Orthobiologics and hyaluronic acid usage in the Netherlands: an electronic survey of 265 orthopaedic surgeons and sports physicians

Purpose “Biologic therapies” in the field of orthopaedic surgery and sports medicine, so called orthobiologics, have been gaining significant interest from physicians and patients, with increasing usage over the recent years. The aim of this study is to (1) evaluate the usage of orthobiologics in the Netherlands, (2) to clarify the reasons for the use or non-use of orthobiologics, and (3) the most addressed disease for use of orthobiologics. Methods The authors created a 19-quenstion online survey comprised of both closed-ended and open-ended response questions in order to examine the use of and the indication for orthobiologics. The survey was sent to all the members of the Dutch Orthopaedic Association and Netherlands Association of Sports Medicine of which 15% responded. Results The majority of the 265 respondents (65%) did not treat patients with or refer patients for treatment with orthobiologics. The most important reasons for not using orthobiologics were the lack of scientific evidence, the lack of good experience, and the lack of insurance coverage. Of the physicians that used orthobiologics, the most used hyaluronic acid (76%) and platelet-rich plasma (27%). Orthobiologics were most used for knee osteoarthritis and medial or lateral epicondylitis. Conclusion Although some orthobiologic treatments might be effective and the research interest is growing, our study shows that the majority of orthopaedic and sport physician clinicians in the Netherlands still does not make use of orthobiologics as a treatment option, but almost a third of them is contemplating to start using orthobiologics. Level of evidence III.

Performance diagnostics in endurance sports – anaeroboc threshold, VO2max, aerobic capacity – where do we go?

Exercise testing in athletes and patients is an important and valuable diagnostic tool in the hand of the physician and sport scientist. A close collaboration between sport scientist and sport physician creates a win-win-win-situation for athletes and patients and professionals equally. According to the demands of the sport an incremental lactate threshold test (determination of the anaerobic threshold), testing of ­VO2max and performance at VO₂max, and a testing of aerobic capacity (performance at competitional level) are the tests of choice. All tests need to be valid, reliable and sport specific. Sport specificity in testing is for practical purposes the most important.

Expert’s opinion of a home-based exercise program for shoulder pain prevention: application in wheelchair basketball players.

The aim of the study was to assess the structure and content validity of a home-based exercise program, as an instrument to prevent of shoulder pain (SP) in wheelchair basketball players. The proposed program was designed considering previous studies but to be applied in this specific population and; it was composed by exercises based on active mobility (4 exercises), strengthening (5 exercises) and stretching (5 exercises) of the shoulder joint. An ad hoc questionnaire was administered to a convenience sample of 9 experts (1 rehabilitation physician,1 sport physician, 4 physiotherapists and 3 coaches) that fulfilled the defined inclusion criteria. The results showed that experts considered the shoulder home-based exercise program (SHEP) as adequate tool for SP prevention in WB; however, some experts suggested some changes to improve it. According to the qualitative analysis performed, findings revealed two main underlying factors such as “design” (content and structure) and “application” that could influence in the adequate use of the home-based exercise program. This study provided evidence that the presentedhome-based exercise program is a validate tool and could be a powerful tool to prevent shoulder pain in WB player’s population.