Sports Injury Profile
In July 2021, the National Fitness Plan (2021-2025) was issued. The plan proposes that by 2025, the proportion of people who regularly participate in physical activity will reach 385%。Based on the country's population of 1.4 billion, the number of people who exercise regularly covers about 5400 million people.
According to the 2020 National Fitness Activity Survey Bulletin, the proportion of children and adolescents who regularly participate in physical exercise is 559%；The proportion of adults who regularly participate in physical activity is 303%, with the highest proportion in the 40-49 age group at 317%；The proportion of older people who regularly participate in physical activity is 261%, and after the age of 80, there are still 147% of older people regularly participate in physical activity.
With the increase in the number of people exercising, the incidence of sports injuries is increasing year by year, and many people are entering a vicious circle of "injuries while practicing". In China, the incidence of sports injuries is about 10-20%, and it is increasing every year. The most common sports injuries are bone and joint injuries, which are commonly found in more intense sports, such as basketball, football, boxing, etc. Common sports injuries manifest as dislocations and fractures.
Sports medicine is formed by the combination of medicine and sports. Sports medicine originated from orthopedics, but it focuses on sports-related injuries, often using minimally invasive techniques to diagnose various joint injuries and diseases. In this process, a variety of innovative medical technologies have been applied, such as diagnostic technologies such as ultrasound and nuclear scanning; Arthroscopic minimally invasive surgery, tissue engineering, regenerative medicine (stem cell and exosome D bioprinting, etc.); Health promotion and monitoring technologies such as wearables, sensors, etc.
Regenerative medicine applications
Platelet-rich plasma
Platelet-rich plasma (PRP) refers to platelet concentrate extracted from a person's own blood by centrifugation. PRP contains platelets in excess of physiological concentrations, as well as more than 1,500 bioactive proteins, including platelet-derived growth factor (PDGF), transforming growth factor (TGF-), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), etc., which play an important role in tissue repair.
In recent years, PRP has been widely used in many clinical fields as a new regenerative medicine technology to promote repair and restore structure and function in tissues that are traditionally considered to have low repair ability. In the field of sports medicine, PRP can promote the repair of bone and soft tissues, and is autologous, no immune rejection, simple to make, and less damage to the body. Therefore, it is increasingly used in the repair of intra-articular fibrocartilage structures and hyaline cartilage on the joint surface, in degenerative arthropathy, in acute injury of muscle tendons, and in chronic inflammation and terminal disease.
Existing studies have shown that for acute muscle injuries (such as thighs, shoulders, feet, ankles, etc.), ultrasound-guided PRP injection can better relieve early pain, improve range of motion, and speed up recovery than conservative**.
The Expert Consensus on the Application of Platelet-Rich Plasma in Chronic Musculoskeletal Pain Disorders (2021) pointed out that PRP intra-articular injection can significantly improve knee joint function and pain in patients with osteoarthritis. PRP can assist in hip preservation in early femoral head necrosis, reduce postoperative complications, promote functional recovery, significantly relieve pain and slow the progression of the disease. PRP promotes muscle tissue regeneration, tendon healing, and reduces inflammation. Intradiscal injection of PRP is a safe and effective method for discogenic low back pain.
The Expert Consensus on Platelet-rich Plasma PRP** Talus Osteochondral Injury (2023) points out that PRP has a good repair effect on cartilage injury and can be applied to talar osteochondral injury (OLT). OLT is a foot and ankle disease characterized by ankle pain, which can affect joint function and quality of life, and can cause long-term ankle arthritis if not properly managed. Surgery combined with intra-articular PRP injection is an effective means of OLT, and its effect is better than PRP alone or surgery alone**, especially after microfractures.
Commercialization
In 2013, Weigao cooperated with the orthopedic team of Shanghai Sixth Hospital to develop the first domestic PRP preparation kit, which has been used in nearly 400,000 cases since its launch. Wego's products are mainly used in the field of orthopedics, such as osteoarthritis, sports injury, cartilage repair, wound repair and bone repair, etc., and the clinical efficacy has been widely recognized.
As the general distributor of RegenLab in China, Bloomage Biotech has carried out the promotion of the "Platelet-rich Plasma Preparation Kit" (PRP) product in orthopedics, sports medicine, plastic surgery and pain departments in China, and the product has been sold in 17 provinces and 2 cities, with rapid development.
Development challenges
Although there are a large number of studies on the clinical effect and basic application of PRP, the mechanism of action of PRP is not fully understood. Moreover, there is currently no widely accepted standard for PRP concentrations. High concentrations of platelets can be associated with excessive toxicity of growth factors, so in some cases they can do more harm than good.
The Expert Consensus on Autologous Platelet-Rich Plasma Preparation Technology (2021) issued by the Clinical Transfusion Angiology Committee of the Chinese Blood Transfusion Association pointed out that the platelet concentration in PRP in China should be 4-8 times.
Mesenchymal stem cells
Mesenchymal stem cells (MSCs) are pluripotent stem cells that can proliferate highly and have multi-directional differentiation potential, and they also have immunomodulatory and paracrine functions, and play an important role in the repair of damaged tissues in the body.
Studies have shown that MSCS has the potential for high self-proliferation and multidirectional differentiation across germ layers, and can differentiate into a variety of tissue cells such as bone, cartilage, fat, and fibroblasts. In addition to this, MSCs are also able to secrete a variety of immunomodulatory factors, chemokines, and growth factors, which have anti-inflammatory and anti-fibrotic effects.
