01 Mar 2022

Volume 10 Issue 1

From the Executive Editor

March winds and April showers... but in February? Perhaps just another example of the somewhat topsy-turvy world we find ourselves in at the moment? Although we are told, ‘restrictions’ are ending and ‘things’ are returning to normal, from a T&O point of view, we may still beg to differ. However, as an endlessly naïve optimist, I do believe that the winds of change are passing through our specialty and now is a great opportunity for innovative thinking and sustainable solutions. We certainly need to think differently when you realise the scale of the problem as outlined in John’s ‘From the President’ article (page 5).

#SolvingTogether (https://solvingtogether.crowdicity.com) challenges you to submit your ideas that you think will make a difference for our patients – it gives you the opportunity to look at the ideas of others too and to vote for those you think will truly make a difference. So please just go ‘do it’ and put your idea forward.

Both our subspecialty section, (from page 46), and our recent online document www.boa.ac.uk/orthobiologics look at orthobiologic treatments critiquing the rationale and the evidence for their use in different situations and asking the question posed on our front cover: are they the right treatment for Ms X? This review of the evidence is balanced by two interesting and personal perspectives from a surgeon (page 58) and a patient (page 62).

My pledge to you for 2022 was to concentrate on the wider issues of diversity and engagement and as we approach #International Women’s Day it is pleasing to see how far IODA has come in the last two years (page 26). The BOA guidance on parental leave (www.boa.ac.uk/parenthood) is supported by James’s article (page 30) where he asks you to consider being the person you cannot see and supporting them when you do see them. Another group of trainees (page 42) show that you can demonstrate commitment to your profession whilst gaining experience and having fun all without spending a fortune.

There is perhaps no greater change that a person can make than exchanging their UK day job for a role providing humanitarian support to those in dire need in crisis areas (page 38) and encouraging us to recycle to boot! As I begin to introduce you to my presidential theme of sustainable systems, we all need to find ways in which we can contribute little and often.

I always like to learn so was delighted to read the article on implantable devices and MRI (page 22) – some common sense information that we can all put to use for patient benefit.

This issue of the JTO welcomes Fergal Monsell as Honorary Secretary and Simon Britten as Medico-legal Chair – both excellent additions to the BOA team. If you would like to join the team we will be looking for nominations for Trustee positions soon (page 9) – we need yet more diversity: northerners would be very welcome!

Unbelievably (to me!) this is my last editorial and as I hand over the JTO reins to the capable pair of hands that belong to Simon Hodkinson, your new Executive Editor, I would like to thank Nicholas Dunwell and Annette Heninger for guiding my editorial hands over the last 18 months and Hiro Tanaka and Fergal Monsell for helping to commission the content for JTO. Your help has been much appreciated. I will take a short breather before returning – albeit on a different page of the JTO!

Deborah Eastwood, Vice President


Subspecialty Section


Breaking down barriers to flexible training in trauma and orthopaedics

  1. Murphy O. Interview: RCS England’s diversity review - Baroness Helena Kennedy QC and RCS England President Neil Mortensen discuss the independent diversity review and the College's next steps. Bull R Coll Surg Engl. 2021;103:124-9.
  2. Walls J. Flexible Training For A Modern Surgical Workforce. Ann R Coll Surg Engl (Suppl). 2006;88:44-7.
  3. Bellini MI, Graham Y, Hayes C, et al. A woman’s place is in theatre: women’s perceptions and experiences of working in surgery from the Association of Surgeons of Great Britain and Ireland women in surgery working group. BMJ Open. 2019;9:e024349. 
  4. Royal College of Surgeons. Less Than Full Time (LTFT) Training in Surgery: JCST Policy Statement, 2017. Available at: www.rcseng.ac.uk/careers-in-surgery/careers-support/flexible-training-and-working/flexible-training-in-surgery.
  5. NHS Digital. Narrowing of NHS gender divide but men still the majority in senior roles. March 2018. Available at: https://digital.nhs.uk/news/2018/narrowing-of-nhs-gender-divide-but-men-still-the-majority-in-senior-roles. (Accessed 5th November 2021).
  6. NHS Digital. Freedom of information request for the percentage of UK female consultant orthopaedic surgeons. Available at: https://digital.nhs.uk/about-nhs-digital/contact-us/freedom-of-information/freedom-of-information-disclosure-log/september-2021/freedom-of-information-request-nic-581204-c1p2d.  (Accessed 30th December 2021).
  7. Harries RL, Rashid M, Smitham P, et al. What shape do UK trainees want their training to be? Results of a cross-sectional study. BMJ Open. 2016;6:e010461.
  8. Harries RL, Gokani VJ, Smitham P on behalf of the councils of the Association of Surgeons in Training and the British Orthopaedic Trainees Association, et al. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open. 2016;6:e010136.
  9. Hampton, T, Greenhalgh, R, Ryan, D, et al. Female surgical trainee attrition. Bull R Coll Surg Engl. 2016;98:134-7.
  10. Roche CD. Locked in – Locked out: Inflexibility in UK training.  Trauma. 2021;23(2):87-9.
  11. Royal College of Surgeons. Less Than Full Time (LTFT) Training in Surgery: JCST Policy Statement, 2017. Available at: www.rcseng.ac.uk/careers-in-surgery/careers-support/flexible-training-and-working/flexible-training-in-surgery.
Appendix 1 - Thematic Analysis
Appendix 1: Thematic analysis with a sample of the direct quotes from which the themes and subthemes were derived


