Application of Biologics in the Treatment of the Rotator Cuff, Meniscus, Cartilage, and Osteoarthritis

Anz, Adam W.; Hackel, Joshua G.; Nilssen, Erik C.; Andrews, James R.

doi:10.5435/jaaos-22-02-68

Cited by 45 publications

(53 citation statements)

References 51 publications

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“…[23][24][25][26][27][28] Although the rules and regulations remain unclear, clinicians that are interested should carry-on with the best available guidelines to ensure safety and compliance during delivery in clinical practice to avoid regulatory infraction. 29 While ill-defined regulation encourages experimentation and novel clinical application, efficacy and patient safety concerns are a real concern.…”

Section: Regulatory Implications Facing Cartilage Regenerative Medicinementioning

confidence: 99%

Concepts in regenerative medicine: Past, present, and future in articular cartilage treatment

Anz

Bapat²,

Murrell

2016

Journal of Clinical Orthopaedics and Trauma

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Regenerative medicine is emerging with great interest and hope from patients, industry, academia, and medical professionals. Cartilage regeneration, restoration, or repair is one of the prime targets that remains largely unsolved, and many believe that regenerative medicine can possibly deliver solutions that can be widely used to address the current gap(s) in treatment. In the United States, Europe, Australia, and India the regulation of regenerative based treatments has become a big debate. Although the rules and regulations remain unclear, clinicians that are interested should carry-on with the best available guidelines to ensure safety and compliance during delivery in clinical practice to avoid regulatory infraction. Many have made significant investment of time, resources, and facilities in recent years to provide new regenerative treatment options and advance medical care for patients. Instead of reinventing the wheel, it would be more efficient to adopt currently accepted standards and nomenclature borrowed from transplantation science, and cord blood storage industries. The purposes of this article are to provide some historical background to the field of regenerative medicine as it applies to cartilage, and how this field has developed. This will be followed by a separate discussion on regulatory oversight and input and how it has influenced access to care. Furthermore, we discuss current clinical techniques and progress, and ways to deliver these treatments to patients safely, effectively, and in a cost sensitive manner, concluding with an overview of some of the promising regenerative techniques specific to cartilage.

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Section: Regulatory Implications Facing Cartilage Regenerative Medicinementioning

confidence: 99%

Concepts in regenerative medicine: Past, present, and future in articular cartilage treatment

Anz

Bapat²,

Murrell

2016

Journal of Clinical Orthopaedics and Trauma

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“…A direct intra-articular administration of cells suspended in a phosphate-buffered saline led to a significant improvement in tissue regeneration at weeks 2, 4, and 8 posttreatment [53–55]. Larger defects usually call for the employment of an SC-loaded scaffold; on the other hand, smaller defects or scenarios involving augmentation of repair of the meniscus might not call for scaffold use because SCs seem to be capable to concentrate and stay at the site of repair [53, 54, 56]. …”

Section: Mscs and The Meniscusmentioning

confidence: 99%

The Holy Grail of Orthopedic Surgery: Mesenchymal Stem Cells—Their Current Uses and Potential Applications

Berebichez-Fridman

Gómez-García

Granados-Montiel

et al. 2017

Stem Cells International

104

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Only select tissues and organs are able to spontaneously regenerate after disease or trauma, and this regenerative capacity diminishes over time. Human stem cell research explores therapeutic regenerative approaches to treat various conditions. Mesenchymal stem cells (MSCs) are derived from adult stem cells; they are multipotent and exert anti-inflammatory and immunomodulatory effects. They can differentiate into multiple cell types of the mesenchyme, for example, endothelial cells, osteoblasts, chondrocytes, fibroblasts, tenocytes, vascular smooth muscle cells, and sarcomere muscular cells. MSCs are easily obtained and can be cultivated and expanded in vitro; thus, they represent a promising and encouraging treatment approach in orthopedic surgery. Here, we review the application of MSCs to various orthopedic conditions, namely, orthopedic trauma; muscle injury; articular cartilage defects and osteoarthritis; meniscal injuries; bone disease; nerve, tendon, and ligament injuries; spinal cord injuries; intervertebral disc problems; pediatrics; and rotator cuff repair. The use of MSCs in orthopedics may transition the practice in the field from predominately surgical replacement and reconstruction to bioregeneration and prevention. However, additional research is necessary to explore the safety and effectiveness of MSC treatment in orthopedics, as well as applications in other medical specialties.

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“…Accordingly, in the United States these cells can only be used in an FDA-approved trial after a stringent review process 5, 8 . A serious consideration is that ESC and iPS cells have oncogenic potential.…”

Section: Overview Of Cell Types and Classificationsmentioning

confidence: 99%

“…In fact, a principal reason why cellular therapies have not been implemented more rapidly in the clinical setting is because of the complex and evolving regulatory requirements that have surrounded cellular products in recent years. 8 …”

Section: Regulatory Aspectsmentioning

confidence: 99%

Cell-based Approaches for Augmentation of Tendon Repair

Carballo

Lebaschi

Rodeo

2017

Techniques in Shoulder &Amp; Elbow Surgery

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Cell-based approaches are among the principal interventions in orthobiologics to improve tendon and ligament healing and to combat degenerative processes. The number of options available for investigation are expanding rapidly and investigators have an increasing number of cell types to choose from for research purposes. However, in part due to the current regulatory environment, the list of available cells at clinicians’ disposal for therapeutic purposes is still rather limited. In this review, we present an overview of the main cellular categories in current use. Notable recent developments in cell-based approaches include the introduction of diverse sources of mesenchymal stem cells, pluripotent cells of extra-embryonic origin, and the emerging popularity of fully differentiated cells such as tenocytes and endothelial cells. Delivery strategies are discussed and a succinct discussion of the current regulatory environment in the United States is presented.

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Application of Biologics in the Treatment of the Rotator Cuff, Meniscus, Cartilage, and Osteoarthritis

Cited by 45 publications

References 51 publications

Concepts in regenerative medicine: Past, present, and future in articular cartilage treatment

Concepts in regenerative medicine: Past, present, and future in articular cartilage treatment

The Holy Grail of Orthopedic Surgery: Mesenchymal Stem Cells—Their Current Uses and Potential Applications

Cell-based Approaches for Augmentation of Tendon Repair

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