AANA Lab Course 913 - Advanced Knee Course-Orthobiologics Injections in the Knee (BMAC, Amniotic, Fat)_ What’s Appropriate Based on the Evidence_ Faculty Lecture

Orthobiologics Injections in the Knee (BMAC, Amniotic, Fat)_ What’s Appropriate Based on the Evidence_ Faculty Lecture_ Brian Chilelli, MD

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This presentation by Dr. Brian Chilelli of Northwestern Medicine provides an overview of orthobiologics—biologic cells and growth factors used in treating degenerative joint conditions such as osteoarthritis (OA). Orthobiologics include autologous blood products like platelet-rich plasma (PRP), placental tissues (amniotic membrane, umbilical cord), and cell-based therapies derived from bone marrow, adipose tissue, synovium, or peripheral blood.<br /><br />The NIH defines stem cells as unspecialized cells capable of self-renewal and differentiation. However, the term "stem cell" is often misapplied, especially in clinical studies, leading to confusion. Dr. Arnold Caplan suggests renaming mesenchymal stem cells (MSCs) as “Medicinal Signaling Cells” to highlight their role in secreting bioactive factors that modulate repair rather than directly regenerating tissue.<br /><br />In the US, FDA regulations allow only minimal manipulation of cells, homologous use, no addition of substances, and restricted use for autologous or close relative applications. Culturing, expansion, or adding growth factors to cells is not allowed.<br /><br />Bone Marrow Aspirate Concentrate (BMAC) is minimally manipulated and contains growth factors promoting healing and cartilage repair, showing good clinical outcomes in studies though evidence is variable. Similarly, adipose tissue–derived MSCs (AD-MSCs) can be harvested easily and have shown promise in improving knee OA symptoms and enhancing cartilage regeneration. <br /><br />Amniotic-derived treatments offer growth factors but lack true stem cells; products should not be labeled as stem cell therapies although their bioactive components may aid treatment.<br /><br />Many published studies on stem cell therapies for knee OA suffer from inconsistent terminology, small sample sizes, and methodological issues. More rigorous randomized controlled trials are needed.<br /><br />In summary, intra-articular injections of cell-based orthobiologics such as BMAC, AD-MSCs, and amniotic suspensions have potential to improve pain and function in OA and cartilage repair, while PRP remains effective. Careful attention to nomenclature and regulatory compliance is essential for clinical application and patient counseling.

Keywords

orthobiologics

osteoarthritis

platelet-rich plasma

mesenchymal stem cells

bone marrow aspirate concentrate

adipose-derived stem cells

amniotic membrane

FDA regulations

cartilage repair

randomized controlled trials