Diversity in trauma and orthopaedics: Rationale for an inclusive culture

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  2. Emery SE, Carousel Presidents. Diversity in Orthopaedic Surgery: International Perspectives: AOA Critical Issues. J Bone Joint Surg Am. 2019;101(21):e113.
  3. Mulcahey MK, Waterman BR, Hart R, Daniels AH. The Role of Mentoring in the Development of Successful Orthopaedic Surgeons. J Am Acad Orthop Surg. 2018;26(13):463-71.
  4. Hiemstra LA WT, Mulpuri K, Vezina C, Kerslake S. Dissecting disaprity: improvements towards gender parity in leadership and on the podium within the Canadian Orthopaedic Association. Journal of ISAKOS. 2019;4(5):227-32.
  5. Green J, Chye V, Hiemstra L, Fellander-Tsai L, Incoll I, Weber K, et al. Diversity: Women in orthopaedic surgery - a perspective from the International Orthopaedic Diversity Alliance. Journal Of Trauma and Orthopaedics. 2020;8(1):44-51. Available at: www.boa.ac.uk/resources/knowledge-hub/jto-march-2020.html.
  6. Baldwin K, Namdari S, Bowers A, Keenan MA, Levin LS, Ahn J. Factors affecting interest in orthopedics among female medical students: a prospective analysis. Orthopedics. 2011;34(12):e919-32.
  7. Bucknall V, Pynsent PB. Sex and the orthopaedic surgeon: a survey of patient, medical student and male orthopaedic surgeon attitudes towards female orthopaedic surgeons. Surgeon. 2009;7(2):89-95.
  8. Jones M. Survey report Breaking barriers; developing drivers for female surgeonsumbraco.surgeons. Royal Australasian College of Surgeons (2020). Available at: www.surgeons.org/-/media/Project/RACS/surgeons-org/files/operating-with-respectcomplaints/Break-barriers-report_2020.pdf.
  9. O'Connor MI. Medical School Experiences Shape Women Students' Interest in Orthopaedic Surgery. Clin Orthop Relat Res. 2016;474(9):1967-72.
  10. Siddiqua A, Bhandari M, Hiemstra L, Hiasat N. Championing Women Orthopaedic Surgeons: Preparing for an Inclusive Future. OE Insights [Internet]. 2021. Available at: https://myorthoevidence.com/Insight/Show/102?vgo_ee=XF2MKDPnRXov+c4dv3UaxjLD70TX2s/zVrzXTDqfqIY=@AOA_President.
  11. Templeton K, Bernstein CA, Sukhera J, Nora LM, Newman C, Burstin H, et al. Gender-Based Differences in Burnout: Issue Faced by Women Physicians. NAM Perspectives Discussion Paper. Washington, DC: National Academy of Medicine; 2019. Available at: https://nam.edu/gender-based-differences-in-burnout-issues-faced-by-women-physicians.
  12. Rotenstein L, Harry E, Wickner P, Gupte A, Neville BA, Lipsitz S, et al. Contributors to Gender Differences in Burnout and Professional Fulfillment: A Survey of Physician Faculty. Jt Comm J Qual Patient Saf. 2021;47(11):723-30.
  13. Cohen M, Kiran T. Closing the gender pay gap in Canadian medicine. CMAJ. 2020;192(35):E1011-E1017.
  14. Bellini MI, Graham Y, Hayes C, Zakeri R, Parks R, Papalois V. A woman's place is in theatre: women's perceptions and experiences of working in surgery from the Association of Surgeons of Great Britain and Ireland women in surgery working group. BMJ Open. 2019;9(1):e024349.
