For generations, professional athletes have done whatever it takes to stay in the game: playing through pain, gulping handfuls of anti-inflammatory pills, sitting in frigid ice baths and even undergoing surgeries to play a few more months or years. In recent months, the buzz in the world of pro sports has been a new treatment for early arthritis changes that some of these athletes face.
While Orthokine, a procedure developed in Dusseldorf, Germany by Dr. Peter Wehling and molecular biologist Dr. Julio Reinicke, has been around for years, it didn't receive media attention until top athletes started trying it. Los Angeles Lakers star Kobe Bryant underwent the procedure last summer. He plans to return this offseason for a repeat injection and reportedly has convinced his Lakers teammates Andrew Bynum to have it. Other athletes who have had the Orthokine treatment include New York Yankees star Alex Rodriguez and former Portland Trail Blazers center Greg Oden, whose NBA career has largely been a disappointment due to four knee surgeries.
As word of mouth spreads between pro athletes and media reports increase, it seems logical to expect patients in the United States will inquire about the procedure. On his website, Dr. Wehling points out that Orthokine produces a "protein from the patient's own blood by a special technique" and then injects it into the joint affected by osteoarthritis. He claims that the therapy "provides our patients with effective and long-lasting pain relief."
Dr. Wehling argues that osteoarthritis is more complex than simple wear of the joint over time. The theory for Orthokine centers on attempting to stop the breakdown of the articular cartilage. Interleukin-1 (IL-1) is a protein present throughout the body that has been attributed to joint inflammation and articular cartilage breakdown. Another protein present in the body, Interleukin-1 receptor antagonist (IL-1RA), prevents IL-1 from activating its receptors and initiating its catabolic effects. Dr. Wehling's procedure reportedly involves drawing blood from the patient in a syringe designed to augment the production of IL-1RA. Once injected into the arthritic joint, the IL-1RA theoretically prevents the joint inflammation and decreases pain.
Proponents cite a study, also performed in Dusseldorf, which compares Orthokine to hyaluronic acid (HA) and placebo injections for patients with knee osteoarthritis. In the study, published in the journal Osteoarthritis and Cartilage, A.W.A. Baltzer, MD et al perform a double-blinded, randomized controlled trial and did show that Orthokine produced a larger decrease in symptoms and increase in quality of life than HA and placebo. Interestingly the authors point out that even at two-year follow up, HA and even the placebo injections had persistent benefits, but not to the level that Orthokine did.
In December, Dr. Wehling, who also has reportedly treated Hollywood celebrities and Pope John Paul II, told ESPN the Magazine, "I am the only one to have found a way to cure arthritis." The theory does make sense, at least. If a physician can prevent the degeneration of articular cartilage, arthritis pain would decrease.
Unfortunately, sports medicine surgeons are becoming more skeptical of procedures that sound good in theory. Platelet-rich plasma (PRP) use skyrocketed in recent years after a similar course – logical basic science theory, use in a few prominent athletes, media exposure of those uses, and increased public demand for the injections. PRP, which has been used for a number of conditions, hasn't been proven effective in well-designed U.S. studies. Double-blinded, randomized controlled trials, including those using PRP for Achilles tendinopathy, lateral epicondylitis and augmenting rotator cuff repairs, have shown little, if any, benefit.
Maybe Orthokine will prove to be effective, not just based on testimonials or professional athletes and celebrities, but in scientific studies. Arguably the two most prominent sports medicine journals in the United States, The American Journal of Sports Medicine and The Journal of Bone and Joint Surgery, contain no studies about Orthokine. I have no doubt that research on Orthokine is being conducted right now in medical centers across the U.S.
Even if science does prove that Orthokine does prevent cartilage breakdown, one could argue that it is still not a "cure" for osteoarthritis. After all, the cartilage already damaged would stay in that condition. This procedure, and really any injection or surgery available, does not appear to effectively and conclusively regrow cartilage. I always tell patients with osteoarthritis that if someone actually finds a cure for arthritis, he or she will make billions of dollars. Curing arthritis – meaning not simply relieving pain but actually restoring the cartilage back to normal – would be one of the landmark scientific breakthroughs of our time.
But Orthokine also points out a bigger issue for sports medicine physicians and surgeons who treat athletes and active patients. We want these procedures to work. Maybe not specifically Orthokine or just for treating osteoarthritis, but we want and need procedures to treat some of these injuries. Like osteoarthritis, we have few options for chronic tendon problems like tennis elbow, patellar tendinopathy, and Achilles tendinopathy if the first-line treatments like rest, ice, anti-inflammatory medications, and braces don't work. But for pro athletes, their sports are their jobs, their careers, and their livelihoods. And as sports medicine surgeons, we try everything in our power to get them back to play.
And it's not just for elite athletes, either. There are so many active people that just don't want to stop exercising or playing sports. If osteoarthritis or a long-standing tendon or muscle problem persists, they are often willing to pay thousands of dollars because insurance companies usually don't pay for these treatments. As sports medicine surgeons, we often try some of the techniques, knowing there is abundant data to show that they might not work, because nothing else has worked for them either. Fortunately most active patients don’t need these new, unproven treatments. We hope that one day we will develop the cure for osteoarthritis and some of these other sports injuries. It just appears we still have a long road ahead of us.
Orthokine: Viable Option or False Hope in Sports Medicine? FeaturedWritten by David Geier, MD, Director of MUSC Sports Medicine | June 22, 2012
This article is written by David Geier, MD, Director of MUSC Sports Medicine at the Medical University of South Carolina. Dr. Geier maintains a sports medicine blog discussing key issues in the field today.
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