Platelet-rich plasma vs bone marrow aspirate concentrate:An overview of mechanisms of action and orthobiologic synergistic effects

The use of orthobiologics as a novel therapy for the treatment of numerous musculoskeletal disorders has increased considerably over the past decade.Currently,there are multiple alternatives available as suitable treatments;however,the use of autologous blood-derived products such as platelet-rich plasma(PRP),bone marrow aspirate(BMA)and BMA concentrate(BMAC),specifically,is expanding.Although many investigations attempted to demonstrate the effectiveness of these therapies,even with positive results,the literature lacks standardized protocols and overall accuracy in study designs,which leads to variance and difficulty in reproducibility of protocols.The efficacy of PRP for the treatment of cartilage,bone and muscle tissues is well known.Although BMAC has generated optimistic results for the same purposes,its applicability in clinical trials is still relatively recent when compared to PRP.Both products demonstrate the potential to set forth reparative processes,each in their own distinct mechanism.The combination of these biological products has been previously proposed,yet little is known about their synergism.Evidence indicates that growth factor,cytokine,and chemokine profiles seen in both PRP and BMAC vary but are likely to work synergistically to enhance musculoskeletal healing.BMAC products seem to work well without PRP;however,the addition of PRP to BMAC has been shown to act as a rich and natural source of culture medium for stem cells located either peripherally or in the bone marrow itself.Nevertheless,additional variables associated with the use of BMAC and PRP in orthopedics must be further evaluated in order to consolidate the efficacy of this therapeutic strategy.

Biofat grafts as an orthobiologic tool in osteoarthritis:An update and classification proposal

Among degenerative musculoskeletal disorders,osteoarthritis remains one of the main causes of pain and disability in the adult population.Current available alternatives to alleviate symptoms include conservative treatments such as physical therapy,anti-inflammatory drugs and an educational approach to lifestyle modification.The use of certain analgesics,such as opiates and corticosteroids offer short-term results but does not address the etiological source of pain and disability.In addition,prolonged use of such medications can cause additional complications.Therefore,the demand for regeneration of joint cartilage has led to an alternative approach called"orthobiologics".This alternative is based on cellular and molecular components capable of inducing and promoting tissue repair.Products derived from adipose tissue have been studied as an excellent source of orthobiologics in an attempt to promote joint cartilage repair.However,the lack of standardization regarding collection and processing protocols presents a challenge for the generalization of study results and determination of effectiveness.To the best of our knowledge,orthobiologics derived from fat have not yet been classified.Therefore,this manuscript proposes the HGS classification system which aims to describe certain parameters that are relevant to the quality of organic products regarding harvesting techniques(H),graft type(G),and number of centrifugations(S).The more parameters used would imply greater characterization and complexity of the evaluation of the biological product used.The HGS classification may provide a valuable contribution to the understanding of clinical procedures and research results,aiming to ultimately usher in a standardization of optimal practice.

Bone marrow-derived products: A classification proposal – bone marrow aspirate, bone marrow aspirate concentrate or hybrid?

Degenerative musculoskeletal disorders are one of the top causes of pain and disability in the adult population.Current available alternatives to mitigate symptoms include conservative treatments such as the administration of pharmacological agents and an educative approach towards lifestyle modification.The use of certain analgesics,such as opiates and corticosteroids,delivers short term results but do not address the etiological source of pain and disability.Also,prolonged use of such medications may cause additional complications.Therefore,the demand for musculoskeletal tissue regeneration has led to an alternative approach referred to as“orthobiologics”.This alternative is based on cellular and molecular components capable of inducing and promoting tissue repair.Bone marrow(BM)aspirate(BMA)and concentrate are well-known orthobiologics used to treat musculoskeletal conditions.Orthobiologics derived from the BM have been discussed in the literature;however,the lack of standardization regarding collection and processing protocols presents a challenge for generalization of study outcomes and determination of efficacy.Since BM-derived orthobiologics have not yet been classified,to our knowledge,this manuscript proposes the ACH classification system,which speaks to BMA(A),BMA and concentrate(C)and hybrid(H),which combines A and C.This classification proposes and describes 8 parameters that are relevant for the quality of biological products.The more parameters used would imply greater characterization and complexity of the evaluation of the biological product used.The ACH classification envisages a necessary contribution to the comprehension of both clinical procedures and research outcomes,ultimately ushering in a standardization of best practice.