  15. Fleming S, Fisher R. Sexual assault in surgery: a painful truth. Bulletin of the Royal College of Surgeon of England. 2021;September:282-5.
  16. Ayers CE. Minorities and the orthopaedic profession. Clin Orthop Relat Res. 1999 May;(362):58-64.
  17. Poon S, Kiridly D, Mutawakkil M, Wendolowski S, Gecelter R, Kline M, et al. Current Trends in Sex, Race, and Ethnic Diversity in Orthopaedic Surgery Residency. J Am Acad Orthop Surg. 2019;27(16):e725-e33.
  18. Ramirez RN, Franklin CC. Racial Diversity in Orthopedic Surgery. Orthop Clin North Am. 2019;50(3):337-44.
  19. Ode GE, Williams RJ, Harrington MA, Bennett CH, Hogan MV, Porter S. Achieving a Diverse, Equitable, and Inclusive Environment for the Black Orthopaedic Surgeon: Part 2: Obstacles Faced in Inclusion and Retention of Black Orthopaedic Residents. J Bone Joint Surg Am. 2021;103(11):1040-5.
  20. Hunt V, Layton D, Prince S. Diversity Matters. Mckinsey & Company; 2015. Available at: www.mckinsey.com/insights/organization/~/media/2497d4ae4b534ee89d929cc6e3aea485.ashx.
  21. McDonald TC, Drake LC, Replogle WH, Graves ML, Brooks JT. Barriers to Increasing Diversity in Orthopaedics: The Residency Program Perspective. JB JS Open Access. 2020;5(2).
  22. Dixon-Fyle S, Hunt V, Dolan K, Prince S. Diversity Wins - How Inclusion Matters. Mckinsey & Company; 2020. Available at: www.mckinsey.com/~/media/mckinsey/featured%20insights/diversity%20and%20inclusion/diversity%20wins%20how%20inclusion%20matters/diversity-wins-how-inclusion-matters-vf.pdf.
  23. Leopold SS. Editorial: What You Can Do to Support Women in Orthopaedics Worldwide. Clin Orthop Relat Res. 2021;479(9):1881-4.
  24. Leopold SS. Editorial: Fears About #MeToo are No Excuse to Deny Mentorship to Women in Orthopaedic Surgery. Clin Orthop Relat Res. 2019;477(3):473-6.
  25. Ibarra H. A Lack of Sponsorship is Keeping Women from Advancing into Leadership. Harvard Business Review; 2021. Available at: https://hbr.org/2019/08/a-lack-of-sponsorship-is-keeping-women-from-advancing-into-leadership.
  26. Ode GE, Bradford L, Ross WA, Carson EW, Brooks JT. Achieving a Diverse, Equitable, and Inclusive Environment for the Black Orthopaedic Surgeon: Part 1: Barriers to Successful Recruitment of Black Applicants. J Bone Joint Surg Am. 2021;103(3):e9.
  27. Balch Samora J, Van Heest A, Weber K, Ross W, Huff T, Carter C. Harassment, Discrimination, and Bullying in Orthopaedics: A Work Environment and Culture Survey. J Am Acad Orthop Surg. 2020;28(24):e1097-e104.
  28. Whicker E, Williams C, Kirchner G, Khalsa A, Mulcahey MK. What Proportion of Women Orthopaedic Surgeons Report Having Been Sexually Harassed During Residency Training? A Survey Study. Clin Orthop Relat Res. 2020;478(11):2598-606.
  29. Harbold D, Dearolf L, Buckley J, Lattanza L. The Perry Initiative's Impact on Gender Diversity Within Orthopedic Education. Curr Rev Musculoskelet Med. 2021;14(6):429-33.
  30. Mason BS, Ross W, Ortega G, Chambers MC, Parks ML. Can a Strategic Pipeline Initiative Increase the Number of Women and Underrepresented Minorities in Orthopaedic Surgery? Clin Orthop Relat Res. 2016;474(9):1979-85.

