Choosing Wisely:

Avoid use of orthopedic therapeutic biologics including platelet-rich plasma and stem cell treatment for foot and ankle problems without first considering established, conventional treatment options.

Rationale and Comments: Orthopedic therapeutic biologics (orthobiologics) comprise a variety of tissue grafts and autologous blood products that include platelet rich plasma and mesenchymal stem cell treatment. Surgeons bear responsibility to offer their patients efficacious, safe, and cost-effective treatments. Orthobiologic treatment can be costly and may not be covered by insurance. Patients can become financially vulnerable, especially when pursuing orthobiologic treatment that extends beyond its intended use, scientific support, or regulatory approval. Surgeons should be well versed in the scientific basis, techniques, potential risks, and regulatory status of orthobiologic treatments. Furthermore, surgeons should review the risks, benefits, and anticipated efficacy of orthobiologic therapy with patients in advance. Orthobiologic treatment options represent a rapidly expanding area of interest for both patients and providers, but remain relatively new and understudied. There is ongoing need for investigative research.
Sponsoring Organizations:
  • American Orthopaedic Foot & Ankle Society
  • Sources:
  • American Academy of Orthopaedic Surgeons guidelines
  • Disciplines:
  • Orthopedic
  • References: • American Academy of Orthopaedic Surgeons. Position statement: innovation and novel technologies in orthopaedic surgery. Position statement 1185. 2020. https://www.aaos.org/globalassets/about/position-statements/1185---innovation-and-novel-technologies-in-orthopaedic-surgery-updated2020.pdf
    • American Academy of Orthopaedic Surgeons. Position statement: use of emerging biologic therapies. Position statement 1187. 2020. https://www.aaos.org/globalassets/about/position-statements/1187-use-of-emerging-biologic-therapies-updated2020.pdf

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