Application of Orthobiologics in Achilles Tendinopathy: A Review

Abstract

Orthobiologics are biological materials that are intended for the regeneration of bone, cartilage, and soft tissues. In this review, we discuss the application of orthobiologics in Achilles tendinopathy, more specifically. We explain the concepts and definitions of each orthobiologic and the literature regarding its use in tendon disorders. The biological potential of these materials can be harnessed and administered into injured tissues, particularly in areas where standard healing is disrupted, a typical feature of Achilles tendinopathy. These products contain a wide variety of cell populations, cytokines, and growth factors, which have been shown to modulate many other cells at local and distal sites in the body. Collectively, they can shift the state of escalated inflammation and degeneration to reestablish tissue homeostasis. The typical features of Achilles tendinopathy are failed healing responses, persistent inflammation, and predominant catabolic reactions. Therefore, the application of orthobiologic tools represents a viable solution, considering their demonstrated efficacy, safety, and relatively easy manipulation. Perhaps a synergistic approach regarding the combination of these orthobiologics may promote more significant clinical outcomes rather than individual application. Although numerous optimistic results have been registered in the literature, additional studies and clinical trials are still highly desired to further illuminate the clinical utility and efficacy of these therapeutic strategies in the management of tendinopathies.

Orthobiologic Management Options for Degenerative Disc Disease

“…However, these same cells also produce matrix metalloproteinases which degrade the NP ECM. The presence of anabolic signals such as IGF-1, TGF and bFGF promotes ECM deposition [16], whereas various inflammatory cytokines (typically secreted following tissue injury promote ECM degradation [8,9,[17][18][19][20]. Therefore, if the cellular microenvironment shifts IVD cells to a catabolic state, degradation of the NP matrix will begin [21].…”

“…Some of the most popular contemporary orthobiologic alternatives commercially available are autologous solutions such as platelet-rich plasma (PRP), bone marrowderived products and adipose tissue derivatives [8]. These materials trigger a wide set of biological responses that contribute to the amelioration of regeneration in areas where standard tissue healing is disrupted or difficult to achieve [9]. Although the biological mechanisms are complex, the aforementioned products share many similarities, especially in virtue of autocrine and paracrine signaling via release of several bioactive molecules [8][9][10][11].…”

“…These materials trigger a wide set of biological responses that contribute to the amelioration of regeneration in areas where standard tissue healing is disrupted or difficult to achieve [9]. Although the biological mechanisms are complex, the aforementioned products share many similarities, especially in virtue of autocrine and paracrine signaling via release of several bioactive molecules [8][9][10][11].…”

Comparative Regenerative Effects of Allogeneic Bone Marrow and Patellar Ligament Fat Pad Mesenchymal Stem Cells on Experimental Superficial Digital Flexor Tendonitis in New Zealand Rabbits

“…ectopic but ADSCs induce neovascularization and inhibit inflammation in the early phase of tendon injury, so demonstrated as the best source for tendon repair (Ramires et al, 2022).…”

Cannabidiol for musculoskeletal regenerative medicine

“…OA, for instance, remains the utmost typical degenerative and progressive joint disease affecting vital musculoskeletal (MSK) structures like cartilage, ligaments, and bone. 7,8 Furthermore, the Global Burden of Disease Study 2019 revealed that the number of patients suffering from OA increased globally around 48% from 1990 to 2019, which represents OA as 15th most common cause of number of years lived with disability. 9 This fact is associated with risk factors like the aging and the prevalence of poor metabolic health, especially the obesity.…”