Biologic Therapy for Painful or Injured Joints and Tendons

1. Patient Selection Criteria

Ideal Candidates:

• Patients with mild to moderate joint degeneration (e.g., osteoarthritis).
• Individuals with tendon injuries, such as tendinitis, partial tears, or chronic overuse injuries.
• Athletes or active individuals seeking accelerated recovery.

Contraindications:

• Active infections in or near the injection site.
• Severe joint deformities or tendon ruptures requiring surgical intervention.
• Patients with uncontrolled chronic conditions, such as diabetes or autoimmune diseases, without prior evaluation.

2. Preparation

Clinic Preparation:

• Ensure a sterile treatment environment with all instruments disinfected.
• Required equipment includes biologic product vials, sterile syringes (1–5 mL), ultrasound or fluoroscopy for guidance, and antiseptic solutions.

Patient Preparation:

• Informed Consent: Educate the patient about the procedure, expected outcomes, potential risks, and follow-up care.
• Anesthesia Options: Offer a local anesthetic (e.g., lidocaine) for injection site comfort, allowing 5–15 minutes for it to take effect.
• Skin Preparation: Cleanse the treatment area with antiseptic solutions to minimize infection risk.

3. Dosage and Administration

Injection Sites and Depth:

• Joints (Intra-Articular):
  • Common joints include the knee, shoulder, hip, and elbow.
  • Inject biologics into the joint cavity (synovial space) using ultrasound or fluoroscopic guidance. It is highly recommended to use imaging guidance for these sensitive injections.
  • Depth: 1–4 cm, depending on the joint, patient anatomy, and guidance tool.
  • Administer 1–3 mL of biologic product per joint, depending on the size of the joint and severity of the condition.
• Tendons (Peritendinous or Intratendinous):
  • Common tendons include the Achilles tendon, rotator cuff, and patellar tendon.
  • Depth: Inject into the tendon sheath or directly into the tendon under ultrasound guidance.
  • Administer 0.5–1 mL per tendon, ensuring precise delivery to the affected area.

Injection Technique:

• Use imaging guidance to locate the injection site and ensure accurate placement of the biologics.
• Administer the biologic product slowly to minimize discomfort and ensure even distribution.
• Apply gentle pressure to the injection site post-procedure to reduce swelling or bruising.

4. Post-Treatment Care

• Advise patients to avoid strenuous activities or high-impact movements for 24–48 hours post-treatment.
• Mild swelling, discomfort, or stiffness is normal and should subside within a few days.
• Recommend acetaminophen for pain relief; avoid NSAIDs to support the inflammatory healing phase.
• Schedule a follow-up visit 4–6 weeks after the procedure to assess pain reduction, mobility, and functional improvements.

5. Safety Precautions

• Observe the patient for 10–15 minutes post-procedure to ensure there are no immediate adverse reactions, such as swelling or allergic responses.
• Keep emergency supplies (e.g., epinephrine and antihistamines) readily available.
• Use strict aseptic techniques during preparation and injection to minimize the risk of infection.

6. Follow-Up and Monitoring

• Assess progress during the first follow-up appointment, focusing on pain levels, mobility, and patient satisfaction.
• Document outcomes and consider additional sessions if needed.
• Recommend regular check-ins over 6–12 months to track improvements and adjust treatments as necessary.
• Additional treatments may be spaced 4–6 weeks apart for optimal results, depending on the condition.

Summary

Biologic therapy provides an innovative, minimally invasive solution for painful or injured joints and tendons, offering a regenerative alternative to surgery and long-term medication use. By targeting the affected area, medical professionals can assist healing, reduce inflammation, and restore function. Following this protocol helps ensure safe and personalized care with the goal of helping patients regain mobility and improve their quality of life.