AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Biologics in the Office-Jeremy M. Burnham, M.D.

Biologics in the Office-Jeremy M. Burnham, M.D.

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This presentation by Dr. Jeremy M. Burnham discusses the current landscape of biologic therapies in orthopedic sports medicine, focusing on treatments available and their evidence base as of 2020.<br /><br />Biologics aim to harness mesenchymal stem cells (MSCs), growth factors, and cytokines to activate the body’s healing and reparative processes. Current biologics used in U.S. orthopedic practice include hyaluronic acid (HA), platelet-rich plasma (PRP), autologous stem cells (bone marrow aspirate concentrate—BMAC, adipose-derived), and amniotic/umbilical tissue.<br /><br />Hyaluronic acid, formerly sourced from rooster combs and now produced by fermentation, functions by binding CD-44 and inhibiting inflammatory cytokines (IL-1b). Clinically, HA provides chondroprotection, anti-inflammatory effects, joint lubrication, and shock absorption. It improves pain and function scores in osteoarthritis (OA) and can delay knee replacement surgery by months to years. HA is typically administered as three weekly injections every 6-8 months and is often covered by insurance.<br /><br />PRP involves a supraphysiologic concentration of autologous platelets containing growth factors, cytokines, and interleukins. PRP types include Leukocyte Poor (LP-PRP), which is anti-inflammatory, and Leukocyte Rich (LR-PRP), which is more inflammatory. PRP has demonstrated good clinical outcomes especially in mild to moderate knee OA, patellar tendinopathy, lateral epicondylitis, and some rotator cuff pathologies. Recommendations include 1-3 LP-PRP injections over weeks for knee OA and LR-PRP for certain tendinopathies. PRP injections are most effective in younger patients with less severe disease.<br /><br />Autologous stem cells, such as BMAC, show variable results, with some evidence supporting use in rotator cuff repair. Adipose-derived MSC therapies are anticipated to expand. Amniotic tissue products are used but lack high-quality clinical evidence.<br /><br />Overall, evidence is strongest for LP-PRP in knee OA and LR-PRP in patellar tendinopathy and lateral epicondylitis. Data for other indications like ACL repair, Achilles tendinosis, meniscus, and muscle regeneration are weaker.<br /><br />Key points stressed include cost-conscious, ethical use of biologics grounded in sound scientific evidence and understanding of underlying mechanisms. Appropriate patient expectations and further high-quality research are necessary for successful integration of biologics into sports medicine.<br /><br />In summary, biologics represent promising but still developing modalities that currently complement nonoperative treatments for various musculoskeletal conditions, particularly knee osteoarthritis and tendinopathies.

Keywords

biologic therapies

orthopedic sports medicine

mesenchymal stem cells

hyaluronic acid

platelet-rich plasma

autologous stem cells

knee osteoarthritis

patellar tendinopathy

lateral epicondylitis

rotator cuff repair