American Orthopaedic Foot & Ankle Society

View all recommendations from this society

Released January 15, 2021

Avoid use of orthopaedic therapeutic biologics including platelet rich plasma and stem cell treatment for foot and ankle problems without first considering established, conventional treatment options.

Orthopaedic therapeutic biologics (orthobiologics) comprise a variety of tissue grafts and autologous blood products that include platelet rich plasma (PRP) and mesenchymal stem cell treatment. Surgeons bear responsibility to offer their patients efficacious, safe and cost-effective treatments. Orthobiologic treatment can be costly and may not be covered by insurance. Patients can become financially vulnerable especially when pursuing orthobiologic treatment that extends beyond its intended use, scientific support, or regulatory approval. Surgeons should be well-versed in the scientific basis, techniques, potential risks, and regulatory status of orthobiologic treatments. Furthermore, surgeons should review the risks, benefits, and anticipated efficacy of orthobiologic therapy with patients in advance. Orthobiologic treatment options represent a rapidly expanding area of interest for both patients and providers, but remain relatively new and understudied. There is ongoing need for investigative research.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider.

How The List Was Created

In order to formulate this list, the American Orthopaedic Foot & Ankle Society Evidence-Based Medicine Committee reviewed the society position statements on foot and ankle care and solicited expert opinion from specialty leaders to prepare an initial list of topics for the Choosing Wisely website. The Evidence-Based Medicine Committee members reviewed the scientific literature on each statement and presented draft statements with supporting evidence to the committee for discussion. The finalized list was then reviewed and approved by the AOFAS Board of Directors.

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American Academy of Orthopaedic Surgeons. Position Statement: Innovation and Novel Technologies in Orthopaedic Surgery. Position Statement 1185 – Revised September 2020. 1185—innovation-and-novel-technologies-in-orthopaedic-surgery-updated2020.pdf (

American Academy of Orthopaedic Surgeons. Position Statement: Use of Emerging Biologic Therapies. Position Statement 1187 – Revised September 2020. 1187-use-ofemerging-biologic-therapies-updated2020.pdf (