Biologic Orthopedics Journal <p style="margin: 0px; line-height: 115%;"><span style="margin: 0px; line-height: 115%; font-family: 'Garamond',serif; font-size: 14pt;">The Biologic Orthopedics Journal is being launched as a new online resource of evidence-based research and analysis, along with thoughtful discussion and commentary related to approaches to orthopedic biologics, their use and their promotion. The Journal will provide free and open access to scholarly work, education and discussion to meet the needs of practitioners, health workers, researchers, scientists and policy makers. The journal will be managed by the Biologic Orthopedics Journal Association, which will be responsible for administering the process of article submissions, review, and publication along with the supporting complements, a website and digital platform to empower readers of the journal and connect them to critical resources.</span></p> <p style="margin: 0px; line-height: 115%;"><span style="margin: 0px; line-height: 115%; font-family: 'Garamond',serif; font-size: 14pt;">&nbsp;</span></p> <p style="margin: 0px; line-height: 115%;"><span style="margin: 0px; line-height: 115%; font-family: 'Garamond',serif; font-size: 14pt;">The Journal articulates and disseminates new science and clinical research for advancing the scholarship and practice of regenerative medicine in the field of orthopedics and to provide evidence-based best practices.<span style="margin: 0px;">&nbsp; </span>The journal also increases world-wide exposure to the innovations, experiences and perspectives of practitioners working in the field. Article submissions are encouraged from throughout the world, and be subject to peer review. As such, this journal serves as a reputable and authoritative resource to help influence clinical practice, research funding, policy, and operational decisions regarding biologics in orthopedics.&nbsp;</span></p> en-US (Scott Bryant) (Scott Bryant) Wed, 15 Apr 2020 13:00:29 +0000 OJS 60 The Average Level Of Evidence Of Papers Published In Six Orthopedic Journals <p><em><span style="font-weight: 400;">Background</span></em></p> <p><span style="font-weight: 400;">An assessment of the average level of evidence (LOE) of clinical research papers in peer reviewed orthopedic surgery journals has not previously been published. In this paper we report on the average LOE of papers published in six of the top English language orthopedic surgery journals.</span></p> <p>&nbsp;</p> <p><em><span style="font-weight: 400;">Methods</span></em></p> <p><span style="font-weight: 400;">Six well established orthopedic journals were identified by using the Google Scholar H5 Journal Index.&nbsp; We selected 6 of the top ten journals identified by the Index. The six journals that were evaluated for this project were as follows:&nbsp; The American Journal Of Sports Medicine (AJSM); Clinical Orthopedics and Related Research (CORR); Journal of Bone and Joint Surgery (JBJS); Knee Surgery, Sports, Traumatology, Arthroscopy (KSSTA); Journal of Arthroscopy (Arthros.); and the Journal of Shoulder and Elbow Surgery (JSES). Thirteen consecutive monthly issues (July, 2018 - July, 2019) of each journal were evaluated for the LOE of each clinical paper. The assigned LOE was used if published, or the level of evidence was assigned by the senior author (DAB) if one was not listed. For each journal, the overall mean LOE along with the variance and standard deviation was calculated with all confidence intervals set at&nbsp; 95%. Summary data was statistically analyzed to provide an overall mean LOE for the 6 journals evaluated.</span></p> <p>&nbsp;</p> <p><em><span style="font-weight: 400;">Results</span></em><span style="font-weight: 400;">&nbsp;</span></p> <p><span style="font-weight: 400;">For AJSM, we evaluated 246 clinical research articles that had an average LOE of 2.96 +/- 0.16. For CORR, we evaluated 155 papers that had an average LOE of 2.83 +/- 0.19.&nbsp; For JBJS, we evaluated 164 papers that had an average LOE of 3.04 +/- 0.13. For KSSTA, we evaluated 402 papers that had an average LOE of 3.05 +/- 0.16. For Arthros. we evaluated 226 papers that had an average LOE of 3.19 +/- 0.10. For JSES, we evaluated 237 papers that had an average LOE of 3.25 +/- 0.13.