The consensus on whether regenerative medicine is effective in sports medicine is still up in the air, according to Michael Ciccotti, MD, of Rothman Orthopaedic Institute in Philadelphia.
Dr. Ciccotti spoke with Becker's about the current research and potential of biologics in sports medicine.
Note: This conversation was edited for clarity.
Question: How do you feel about biologics in sports medicine, and what are your predictions for regenerative medicine in athletic care?
Dr. Michael Ciccotti: The theory of biologics is brilliant. Heal thyself. We all have these chemical factors in our blood that mediate healing, and we have these immature cells in our body that might be able to differentiate into mature types of musculoskeletal cells. And if we could harness the potential of that to enhance recovery or speed up healing or to develop into healthy tissue, well that's brilliant.
The reality is that the research is just all over the place and hasn't consistently shown that we've figured out how to modulate or how to direct our own healing system or our biologics to do what we hope that it would do. There has been an enormous amount of research that has looked at biologics in orthopedics. A systematic review published in 2021 identified almost 500 articles published over a prior 10-year period looking at biologics such as PRP, mesenchymal stem cells, and bone marrow aspirate and attempted to identify if they were beneficial. Some of the studies suggest perhaps they might enhance healing. Some suggested that they didn't change it at all, and others suggested they might have caused some type of adverse inflammatory response, and so ultimately didn't really benefit the patient. Major League Baseball in collaboration with Scripps Clinic in San Diego, the University of Utah in Salt Lake City, Hospital for Special Surgery in New York City, and the Rothman Institute performed arguably the largest study in the world looking at biologic treatment for partial tears of the elbow ulnar collateral ligament in throwers.
Complete tears of the ulnar collateral ligament are easier with respect to treatment decision-making. If it's fully torn and the baseball player can't throw, surgery is appropriate. The partial tears, however, are more subtle. Some partial tears can be treated nonoperatively. We looked at 544 professional baseball players that had partial ulnar collateral ligament tears and a portion of them were treated with traditional nonoperative treatment, including rest, anti-inflammatories, rehab and a progressive throwing program. The remaining portion had that same traditional nonoperative treatment plus a biologic treatment, such as platelet-rich plasma. We found that there was no statistically significant difference in outcome whether an athlete used a biologic or not. It didn't get them back any faster. It wasn't more likely to get them back nonoperatively, and ultimately it did not decrease the incidence of needing UCL surgery in the future. And so, specifically with partial ulnar collateral ligament tears of the elbow, biologics have not yet been shown to be beneficial.
But I would emphasize that this does not mean that we give up on the potential benefit of biologic treatments. Rather, the current ambiguity of research findings is a reflection of the need to perform continued, higher-level research on its applicability and optimal use. The theory of biologics is brilliant. We just haven't figured out how to harness it yet. We need to persevere as researchers and perform more precise, continued research in order to optimize the use of biologics.