Autologous Protein Solution (APS) and Osteoarthritis of the Knee: A Scoping Review of Current Clinical Evidence

Abstract

Knees are the most regularly affected weight-bearing joints in osteoarthritis (OA), impacting millions of individuals across the globe. The incidence of knee OA will further rise with increasing rates of obesity and lifespan, resulting in a significant increase in the worldwide socioeconomic burden. Conventional therapies used to manage the symptoms associated with knee OA have limitations. Lately, there has been an increased interest in the use of autologous peripheral blood-derived orthobiologics (APBO), including autologous protein solution (APS), for the management of knee OA. Here, the primary objective is to summarize the outcomes of clinical studies involving APS for the treatment of knee OA. Several databases (Embase, Scopus, PubMed, and Web of Science) were searched using terms for the intervention “APS” and treatment “knee OA” for articles published in English until January 21, 2024. All clinical studies using APS as an intervention for the treatment of knee OA were included. Studies not utilizing APS alone or not aiming at the management of knee OA were excluded. Six clinical studies that met our predefined search terms and inclusion and exclusion criteria were included in this study. The results demonstrated that the intra-articular administration of APS is safe and efficacious in reducing pain and/or improving function in patients suffering from knee OA. However, more multicenter, randomized controlled trials involving active comparators, with adequate power and long-term follow-up along with post-market real-world studies in clinical practice are required to further assess the efficacy of APS and justify its regular clinical use for the management of knee OA.

Exosomes for the Management of Low Back Pain: A Review of Current Clinical Evidence

“…The last decade has seen a marked increase in the use of orthobiologics for regenerative medicine applications, including managing chronic MSK pain conditions [18]. Orthobiologics currently utilized in the clinical practice include autologous peripheral blood-derived orthobiologics, such as leukocyte-rich or poor platelet-rich plasma; adipose tissue-derived formulations, such as stromal vascular fraction; bone marrow aspirate concentrate; and perinatal tissue-derived biologics such as amniotic tissue (membrane and/or fluid), umbilical cord and Wharton's jelly [2,[18][19][20][21][22][23][24]. The effectiveness of these biologics is credited to the presence of stem cells and/or bioactive molecules such as growth factors, cytokines, and extracellular vesicles or exosomes [25].…”

Editorial: Regenerative biologics for musculoskeletal injuries

“…In addition to the need for more studies, including non-randomized and randomized controlled trials (RCTs), to further establish the safety and efficacy of aforementioned biologics, future studies assessing the effectiveness of one biologic compared to the another are warranted to aid clinicians in determining the optimal biologic for MSK regenerative medicine applications. Moreover, even though RCTs are considered most trustworthy and the majority of the clinical recommendations are given based on the results obtained from them, the conditions in a RCT are controlled (i.e., study participants are selected with the goal of reducing comorbidities and the study protocol is designed to guarantee highest participant(s) and investigator(s) compliance) and they do not incorporate the divergent characteristics of real-world populations ( 4 , 5 ). Therefore, it is vital to incorporate real-world evidence with RCTs to complement it and to improve the wholeness of evidence-based medicine evaluations.…”