Orthobiologics by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030847449
Publisher: Springer International Publishing

15.7 Conclusion

LE is a common and disabling condition that leads to pain, time away from work and sport, and difficulty with activities of daily living. The goals of treatments (both orthobiologic and non-orthobiologic) are to completely relieve pain and rapidly restore long-term function.

After reviewing the wide range of available treatments and their results, there is emerging evidence for the effectiveness of orthobiologic therapies for LE. PRP is the most commonly used and best documented of these therapies. PRP appears to be superior to traditional steroid injection therapies. However, the optimal timing, dose, and composition of PRP injections remain to be established.

Other therapies are promising, but remain much less well developed, and their efficacy is not yet firmly established. These include injection of culture-expanded autologous fibroblasts (from skin, tendon, bone marrow, or adipose origin) processed autologous serum or injection of gold-induced cytokines. Preliminary evaluation of these alternative therapies shows that they are safe and exhibit minimal side effects. These orthobiologic alternatives must be considered investigational, as the body of available studies is insufficient to provide definitive evidence of clinical efficacy and incremental value beyond the current efficacy of PRP.

A fundamental limitation in the current literature is the lack of reporting of the composition of the orthobiologic administered, as well as frequent absence of details related to the processing of the material, technique of administration, and post-injection rehabilitation protocol. We encourage authors to report the “Minimum Information for Studies Evaluating Biologics in Orthopaedics” (MIBO) criteria for all clinical studies reporting on orthobiologics [66]. Another distinct limitation in the current literature is the paucity of follow-up imaging studies to evaluate changes in the structure and composition of the treated tendon. Future goals should focus on the completion of additional long-term controlled studies that further highlight safety and adverse events, cost-effectiveness, long-term efficacy, indications, patient selection, preparation and procedure standardization, characterization, and quality management, as this will likely help to eliminate the great variability seen in the current results.

Take-Home Messages

The mainstay of treatment of LE is conservative and can include NSAIDs, paracetamol (acetaminophen), physiotherapy, and extracorporeal shockwave therapy as initial treatment and should be carried out for at least 6 weeks before considering alternative approaches.

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