Orthobiologics: A Deep Dive On Techniques That Deliver Results | Conversations in Regen Episode 14

Unlock the truth behind Orthobiologics: A Deep Dive On Techniques That Deliver Results in this eye-opening episode.

Cartilage Regeneration Isn’t What You Think → Visit the website to learn more https://pxllnk.co/AD/BOBsite

What if the real reason your cartilage treatments aren’t working has nothing to do with the injection itself? What if the science behind stem cells is far more misunderstood than most physicians realize? And what if the missing link to successful outcomes is hidden in the delivery, not the product? In this episode of Conversations in Regenerative Medicine, Dr. Ariana DeMers sits down with world-renowned orthopedic surgeon Dr. Dimitrios Tsoukas to explore Orthobiologics: A Deep Dive On Techniques That Deliver Results—and uncover the core challenges many clinicians silently struggle with.

In this in-depth interview, viewers get a structured, practical breakdown of the real obstacles behind cartilage pathology, including why cartilage is so notoriously difficult to regenerate, why common assumptions about stem cell therapy are incomplete, and how current regenerative medicine techniques—PRP therapy, BMAC, MFat, orthobiologic injections, and advanced cartilage repair approaches—fit into modern orthopedic decision-making. Dr. Tsoukas brings clarity to recurrent clinical questions: Can you regenerate cartilage? What is the role of adipose-derived products? Does mechanical axis correction still matter? When does microfracture fail? This episode provides a rare look into biologic, structural, and functional failures—and how expert clinicians merge science with technique to produce meaningful orthopedic healing. Throughout the conversation, the topic Orthobiologics: A Deep Dive On Techniques That Deliver Results is not just explored, but reframed, giving physicians practical insights they can implement immediately.

Viewers will also gain a clear, actionable overview of real-world regenerative strategies discussed in the video—ranging from cartilage regeneration treatment options to knee cartilage regeneration medicine, cartilage repair sequencing, senolytic support, emerging scaffolding technologies, and the surprising rise of auricular cartilage micrografting. Dr. Tsoukas shares clinical nuance behind patient selection, biologic product quality, dosing variability, standardization challenges, and why combining corrective surgery with biologics often produces superior outcomes. For clinicians seeking to understand how to treat cartilage damage, optimize regenerative cartilage treatment, or refine their approach to PRP treatment and platelet-rich plasma therapy, this conversation delivers a reasonable, experience-backed roadmap rooted in modern regenerative orthopedic practice. By the time the discussion concludes, the viewer has a complete narrative of Orthobiologics: A Deep Dive On Techniques That Deliver Results—from scientific foundations to practical execution.

If you’re a clinician, regenerative practitioner, or orthopedic provider aiming to elevate outcomes and stay ahead in the fast-growing field of medical innovation, this description is your gateway to a master-level discussion. Be sure to subscribe, like, comment, and connect with me directly for deeper training, hands-on workshops, and upcoming regenerative medicine events. 

Building a successful cash-based orthobiologic practice is not a single decision. It is a series of the right decisions made in the right order. The Business of Orthobiologics offers three distinct programs designed to meet physicians at different stages of readiness — whether you are just beginning to explore PRP, ready to build a full practice system, or committed to going all-in on a comprehensive transformation.

Learn More here: https://thebusinessoforthobiologics.com/programs-explanation 

_______________________________________________________

Follow us and subscribe to our links below ⏬⏬⏬

Website: businessoforthobiologics.com
Apple Podcast: apple.co/3Azvt3R
Spotify: spoti.fi/3oICYmh
Youtube: bit.ly/drariana

Transcript

SPEAKER_00 0:00

I feel that the next big thing in regenerative medicine is gonna be allogenics from newbirds, maybe placental mesenchymal stem cells.

SPEAKER_01 0:09

Who knew we have a regenerative product right on our abdomen, right? We carry our own regeneration right here.

SPEAKER_00 0:17

For me, this whole combination is the next step in orthopedic care and in sports medicine care as well.

