Faced with both exciting new research and dangerous hype about such treatments as platelet-rich plasma and stem cells for osteoarthritis of the knee, I've begun to adopt what I call the Orthobiological Surgeon's Prayer: I ask for the ability to help when I can, the judgment to know when I can and cannot help, and the wisdom to know the difference.
Among the many biological substances that might help chondroprotection and chondrofacilitation, platelet-rich plasma and hyaluronic acid injections are supported by early and significant evidence. It's too early yet to make confident use of stem cells or amniotic fluid, and we must warn patients to be particularly careful about claims for these substances.
Such claims are coming fast and furious as unscrupulous businesses keep popping up to exploit patients' desperation and confusion and the gap between hope and knowledge, even as the US Food and Drug Administration (FDA) attempts to clamp down on them. That makes it particularly important for clinicians to understand the fast-moving science behind them.
It's important to remember that the FDA grants exemptions under section 361 of the Public Health Service Act for human cell, tissues, and cellular and tissue-based products only for homologous use and only if they are minimally manipulated.
