INJECTABLE BIOLOGICS
In the absence of reliable evidence, it is the opinion of the work group that injectable biologics, such as stem cells or platelet-rich plasma, cannot be recommended in the treatment of glenohumeral osteoarthritis

Rationale

There is lack of evidence of the utilization of biologics in the treatment of osteoarthritis of the glenohumeral joint. Biologics refers specifically to platelet rich plasma and cells derived from bone marrow aspirate or adipose cells. There was consensus from the panel that better standardization and high-quality evidence from clinical trials is needed to provide definitive evidence on the efficacy of biologics in glenohumeral OA. Carr and Rodeo provide some clarity in the misuse of terms such as stem cells and related to biologics and provide basic science on its potential benefit for different shoulder pathologies. It further stresses the importance of high-quality studies needed in this area of orthopedics. Additionally, Murray et al provide specifications for minimum requirements for reporting clinical studies involving PRP and MSCs. This may help to provide comparisons between the different cell therapies and its effect on shoulder pathologies such as glenohumeral arthritis.  

 

Strength of Evidence (evidence quality): No reliable evidence

 

Benefits & Harms:

Currently there is no evidence supporting the benefit of these interventions and the potential harm is that seen with all unregulated injectables.

 

Cost Effectiveness/Resource Utilization

The marketing of injecting biologics has and continues to outpace the science. There is a significant cost to patients without any current scientific evidence proving efficacy in glenohumeral arthritis. 

 

Future Research:

High-quality studies are needed in the use of biologics for the treatment of glenohumeral osteoarthritis.

 

Additional References:

Carr, J.B., Rodeo, S.A., The role of biologic agents in the management of common shoulder pathologies: current state and future directions. J Shoulder and Elbow Surg. 2019;28: 2041-2052.

Chu, C.R., Rodeo, S., Bhutani, N., et. al. Optimizing clinical use of biologics in orthopaedic surgery: consensus recommendations from the 2018 AAOS/NIH U-13 conference. J Am Acad Ortho Surg. 2019;27(2):e50-e63.

Murray IR, Geeslin AG, Goudie EB, Petrigliano FA, LaPrade RF. Minimum Information for Studies Reporting Biologics in Orthopaedics (MIBO): Platelet Rich Plasma and Mesenchymal Stem Cells. J Bone Joint Surg Am 2017;99(10):809-19


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