SPEAKER_01 0:32

Welcome, welcome, welcome to Conversations in Regenerative Medicine, where we are exploring the frontiers of platelet-rich plasma, bone marrow concentrate, microfragmented adipose tissue, and we also tackle some more controversial topics and discover cutting-edge insights that are shaping the future of interventional orthobiologics. So, welcome. For those of you who don't know me, I'm Dr. Ariana de Murs. I'm a board certified fellowship trained orthopedics, sports medicine surgeon, and regenerative medicine expert. I do a lot of educating and training in not only orthobiologics, but ultrasound. And I've successfully moved my rural Northern California practice away from insurance, and I focus on cash-based procedures. But my main passion is helping doctors to incorporate orthobiologics seamlessly and successfully in their practice. I want to welcome Dr. Demetrius Zukis, all the women from Greece today to join us in our conversations. He is the director of the Orthopedic Clinic for Advanced Arthroscopic Sports and Regenerative Surgery in Athens, Greece. He is the founder and director of MySME Center, Teaching Center for ISICOM, ICR Medicine ESCOM. He is the founder and director of Elite Regenerative Clinic in Athens, which is a lipogen center of excellence, and he's founding member of the International Regenerative Medicine and Expert Society. And he's also my friend. So welcome, Dr. Everett Sucas. Thank you so much for joining us from across the pond. I want to thank everybody for joining us. We're going to hear from internationally renowned experts in regenerative medicine. We're going to talk a little bit more about controversial topics in orthobiologics and regenerative medicine. And hopefully, we can gain some insights to implement in your practice immediately. And we'll have a live QA session to answer your burning questions. So orthobiologic treatments will be first-line treatment for musculoskeletal care in the next five years. The train is leaving the station. If you are not actively offering this for your patients, you've got to get on the train. It's leaving the station. So the problem is, is that successful integration of orthobiologics is sometimes difficult. Many of us are looking for how to have successful orthobiologics practice. But it's hard, right? We know orthobiologics is the best treatment for our patients. And maybe we've tried some things, but maybe we don't know the science, don't know the techniques, don't know cash-based business, marketing, sales. And maybe you've thought, maybe I'm just not this good at business, but it's not our fault because we didn't learn this in school. Maybe some of you are struggling with how to be successful and how to capitalize on the $4 billion orthobiologic market out there. Maybe you're thinking we deserve more. Why is this so hard? So if you can, please just put in the chat what you're struggling with most. My favorite question is how do we win? And while we are talking about the science today, we actually need to also consider how we talk about this with our patients. So we all win. And you need a system, right? We're not gonna go over all of this today, but we are gonna go into getting you a little bit further down this journey to be wildly successful in your orthobiologic practice. So you need a system. We're gonna start with orthobiologic knowledge. So, Dr. Sukas, we are going to get down to business. We have questions, my friend. We have questions. So, my first question to you is cartilage regeneration has remained one of the toughest frontiers in orthopedics. How has stem cell science begun to close this gap?

SPEAKER_00 5:06

Okay, dear Arianna, thank you so much for having me here with you. It's an amazing opportunity to talk to a famous podcast and with a lady, a queen of orthobiologics. We have so much to share and talk about. Okay, cartilage. Cartilage, it's the most stubborn, difficult, and fascinating anatomical tissue. And I'm saying that because it's really difficult to regenerate cartilage, and this is because of several reasons. First of all, cartilage doesn't have any blood vessels, it doesn't have nerves, it doesn't have lymphatic drenas, healing capacity depends entirely on slowly diffusion of synovial. So it's a very difficult anatomical tissue. Second thing is that you cannot really reproduce the zonal architecture that cartilage has. Cartilage has three layers, three zones: higher, media, lower, that you cannot really reproduce that. Having also water inside, cartilage too, having protooglycans, it's very hard to do this stature. It's amazing how difficult and complex is the whole architecture of cartilage. And if you have an injury in the cartilage, or if you have, let's say, early arthritis, then it's the chondrocytes, they don't have really strong capacity of differentiating, proliferating. They are only 1 to 5% of cartilage volume. So it's easier for the matrix to be destroyed than repaired. That's why it's so difficult to repair, to heal, or to regenerate cartilage, and that's why it's so fascinating for us trying to do that. Now, how has stem cell size become to close the gap? Has it really?

SPEAKER_01 7:11

Yeah, maybe, right? Are we are we on the precipice of being able to regenerate cartilage? Have we gotten to a point where we at least understand the problem? Or maybe we don't.

SPEAKER_00 7:29

I think so. I agree with you. Maybe the gap is not closed yet, of course, but I think we're on the way to do that. And there are two big wrong ideas about how stem cells are working, about cartilage surgen eraser. There are two Miss Cornet, how you say that?

SPEAKER_01 7:46

This misconceptions.