Knife before wife, or so they say

  1. GOV.UK Press release (18 February 2018): New ‘Share the joy’ campaign promotes shared parental leave rights for parents. Available at: www.gov.uk/government/news/new-share-the-joy-campaign-promotes-shared-parental-leave-rights-for-parents.
  2. British Orthopaedic Association (2021). Survey on burnout and wellbeing among trauma and orthopaedic surgeons. Available at: www.boa.ac.uk/latest-news/survey-on-burnout-and-wellbeing.html.
  3. Khoushhal Z, Hussain M, Greco E, Mamdani M, Verma S, Rotstein O, et al. Prevalence and Causes of Attrition Among Surgical Residents: A Systematic Review and Meta-analysis. JAMA Surg. 2017;152(3):265-72.
  4. General Medical Council. Chapter 2: Our data on medical students and doctors in training in the UK Doctors. 2018;57–72. Available at: www.gmc-uk.org/-/media/gmc-site-images/about/what-we-do-and-why/data-and-research/somep-2017/somep-2017-final-full.pdf.
  5. Moberly T. A fifth of surgeons in England are female. BMJ. 2018;363(k4530).
  6. Statista (2019). Number of female held CEO positions in FTSE companies in the United Kingdom (UK) as of June 2019. Available at: www.statista.com/statistics/685208/number-of-female-ceo-positions-in-ftse-companies-uk.
  7. Harries RL, Gokani VJ, Smitham P, Fitzgerald JE; councils of Association of Surgeons in Training and British Orthopaedic Trainees Association. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open. 2016;6(4):e010136.
  8. British Medical Association (2021). Shared Parental Leave. Available at: www.bma.org.uk/pay-and-contracts/maternity-paternity-and-adoption/leave/shared-parental-leave.

James Lind Alliance Priority Setting Partnership - ‘Top 10’ research priorities in foot and ankle surgery

  1. Elwyn G, Crowe S, Fenton MA, Firkins L, Versnel J, Walker S. Identifying and prioritizing uncertainties: patient and clinician engagement in the identification of research questions. J Eval Clin Pract. 2010;16(3):627-31. 
  2. Staley K, Crowe S, (2019). More than a top 10: How James Lind Alliance Priority Setting Partnerships transform research, people and organisations. Available from: www.jla.nihr.ac.uk/making-a-difference/downloads/More-Than-a-Top-10-report.pdf.
  3. Crowe S, Fenton M, Hall M, Cowan K, Chalmers I. Patients’, clinicians’ and the research communities’ priorities for treatment research: there is an important mismatch. Res Involv Engagem. 2015;1:2.
  4. Milne I, (2012). Who was James Lind, and what exactly did he achieve? JLL Bulletin: Commentaries on the history of treatment evaluation. Available at: www.jameslindlibrary.org/articles/who-was-james-lind-and-what-exactly-did-he-achieve.
  5. Partridge N, Scadding J. The James Lind Alliance: patients and clinicians should jointly identify their priorities for clinical trials. Lancet. 2004;364(9449):1923-4.
  6. Cowan K, Oliver S, (2021). The James Lind Alliance Guidebook: version 10. Available at: www.jla.nihr.ac.uk/jla-guidebook/downloads/JLA-Guidebook-Version-10-March-2021.pdf.
  7. Houchen et al on behalf of the PHOSP-COVID consortium. Joint patient and clinician priority setting to identify ten key research questions regarding the long-term sequelae of COVID-19. Thorax, In press. 
  8. Rowbotham NJ, Smith SJ, Elliott ZC, Leighton PA, Rayner OC, Morley R, Smyth AR. Adapting the James Lind Alliance priority setting process to better support patient participation: an example from cystic fibrosis. Res Involv Engagem. 2019;5:24.

