Regenerative Sports Medicine: Past, Present, and Future (Adapted From the PASSOR Legacy Award Presentation; AAPMR; October 2016)

Abstract

Regenerative medicine has shown dramatic expanse and evolution in the past decade. Within that milieu, physiatrists are taking an active role in research, clinical care delivery, and education. The purpose of this review is to provide a balance among evidence, theory, experience, clinical trends, and the foreseeable future. We focus on the literature that reports the research with the best methodology in each practice area, recognizing that the level of evidence varies substantially among different treatment modalities and conditions. The following elements are included: an overview of the evolution of currently available regenerative techniques, evidence base for each available modality (prolotherapy, platelet rich plasma, bone marrow aspirate concentrate and stem cells, adipose-derived stem cells, and amniotic tissue products), general principles in the application of these treatments, and discussion and a vision of what lies ahead. We expect that practitioners will use this review to facilitate clinical decision making and to provide a core knowledge base to assist when counseling patients. LEVEL OF EVIDENCE: IV.

Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: A systematic review

“…Orthobiologics have recently gained traction as a management option for these disorders. Three of the most commonly used orthobiologic agents are prolotherapy, platelet-rich plasma (PRP) and medicinal signaling cells (MSCs), the latter of which are typically obtained from autologous bone marrow aspirate or adipose tissue [16,17].…”

Regenerative Medicine for Axial and Radicular Spine‐Related Pain: A Narrative Review

“…Additional studies on spine‐related pain are now being published at increasing rates as the science behind and evidence for regenerative medicine continues to expand for other musculoskeletal ailments . Of the 35 reviewed articles, 25 have been published in the past 5 years.…”

“…In addition to these more routine treatments, there exists a multitude of other treatment options for spine‐related pain. Orthobiologic therapy is an alternative treatment option in the multimodal management of pain . As new treatment modalities emerge, it is a medical and ethical necessity to continually review and assess the available literature for the effectiveness of available therapies.…”

Extracorporeal Shockwave Therapy Versus Platelet‐rich Plasma for Achilles Tendinopathy

“…Taken at face value, studies investigating the use of PRP to treat mid‐substance Achilles tendinopathy have generally failed to show benefit up to 1 year post‐treatment 10 . Now—before you stop reading and choose to end this debate prematurely—we feel that a critical appraisal of the primary literature reveals that these negative conclusions are substantially flawed.…”