SPEAKER_00 7:48

Misconceptions, thank you so much. The first one is the first one is that stem cells, their main work is anti-inflammatory work.

SPEAKER_01 7:57

Don't miss out. Please subscribe to our newsletter now to stay ahead of the world of orthobiologics. You can find the link below. Additionally, if you're ready to start this journey with me in my orthobiologics masterclass, come join us.

SPEAKER_00 8:12

And that's it. They are very strong anti-inflammatories, which is wrong. Okay, this is just one tiny thing of what stem cells are doing for cartilage. And the second one is that stem cells can produce directly healthy cartilage, which is not the case, not at all. What they are really doing is they are following a biological path and they have different capacities, stem cells, when you inject them interarticularly for let's say focal cartilage vision or for osteoarthritis. First of all, as we know, they have the paracrine signaling effect, which means that they release biological molecules and they start to slow down inflammation, they start to augment the capacity for extracellular matrix to be repaired slowly, they fight cytokines, so they have they are doing so many different things. The second one is immunomodulation. Okay, they are changing the whole environment, the niche where you are putting the stem cells, and they are also offering bioscaffold. This is, let's say, a new conception that they are also working as bioscaffolding and they are giving the time to signals to remain in the scaffold and to start the healing process. So it's not that we inject in a joint. This is a misconception, that's like you perfectly helped me to know the word. If you inject stem cells, you are not going to produce cartilage immediately and cover a lesion. You are having a cascade of biological procedures that they are going to work on that and build on that. So it's not that easy.

SPEAKER_01 10:06

We have a second question, right? So many physicians are talking about stem cell therapy as this breakthrough treatment. Is the clinical reality lagging behind the enthusiasm, or have we just not figured out a way to either deliver viable amount of cells or dose, or have we not been able to optimize the host? Like, do we have enough clinical data to be able to say that stem cell therapy is the end all BL?

SPEAKER_00 10:44

I start I started working with stem cells about 13-14 years ago, and with PRP 15 or 16 years ago. And I was accused on the time that I'm dealing with voodoo medicine and what is this thing. Yeah, yeah, yeah. It was amazing. And I feel so happy right now that we have so many good published studies that they are proving that if it's done correctly, they are safe, and most of all they are effective in several cases. Of course, you have to have the right indications and the right patients, because for me, right now you cannot use it to everybody. So it's a breakthrough for sure. It's not a voodoo medicine, it's evidence-based. We have many, many, many clinical studies that they are exceptional and they are proving that they can offer the best in our patients. For example, I'm using MFAT, microfragmented fat of lipogens. Of course, I'm not promoting the company, I'm just saying that they have more than 100-120 public studies, and they are not just FDA cleared. Soon they are going to be FDA approved for neosterarthritis. That is amazing and is a giant step forward. So, regenerative medicine is here to stay. And I strongly believe that we are gonna have amazing results if we finalize what we are doing, in which doses, how, and in which patients.

SPEAKER_01 12:22

Absolutely, absolutely, and collect that data, right? Without the data to collect it, like we can do all these great things, but if we don't manage and monitor and follow our patient outcomes, then we can't really say if the clinical reality what's happening with the clinical reality, right? Uh everybody needs to collect data, data, data, data, data. Please, you can put it on a spreadsheet, you can tabulate it with a pencil, but really collecting your clinical patient-reported outcomes is really important, as well as defining what it is that you're actually doing. I think those two things are so, so important. So thank you so much for bringing that up. Now, we still have questions for you. So across, you know, across different clinics and countries, protocols are different with respect to sourcing, dosing, preparation. What do you consider as the non-negotiable parameters for this though these treatments for stem cell type treatments?

