The Use of Biological Approaches in the Treatment of Shoulder Pathology: A Critical Analysis Review

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Shoulder pain is the second most common musculoskeletal complaint encountered in primary care offices, occurring in about 51% of patients1. Over the last few years, major advances have been made in both the operative and nonoperative treatment of shoulder pain and pathological conditions. However, because of increasing patient age and the rising number of active patients, there is a demand for improved treatment of all shoulder abnormalities. Therefore, the use of orthobiologics in shoulder surgery has expanded rapidly over the past decade. Some of the commonly used biologics in shoulder surgery include progenitor cells, growth factors, platelet-rich plasma (PRP), and biological matrices. The potential advantages of biological augmentation of traditional shoulder surgical techniques include minimal invasiveness, improved healing capacity, and more-rapid recovery. Conversely, the use of biologics is currently expensive, and the evidence of long-term effectiveness is limited. Furthermore, the body of literature on the use and efficacy of biologics in shoulder surgery is heterogeneous with regard to indications, therapies, processing methods, and inoculation. Although some studies have demonstrated encouraging results following either isolated treatment with biologics or biologic-augmented surgery, other studies have failed to demonstrate substantial benefit. Given the heterogeneity and paucity of critical analyses within the literature, the objective of the present review is to evaluate the value of orthobiologics in the treatment of shoulder pathologies. More precisely, we aim to perform a balanced evaluation of biologic augmentation of existing modalities for the treatment of focal chondral defects, osteoarthritis, and rotator cuff tears.
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