AANA25 Shoulder Access Pass-CONCURRENT SESSION 1A: AANA/BA Session: Knee and Shoulder

Video Transcription

Video Summary

This combined ANNA/Biologics Association (BA) session opened with an overview of the BA’s mission: convening member societies to provide a unified, ethical, evidence-based voice in orthobiologics, emphasizing safety, efficacy, standards, and education. A major BA initiative is BARB (Biologics Association Registry and biospecimen repository), currently focused on PRP samples from knee osteoarthritis patients (over 600 collected) to link clinical outcomes with detailed biologic analyses.<br /><br />Don Buford reviewed practical PRP analytics using CBC testing of whole blood and PRP to calculate platelet dose (volume × concentration), platelet concentration factor, platelet recovery %, leukocyte categorization, hematocrit targets, and “cost per billion platelets,” arguing platelet dose is the strongest current correlator with outcomes and should guide kit selection.<br /><br />Scott Rodeo then discussed emerging rationale for platelet-poor plasma (PPP) in muscle injury: PRP may promote proliferation but inhibit myogenic differentiation via factors like TGF-β and myostatin, while PPP may better support differentiation. Early clinical data suggest faster return to play and less post-injection pain with PPP versus leukocyte-rich PRP.<br /><br />Catherine Esser presented bilateral synovial fluid data after ACL injury, showing the contralateral “healthy” knee also exhibits inflammatory and remodeling cytokine changes; RANTES was elevated acutely and correlated with worse pre-op function, undermining use of the contralateral knee as a biologic control.<br /><br />Other talks covered: an aragonite/coral osteochondral scaffold designed to recruit endogenous cells for bone and hyaline-like cartilage repair; BMAC augmentation for talar osteochondral lesions and bone marrow edema; Brian Cole’s evidence-informed use of PRP/BMAC/adipose as surgical adjuncts (noting heterogeneity and limited long-term differences in many settings); and building an orthobiologics program with patient communication focused on dosing and biology.<br /><br />Scott Bruder summarized exosomes: biologically promising but currently illegal for routine therapeutic use outside FDA-regulated IND/BLA pathways, warning against commercially marketed “exosome” injections and clarifying similar regulatory issues with injectable amniotic products. The session ended with case discussions and debate on NSAIDs, protocols, and perioperative inflammation modulation.

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Keywords

Biologics Association (BA)

orthobiologics

BARB registry

biospecimen repository

platelet-rich plasma (PRP)

platelet dose calculation

CBC-based PRP analytics

knee osteoarthritis

platelet-poor plasma (PPP)

muscle injury return-to-play

ACL injury synovial fluid cytokines

contralateral knee inflammation

osteochondral scaffold aragonite coral

bone marrow aspirate concentrate (BMAC)

exosome regulation FDA IND/BLA