SPEAKER_00 13:37

Okay, that's a great question. Please let me give you a flowchart or a protocol that I am using based on my experience. And maybe it would be useful for our followers tonight that they are listening to us. This is what I have in mind when I have to deal with a patient with cartilage problems. First of all, the first category is young to middle-aged patients that they have focal lesion of the cartilage. That means remaining cartilage is healthy and we have a focal, well-characterized focal lesion of the cartilage. Then in this case, my protocol is like this. First of all, I have to correct the mechanical axis of the joint. If there is a problem, then I have to perform osteotomies. I have to preserve the meniscus if we are talking about the knee. And that means repair of the meniscus or even to use a scaffold, meniscal scaffold if the patient had in the past a minisectomy. Because if you don't correct the axis and if you don't have the cushion of the meniscus, then whatever you're gonna do is gonna fail in the cartilage. And then I'm addressing the cartilage problem with problems like the weight, BMI, or other problems that the patient may have, like diabetes or if he's taking statins. What I'm doing is that I'm not doing microfracturing anymore because I've seen, and not only me, of course, it's it's for everybody that used to do microfractures that we have a lot of problems with the subchondral bone, and there are many bone marrocidemas, and sometimes you have production of new cartilage, maybe fibrocartilage, but outside the borders of the lesion, which causes many problems to the patient. So I'm not doing microfractures anymore. What I'm doing is either I use biological membranes of collagen 2 oronic acid with bone marrow, aspirated, concentrated, which is arthroscopically completely. I'm not opening the joint with amazing results. Or I'm using the Arphrex technique of autocard, which is minced cartilage, autologous chondrocytes with thrombin and PRP, and you cover completely the lesion. So it's let's say the fourth generation of ACI of autologous cartilage implantation with really excellent results. So this is I think straightforward. When you have a focal lesion, everybody knows what to do. The problem is when you have diffuse cartilage pathology, then what are you going to do? In this case, you can help patients to delay the arthroplastic because if you are close to Kelgar 4, close to bone-to-bone, there are not much to do, but you can offer injections mostly of M fat or SVF. I think the older the patient is, the more I use adipose tissue-derived stem cells and especially M fat or SVF. I keep BMAC for younger to middle-aged patients. And this is the protocol I use, and I think it's it's biologically correct, and you have to be very strict about the patients that you are implying these techniques. You have to be very strict. You have to correct many, many problems like obesity before performing a procedure, like we said. You can offer them xenolytic cycles, which is something new. I mean, you have to energize his stem cells again if he's a middle-aged or older patient, because uh one pillar of aging is stem cell exhaustion. We know about that. It's not only mitochondria or DNA or epigenome. You have to offer him xenolytic cycles, maybe with special supplements. And I would like to say that in your podcast, Ariana, that I work in Greece and the product is ready for a supplement with many synolytic factors, that I'm going to use it pre-operation and post-operation to my patients. So let's say this is my flowchart about a patient having a cartilage pathology.

SPEAKER_01 18:04

That's amazing. So I think my my listeners are there's gonna be some questions, but I have questions. So in Europe, there is much love of osteotomies. In the US, osteotomies have fallen out of favor or are not used as uh frequently as in Europe, and a lot of very successful treatments, one of the pillars has been osteotomies. So then the question uh begs number one, if you don't have the ability to do osteotomies, can you still get some benefit? And then number two, what do you think is more powerful? The osteotomy or the injection?

SPEAKER_00 18:57

Okay. What I really believe that is a big debate about osteotomies and partial replacements, partial replacements. And there are orthopaedic surgeons that they prefer osteotomies or others they prefer partial, but still there are indications for both of them. And like I always said, you have to respect indications. You cannot do an osteotomy to a patient older than 60 years old with knee laxity, for example. You have to go for partial knee replacement. Oteotomy is an excellent, excellent surgery, excellent. And it offers time to the patient till he finally does a total knee replacement. I said there is a big debate between the two procedures. And there is always a big question if you perform a partial joint reconstruction, is it easier to convert it to a total joint replacement or not? Or osteotomy is easier. And like you said, is it stronger to have orthobiologics or osteotomy? For me, the combination is the best. I mean, if you have an axis, axis problem, axis problem, then generative medicine are gonna fail, the injections are gonna fail. You have to correct the axis, uh the mechanical axis. Otherwise, it's not going to work. It's not going to work. Or if you have any lacking medial or lateral miniscus, doesn't matter how many injections you are gonna perform, it's gonna fail because you don't have the cussian that the meniscus is offering. So you have to do miniscus, scaffold of the meniscus to implement it in the joint and then do regenerative injections. So for me, the best is osteotomy plus injections, otherwise, it's not gonna work, it's not gonna work.

SPEAKER_01 20:52

Great, great. Yeah, so thank you so much for that. Like we said, this is controversial, right? Can we do a partial knee replacement with orthobiologic injections? Maybe. Can we do microfragmented adipose tissue to augment the meniscus? Maybe, right?

SPEAKER_00 21:18

I think it's not enough, but okay, it's provocative for sure.

SPEAKER_01 21:21

Right? Consider it's a consideration, at least, right?

SPEAKER_00 21:24

It's a consideration, yeah. But okay, we have to test uh much more things about it. We'll see in the future.

