Utilization of Orthobiologics by Sports Medicine Physicians: A Survey-based Study

Abstract

Introduction: Investigations are rapidly increasing into products referred to as orthobiologics and their utility in the nonsurgical and surgical treatment of diverse orthopaedic pathology.

Methods: Members (599) of the American Orthopaedic Society for Sports Medicine were sent a survey that assessed their usage, motivation for use, and perceived efficacy of the following orthobiologics: leukocyte-rich platelet-rich plasma, leukocyte-poor platelet-rich plasma (PRP-LP), bone marrow aspirate concentrate, amniotic membrane products, adipose-derived mesenchymal stromal cells, and umbilical cord-derived cells. Application of these orthobiologics for the following pathologies was assessed: osteoarthritis, muscle injuries, tendon injuries, ligament injuries, labral injuries, and focal articular cartilage tears.

Results: The survey was completed by 165 respondents (27.5%), of which 66.1% reported using at least one orthobiologic in their practice. Orthobiologic users reported the following: 71.6% are increasing their use, and 23.9% advertise their use. PRP-LP is the most commonly used orthobiologic for 76.1%, with 30% of PRP-LP users reporting use due to competitor utilization. The pathology most commonly treated with orthobiologics is osteoarthritis, for 71.6% of users, who primarily use PRP-LP in the knee joint. Leukocyte-rich platelet-rich plasma is the most popular orthobiologic in muscle, ligament, tendon, and labral injuries, whereas bone marrow aspirate concentrate is most popular for focal articular cartilage injuries. Primary orthobiologic-eligible groups were adults and recreational noncompetitive athletes. More than half (>50%) of orthobiologic users perceived all but umbilical cord-derived cells to be efficacious.

Conclusion: Orthobiologics are used by a significant number of sports medicine physicians and are likely increasing in popularity. Among orthobiologics, platelet-rich plasmas are the most popular, and osteoarthritis is the pathology most likely to be treated. Orthobiologics are sometimes used for reasons other than clinical efficacy, especially competitor utilization, and physicians are disparate in their application of these products.

Figure 1

Clustered bar chart showing the percentage of users of each particular orthobiologic who believed that the product was efficacious when treating patients and percentage who attested to using a product because their competitors were using the product. Ad-MSC = adipose-derived mesenchymal stromal cells, AMP = amniotic membrane products, BMAC = bone marrow aspirate concentrate, PRP-LP = leukocyte-poor platelet-rich plasma, PRP-LR = leukocyte-rich platelet-rich plasma, UCD = umbilical cord–derived cell

Figure 2

Clustered bar chart showing percentage utilization of each orthobiologic by respondents who used any orthobiologics and how often each orthobiologic was combined with hyaluronic acid by those who used each specific orthobiologic. Ad-MSC = adipose-derived mesenchymal stromal cells, AMP = amniotic membrane products, BMAC = bone marrow aspirate concentrate, PRP-LP = leukocyte-poor platelet-rich plasma, PRP-LR = leukocyte-rich platelet-rich plasma, UCD = umbilical cord–derived cell

Figure 3

Clustered bar chart showing the percentage of orthobiologic users who applied at least one orthobiologic to the listed pathologies in any setting, the surgical setting, or the nonsurgical setting.