Orthobiologics: Scientific background

  1. Gurdon JB. From nuclear transfer to nuclear reprogramming: the reversal of cell differentiation. Annu Rev Cell Dev Biol 2006;22:1-22. 
  2. Takahashi K, Yamanaka S. Induction of pluripotent stem cells from mouse embryonic and adult fibroblast cultures by defined factors. Cell 2006;126(4):663-76.
  3. Caplan AI. Mesenchymal stem cells. J Orthop Res 1991;9(5):641-50.
  4. Dominici M, Le Blanc K, Mueller I, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 2006;8(4):315-7. 
  5. Viswanathan S, Shi Y, Galipeau J, et al. Mesenchymal stem versus stromal cells: International Society for Cell & Gene Therapy (ISCT®) Mesenchymal Stromal Cell committee position statement on nomenclature. Cytotherapy 2019;21(10):1019-24.
  6. Murray IR, Chahla J, Frank RM, et al. Rogue stem cell clinics. Bone Joint J 2020;102-b(2):148-54. 
  7. Caplan AI. Mesenchymal Stem Cells: Time to Change the Name! Stem Cells Transl Med 2017;6(6):1445-51.
  8. Murray IR, Chahla J, Safran MR, et al. International Expert Consensus on a Cell Therapy Communication Tool: DOSES. J Bone Joint Surg Am 2019;101(10):904-11.
  9. Robinson PG, Murray IR, West CC, et al. Reporting of Mesenchymal Stem Cell Preparation Protocols and Composition: A Systematic Review of the Clinical Orthopaedic Literature. Am J Sports Med 2018:363546518758667. 
  10. Wiggers TG, Winters M, Van den Boom NA, et al. Autologous stem cell therapy in knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med 2021;55(20):1161-69. 
  11. Murray IR, Robinson PG, West CC, et al. Reporting Standards in Clinical Studies Evaluating Bone Marrow Aspirate Concentrate: A Systematic Review. Arthroscopy 2018;34(4):1366-75.
  12. Sundman EA, Cole BJ, Karas V, et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014;42(1):35-41.
  13. Mussano F, Genova T, Munaron L, et al. Cytokine, chemokine, and growth factor profile of platelet-rich plasma. Platelets 2016:1-5.
  14. Roh YH, Kim W, Park KU, et al. Cytokine-release kinetics of platelet-rich plasma according to various activation protocols. Bone Joint Res
  15. Lamplot JD, Rodeo SA, Brophy RH. A Practical Guide for the Current Use of Biologic Therapies in Sports Medicine. Am J Sports Med 2020;48(2):488-503. 