SPEAKER_01 21:32

Well, yeah, we gotta have the study, right? We gotta do the data collection.

SPEAKER_00 21:36

But M fat is an excellent scaffold. M fat is an excellent scaffold, so that's why I really love it as an adipose tissue biological product, is a scaffold containing all the important cells and growth factors. So you have the whole triangle of regeneration, and that's why it's an amazing product, really amazing.

SPEAKER_01 21:58

Who knew? We have it right. A regenerative product right on our abdomen, right? We carry our own regeneration right here. All right.

SPEAKER_00 22:11

Who knew? I'm sorry to interrupt you, but as classical orthopedic surgeons, uh trained for years to use metals, discussing now about this evolution of regenerative medicine. And I have to confess, I was a TEDx speaker on this subject. This is what I called it meta-orthopedics. Meta is a Greek word, Ariana, meta, it means after. After. What is after orthopedics? After the next step. And this was a TEDx speaking of me in Kingali, in Africa, which was amazing. And I said for me, meta-orthopedics means minimally invasive orthopaedic procedures like afhroscopies. You cannot always do that for sure. But you have to try to delay very strenuous operations unless you have no other option. To implement regenerative procedures plus functional rehabilitation with xenolytic cycles. For me, this whole combination is the next step in orthopedic care.

SPEAKER_01 23:20

Don't miss out. Please subscribe to our newsletter now to stay ahead of the world of orthobiologics. You can find the link below. Additionally, if you're ready to start this journey with me in my orthobiologics masterclass, come join us.

SPEAKER_00 23:35

And in sports medicine care as well.

SPEAKER_01 23:37

Well, that's really fascinating. So when I think about orthobiologic candidacy, I am always trying to get down to the root cause of why, what the diagnosis is, what happened, and what failed. So if there is a structural failure, or is there a biologic failure, or is there a functional failure? And so you might have the answer that it's all of the above. And so you then need a solution for each mode of failure, right? So you need a solution for the structural failure, which is usually surgery. You need a solution for the biologic failure in the realm of orthobiologics, syneletics, any of those to solve the biologic failure problem. And then you need to add the solution for the functional failure, which is rehabilitation. So that's been kind of my framework. And it sounds like that's exactly the same framework that you're working on from a candidacy standpoint and what to do to get the best outcomes for your patients. Is that correct?

SPEAKER_00 24:48

Is that completely correct? I definitely agree with you. Definitely.

SPEAKER_01 24:51

Nice.

SPEAKER_00 24:52

This is a reason.

SPEAKER_01 24:54

We have some more questions for you. You haven't gotten off the hook so far. So we have our last question here. When we're choosing between autologous and allogenaic stem cell sources for our cartilage regeneration, can you help us understand the clinical trade-offs that matter most to you in your decision making?

SPEAKER_00 25:15

Okay, I could give you a very simple and easy answer to your question, Ariana, but just by saying that I'm not allowed to use allogenic stem cells in Greece.

SPEAKER_01 25:25

I see either in the United States. But across the world, there are lots of really good applications and there's some really good data. So if you could use allogenic sources, what would be that decision-making point?

SPEAKER_00 25:41

I feel that the next big thing in regenerative medicine is gonna be allogenics from newbirds, maybe placental mesenchymal stem cells, like my friend Bob Hariri is doing in the States. They are so powerful and yield and the quality are amazing. So I wish I could have the possibility if I was completely sure that they are safe. I would love to use them as exosomes as well. I think these are the future, but so far we are not we are not having the data and the studies to prove that and to feel completely safe. But for me, maybe banking of autologous stem cells, banking of autologous stem cells would be a great solution. Allogenic stem cells and ageosomes could be a great solution because you can have repetitively sessions of stem cells in the same patient without the procedure of lipoaspiration or bone marrow from iliac crest, and you can protect the patient of problems like cardiac problems that are not allowed him to take even a minor anaesthesia or bleeding problems that you cannot stop the medications that he is taking, it's simpler, faster, and maybe it would be it would have better results. So I would be happy, I would be happy to have this weapon as well, but we have to be completely sure and safe about how we can use them. And something else, which is much more not more important, but as important that when you have allogenic products, you are sure about the standardization of the product. About the dose, about the procedure, about the technique. It's standardized, which is very, very important. And this is the lack of standardization and the lack of same techniques, results, dose, everything in autologous, for me it's the main problem in regenerative medicine. And many guys are performing, let's say, lipoaspiration. Is it the same every time? The adipose tissue that you are collecting, is it the same after every procedure? Have you been gentle enough gentle enough to take the fat and protect it in order to have the right adipose-derived stem cells? And many, many other questions. So, allogenic products, you have standardized product, which is very important.

