Sports Science vs “Boutique Medicine”

T he practice of sports medicine in 2011 is fascinating. The advancement of disciplines like tissue engineering has expanded our armamentarium tremendously. Along with the typical orthopaedic toolbox of metal plates, rods, methylmethacrylate, and polyethylene comes synthetic membranes, biologic scaffolds, platelet-rich plasma (PRP), and stem cell treatments. To some extent, we can already biologically replace several musculoskeletal structures; these fascinating developments were just wishful thinking a couple of years ago. As the areas of articular cartilage, ligament, bone, and muscle research progress, interesting and challenging clinical and ethical questions have arisen: when are these technologies appropriate for clinical trials and eventual human treatment protocols? Are clinical experiments justified? Are they ethical? How much laboratory or clinical outcome data do clinicians need to implement new approaches to chronic unanswered problems? Who decides if animal data or limited clinical trials are sufficient? These questions and many more confront the clinician when a desperate patient presents with a difficult clinical problem. At times, the issue is the timing: an elite athlete before a championship event without enough time for mainstream treatment protocols. Other times, it's the severity or chronicity of the injury: a past high-level performer facing the possibility of the end of a career. Or it's not even an athlete at all, just an " ordinary Joe, " medically uninformed, trying to avoid surgery or salvage an acceptable level of function. These issues must be carefully considered to protect the patient and the integrity of the health care system. These dilemmas force clinicians to decide on their type of practice and reputation. Are they knowledgeable clinicians who are up-to-date on the science and applicability of emerging technologies and therapies? Will they rely on solid research to make evidence-based decisions and recommendations for their patients? Or, are they willing to use unproven, untested forms of treatment to claim being " on the cutting edge " or for financial gain? In the United States today, sports medicine practitioners are granted a lot of leeway in their practice: some of this clinical freedom is understandable and justified. After all, medicine is an art—hopefully, one that is well based on scientific principles and clinical experience. This is where the door is open to treatments like PRP and stem cells. The clinical potential is apparent; these new treatments make sense. Applying the growth factors concentrated in PRP and pluripotential cells to musculoskeletal injuries appears to be a …