Abstract
Background:
Injectable orthobiologics such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and autologous protein solution (APS) have gained popularity as regenerative options for knee osteoarthritis (OA). Despite widespread clinical and public interest, evidence from randomized controlled trials (RCTs) remains heterogeneous, and public understanding may be shaped more by media representation than by data-driven evidence.
Purpose:
To synthesize the current evidence on injectable orthobiologics for knee OA and evaluate whether media portrayals align with the strength and quality of available clinical evidence.
Study Design:
Systematic review; Level of evidence, 1.
Methods:
A dual-pronged systematic review was performed on March 31, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Web of Science were searched for RCTs comparing injectable orthobiologics (PRP, MSCs, APS) versus placebo (saline or sham) in knee OA. Study quality was assessed using the Cochrane Risk of Bias 2 tool. In parallel, the Factiva database was searched for English-language news articles reporting on injectable orthobiologics for knee OA. Extracted variables included biologic type, benefits and drawbacks discussed, and tone (favorable, neutral, or cautionary).
Results:
Of 869 articles, 14 RCTs met the inclusion criteria. Eight demonstrated significant improvements in pain and 10 in function following orthobiologic injections, although heterogeneity and risk of bias were frequent. The media review identified 124 relevant articles from 3482 potential articles: 79.0% highlighted therapeutic benefits, only 29.8% mentioned drawbacks, and 37.1% used the term stem cell without specifying the product. Mentions of commercial entities occurred in 35.5% of articles, with no corresponding disclosures. Overall, 66.1% of media articles were favorable in tone.
Conclusion:
Our review showed that while RCT evidence remains inconsistent, media portrayals of orthobiologics are predominantly positive, often lacking nuance or acknowledgment of uncertainty. This disconnect may encourage unrealistic expectations and premature adoption of these therapies.