SPEAKER_01 28:30

Yeah, absolutely. I think ultimately what we're doing now is the first step. And as we continue to collect data, as we continue to move the science forward with both acellular and cellular technologies and standardization and safety profiles, I think you're exactly right. We are going to be able to determine what the right option is. Are we going to bank our own and have multiple withdrawals? Are we going to standardize and have it be pooled? You know, what do you do about the issues with the graft versus host for the allogenaic piece? What about IPS cells where you're reprogramming your own cells from your skin? What about like so there's so many options that are compelling enough to really work forward and continue to collect data, continue to push the science, continue to understand the problem. Because if you don't understand the problem, you can't really understand what the solutions may be. But you know, thank you so much for providing a really good framework, some really compelling both questions and answers. And I just really wanted to thank you so much for if I could say something something more very fast, Ariane. Absolutely.

SPEAKER_00 29:55

Thank you so much. I think it's interesting. Another technique that I'm using the last three years, and actually, we published our preliminary results. It's an amazing technique about getting cartilage micrografts from the ear of the patient.

SPEAKER_01 30:11

Yeah, I was wondering if you're gonna tell me about this.

SPEAKER_00 30:15

Yeah, you know, there was a study how many years ago? I don't recall it, from the nose, and now they start it again taking cartilage micrografts from the nose. But what we are doing is auricular from the concha of the ear with just topical anesthesia, very easy. You can you can do it in office, and you are using that, you desegrate it, you make it soluble, and you inject it in the joint for cartilage problems, but purely for cartilage problems. And this works. There are many studies so far, because these are progenitor stem cells, progenitor stem cells, and they have an amazing result in cartilage pathology. So, thank you so much for letting me say that as well. It's an amazing from a Spanish company called Mitocel. Uh, the guys have made an exceptional work, and I'm really happy to perform this procedure.

SPEAKER_01 31:11

So, you're telling me that you take a little microcartilage biopsy from my ear, you mix it.

SPEAKER_00 31:19

You perform three tiny holes with a punch biopsy, 2.5 millimeters, three very tiny holes in the concept of the ear, and you are taking the pieces of the cartilage that they are taking off from the three holes. You are making three small holes, and then uh you inject it with normal saline and with a special instrument they got with rotors, and they make it soluble, and so you can inject it, you can inject it in the shoulder and the knee, the hip for cartilage pathology, or if you change the area, if you go to the mastoid area and you take it the cartilage on there, you can use it for tendon pathology. So, this is something amazing. It's uh it's wow, yeah, yeah, yeah. It's quite interesting.

SPEAKER_01 32:05

Phenomenal. And is it same day application?

SPEAKER_00 32:09

Absolutely same day, minimal manipulation, FDA completely approved, it's not officially, sorry, not approved, but whatever FDA sets standards for sales procedures, yeah, they help. So it's a very good in my flowchart. I use it. Let's say if I have a pathology like arthritis Kelgar-Rorson 2, I use PRP, with which is another very big conversation. We cannot do it right now. And if I have a more severe cartilage pathology, I use this procedure. And of course, for Kelgan-Rorson early 4, I use stem cells. So this is I organize my job and my procedures and biological solutions.

SPEAKER_01 32:57

Well, now I'm gonna have to come to Greece and learn this procedure so that I can. Yes, you have to have another option for my patients to not have to do lipoaspirate, not have to do bone marrow concentrate, and just take a little puncture from their ear. That's amazing. That's phenomenal. Thank you so much for sharing that. You know, as usual, you are a wealth of knowledge and such an inspiration to continue learning and continue the conversation about the future of regenerative medicine. So I just want to thank you again for being a part of our podcast. And hopefully, we'll see you again in the near future when we talk about PRP, maybe.

SPEAKER_00 33:42

Yeah, it was an honor, Ariana. Thank you so much. Always at your disposal. Always. Thank you so much.

