Treatment Pyramid

Modern orthopedics uses a stepwise approach: from simple to complex. Each step is applied when the previous one is insufficient.

Step 1: Basic Therapy

NSAIDs (ibuprofen, diclofenac), muscle relaxants, analgesics. Physiotherapy, exercise therapy, massage. Orthoses and braces. Activity modification. Effective for acute conditions and mild chronic cases. Limitation: does not eliminate the cause, only symptoms.

Step 2: Injection Therapy

Corticosteroids (temporary effect 2-6 weeks). Hyaluronic acid (lubrication for 3-6 months). PRP (stimulation for 6-12 months). Limitation: does not regenerate tissue, cortisone destroys.

→ PRP vs hyaluronic acid vs MIBRAR

Step 3: MIBRAR (regenerative medicine)

CGF + Lipogems®: true tissue regeneration with stem cells. The only method that restores cartilage, discs, tendons at the cellular level. Lifelong effect. Outpatient, without general anesthesia.

Step 4: Surgery

Arthroscopy, decompression, spinal fusion, joint replacement. Indicated when conservative treatment is ineffective or for absolute indications.

→ MIBRAR vs surgery

Comparison by Diseases

Herniated Disc

Conservatively (steps 1-3)

85-90% of herniations are treated without surgery. Basic therapy 4-6 weeks. If ineffective: epidural injections, then MIBRAR (disc regeneration). Indications: herniations up to 10-12 mm without paresis.

Surgically

10-15% of herniations. Absolute indications: cauda equina syndrome, progressive paresis. Relative: conservative treatment ineffective > 6-12 weeks, unbearable pain.

Knee Osteoarthritis (Gonarthrosis)

Conservatively (steps 1-3)

Stages 1-3: weight loss, exercise therapy, NSAIDs. If ineffective: GC/PRP, then MIBRAR (cartilage regeneration). Arthroscopic debridement proven ineffective (Moseley 2002, Kirkley 2008).

Surgically

Stage 4 (bone-on-bone): joint replacement. Average age for prosthesis: 65-70 years. Prosthesis lifespan: 15-20 years. MIBRAR provides full regeneration, making prosthesis unnecessary in most cases.

Rotator Cuff Tear

Conservatively (steps 1-3)

Partial tears, small full tears in patients > 60 years without high functional demands. Exercise therapy + MIBRAR (tendon regeneration). Effectiveness for partial tears: 85%.

Surgically

Full tears > 3 cm with retraction, young patients, athletes. Arthroscopic repair + MIBRAR to improve healing (re-tear rate decreases from 30% to 10%).

Epicondylitis

Conservatively (steps 1-3)

95% of cases. Rest, brace, NSAIDs, eccentric exercises. For chronic: MIBRAR (tendon regeneration). Corticosteroids NOT recommended (worsens long-term prognosis).

Surgically

5% — if ineffective > 12 months. Nirschl procedure (debridement). Unpredictable results, prolonged rehabilitation. MIBRAR significantly more effective.

Why MIBRAR is Unique

Fills the Gap