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Hurley ET, Sherman SL, Stokes DJ, Rodeo SA, Shapiro SA, Mautner K, Buford DA, Dragoo JL, Mandelbaum BR, Zaslav KR, Cole BJ, Frank RM. Experts Achieve Consensus on a Majority of Statements Regarding Platelet-Rich Plasma Treatments for Treatment of Musculoskeletal Pathology. Arthroscopy 2024; 40:470-477.e1. [PMID: 37625660 DOI: 10.1016/j.arthro.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/23/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To establish consensus statements on platelet-rich plasma (PRP) for the treatment of musculoskeletal pathologies. METHODS A consensus process on the treatment of PRP using a modified Delphi technique was conducted. Thirty-five orthopaedic surgeons and sports medicine physicians participated in these consensus statements on PRP. The participants were composed of representatives of the Biologic Association, representing 9 international orthopaedic and musculoskeletal professional societies invited due to their active interest in the study of orthobiologics. Consensus was defined as achieving 80% to 89% agreement, strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. RESULTS There was consensus on 62% of statements about PRP. CONCLUSIONS (1) PRP should be classified based on platelet count, leukocyte count, red blood count, activation method, and pure-plasma versus fibrin matrix; (2) PRP characteristics for reporting in research studies are platelet count, leukocyte count, neutrophil count, red blood cell count, total volume, the volume of injection, delivery method, and the number of injections; (3) the prognostic factors for those undergoing PRP injections are age, body mass index, severity/grade of pathology, chronicity of pathology, prior injections and response, primary diagnosis (primary vs postsurgery vs post-trauma vs psoriatic), comorbidities, and smoking; (4) regarding age and body mass index, there is no minimum or maximum, but clinical judgment should be used at extremes of either; (5) the ideal dose of PRP is undetermined; and (6) the minimal volume required is unclear and may depend on the pathology. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A.
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
| | - Daniel J Stokes
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane A Shapiro
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Kenneth Mautner
- Department of Physical Medicine & Rehabilitation, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | | | - Jason L Dragoo
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Bert R Mandelbaum
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California, U.S.A.; Clínica Espregueira, FIFA Medical Centre of Excellence, Porto, Portugal
| | - Kenneth R Zaslav
- Lenox Hill Hospital Northwell Health Orthopedic Institute, New York, New York, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Frank RM, Sherman SL, Chahla J, Dragoo JL, Mandelbaum B, Anz AW, Bradley JP, Chu CR, Cole BJ, Farr J, Flanigan DC, Gomoll AH, Halbrecht J, Horsch K, Lattermann C, Leucht P, Maloney WJ, McIntyre LF, Murray I, Muschler GF, Nakamura N, Piuzzi NS, Rodeo SA, Saris DBF, Shaffer WO, Shapiro SA, Spindler KP, Steinwachs M, Tokish JM, Vangsness CT, Watson JT, Yanke AB, Zaslav KR. Biologic Association Annual Summit: 2020 Report. Orthop J Sports Med 2021; 9:23259671211015667. [PMID: 34164559 PMCID: PMC8191082 DOI: 10.1177/23259671211015667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/21/2021] [Indexed: 01/20/2023] Open
Abstract
Interest and research in biologic approaches for tissue healing are exponentially growing for a variety of musculoskeletal conditions. The recent hype concerning musculoskeletal biological therapies (including viscosupplementation, platelet-rich plasma, and cellular therapies, or “stem cells”) is driven by several factors, including demand by patients promising regenerative evidence supported by substantial basic and translational work, as well as commercial endeavors that complicate the scientific and lay understanding of biological therapy outcomes. While significant improvements have been made in the field, further basic and preclinical research and well-designed randomized clinical trials are needed to better elucidate the optimal indications, processing techniques, delivery, and outcome assessment. Furthermore, biologic treatments may have potential devastating complications when proper methods or techniques are ignored. For these reasons, an association comprising several scientific societies, named the Biologic Association (BA), was created to foster coordinated efforts and speak with a unified voice, advocating for the responsible use of biologics in the musculoskeletal environment in clinical practice, spearheading the development of standards for treatment and outcomes assessment, and reporting on the safety and efficacy of biologic interventions. This article will introduce the BA and its purpose, provide a summary of the 2020 first annual Biologic Association Summit, and outline the future strategic plan for the BA.
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Affiliation(s)
- Rachel M Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
| | - Jason L Dragoo
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bert Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | | | - Adam W Anz
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - James P Bradley
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Constance R Chu
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Brian J Cole
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Jack Farr
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - David C Flanigan
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Andreas H Gomoll
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Joanne Halbrecht
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Kay Horsch
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Christian Lattermann
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Philipp Leucht
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - William J Maloney
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Louis F McIntyre
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Iain Murray
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - George F Muschler
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Norimasa Nakamura
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Nicolas S Piuzzi
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Scott A Rodeo
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Daniel B F Saris
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - William O Shaffer
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Shane A Shapiro
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Kurt P Spindler
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Matthias Steinwachs
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - John M Tokish
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - C Thomas Vangsness
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - John Tracy Watson
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Adam B Yanke
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
| | - Kenneth R Zaslav
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Stanford University, Palo Alto, California, USA.,Rush University Medical Center, Chicago, Illinois, USA.,Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California, USA
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