AANA Lab Course 908-Foot and Ankle Arthroscopy (APEx)-Update on Biologics-John Kennedy, M.D.

Update on Biologics-John Kennedy, M.D.

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This presentation by Dr. John G. Kennedy reviews current biologic therapies for cartilage repair, focusing on mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), concentrated bone marrow aspirate (CBMA), and adipose-derived stem cells (ADSCs).<br /><br />MSCs are traditionally believed to differentiate into various cell types, aiding cartilage repair for over 20 years, though their exact mechanisms remain unclear. Recent studies suggest their benefits often come from paracrine effects—secretion of bioactive factors (secretome)—rather than direct cell replacement, exerting trophic, immunomodulatory, and antimicrobial functions.<br /><br />PRP's anti-inflammatory properties include inhibition of IL-1β and TNF-α pathways, promoting chondrogenesis and extracellular matrix production. Systematic reviews of basic science and clinical studies reveal majority positive outcomes with PRP for cartilage lesions and osteoarthritis, yet inconsistencies in PRP preparation and patient factors (e.g., exercise, NSAIDs, smoking) influence efficacy.<br /><br />CBMA, rich in stem cells and cytokines such as IL-1 receptor antagonist (IL-1Ra), shows improved cartilage repair histologically and clinically compared to microfracture alone, especially for larger or cystic lesions. Clinical trials demonstrate better MRI outcomes and functional scores with CBMA augmentation.<br /><br />Adipose tissue therapies using stromal vascular fraction (SVF) or micronized adipose tissue (MAT) offer immunomodulation and potential chondrogenic effects, with favorable clinical improvements reported in knee osteoarthritis. However, variability in cell types, adjuncts, and outcome measures complicate clear conclusions, and the primary benefit may be immunomodulatory rather than direct cartilage regeneration.<br /><br />The takeaway is that biologic augmentation, including PRP and CBMA, is promising for osteochondral lesions and cartilage repair, but optimizing formulations, timing, and understanding patient factors remain critical. Further clinical research is needed to validate efficacy and standardize treatment protocols to address both local cartilage defects and joint environment homeostasis.

Keywords

biologic therapies

cartilage repair

mesenchymal stem cells

platelet-rich plasma

concentrated bone marrow aspirate

adipose-derived stem cells

immunomodulation

chondrogenesis

osteoarthritis treatment

clinical outcomes