Knees are the most commonly impacted weight-bearing joints in osteoarthritis (OA), affecting millions of people worldwide. With increasing life spans and obesity rates, the incidence of knee OA will further increase, leading to a significant increase in the economic burden. Conventional treatment modalities utilized to manage knee OA have limitations. Over the last decade, the role of various autologous peripheral blood-derived orthobiologics (APBOs) for the treatment of knee OA has been extensively investigated. This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA. While numerous studies have demonstrated promising results for these preparations, a notable gap exists in the comparative analysis of these diverse formulations. This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained long-term results. Thus, more adequately powered, multicenter, prospective, double-blind, randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.

Osteoarthritis (OA) of the knee is conventionally managed using non-pharmacological methods, pharmacological agents, and surgery in later stages or when conservative options have failed[1]. These therapies have limitations, like continuously trying to lessen symptoms rather than focusing on the underlying etiology[1]. Recently, there has been considerable interest in the utilization of autologous peripheral blood-derived orthobiologics (APBO) for the management of knee OA[2-11]. Here, we provided an overview while focusing on defining and reporting evidence-based assessments based on the most recent level I clinical studies as well as other levels of clinical evidence for clinical utilization of these APBOs for the management of knee OA.

Platelet-rich plasma (PRP) is the most commonly used orthobiologic, and still its efficacy remains debatable, which is attributed to patient variables, absence of standardized formulation protocol, etc[1,2]. In addition, there is limited literature regarding the most apt PRP formulation[1]. Gupta et al[1] in a recent editorial concluded that clinical outcomes obtained with either leukocyte-rich or leukocyte-poor PRP are similar at the 12-mo follow-up in knee OA patients. Conversely, Xiong et al[2] in an up-to-date systematic review and meta-analysis reported that leukocyte-poor PRP was significantly effective in reducing pain in knee OA patients, whereas leukocyte-rich PRP was not. These contentious outcomes have led researchers and clinicians to explore alternative APBOs for the management of knee OA[3-11]. Different types of APBOs along with the most recent clinical evidence are summarized in Table 1.

The most recent clinical studies described in Table 1 are not without shortcomings. They include variability in the formulation protocols, small cohort sizes, short-term to mid-term follow-up, etc. This variability can lead to inconsistencies in the composition and efficacy of the final product. The short-term to mid-term follow-up periods may not provide sufficient insight into the long-term effectiveness and safety of these treatments. Moreover, there is inadequate literature comparing the efficacy of one APBO to another. This further adds to the dilemma of physicians/surgeons in deciding the most appropriate APBO for the management of knee OA. Despite these constraints, the results from included clinical studies demonstrated the ability of various APBOs in decreasing pain and enhancing function in knee OA patients. Nonetheless, shared standardized formulation protocols for these APBOs must be created to ensure repeatability and reproducibility of outcomes associated with the use of these orthobiologics. In addition, further sufficiently powered, multicenter, prospective, randomized controlled trials with lengthier follow-ups are warranted to determine long-term efficacy and to aid physicians/surgeons in identifying the ideal APBO for managing knee OA along with justifying their routine clinical use.