Biologic Treatments for Sports Injuries II Think Tank—Current Concepts, Future Research, and Barriers to Advancement, Part 3

Abstract

Focal chondral defects of the articular surface are a common occurrence in the field of orthopaedics. These isolated cartilage injuries, if not repaired surgically with restoration of articular congruency, may have a high rate of progression to posttraumatic osteoarthritis, resulting in significant morbidity and loss of function in the young, active patient. Both isolated and global joint disease are a difficult entity to treat in the clinical setting given the high amount of stress on weightbearing joints and the limited healing potential of native articular cartilage. Recently, clinical interest has focused on the use of biologically active compounds and surgical techniques to regenerate native cartilage to the articular surface, with the goal of restoring normal joint health and overall function. This article presents a review of the current biologic therapies, as discussed at the 2015 American Orthopaedic Society for Sports Medicine (AOSSM) Biologics Think Tank, that are used in the treatment of focal cartilage deficiencies. For each of these emerging therapies, the theories for application, the present clinical evidence, and specific areas for future research are explored, with focus on the barriers currently faced by clinicians in advancing the success of these therapies in the clinical setting.

Editorial Commentary: Platelet-Rich Plasma for Knee Osteoarthritis: A “Novel” and Effective Symptomatic Approach

“…In this regard, the use of orthobiologics for the treatment of cartilage disease emerged as an important tool in the orthopaedic armamentarium due to their minimal invasiveness, potentially disease-modifying properties, and effectiveness. [7][8][9] These therapies include plateletrich plasma (PRP), bone marrow aspirate concentrate, and the use of cell-based therapies, among others.…”

The Utility of Biologics, Osteotomy, and Cartilage Restoration in the Knee

“…Although scientific and clinical evidence on biologic therapy is evolving, biologics may help prevent articular cartilage lesion progression and may play a role in the nonsurgical and surgical management of osteoarthritis and focal chondral lesions. [59][60][61] Although knee joint preservation surgery is effective in appropriately indicated patients, revision surgery rates are relatively high, and failure rates increase with longer follow-up. Given the relatively young age of most patients who undergo knee joint preservation surgery, efforts to improve the short-term function and long-term duration of knee joint preservation surgery are under way, with a major focus on biologic augmentation.…”

“…62 PRP, which is an autologous, highly concentrated product containing growth factors and inflammatory mediators, has been reported to enhance chondrocyte proliferation, and ongoing studies are attempting to evaluate the differentiation and functionality of those chondrocytes. 61,63,64 PRP is an autologous product that is produced by harvesting peripheral blood via standard venipuncture techniques, spinning the peripheral blood in a centrifuge to concentrate platelets above baseline levels, and injecting the finished product into an affected area. Platelets are of interest because they contain a variety of growth factors that are known to stimulate the proliferation of local progenitors, direct cell differentiation, and modify inflammatory responses.…”

“…In general, stem cells are classified as embryonic stem cells, induced pluripotent stem cells, or adult stem cells. 61 Stem cells are subclassified as autologous or allogeneic. Autologous adult MSCs are mostly harvested from bone marrow and adipose tissue.…”

Current State for Clinical Use of Stem Cells and Platelet-Rich Plasma

“…There are numerous regulatory hurdles that challenge the widespread implementation and adoption of new advancements in the field of biologics [124]. In the United States, the U.S. Food and Drug Administration (FDA) is the regulatory body that oversees implementation of new medical technologies, including MSCs and PRP [124][125][126][127]. In Europe, the European Union (EU) and the European Medicines Agency (EMA), in addition to individual national agencies, oversee regulations governing biologic therapeutics [128,129].…”