</span></p> <p><span style="font-weight: 400;">In summary, for the 1425 clinical research papers published in 98 issues of 6 of the top orthopedic journals, we found the average Level Of Evidence to be 3.05 +/- 0.16.&nbsp;</span></p> <p><span style="font-weight: 400;">&nbsp;</span></p> <p><em><span style="font-weight: 400;">Conclusions</span></em></p> <p><span style="font-weight: 400;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;The goal of scientific study design is to prove or disprove a hypothesis while minimizing bias and errors.&nbsp; The gold standard for therapeutic studies has been a double blind, randomized controlled trial (RCT). However, it is not possible or feasible for every clinical study to have a blinded RCT design.&nbsp; Additionally, clinically relevant and actionable data can come from studies that are not RCTs. In a medical discipline like orthopedics many interventions are invasive, making controlled trials or blinded trials unethical or technically not practical. Our analysis of over 1400 peer reviewed publications in one year in 6 of the top English language orthopedic journals reveals that the average level of evidence deemed worthy of publication is level 3. In terms of the most common study design, the average published clinical study in these orthopedic journals was a case-control study.&nbsp;</span></p> Don Buford, MD; Sharmila Tulpule, Jasmine Hyder, Henry Boot Copyright (c) 2020 Biologic Orthopedics Journal Wed, 09 Dec 2020 00:00:00 +0000 Regeneration of Full-Thickness Supraspinatus Rotator Cuff Tendon Tear after Treatment with Autologous Mesenchymal Stem Cells <p>Rotator cuff tear (RCT) is primarily a disease of middle-aged and older patients. Observational data estimated linear increment in the frequency of RCT over time due to the degenerative process. However, a good proportion of tears in older patients are asymptomatic and do not require any intervention. Sport and non-sport Injuries can contribute to RCTs. Many RCTs can be treated non-surgically with anti-inflammatory medication, steroid injections, and physical therapy for symptomatic relief and to restore shoulder strength and function. Rotator cuff tendon tears have limited ability to heal on their own and most often surgical repair is recommended in people failing non-operative therapy. The recovery time after surgery can be a lengthy process. There are no conclusive data to support the routine use of biologic therapy like mesenchymal stem cells (MSCs) or platelet-rich plasma (PRP) in the treatment of symptomatic RCTs. Herein we report a full-thickness supraspinatus tear (SST) in an elderly patient’s shoulder following three injuries. The tear was confirmed by ultrasound scan (USS) and magnetic resonance imaging (MRI) with SST of 9 mm in length and 13 mm in width which was unresponsive to anti-inflammatory medicines, rehabilitation and steroid injections. The subject, however, did have a definitive clinical and radiological response to a single therapeutic injection using autologous adipose tissue-derived MSCs combined with PRP, the injections were performed by ultrasound guidance into the subacromial bursa, supraspinatus tendon and tendon insertion respectively. After five months an USS showed some healing of the SST. Eight months post-MSC therapy the subject had significant improvement in symptoms, and dramatic improvement of the Disability of the Arm, Shoulder and Hand (DASH) score from baseline of 88.3 prior to the therapy to 16.3 at the final visit. Follow-up MRI scan revealed complete healing of the SST indicating the possible successful outcome of MSC therapy as an alternative non-surgical treatment.</p> Hassan Mubark Copyright (c) 2020 Biologic Orthopedics Journal Wed, 02 Sep 2020 00:00:00 +0000 Hope, Hype, Hurdles & Future Perspective for PRP, PRP versus Hyaluronic Acid Injection in Osteoarthritis of Knee: A Review Article. <p class="Default"><strong>Background</strong><br>Comparative studies of platelet-rich plasma (PRP) and hyaluronic acid show variable results.</p> <p class="Default"><strong>Purpose</strong><br>A review was conducted to understand the current role of PRP and its efficacy versus hyaluronic acid in osteoarthritis (OA) of the knee joint.