AANA Fellowship Education - Biologics: Separating Fact from Fiction-Presentation (PDF)

Presentation (PDF)

Pdf Summary

The webinar "Biologics: Separating Fact From Fiction" held on 9/29/2020, featured experts from the University of Colorado and OrthoIndy discussing modern biologic treatments in orthopedics, focusing on platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and amniotic tissue products.<br /><br />PRP was reviewed in detail by Dr. Jason Dragoo, explaining formulations: leukocyte-poor PRP (LP-PRP) for osteoarthritis (OA) with inflammation due to its anti-inflammatory properties, and leukocyte-rich PRP (LR-PRP) for tendinopathies with pro-inflammatory effects. Evidence supports LP-PRP benefits symptoms of OA and inflammation, while LR-PRP helps tendinopathies like lateral epicondylitis and plantar fasciitis. However, PRP shows limited evidence for muscle, bone, or cartilage regeneration and acute injuries. Novel approaches include PRP enriched with protective proteins (α-2 macroglobulin) and heating methods to boost anti-inflammatory IL-1ra, though not FDA approved.<br /><br />Bone marrow aspirate concentrate (BMAC) contains mesenchymal stem cells increased via centrifugation, used for bone marrow lesions and osteochondral defects. Case studies illustrated biologic treatments combining core decompression, BMAC injection, and calcium phosphate cement.<br /><br />Dr. Jack Farr discussed amniotic (placental-derived) tissue products, emphasizing variability in composition and processing that impacts clinical efficacy and safety, highlighting the need for standardized products. Preclinical models show promising cartilage, bone repair, and tendon healing effects. Limited human studies suggest amniotic suspensions may improve pain and function in OA and tendinopathies with good safety profiles, but robust randomized controlled trials (RCTs) are lacking and necessary, especially with upcoming FDA regulatory changes.<br /><br />Clinical cases demonstrated successful use of PRP and amniotic tissue injections in patients with knee osteoarthritis, providing symptom relief and functional improvements, often avoiding surgery.<br /><br />The consensus urges clear reporting on biologic formulations used in research to ensure comparability and reliable conclusions. Overall, regenerative orthopedics shows promise, but practitioners must distinguish evidence-based applications from unsupported claims and continue rigorous study of biologic therapies for orthopedic conditions.

Keywords

Biologics

Platelet-Rich Plasma (PRP)

Leukocyte-Poor PRP (LP-PRP)

Leukocyte-Rich PRP (LR-PRP)

Bone Marrow Aspirate Concentrate (BMAC)

Amniotic Tissue Products

Osteoarthritis (OA)

Tendinopathies

Regenerative Orthopedics

FDA Regulatory Changes