I usually wake up and get to bed early, but because of Father’s day, last night, I was up at 2 am and thought to myself, why not try to see Jupiter? This made me feel a bit like Galileo, which got me thinking, who is the father of regenerative medicine? Answering that question just depends on how far you want to go back and how you ask the question.
Jupiter in Opposition
All this week, the earth has been between the Sun and Jupiter. The Internet news said that Jupiter would be sitting there all nice and bright right next to the moon. I was up at 2 am this morning because my kids had decided, very late at night, to drive from Boulder to the mountains where we have a cabin. Hence I was up.
Being up at 2 am in a place where there is little city light, I checked the sky out back to see if Jupiter was there. I wasn’t disappointed. I had a superzoom camera and took pics of Jupiter, it’s moons and our moon (those are above). All of that made me feel a bit like Galileo (if he had a digital camera with image stabilization strapped to the end of one of his telescopes). Which got me thinking, who is the Galileo of modern regen med in orthopedics?
The Ancient Fathers of Regen Med
This is one of those questions where the answer depends on how you phrase it. If we go way back, you can trace regenerative orthopedics to the ancients. And you thought this stuff was new?
The earliest form of regenerative orthopedics was used by the Egyptians. In the 18th dynasty, in the time of Amenhotep III (circa 1350 BC.) pin firing (still in use today) was used to treat lame horses. A hot iron poker was placed into a non-healing tendon to cause a brief inflammatory healing response by creating minor damage in the tendon. The first recorded use of this technique in humans was by Hippocrates (circa 400 BC), who used a hot poker in the axilla to repair a dislocated shoulder.
Hence the early attempts at regen med were using heat to cause microdamage to a non-healing tendon or ligament in hopes that the body would repair the area. However, by the 19th century, the focus would shift to using chemical debridement. This is the same idea, but instead of heat being used to kill local cells, instead, chemicals are used to cause microdamage.
In the 1830s, Alfred Velpeau, MD, injected a patient with an iodine solution to treat an inguinal hernia. Then in the 1880s, a Rene Leriche, MD, injected ligaments with procaine demonstrating that ligaments could cause a specific pain pattern. From that point until the 1920’s, the focus of soft tissue regen med was mainly on treating hernias.
The next phase in orthopedic regen med traces back to Earl Gedney, DO. In the early 1930s, Gedney had injured his thumb ligaments and was told by his colleagues that his surgical career was over. Hence, he decided to be his own doctor and used the same injection solutions used by physicians treating hernias on his damaged thumb ligaments.
In the late 1930s, Gedney published two case reports in the knee and low back. The 1930s also provided histology research demonstrating that collagen was being regenerated at the injection site of these irritant procedures. During the 40s and 50s, there were many articles published on the use of what was eventually called prolotherapy. At that point, the father of the field was a physician by the name of George Hackett who was injecting hypertonic dextrose.
The Modern Fathers
The modern fathers of orthopedic regen med are a bit clearer. However, even here, it depends on which question you ask. If we’re talking about platelet-rich plasma, you get a different answer than if we’re discussing stem cells. To keep this simple, we’ll focus on stem cells.
The earliest recorded use of stem cell preparations to treat orthopedic conditions traces back to the 80s and 90s and to Phillipe Hernigou in Paris. This was the use of bone marrow concentrate to treat primarily fracture non-union and avascular necrosis. This was also the first attempt to link the stem cell content of the bone marrow to its effectiveness. So asked this way, Phillpe Hernigou is the father of modern orthobiologics.
Also in the 90s we saw the first autologous chondrocyte procedures. These were performed in Sweeden by Lars Peterson and involved cultured chondrocytes that were surgically implanted into cartilage lesions. This eventually became the Genzyme Carticel procedure.
If our focus is solely on regen med techniques in orthopedics, Dick Steadman has a claim as well. His microfracture technique to stimulate healing by poking holes in the exposed bone of cartilage injuries was first published in the late 90s. While not a stem cell or lab grown cell procedure, it marked a shift in surgical thinking towards natural repair.
In equine athletes, Wayne McIlwraith of CSU can make a claim. He published his first paper on culture-expanded MSCs in 2008 and then a clinical paper in 2009. In fact, I worked with the CSU staff in 2005 when they were treating athletic horses with bone marrow stem cells.
When it comes to treating common orthopedic diseases like osteoarthritis or tendon/ligament tears with stem cells, that’s an honor that I can claim. I published the first papers on these applications in the 2008 time frame. However, even that could be murky, because after speaking with Herigou, he has bone injection cases for the treatment of knee arthritis and shoulder rotator cuff tears that date back to that time. However, he has yet to be permitted by French authorities to publish some of those papers. So I guess you can say that we were both working on treating these common orthopedic problems using stem cells with different approaches (mine in the joint and his in the bone).
If you focus on other types or orthobiologics, like PRP, then some of the earliest fathers of the field were dentists. You could also add in early orthopedic PRP pioneers like Mishra, Gobbi, Filardo, and Kon. So, as I have discussed, the answer to this question always depends on exactly how you ask it.
The upshot? Orthopedic regenerative medicine has many fathers. So here’s to all of these men who took a chance and some risk to try to find a better way to help patients! Also, happy Father’s day!