Orthobiologics: Osteoarthritis

  1. VersusArthritis (2021). The state of Musculoskeletal Health 2021. Available at: www.versusarthritis.org/about-arthritis/data-and-statistics/the-state-of-musculoskeletal-health. Accessed 29 Jan 2022. 
  2. Bayliss LE, Culliford D, Monk AP, et al. The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study. Lancet 2017;389(10077):1424-30. 
  3. Mobasheri A, Saarakkala S, Finnilä M, et al. Recent advances in understanding the phenotypes of osteoarthritis. F1000Research 2019;8 
  4. Mahmoudian A, Lohmander LS, Mobasheri A, et al. Early-stage symptomatic osteoarthritis of the knee - time for action. Nat Rev Rheumatol 2021;17(10):621-32. 
  5. National Institute for Health and Care Excellence. Autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee: technology appraisal guidance [TA477]. 2017. Available at: www.nice.org.uk/guidance/ta477. Accessed 29 Jan 2022. 
  6. Piuzzi NS, Ng M, Chughtai M, et al. The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective. J Knee Surg 2018;31(6):551-56. 
  7. Shi WJ, Tjoumakaris FP, Lendner M, et al. Biologic injections for osteoarthritis and articular cartilage damage: can we modify disease? Phys Sportsmed 2017;45(3):203-23. 
  8. Belk JW, Kraeutler MJ, Houck DA, et al. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2020:363546520909397. 
  9. Gong H, Li K, Xie R, et al. Clinical therapy of platelet-rich plasma vs hyaluronic acid injections in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized double-blind controlled trials. Medicine (Baltimore) 2021;100(12):e25168.
  10. Tan J, Chen H, Zhao L, et al. Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Meta-analysis of 26 Randomized Controlled Trials. Arthroscopy 2021;37(1):309-25.
  11. Dong Y, Zhang B, Yang Q, et al. The effects of platelet-rich plasma injection in knee and hip osteoarthritis: a meta-analysis of randomized controlled trials. Clin Rheumatol 2021;40(1):263-77. 
  12. Nie LY, Zhao K, Ruan J, et al. Effectiveness of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Clinical Trials. Orthop J Sports Med. 2021;9(3):2325967120973284. 
  13. Chen Z, Wang C, You D, et al. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: A meta-analysis. Medicine (Baltimore) 2020;99(11):e19388. 
  14. Han Y, Huang H, Pan J, et al. Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis. Pain Med 2019;20(7):1418-29.
  15. Shen L, Yuan T, Chen S, et al. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2017;12(1):16.
  16. Dai WL, Zhou AG, Zhang H, et al. Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials. Arthroscopy 2017;33(3):659-70.e1. 
  17. American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Knee (NonArthroplasty) Evidence-Based Clinical Practice Guideline. 2021. Available at: www.aaos.org/oak3cpg. Accessed 29 Jan 2022.
  18. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken) 2020;72(2):220-33. 
  19. Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019;27(11):1578-89. 
  20. National Institute for Health and Care Excellence.  Platelet-rich plasma injections for knee osteoarthritis. [IPG637]. 2019. Available at: www.nice.org.uk/guidance/ipg637. Accessed 22 Jan 2022. 
  21. Baltzer AW, Moser C, Jansen SA, et al. Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage 2009;17(2):152-60. 
  22. Auw Yang KG, Raijmakers NJ, van Arkel ER, et al. Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial. Osteoarthritis Cartilage 2008;16(4):498-505.
  23. Kon E, Engebretsen L, Verdonk P, et al. Clinical Outcomes of Knee Osteoarthritis Treated With an Autologous Protein Solution Injection: A 1-Year Pilot Double-Blinded Randomized Controlled Trial. Am J Sports Med 2018;46(1):171-80. 
  24. Imam MA, Mahmoud SSS, Holton J, et al. A systematic review of the concept and clinical applications of Bone Marrow Aspirate Concentrate in Orthopaedics. SICOT J 2017;3:17.
  25. Martin DR, Cox NR, Hathcock TL, et al. Isolation and characterization of multipotential mesenchymal stem cells from feline bone marrow. Exp Hematol 2002;30(8):879-86. 
  26. Goncars V, Jakobsons E, Blums K, et al. The comparison of knee osteoarthritis treatment with single-dose bone marrow-derived mononuclear cells vs. hyaluronic acid injections. Medicina (Kaunas, Lithuania) 2017;53(2):101-08. 
