The growth in regenerative medical efforts to enhance one’s natural reserves to facilitate healing and resolution of musculoskeletal conditions is appealing and thought provoking. Our prior issue focused on outpatient ultrasound-guided procedures, further expanding the field of the neuromusculoskeletal or orthopedic Interventionalist. This regenerative issue certainly further pushes the envelope into an area that is certainly sure to challenge some practitioners’ comfort levels, but it is possibly a glimpse of what may be a paradigm shift. Preliminary studies, clinical experience, and patient anecdotal reports on the positive effects of regenerative treatments make it difficult to discount these modalities. Frequently, the only other options open for these patients through our traditional treatment algorithms were surgery. As with many technological advances, theories and claims frequently outpace literature. The lack of high-quality studies, especially in the human model, makes it difficult to establish a sound standard of care in this ever-expanding field. Many questions remain unanswered regarding efficacy, appropriate patient candidacy, optimal graft sources and harvesting techniques, quantification of mesenchymal cells, use of growth factor facilitators, nutritional support, and various other novel techniques to downregulate nociceptors and enhance autonomic contributors to healing.
This issue of Physical Medicine and Rehabilitation Clinics of North America in some ways may seem premature because the data certainly are in their infancy, but at the same time, it is hoped, may serve as a catalyst. The issue of safety is certainly of concern as regulatory agencies struggle to balance the scale between encouraging innovation while safeguarding patient safety. Fortunately, a concerted effort is evolving to more definitively answer many of these questions. The clinician must temper enthusiasm for meeting the demand of an ever-expanding patient market with techniques based on sound scientific reasoning while remaining within governmental guidelines.
The editor is extremely grateful to the authors and their willingness to share their diverse approaches and expertise. They take us from basic science and physiology to didactic-oriented clinical techniques treating a variety of musculoskeletal conditions. The frontier for the minimally invasive musculoskeletal and regenerative practitioner is encouraging, challenging a complacency of what currently is for a vision of what can be. I hope the reader will enjoy the journey.
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