Biologic and Cellular Therapies in the Clinical Setting: Standardization and Collaboration

The use of orthobiologics in treating musculoskeletal (MSK) pathologies ranging from stressed tendons and ligaments to joint osteoarthritis to lower back pain has increased dramatically over the past two decades. The orthobiologics that will be reviewed herein are hyaluronic acid (HA), platelet-rich plasma (PRP), bone marrow concentrate (BMC) and adipose tissue-derived stromal vascular fraction (SVF). The history and a description of each of these preparations will be discussed briefly. A brief survey of potential mechanisms of therapeutic benefit will be provided, along with highlights of relevant clinical studies that will illustrate the use of each orthobiologic. The expanding use of PRP, BMC and SVF has been driven by the availability of commercial technologies that permit the generation of these autologous therapies with minimal delay in providing point-of-care treatment. Challenges remain, including a better understanding of what a dose is, minimal doses of critical components (e.g., Platelet number), the frequency of retreatment, and how to optimally deliver the autologous therapy in treating a broad spectrum of MSK pathologies. Collaborative efforts, the use of registries and publication of high quality, adequately powered clinical studies will contribute to better defining best practices when using HA, PRP, BMC and SVF therapies for MSK pathologies.