Hype, Promise and Reality: Orthopaedic Use of Biologics in 2020 (AANA20)-OrthoBiologics and Cartilage Repair-Dr. Brian J. Cole

OrthoBiologics and Cartilage Repair-Dr. Brian J. Cole

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Dr. Brian J. Cole, a leading orthopedic surgeon and researcher, addresses the substantial challenges and evolving treatments related to osteoarthritis (OA), tendonitis, and soft tissue injuries. OA affects over 52 million Americans, predominantly older adults, with 1 million joint replacements annually; tendon injuries also cause millions of sports-related medical visits, with rotator cuff repair re-tear rates as high as 40-60%. The proliferation of unregulated online “stem-cell” therapies in the U.S. raises concerns over misleading patient information.<br /><br />Orthobiologics, including platelet-rich plasma (PRP), bone marrow concentrate (BMC), mesenchymal stem cells (MSCs), and amniotic tissues, are explored as potential treatments to modify disease processes and promote tissue regeneration, either alone or adjunct to surgery. The FDA’s regulatory landscape is tightening, focusing on ensuring safety and efficacy of these biologic products.<br /><br />PRP variations differ in platelet and white blood cell concentrations, affecting clinical outcomes; leukocyte-poor PRP (LP-PRP) shows better anti-inflammatory effects over leukocyte-rich PRP (LR-PRP). Clinical trials demonstrate PRP’s potential benefits in osteoarthritis, tendinopathies, and rotator cuff repair, although results are sometimes contradictory, emphasizing the need for refined protocols.<br /><br />MSCs, primarily from bone marrow and adipose tissue, are recognized for their paracrine effects that modulate inflammation and promote healing rather than direct tissue regeneration. Dr. Cole advocates ceasing the term “stem cell” for current therapies, favoring “connective tissue progenitor cells.” MSC augmentation has shown improved rotator cuff healing rates and outcomes.<br /><br />Advanced cartilage repair techniques such as microdrilling combined with scaffolds like BioCartilage mixed with PRP or BMC enhance tissue repair while preserving bone integrity, reducing revision rates compared to traditional microfracture. In chronic bone marrow lesions linked to OA progression, intraosseous biologic injections (BioPlasty) are promising.<br /><br />For rotator cuff tears, biologic augmentation with MSCs or PRP may promote enthesis regeneration and reduce re-tear rates. Similarly, PRP demonstrates efficacy in treating partial UCL tears, lateral epicondylitis, and patellar tendinosis, improving pain and functional outcomes.<br /><br />Overall, Dr. Cole emphasizes evidence-based use of orthobiologics integrated with surgical techniques tailored to individual pathology, pushing toward regenerative rather than purely symptomatic treatment of musculoskeletal conditions. However, more high-quality, randomized controlled trials are needed to standardize protocols and confirm long-term benefits.

Keywords

osteoarthritis

orthobiologics

platelet-rich plasma

mesenchymal stem cells

rotator cuff repair

tendonitis

bone marrow concentrate

FDA regulation

cartilage repair

connective tissue progenitor cells