Nonoperative and Operative Soft Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Elbow and Upper Extremity: An Orthoregeneration Network (ON) Foundation Review Authors

Tiago Lazzaretti Fernandes; Francesca Taraballi; Zhenxing Shao; Philip P Roessler; Sebastián Cardona-Ramírez

doi:10.1016/j.arthro.2024.04.022

Nonoperative and Operative Soft Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Elbow and Upper Extremity: An Orthoregeneration Network (ON) Foundation Review Authors

Arthroscopy. 2024 May 7:S0749-8063(24)00326-8. doi: 10.1016/j.arthro.2024.04.022. Online ahead of print.

Authors

Tiago Lazzaretti Fernandes¹, Francesca Taraballi², Zhenxing Shao³, Philip P Roessler⁴, Sebastián Cardona-Ramírez⁵

Affiliations

¹ Sports Medicine Division, Institute of Orthopaedics and Traumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil. Electronic address: tiago.lazzaretti@usp.br.
² Center for Musculoskeletal Regeneration, Orthopedics and Sports Medicine, Houston; Methodist Hospital, Houston Methodist Academic Institute, Houston, Texas, USA.
³ Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
⁴ Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany; Gelenkzentrum Mittelrhein, Koblenz, Germany.
⁵ Grupo de Investigación OHVRI, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia.

PMID: 38723874
DOI: 10.1016/j.arthro.2024.04.022

Abstract

Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the elbow and upper extremity including the tendons (lateral epicondylitis, medial epicondylitis, biceps tendonitis, triceps tendonitis), articular cartilage (osteoarthritis, osteochondral lesions), and bone (fractures, non-unions, avascular necrosis, osteonecrosis). Promising and established treatment modalities include hyaluronic acid (HA); botulinum toxin; corticosteroids; leukocyte-rich and leukocyte-poor platelet-rich plasma (PRP); autologous blood; bone marrow aspirate (BMA) comprising mesenchymal stromal cells (alternatively termed medicinal signaling cells and frequently mesenchymal stem cells) and BMA concentrate (BMAC); MSC harvested from adipose and skin (dermis) sources; vascularized bone grafts; bone morphogenic protein (BMP) scaffold made from osteoinductive and -conductive -tricalcium phosphate (-TCP) and poly-ε- caprolactone (PCL) with hydrogels, human MSC, and matrix metalloproteinases (MMPs); and collagen sponge. Autologous blood preparations such as autologous blood injections and platelet-rich plasma show positive outcomes for non-responsive tendinopathy. In addition, cellular therapies such as tissue-derived tenocyte-like cells and MSC show a promising ability to regulate degenerative processes by modulating tissue response to inflammation and preventing continuous degradation and support tissue restoration.

Keywords: Extensor tendons; epicondilopathy; golf elbow; joint disease; orthopaedic biologics; orthoregeneration; regenerative therapy; tennis elbow.