Hype, Promise, and Reality: Orthopaedic Use of Biologics in 2025 (2025 Annual Meeting)-Hype, Promise, and Reality: Orthopaedic Use of Biologics in 2025

Video Transcription

Video Summary

The video is a detailed professional discussion on the current state and future of biologics in orthopedic medicine, focusing primarily on cell therapy, platelet-rich plasma (PRP), and cartilage restoration techniques.<br /><br />Dr. Scott Rodeo begins by discussing cell therapy's application in rotator cuff repair, emphasizing the complexity of biologic targets like inflammation modulation, matrix synthesis, and angiogenesis. He stresses the importance of evidence-based approaches amidst aggressive marketing of unproven stem cell therapies. Rodeo clarifies that many "stem cell" treatments are actually various minimally manipulated cell populations with paracrine effects rather than true stem cells that engraft. Clinical trials show promising but mixed results in structural healing with these therapies, though often without clear clinical outcome improvements. Future directions include stimulating intrinsic stem cells, exosome therapies, and better cell characterization.<br /><br />Dr. Ken Zasloff then elaborates on PRP's mechanism and clinical evidence in treating knee osteoarthritis (NeoA). PRP contains over 1,500 proteins with both anabolic and anti-inflammatory properties. Numerous randomized controlled trials and systematic reviews demonstrate PRP's superiority in symptom relief compared to placebo, hyaluronic acid, or corticosteroids. However, heterogeneity in PRP preparations affects results, highlighting the need for standardization and dose quantification. Emerging data challenge assumptions about leukocyte content's role. Work is ongoing to identify biomarkers predicting response and optimize PRP formulations, including combinations with platelet-poor plasma and hyaluronic acid.<br /><br />Dr. Jason Jordan covers advancements in cartilage restoration, explaining that no perfect resurfacing exists and environmental optimization is essential alongside biologics. He reviews techniques like MACI (matrix-induced autologous chondrocyte implantation) and newer single-stage juvenile chondrocyte therapies, noting good medium-term outcomes. He discusses global culture-expanded cell trials improving cartilage thickness and highlights adipose-derived cells' growing popularity due to higher cell yields. Emerging FDA-regulated allogeneic cell therapies and scaffold products like Agile C are also discussed, emphasizing careful patient selection and balancing innovation with safety.<br /><br />Finally, regulatory and legal issues regarding biologics are reviewed, including FDA classifications, minimal manipulation criteria, homologous use, and enforcement risks related to unapproved stem cell claims. The American Orthopaedic Society provides resources like a biologics dashboard to clarify legality. Challenges include inconsistent insurance reimbursement, concerns over false advertising, and the need for rigorous clinical trials. The discussion underscores the importance of evidence-based, personalized biologic treatments in orthopedics' evolving landscape.

Asset Caption

Stephen C. Weber, M.D. | Kenneth R. Zaslav, M.D. | Scott A. Rodeo, M.D. | Jason L. Dragoo, M.D., FAANA

Keywords

biologics

orthopedic medicine

cell therapy

platelet-rich plasma

PRP

cartilage restoration

rotator cuff repair

stem cell therapies

clinical trials

knee osteoarthritis

MACI

adipose-derived cells

FDA regulations