tendon-related pain find relief to be able to enjoy quality, pain-free sleep again. And, he has seen many first responders with chronic low back pain return to their physically demanding jobs pain-free.
“It is an honor and privilege to participate in cases like this as a physician,” he said.
Dr. Matthew Gnirke, whose primary specialty is Interventional Sports and Spine Medicine, is joining Vail Summit Orthopaedics and Neurosurgery in August. He completed his residency training in Physical Medicine and Rehabilitation at the University of Colorado, where he was chief resident. Subsequent to this, Dr. Gnirke went on to advanced fellowship training with Dr. Marko Bodor in Napa, California. His fellowship training was focused on the practice of interventional sports and spine with an emphasis on regenerative medicine.