  27. Chahla J, Dean CS, Moatshe G, et al. Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee: A Systematic Review of Outcomes. Orthop J Sports Med 2016;4(1):2325967115625481. 
  28. Anz AW, Hubbard R, Rendos NK, et al. Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 1 Year: A Prospective, Randomized Trial. Orthop J Sports Med 2020;8(2):2325967119900958.
  29. Centeno C, Sheinkop M, Dodson E, et al. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med 2018;16(1):355. 
  30. Shapiro SA, Kazmerchak SE, Heckman MG, et al. A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis. Am J Sports Med 2017;45(1):82-90. 
  31. Panchal J, Malanga G, Sheinkop M. Safety and Efficacy of Percutaneous Injection of Lipogems Micro-Fractured Adipose Tissue for Osteoarthritic Knees. Am J Orthop (Belle Mead NJ) 2018;47(11).
  32. Russo A, Condello V, Madonna V, et al. Autologous and micro-fragmented adipose tissue for the treatment of diffuse degenerative knee osteoarthritis. J Exp Orthop 2017;4(1):33. 
  33. Cattaneo G, De Caro A, Napoli F, et al. Micro-fragmented adipose tissue injection associated with arthroscopic procedures in patients with symptomatic knee osteoarthritis. BMC Musculoskelet Disord 2018;19(1):176. 
  34. Hudetz D, Borić I, Rod E, et al. The Effect of Intra-articular Injection of Autologous Microfragmented Fat Tissue on Proteoglycan Synthesis in Patients with Knee Osteoarthritis. Genes (Basel) 2017;8(10):270.
  35. Gobbi A, Dallo I, Rogers C, et al. Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: a multi-centric, international study. Int Orthop 2021;45(5):1179-88. 
  36. Heidari N, Noorani A, Slevin M, et al. Patient-Centered Outcomes of Microfragmented Adipose Tissue Treatments of Knee Osteoarthritis: An Observational, Intention-to-Treat Study at Twelve Months. Stem Cells Int 2020;2020:8881405. 
  37. Garza JR, Campbell RE, Tjoumakaris FP, et al. Clinical Efficacy of Intra-articular Mesenchymal Stromal Cells for the Treatment of Knee Osteoarthritis: A Double-Blinded Prospective Randomized Controlled Clinical Trial. Am J Sports Med 2020;48(3):588-98. 
  38. Hong Z, Chen J, Zhang S, et al. Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial. Int Orthop 2019;43(5):1123-34.
  39. Medicines & Healthcare products Regulatory Agency.  Consultation on Point of Care manufacturing. Published 12 August 2021. Available at: www.gov.uk/government/consultations/point-of-care-consultation/consultation-on-point-of-care-manufacturing. Accessed 29.01.2022. 
  40. Lamo-Espinosa JM, Blanco JF, Sánchez M, et al. Phase II multicenter randomized controlled clinical trial on the efficacy of intra-articular injection of autologous bone marrow mesenchymal stem cells with platelet rich plasma for the treatment of knee osteoarthritis. J Transl Med 2020;18(1):356. 
  41. Bastos R, Mathias M, Andrade R, et al. Intra-articular injection of culture-expanded mesenchymal stem cells with or without addition of platelet-rich plasma is effective in decreasing pain and symptoms in knee osteoarthritis: a controlled, double-blind clinical trial. Knee Surg Sports Traumatol Arthrosc 2020;28(6):1989-99. 
  42. Lamo-Espinosa JM, Mora G, Blanco JF, et al. Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: multicenter randomized controlled clinical trial (phase I/II). J Transl Med 2016;14(1):246. 
  43. Lamo-Espinosa JM, Mora G, Blanco JF, et al. Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: long-term follow up of a multicenter randomized controlled clinical trial (phase I/II). J Transl Med 2018;16(1):213.
  44. Gupta PK, Chullikana A, Rengasamy M, et al. Efficacy and safety of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (Stempeucel®): preclinical and clinical trial in osteoarthritis of the knee joint. Arthritis Res Ther 2016;18(1):301.
  45. Vega A, Martín-Ferrero MA, Del Canto F, et al. Treatment of Knee Osteoarthritis With Allogeneic Bone Marrow Mesenchymal Stem Cells: A Randomized Controlled Trial. Transplantation 2015;99(8):1681-90. 
  46. Freitag J, Bates D, Wickham J, et al. Adipose-derived mesenchymal stem cell therapy in the treatment of knee osteoarthritis: a randomized controlled trial. Regen Med 2019;14(3):213-30.
  47. Lee WS, Kim HJ, Kim KI, et al. Intra-Articular Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis: A Phase IIb, Randomized, Placebo-Controlled Clinical Trial. Stem Cells Transl Med 2019;8(6):504-11.

