Biologic Adjuvants for Foot and Ankle Conditions

Abstract

Orthobiologics are a family of treatments including molecules, cells, or tissues that aid in reparative musculoskeletal processes, employed in the setting of surgical or nonsurgical therapies to supplement bone, cartilage, and tissue regeneration. They are classified as bone grafts, growth factors, stem cell therapy, blood-based preparations, viscosupplementation, and scaffold-based therapy. The most common orthobiologic products used in foot and ankle include platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), bone morphogenic proteins, and platelet derived growth factor (PDGF). While extracorporeal shock wave therapy is not itself a biologic, it does stimulate a biologic response, and is included in this chapter. There is ample level I evidence supporting PRP use for osteochondral lesions of the talus, plantar fasciitis, chronic remitting non-insertional Achilles tendinopathy, and diabetic foot ulcers. PRP may also provide benefit in ankle osteoarthritis and fracture healing. recombinant human PDGF has been consistently proven in level I studies as a safe and effective alternative to autograft to augment ankle and hindfoot fusions, eliminating the morbidity associated with autograft harvesting. Bone marrow aspirate concentrate may be considered as an adjuvant treatment for bone healing, osteochondral lesions of the talus, and Achilles tendon repair. Extracorporeal shock wave therapy is a treatment option for patients with plantar fasciitis and Achilles tendinosis. Cell-based therapies may provide cells capable of osteoblastic differentiation and osteogenic potential, however, further investigation is warranted. In general, orthobiologics have rapidly expanding indications and are becoming increasingly accepted given their clinical benefits of improved pain and function, minimally invasive delivery, and positive safety profiles. To strengthen future evidence-based guidelines for biologic use in foot and ankle, higher evidence studies are required with improved standardization of concentration, treatment protocols, and outcome measures.