</p> <p class="Default"><strong>Methods</strong><br>Out of 170 identified studies, 14 studies involving 1575 patients with 637 males and 938 females were selected based on PRISMA flow chart guidelines and were analyzed for the study.</p> <p class="Default"><strong>Results</strong><br>A standard PRP regimen consisting of 2–3 intra-articular injections (IA) of 4–6 mL of leucocyte poor PRP at 1–2 weekly intervals provides a better result than HA during the first 3–6 months, and which may continue up to one year. PRP and HA may have synergistic effect; pain and swelling are the two most com-mon complications with PRP, the incidence is more with leucocyte rich PRP (LP-PRP) and intra-osseous PRP treatment.<br>Conclusion<br>PRP provides hope and is more effective than hyaluronic acid in pain relief and improving the quality of life in mild to moderate osteoarthritis of the knee joint. However, hype, that is effective in all, irrespective of grades of OA, mal-aligned or stiff knee, ligamentous laxity, and can avoid joint replacement is a big hindrance in establishing it as a preferred treatment in OA knee. The author follows the above-mentioned PRP regimen; and recommends to combine leucocyte poor PRP with HA for IA injections &amp; with LP-PRP injections along with the two most common painful points (medial collateral ligament, pesanisernius) in a highly painful OA knee. PRP may not address extra-articular causes of knee pain (mal-alignment, muscle wasting, tendinosis), should be corrected for optimum outcome. Contact sports, running, exercises putting pressure on knee and NSAID should be avoided during PRP treatment. Also, more randomized controlled trials are required to further standardize the PRP preparation, administration, injection interval &amp; proper documentation of efficacy and complications in the regenerative registry.</p> Ashok Kumar, Anikait Ghosh Kadamb, Krish Ghosh Kadamb Copyright (c) 2020 Biologic Orthopedics Journal Wed, 15 Apr 2020 00:00:00 +0000 Chemical Profile and Clinical Efficacy of Micro-Fragmented Adipose Tissue in the Treatment of Knee Osteoarthritis <p style="text-align: justify;">Intra-articular injections of adipose-derived mesenchymal stromal cells (AD-MSCs) have emerged as a regenerative therapy to combat the progression of knee osteoarthritis (OA). These multipotent cells have been shown to alter the inflammatory processes inside the knee joint at the cellular level, thus creating a treatment option that both modifies the underlying causes of OA and benefits those who are not surgical candidates. This review article serves to present the following objectives: (1) to summarize the techniques used to harvest AD-MSCs, via micro-fragmentation and enzymatic processing, (2) to characterize the chemical profile and immunomodulatory role of these cells from the current literature, (3) to comprehensively review the clinical efficacy of these interventions, from animal to human studies that investigate the safety concerns, biomolecular changes, and key functional outcomes, and (4) to present areas of future research needed to optimize these interventional regenerative therapies in the treatment of knee OA.</p> Jack Haberl, Nathan Hogaboom, Gerard Malanga Copyright (c) 2020 Haberl et al Tue, 23 Jun 2020 00:00:00 +0000 Optimizing Platelet-Rich Plasma (PRP) Injections: A Narrative Review <p>Platelet-rich plasma (PRP) is an orthobiologic treatment that has gained popularity as a potential alternative treatment for various musculoskeletal conditions. The physiologic role of platelets in the healing cascade provides clarity regarding its potential as it releases various growth factors such as platelet-derived growth factor (PDGF), transforming growth factor beta-1 (TGF-β1), and vascular endothelial growth factor (VEGF). However, there are various characteristics of PRP treatments including platelet count, presence or absence of leukocytes and red blood cells, as well as the use of an activating agent that introduces heterogeneity among preparations. This aim of this article is to provide clarity, where available, regarding the optimal characteristics for PRP treatments regarding tendon and ligament injuries as well as articular and muscular pathology.</p> Chris Cherian, Gerard Malanga, Ken Mautner Copyright (c) 2020 Biologic Orthopedics Journal Fri, 20 Nov 2020 00:00:00 +0000