Orthobiologics: Tendinopathy

  1. Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers. 2021;7(1):1.
  2. Abat F, Alfredson H, Cucchiarini M, et al. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. J Exp Orthop. 2017;4(1):18.
  3. Riel H, Lindstrøm CF, Rathleff MS, et al. Prevalence and incidence rate of lower-extremity tendinopathies in a Danish general practice: a registry-based study. BMC Musculoskelet Disord 2019;20(1):239. 
  4. Macedo CSG, Tadiello FF, Medeiros LT, et al. Physical Therapy Service delivered in the Polyclinic During the Rio 2016 Paralympic Games. Phys Ther Sport. 2019;36:62-7. 
  5. Millar NL, Murrell GA, McInnes IB. Inflammatory mechanisms in tendinopathy - towards translation. Nat Rev Rheumatol. 2017;13(2):110-22.
  6. Challoumas D, Kirwan PD, Borysov D, et al. Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review. Br J Sports Med. 2019;53(4):251-62. 
  7. Mamais I, Papadopoulos K, Lamnisos D, et al. Effectiveness of Low Level Laser Therapy (LLLT) in the treatment of Lateral elbow tendinopathy (LET): an umbrella review. Laser Ther. 2018;27(3):174-86.
  8. Bjordal JM, Lopes-Martins RA, Joensen J, et al. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008;9:75. 
  9. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7):1539-54.
  10. Zhou Y, Wang JH. PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies. Biomed Res Int. 2016;2016:9103792.
  11. Moraes VY, Lenza M, Tamaoki MJ, et al. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014;2014(4):CD010071.
  12. Chahla J, Cinque ME, Piuzzi NS, et al. A Call for Standardization in Platelet-Rich Plasma Preparation Protocols and Composition Reporting: A Systematic Review of the Clinical Orthopaedic Literature. J Bone Joint Surg Am. 2017;99(20):1769-79.
  13. Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42(2):463-71.
  14. Gosens T, Peerbooms JC, van Laar W, et al. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39(6):1200-8.
  15. de Vos RJ, Windt J, Weir A. Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med. 2014;48(12):952-6. 
  16. Ahmad Z, Brooks R, Kang SN, et al. The effect of platelet-rich plasma on clinical outcomes in lateral epicondylitis. Arthroscopy. 2013;29(11):1851-62.
  17. Muthu S, Patel S, Gobbur A, et al. Platelet-Rich Plasma Therapy Ensures Pain Reduction in the Management of Lateral Epicondylitis - A PRISMA-compliant Network Meta-Analysis of Randomised Controlled Trials. Expert Opin Biol Ther. 2022 [Online ahead of print.]
  18. Liddle AD, Rodríguez-Merchán EC. Platelet-Rich Plasma in the Treatment of Patellar Tendinopathy: A Systematic Review. Am J Sports Med. 2015;43(10):2583-90. 
  19. Andriolo L, Altamura SA, Reale D, et al. Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis. Am J Sports Med 2019;47(4):1001-18. 
  20. Liu CJ, Yu KL, Bai JB, et al. Platelet-rich plasma injection for the treatment of chronic Achilles tendinopathy: A meta-analysis. Medicine. 2019;98(16):e15278.
  21. Nauwelaers AK, Van Oost L, Peers K. Evidence for the use of PRP in chronic midsubstance Achilles tendinopathy: A systematic review with meta-analysis. Foot Ankle Surg. 2021;27(5):486-95.
  22. MS AH, Sazlina SG. Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One. 2021;16(5):e0251111. 
  23. Lin MT, Chiang CF, Wu CH, et al. Comparative Effectiveness of Injection Therapies in Rotator Cuff Tendinopathy: A Systematic Review, Pairwise and Network Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil. 2019;100(2):336-349.e15.
  24. Hurley ET, Hannon CP, Pauzenberger L, et al. Nonoperative Treatment of Rotator Cuff Disease With Platelet-Rich Plasma: A Systematic Review of Randomized Controlled Trials. Arthroscopy. 2019;35(5):1584-91.
  25. Carr AJ, Murphy R, Dakin SG, et al. Platelet-Rich Plasma Injection With Arthroscopic Acromioplasty for Chronic Rotator Cuff Tendinopathy: A Randomized Controlled Trial. Am J Sports Med. 2015;43(12):2891-7.
  26. Le ADK, Enweze L, DeBaun MR, et al. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med. 2018;11(4):624-34.
  27. Shim JW, Lee JS, Park YB, et al. The effect of leucocyte concentration of platelet-rich plasma on outcomes in patients with lateral epicondylitis: A systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(3):634-45.
  28. Creaney L, Wallace A, Curtis M, et al. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011;45(12):966-71.
  29. van den Boom NAC, Winters M, Haisma HJ, et al. Efficacy of Stem Cell Therapy for Tendon Disorders: A Systematic Review. Orthop J Sports Med. 2020;8(4):2325967120915857.
  30. Usuelli FG, Grassi M, Maccario C, et al. Intratendinous adipose-derived stromal vascular fraction (SVF) injection provides a safe, efficacious treatment for Achilles tendinopathy: results of a randomized controlled clinical trial at a 6-month follow-up. Knee Surg Sports Traumatol Arthrosc. 2018;26(7):2000-10.
  31. Nixon AJ, Watts AE, Schnabel LV. Cell- and gene-based approaches to tendon regeneration. J Shoulder Elbow Surg. 2012;21(2):278-94.