The 2020 NBA Orthobiologics Consensus Statement

Abstract

This 2020 NBA Orthobiologics Consensus Statement provides a concise summary of available literature and practical clinical guidelines for team physicians and players. We recognize that orthobiologic injections are a generally safe treatment modality with a significant potential to reduce pain and expedite early return to play in specific musculoskeletal injuries. The use of orthobiologics in sports medicine to safely reduce time loss and reinjury is of considerable interest, especially as it relates to the potential effect on a professional athlete. While these novel substances have potential to enhance healing and regeneration of injured tissues, there is a lack of robust data to support their regular use at this time. There are no absolutes when considering the implementation of orthobiologics, and unbiased clinical judgment with an emphasis on player safety should always prevail. Current best evidence supports the following: Key Points There is support for the use of leukocyte-poor platelet-rich plasma in the treatment of knee osteoarthritis. There is support for consideration of using leukocyte-rich platelet-rich plasma for patellar tendinopathy. The efficacy of using mesenchymal stromal cell injections in the management of joint and soft tissue injuries remains unproven at this time. There are very few data to suggest that current cell therapy treatments lead to any true functional tissue regeneration. Meticulous and sterile preparation guidelines must be followed to minimize the risk for infection and adverse events if these treatments are pursued. Given the high variability in orthobiologic formulations, team physicians must stay up-to-date with the most recent peer-reviewed literature and orthobiologic preparation protocols for specific injuries. Evidence-based treatment algorithms are necessary to identify the optimal orthobiologic formulations for specific tissues and injuries in athletes. Changes in the regulatory environment and improved standardization are required given the exponential increase in utilization as novel techniques and substances are introduced into clinical practice.

The mechanism of action of platelet-rich plasma for knee osteoarthritis: a systematic review

“…Although still controversial, current evidence from clinical research indicates that LP-PRP formulations may represent a better therapeutic option for knee OA, considering the number of adverse reactions, improvement in clinical scores, and recommendations from different investigations 21,[60][61][62] . The data found in basic science research suggests that both LR-PRP and LP-PRP promote a positive response in the treatment of knee OA.…”

“…In vitro studies Rikkers et al, 2020 36 Liu et al, 2019 25 Simental-Mendía et al, 2018 28 Durant et al, 2017 78 Jeyakumar et al, 2017 31 Moussa et al, 2017 32 Russo et al, 2016 79 Yang et al, 2016 23 Zhou et al, 2016 51 Cavallo et al, 2014 60 Chen et al, 2014 33 Wu et al, 2011 34 Akeda et al, 2006 30 Choi, 1980 better cartilage surface restoration, with the presence of proteoglycan and type II collagen, in a greater thickness of hyaline-like cartilage 27,[51][52][53] . Nevertheless, others have observed no significant differences between LR-PRP and LP-PRP when assessing the degenerative process of tissues 53 .…”

Editorial Commentary: Stem Cell Exosomes Can Promote Healing and Muscle Function After Rotator Cuff Repair

“…Barriers exist in terms of cost, the demonstration of efficacy, and the need to determine which patient population will benefit most from the use of these emerging strategies. [1][2][3] Rotator cuff repair appears to be a promising early candidate because recapitulation of the biology of tendon-to-bone attachments and improved muscle quality remain a challenge that has not yet been solved with traditional repair and biologic augmentation strategies. Current stem cell therapy options, which involve either donor harvest or allograft use of stem cells, have not been shown to add considerably to the outcomes of rotator cuff repair.…”

Injectable orthobiologics in professional football (soccer) players: a systematic review

“…10 The evidence regarding the implementation of orthobiologics is still growing, but the strength of recommendation remains controversial. 11 This is particularly true for professional athletes, in which evidence is limited to a small number of low-level evidence publications. 12 This systematic review evaluated the clinical outcomes of PRP, BMAC, and MSCs injections in treating sport-related injuries for professional football (PF) players.…”