There are two types of MSC**: (1) adult MSC, which is taken from bone marrow, adipose tissue, peripheral blood, pulp, etc.; (2) MSCs of neonatal tissue**, obtained from extraembryonic tissues such as placenta, amniotic membranes, and umbilical cord.
According to clinicaltrialsAccording to the GOV clinical registry, there are currently more than 1,300 clinical trials related to mesenchymal stem cells worldwide, covering more than 300 diseases. More than 10 mesenchymal stem cell-based products** have been approved by the FDA worldwide. Mesenchymal stem cells have become one of the most cutting-edge and popular directions in the field of regenerative medicine, with great development potential.
In the field of sports medicine diseases, stem cell clinical trials are gradually increasing, involving osteoarthritis, cartilage defects, meniscus injuries, rotator cuff tears, etc., but more evidence is still needed to confirm the clinical effect.
Osteoarthropathy
Osteoarthropathy is a chronic, prevalent senile joint disease that affects more than 50% of people over the age of 65 worldwide. The World Health Organization (WHO) estimates that there are nearly 1500 million people are sick.
Mesenchymal stem cells are used in the treatment of osteoarthropathy, which has the characteristics of easy access to stem cells, rapid proliferation, strong differentiation potential, small immune rejection, simple transplantation and long-term coexistence. Due to its cartilage differentiation potential and immunomodulatory properties, intra-articular injection of autologous mesenchymal stem cells can effectively promote cartilage structure proliferation, improve the arthritic environment, alleviate symptoms and preserve and improve function. This makes the application of mesenchymal stem cells in osteoarthropathy have great research value and bright application prospects.
Cartilage damage
In terms of the application of stem cells, Chinese researchers collected arthroscopic infrapatellar adipose tissue to prepare autologous alipoglue that retains stem cell components, and combined with microfracture surgery for articular cartilage defects. There is also a team that uses the adipose tissue obtained from liposuction surgery to obtain tiny fragments of adipose tissue through the Lipogerms kit, which shows a good cartilage damage repair effect. In addition, amniotic mesenchymal stem cells and peripheral blood stem cells also show good potential to promote the repair of cartilage, ligaments and other tissue damage.
Meniscus injury
The meniscus is a fibrocartilage plate between the femur and the tibial articular surface, which plays an important role in resorption, maintaining the stability of the knee joint, and transmitting load. Meniscal injury is the second most common injury to the knee joint, and it is conservatively estimated that there are about 100 million patients in China. Due to poor blood supply, the ability to heal itself after a meniscus injury is minimal.
Meniscus injuries are generally immobilized with plaster casts in the acute phase and physical and pharmacological in the chronic phase. Most patients end up with arthroscopic knee surgery and meniscectomy. Complications such as osteoarthritis (OA), knee movement disorders, etc., can be caused after surgery.
In November 2023, the Chinese research team confirmed for the first time in the world the clinical safety and preliminary effectiveness of human embryonic stem cells (HESC)** immune and matrix regulatory cells (IMRC)** meniscal injury, and further revealed the important molecular mechanism of stem cell repair meniscus cartilage, providing a new and effective means for clinical meniscus injury.
Arthroscopic minimally invasive technique
Arthroscopy is a special endoscope, which is a minimally invasive technology that has developed rapidly in the past 20 years in China, and is a major breakthrough in joint surgery.
Arthroscopy was originally used as a diagnostic tool and is now more of an important minimally invasive technique. As a diagnostic tool, arthroscopy can see almost all parts of the joint, which is more comprehensive and accurate than cutting the joint. As a tool, arthroscopic surgery can be used for various inflammations in the joint, such as osteoarthritis, synovitis, rheumatoid arthritis, etc.; As well as osteophytes (bone spurs), meniscus injury, anterior and posterior cruciate ligament rupture, joint capsular adhesions, various intra-articular fractures, joint adhesions and joint mobility restriction of various parts, unexplained arthralgia, etc.
In recent years, arthroscopic techniques have received more and more clinical attention. For example, anterior cruciate ligament (ACL) rupture of the knee is one of the most important sports injuries in the field of sports medicine, and arthroscopic repair and reconstruction of ACL has become the gold standard. In addition, China has made a series of important advances in arthroscopic surgery. Two shoulder examination tests, the Hug-UP (Lift Resistance Test) and the ABERR (Abduction External Rotation Resistance Test) for shoulder arthroscopy, are included in the American College of Orthopaedic Surgeons (AAOS) guidelines. Hip arthroscopic surgery and ankle arthroscopic surgery have achieved good results for related sports injuries and diseases**.
Arthroscopic systems mainly include digital camera systems, xenon cold light source systems, arthroscopies, dynamic planing systems, flushing and perfusion systems, plasma radiofrequency vaporizers, surgical instruments, image processing systems, surgical stent systems, etc. Among them, large joint arthroscopy is mainly used for knee, shoulder and hip joints. Small joint arthroscopy is mainly used for elbows, ankles, interphalangeal joints, etc.
At present, the arthroscopic systems used in China are mainly foreign brands, such as Xerox and Ruishi. There is still a certain gap between domestic products and imported products. Mindray Medical, Kailitai and others launched 4K camera systems. Xishan Technology and Kailitai can provide power planing systems. Bond Medical and Fangrun Medical can provide radiofrequency ablation systems.
With the rapid progress of sports medicine and arthroscopic surgery technology in China in recent years, the number and technology of arthroscopic surgery in China have ranked among the top in the world. Although related equipment and medical devices are still dominated by foreign capital, there is a broad space for domestic growth and domestic substitution.
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