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Biological Therapies in Orthopedic Sports Medicine

Maffulli, Nicola, MD, MS, PhD, FRCP, FRCS (Orth)*,†; Alan Barber, F., MD, FACS

Sports Medicine and Arthroscopy Review: June 2018 - Volume 26 - Issue 2 - p 41
doi: 10.1097/JSA.0000000000000186

*Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy

Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK

Plano Orthopedic Sports Medicine Center, Plano, TX

Disclosure: The authors declare no conflict of interest.

Reprints: F. Alan Barber, MD, FACS, Plano Orthopedic and Sports Medicine Center, 5228 West Plano Parkway, Plano, TX 75093.

The burden of soft tissue injuries affects athletes, manual workers, aging individuals, and many others with different anatomic vulnerabilities. The economic costs are variable and often very high. Biological and mechanical homeostatic mechanisms are commonly impaired in orthopedic sports medicine: musculoskeletal tissues are subjected to high stresses and injuries occur. Major athletic injuries often lead to chronic problems, such as osteoarthritis, for which effective treatments still elude us. Various acute and chronic injuries increase the need to identify novel biological therapies to improve the quality of life and the long-term musculoskeletal health in athletes and active individuals.

Regenerative medicine aims to exploit the potential of biological healing by promoting mechanisms to reestablish the functionality of tissue. Controlling and enhancing the regeneration of musculoskeletal tissue is not just a matter of throwing a few cells at the lesion. Molecules, cells, and mechanical forces are hardwired and cooperate in healing mechanisms. Just consider platelet-rich plasma (PRP): an autologous regenerative technology. It is based on the delivery of a pool of growth factors and cytokines with tissue healing potential, and has been widely used in orthopedic sports medicine to enhance tissue healing. Both PRPs and adult mesenchymal stem cells are physiological means to combat injury. In this context, regenerative medicine seeks to enhance these endogenous resources to help tissue homeostasis prevail over hostile microenvironments.

Stem cell therapies are available in centers around the world. They have applications not just for athletes, but also for cerebral palsy, Alzheimer disease, and multiple sclerosis among others. Stem cell therapies are still in their initial stages of implementation, and much research is necessary before they can meet the hopes placed on them.

This issue of Sports Medicine and Arthroscopy Review provides an update for health care professionals interested in regenerative therapies. Leaders in this field from both hemispheres were recruited to address what is known about the composition and use of cell-based products, other differentiated cell therapies, their combination with PRP, and the assumptions upon which to base their mechanisms of action. A robust scientific understanding of how these powerful novel therapies work is needed. We acknowledge that clinical evidence supporting specific indications takes time and resources to develop and as yet are not available.

We are at the cutting edge of orthopedic sports medicine. In an era where many therapies are in the hands of unscrupulous practitioners preying on patients’ desperate need to get better, it is our duty to advance scientifically sound and clinically relevant research. This issue of SMAR goes a long way toward this aim.

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