SPEAKER_01 33:48

So the question is is now that we've kind of done this deep dive on the science, what is the next step to have you know wildly successful outcomes for your patients? So the next step is you know, attracting the right patients, creating a cash-based business, having high converting consults to help get the trick the best for them, and then putting it out all together for success, and that's our practice launch system. So the fast track, then I'm going to invite you for some hands-on workshops. These are workshops that I put on the Business of Orthobiologics Express course, and this is in Clearwater, Florida. And then the next day we have Cadaver Lab to help with lipoaspirate training, bomero harvest and concentration, and then getting your hands on some BRP, bone marrow concentrate processing, and protein concentrate processing. The best part about the whole situation is that it is free. There's no recipe. So if you wanted to scan the QR code for the RSVP dates for not only November but December and January, we are doing that currently. So really, I'd love you guys to come on down. And then really importantly, putting it all together with this business of Orthobiologics Express course. This is a foes pieces of the puzzle that you know you're struggling with to be able to more uh appropriately and concisely offer these options to your patients. Finally, I'd like to offer you early registration to transform your practice with the TrueMD Live in 2026. We're gonna be hosting a day event in February of this year, and we're going to be having not only business training, marketing training, as well as training live. So scan a QR code, get some more information, and reserve your seat. We have just started to open up the registration, so I want to invite you all to the TrueMD event. It's it is definitely something to put on your calendar. So just scan that QR code and make that on your calendar. I am going to definitely turn it over to some questions. I know that there's some questions in the chat. There was a question about the thoughts on the cardistem trials. For those of you who don't know what the cardistem trials are, those are some allogenaic culture expanded products that are going to be grafted surgically. And so these are happening right now in the United States, uh, phase two and phase three trials. So we are definitely keeping our eyes open. There is also a phase three trial that's happening for the indication for lipogems, just like Dr. Sukis talked about, that they are actually now going for indication. Not only do they have an amazingly efficient and effective 510K clear device, but they're now in the middle of this trial to get approval for indication. Now, just because you have an indication doesn't mean that insurance is going to cover it, but that is the next step. That's the step in the process for coverage. So keep your eyes open for that information that's coming up in, you know, maybe 2026. I think they'll may have some preliminary data. There is some questions about, you know, if patients are having mobility issues, that is a functional failure. And that's absolutely right. So does orthobiologics help these mobility issues, the range of motion issues? And in part, if we have to think about why the mobility issue exists. Is it disuse? Is it stiffness due to inflammation? Because if it is, we do see improvement in range of motion after injection-based therapies of either PRP or cellular therapy. That has been something that we've been tracking in our data collection and that does exist. So is it the first-line treatment for, let's say, a flexion contracture? And I would say no. But if it's a good adjunct for inflammatory-based range of motion issues, I believe that it is. So thank you so much for that. And then yeah, your comment about Bob being awesome. Yeah, he is a researcher in the field and has a little bit of a hand in what we were talking about. The IPS cells, these are these are adult cells that are then reprogrammed to do, and right now we have the ability to use PRP, BMC, adipose. We don't currently have the ability to use SVF or other allogeneic tissues. Uh, we do have some opportunity to have culture expanded adipose-derived stem cells for the right patient here in the United States outside the states. There's a couple more options for you, both autologous and allogenaic culture-expanded cells. There is a lot of research looking into exosomes and extracellular vesicle treatment. But like Dr. Tatamasukas talked about, we are looking for that data collection to make sure that we have a really safe product. So if there's any other questions, please don't hesitate to pop them in the chat. Otherwise, I wanted to just thank you for joining us tonight for this really, really fascinating topic of you know, stem cell therapies. And I I thought, you know, we would bring you this really interesting application of adult cartilage cells being used for injection-based therapies from the auricular cartilage. And so it is basically minimally manipulated, it's sized and then re-injected. So we'll see how this company comes through the 510K clearance option for the United States. But man, that it sounds compelling and his data is really quite interesting to be able to have another source for you know cellular therapy. So if you have any other questions, any other comments, I'm happy to take those. Otherwise, I really appreciate and hope that we will see you in the near future either in Clearwater or in Arizona for our TrueMD program and in 2026. So please, please, please, I'll flash those again just in case you didn't get that. Otherwise, thank you so much for joining us. This has been Conversations in Regenerative Medicine with Dr. Dometius Sukis and myself, Ariana Demers. I hope you have a great night and you take care. And we'll see you in two weeks for another compelling conversation. I'm gonna keep it a little secret, but this is gonna be something that you're definitely not gonna want to miss. How to supercharge your regenerative therapies from an unlikely source. So have a great rest of your evening.