Orthopaedic Use of Biologics in 2025 (AANA25)-Hype, Promise, and Reality: Orthopaedic Use of Biologics in 2025

Video Transcription

Video Summary

The panel discussion on biologics and orthopedics in 2025 covers cell therapies, PRP, cartilage restoration, and regulatory issues. Dr. Scott Rodeo emphasizes the complex biology of tendon and rotator cuff healing, noting that current cell therapies likely work via paracrine signaling rather than actual cell engraftment. Various cell sources—bone marrow, adipose tissue, microfragmented fat, and perinatal products—are discussed, with regulatory restrictions limiting many from clinical use. Clinical trials show cell therapy can improve structural healing of rotator cuff repairs but often without correlating improvements in patient-reported outcomes. Future directions include stimulating intrinsic stem cell niches, using exosomes, and better cell characterization.<br /><br />Dr. Ken Zasloff highlights PRP’s multifaceted composition, including over 1,500 proteins, and its demonstrated anti-inflammatory and anabolic effects in osteoarthritis (OA). Meta-analyses and level one trials consistently show PRP outperforms placebo, hyaluronic acid, and corticosteroids in symptom relief up to a year. Key factors influencing efficacy include platelet dose (with higher doses correlating with better outcomes), leukocyte content (debated), and patient factors. Clinical practice is moving toward personalized biologic therapies, aided by biorepositories tracking PRP components and responses.<br /><br />Jason’s segment on cartilage restoration stresses the importance of understanding underlying joint environment and mechanical factors before resurfacing. Advanced techniques like single-stage juvenile chondrocyte implantation show promising medium-term outcomes. Worldwide, culture-expanded cell therapies indicate improvements in cartilage thickness and pain, with adipose-derived cells gaining popularity for their abundance. Regulatory pathways such as “right-to-try” trials enable limited FDA-compliant use of these therapies in the U.S.<br /><br />Finally, regulatory expert outlines the complex U.S. FDA framework governing biologics, emphasizing strict rules against unapproved manipulation or misleading marketing of stem cell products. Compliance risks include legal penalties, with enforcement often driven by competitors. Resources like the AOS biologics dashboard help clinicians navigate legality. Overall, while promising, biologic therapies require more rigorous evidence, standardized characterization, and adherence to evolving regulations to realize their full potential in orthopedic care by 2025.

Asset Caption

Stephen C. Weber, M.D. | Kenneth R. Zaslav, M.D. | Scott A. Rodeo, M.D. | Jason L. Dragoo, M.D., FAANA

Keywords

orthopedic biology

biologics

rotator cuff repair

cell therapy

matrix synthesis

inflammatory mediators

bone marrow

adipose tissue

Platelet-Rich Plasma

osteoarthritis

cartilage restoration

umbilical cord cells

personalized medicine

orthopedics

cell therapies

platelet-rich plasma (PRP)

rotator cuff healing

regulatory issues

stem cell niches

osteoarthritis (OA)

juvenile chondrocyte implantation

FDA regulations