Qing Zhao Ruan

As the population ages, the incidence and prevalence of musculoskeletal degeneration, such as osteoarthritis, increase. While the currently accepted treatment options provide symptomatic and functional improvement, they do not halt the progression of osteoarthritis. This results in the eventual need for surgery for many patients with advanced osteoarthritis. Due to the seemingly inevitable progression of OA, many clinicians and researchers have shifted their focus to regenerative therapies. Orthobiologics, a specific type of regenerative therapy designed to treat orthopedic conditions, has been gaining traction in recent years due to the utilization of autologous biological substances and synthetic peptides in healing musculoskeletal injuries and degenerative conditions. Orthobiologics can be distinguished into one of four classes: cell-based, biologic fluids-based, matrix-based, molecular-based, and based on their composition. In this review, key examples of each class, mechanism of action, and current clinical data for each agent are examined. Limitations of current orthobiologics involve a lack of standardization in the preparation and administration of each agent, as well as uniformity in assessment endpoints across different clinical studies. Lastly, we will discuss future directions of orthobiologics as a therapy for the treatment of osteoarthritis.

As the population ages, the incidence and prevalence of musculoskeletal degeneration, such as osteoarthritis increases. While the currently accepted treatment options provide symptomatic and functional improvement, they do not halt the progression of osteoarthritis. This results in eventual need for surgery for many patients with advanced osteoarthritis. Due to seemingly inevitable progression of OA, many clinicians and researchers have shifted their focus to regenerative therapies. Orthobiologics, a specific type of regenerative therapy designed to treat orthopedic conditions, have been gaining traction in recent years due to utilization of autologous biological substances and synthetic peptides in healing in musculoskeletal injuries and degenerative conditions. Orthobiologics can be distinguished into one of four classes: cell-based, biologic fluids-based, matrix-based and molecular-based, and based on its composition. In this review, key examples of each class, mechanism of action, and current clinical data for each agent are examined. Limitations of current orthobiologics involve lack of standardization in preparation and administration each agent as well as uniformity in assessment end points across different clinical studies. Lastly, we will discuss future directions of orthobiologics as a therapy for treatment in osteoarthritis.

Platelet-rich plasma (PRP) is a commonly used intra-articular therapy for knee osteoarthritis (OA), yet substantial heterogeneity in PRP preparation and delivery limits comparability across trials and complicates clinical translation. We conducted a scoping review in accordance with PRISMA and PRISMA-ScR guidance. MEDLINE and Embase were searched from inception to 15 November 2025 for English-language randomized controlled trials comparing PRP with non-regenerative comparators (e.g., hyaluronic acid, corticosteroids, radiofrequency ablation, or saline placebo) in adults with knee OA. Data were charted on study characteristics, OA severity, injection guidance, centrifugation protocols, injected PRP volume and platelet concentration, dosing regimens, follow-up, adverse events, and overall conclusions (superior/non-inferior/inferior). Twenty-one studies (2012–2025) were included, spanning multiple regions and enrolling 21–288 participants per study with follow-up from 12 weeks to 60 months. PRP protocols varied widely, including single- versus double-spin centrifugation, spin rates and durations, injected volumes (approximately 1.4–8 mL), and platelet enrichment (approximately 1.15x to 9.85x baseline when reported). The most common regimen was three injections, typically weekly. Across studies, major adverse events were not reported, and post-injection pain or transient synovitis/effusion were the most frequent events. PRP for knee OA is generally safe and frequently demonstrates comparable or improved outcomes versus standard injectables, but marked protocol heterogeneity persists. Standardized reporting and consensus parameters for PRP preparation and administration are needed to improve reproducibility and guide evidence-based practice.

This review explores the dual regenerative and antimicrobial properties of platelet- and marrow-derived biologics, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), autologous protein solutions, and plasma fractions. These biologics, widely used in regeneration and tissue repair, offer multiplex bioactivity through growth factors, cytokines, and cellular components that promote healing while reducing infection risk. PRP and BMAC demonstrate significant regenerative effects in musculoskeletal conditions, wound healing, and cartilage repair, with platelets and leukocytes contributing antimicrobial peptides and immune modulation for more indirect regenerative mechanisms. Preparation methods, patient factors, and lack of standardization impact clinical outcomes and efficacy. While promising for reducing reliance on chronic pain medications and improving function, these therapies face limitations including inconsistent preparation and utilization protocols, limited long-term safety data, and regulatory challenges. Here, we review the need for consensus-building, standardized procedures, and robust research to optimize clinical integration and realize the full potential of biologic regenerative therapies in pain medicine.

Background/Objectives: The image guidance of choice for the combination therapy of radiofrequency ablation (RFA) and vertebral augmentation (VA) in the context of vertebral disease from spinal metastases are fluoroscopy and computer tomography (CT). Here, we aimed to assess the roles of both imaging modalities and if adoption of either would influence clinical outcomes of pain, physical function, and quality of life (QoL). RFA has been favored as a minimally invasive option for managing painful spinal metastases, and it is often coupled with VA to treat underlying osseous structural instability. This combination therapy of RFA with VA, which could be performed under CT or fluoroscopy, has in recent years been recognized as highly successful for pain control and functional restoration of metastatic spine lesions. Methods: Our scoping review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The databases accessed were Medline and Embase, and the time frame of the search was set from database inception to 2 January 2025. The inclusion eligibility included primary research studies utilizing clearly defined imaging modalities of interest with measurable clinical end points of pain, quality of life (QoL), analgesic use, or complications. Results: Twenty-two articles were identified after screening fifty-eight papers using the databases. Fluoroscopy alone was the more frequently adopted imaging modality (n = 17/22, 77.3%). Almost all of the papers, regardless of the imaging modality used, consistently demonstrated reduction in pain, improvement in QoL, as well as a decrease in analgesia use. Complications were present but had minimal clinical implications, aside from a single article which appeared to demonstrate significantly higher cement leak rates with a singular case of resultant paraplegia. Conclusions: Fluoroscopy- and CT-guided RFA with VA have both proven to be efficacious in reducing patient discomfort and improving functionality while keeping risks of permanent neurological injuries to a minimum.