The use of stem cell therapies to support tissue healing has far outpaced the supporting scientific and clinical data, according to two reviews published in the Journal of Shoulder and Elbow Surgery.
The authors say that, while there is significant interest in biologic treatment options to improve healing and reduce symptoms more rapidly in osteoarthritis (OA), tendinopathy, ligament injuries and other inflammatory conditions, many of these treatments are still unproven.
As a result, there is uncertainty among medical practitioners and patients about what works and what does not.
The reviews cover several biologic agents, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) and mesenchymal stromal cells (MSCs) derived from adipose tissues.
They conclude that such treatments have great potential based on laboratory studies demonstrating a positive effect of these materials on the basic biology of tissue healing, but the clinical data for their use in treating shoulder and elbow injuries remains limited.
In a review of biologics for managing shoulder pathology, Dr James B. Carr II and Dr Scott A. Rodeo evaluate the basic science and clinical evidence for the most commonly used biologic agents for treating conditions including rotator cuff tears, shoulder OA and tendinopathy.
"There is a critical need for strategies to improve rotator cuff tendon healing following surgical repair and for methods to reverse the progressive muscle atrophy that occurs in patients with rotator cuff tears," Dr Carr and Dr Rodeo write. "The shoulder is therefore an area in which biologic agents are especially appealing."
The authors say that further laboratory and clinical research is needed to define optimal formulations, dosing schedules and approaches for various tissues and injuries.
Meanwhile, a review by Dr Jason L. Dragoo and Dr Molly C. Meadows looks at studies on the use of biologics to treat elbow pathology.
They note that despite fairly widespread use of biologic agents such as PRP for tennis elbow (lateral epicondylitis), there is a need for further research to determine the optimal formulation and administration of PRP injections. More research is also needed on the use of biologic therapy for golfer's elbow (medial epicondylitis), ulnar collateral ligament (UCL) injuries and biceps tendinitis.