{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:07:35Z","timestamp":1789729655680,"version":"4.0.1"},"reference-count":54,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To perform a systematic review evaluating the efficacy of orthobiologic injections as adjuncts to cartilage\u2010preserving surgery in improving clinical, radiographic, and histologic outcomes in adults with focal knee cartilage defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Four databases (PubMed, MEDLINE, EMBASE, and Scopus) were searched through September 2025 for randomized controlled trials assessing adjunctive orthobiologic injections for knee focal chondral lesions. Inclusion criteria were randomized controlled trials reporting pain, function, or cartilage outcomes. Risk of bias was assessed using the Cochrane RoB 2 tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five randomized controlled trials involving 217 patients were included. Interventions included platelet\u2010rich plasma (PRP), peripheral blood stem cells, adipose\u2010derived mesenchymal stem cells, and human adipose\u2010derived mesenchymal progenitor cells, administered intra\u2010 or postoperatively after cartilage\u2010preserving procedures including subchondral drilling and microfracture. Random\u2010effects subgroup meta\u2010analyses of 2 PRP studies showed a small reduction in pain (mean difference, \u22120.93; 95% confidence interval, \u22121.39, \u22120.47;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200917%) and improvement in International Knee Documentation Committee scores in the injection group (mean difference, 13.4; 95% confidence interval, 10.1, 16.7;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). Peripheral blood stem cell\u2009+\u2009hyaluronic acid significantly improved magnetic resonance imaging and histological cartilage scores versus hyaluronic acid alone. Human adipose\u2010derived mesenchymal progenitor cell\u2009+\u2009hyaluronic acid improved Western Ontario and McMaster Universities Osteoarthritis Index and histological scores. Adipose\u2010derived mesenchymal stem cells\u2009+\u2009PRP showed promising arthroscopic and histological outcomes without patient improvement versus PRP alone. Per the RoB 2 tool, 3 studies had some concerns, 1 had low risk, and 1 had high risk of bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Orthobiologic injections, including peripheral blood stem cells, adipose\u2010derived stem cells, and PRP, appear safe and may provide limited functional, radiographic, and histological benefits in select protocols and populations when used alongside cartilage\u2010preserving surgery for focal knee chondral lesions. Current evidence is insufficient to support such injections as stand\u2010alone procedures. Significant heterogeneity across included studies precludes specific clinical recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level II, systematic review of Level I and II studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/arj.70548","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:45:42Z","timestamp":1789728342000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Orthobiologic Injections Adjunctive to Cartilage\u2010Preserving Surgery May Improve Outcomes for Focal Knee Chondral Defects: A Systematic Review of Randomized Controlled Trials With Subgroup Meta\u2010analyses"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8113-3705","authenticated-orcid":false,"given":"Benjamin","family":"Blackman","sequence":"first","affiliation":[{"name":"School of Medicine University of Limerick  Limerick Ireland"},{"name":"Division of Orthopaedic Surgery University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Pulbere","sequence":"additional","affiliation":[{"name":"School of Medicine University of Limerick  Limerick Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7659-5147","authenticated-orcid":false,"given":"Seth","family":"Ybema","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6883-9486","authenticated-orcid":false,"given":"Marc Daniel","family":"Bouchard","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery Department of Surgery McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prushoth","family":"Vivekanantha","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery Department of Surgery McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen","family":"Sritharan","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery University of Toronto  Toronto 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