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"We're going to focus on the cutting edge in biologics," said Allan Mishra, MD, summarizing the primary goal of a new orthopedics society that he has been instrumental in forming and officially launched this week.

This means, he said, new orthopedic approaches that will tend to avoid "the cutting" by using emerging biologics that may substitute for surgery and other invasive approaches.

Speaking to Medical Device Daily by phone through the hubbub of the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS; Rosemont, Illinois) in Las Vegas, Mishra said that the Clinical Biologic Orthopaedic Society (CBOS) is the first organization to put sole emphasis on this emerging sector.

The society's "narrow focus," he said, will be "to discover, design, develop and test biologic solutions for orthopedic problems."

Large orthopedic conferences, he said, usually will feature presentations "on either spine or hip or knee, and each has a biologic session in it — put in the back corner on Sunday morning at 8 o'clock."

Thus the CBOS intends to heighten this emphasis and support increased awareness and collaboration among orthopedic researchers bringing new patient-centered biologic approaches to the field.

Mishra, of the Stanford University Medical Center (Stanford, California), has collaborated with Pietro Randelli, MD, from the Universitá degli Studi di Milano (Milan, Italy), to launch the organization; they co-chaired its inaugural meeting before the AAOS conference and were named as its "presiding founders."

There are 12 other founding members, with Italy, Japan and India joining the U.S. membership to emphasize the group's global reach. And Mishra emphasized that international participation will be a key characteristic of the society.

That emphasis, he said, will help to push a "flat earth" sort of collaboration, with the Internet speeding the exchange of information about new research in the field, and pushing more frequent cross-disciplinary approaches.

A society statement reporting the group's launch listed several examples of research areas to be pursued: "stem cell therapy for osteoarthritis and other musculoskeletal conditions; platelet-rich plasma [PRP] injections for chronic tendonitis, disc regeneration, and accelerated healing; molecular and cell biology and biomaterials for tendon-to-bone healing; and recombinant bone morphogenic proteins to repair fresh fractures."

"Current research," according to the statement, "suggests that these biologic treatments may be used alone or in combination for optimal effect."

Development of the organization has been "percolating" for some months, Patti Davis, a publicist serving as executive director of the CBOS, told MDD, with the AAOS meeting providing the opportunity for the official unveiling.

The organization was originally set to be named the Biologic Orthopaedic Society, but the term "Clinical" was added at the inaugural meeting to highlight the types of research being pursued by the members.

Thus, Mishra told MDD that on the bench-to-bedside continuum, the society will not emphasize the "cell-culture" proof-of-concept work but treatments that have the greatest likelihood of reaching patients – therapies, as he put it, "on the horizon rather than 10 to 20 years away" and "something patients can look forward to, that practicing physicians can look forward to."

Medicine has for several years been predicting that metal and plastic will be supplanted by natural materials, and Mishra said the time for turning those predictions from talk to reality is now at hand.

"Regenerative medicine and biologics are pushing orthopedics into new and exciting directions," Mishra said. "But until we formed the CBOS, no one group represented a vibrant research community that is hard at work developing these applications for orthopedic use."

Mishra's specialty is sports medicine, and he said this sector is "leading the way" in the development of biologic therapies. "We're leading in these approaches right now, a lot of athletes interested, a lot of doctors," he said, repeating the emphasis on "cutting-edge" approaches that avoid "cutting."

Mishra shares an interest with Randelli in the use of PRP, and Rendelli has developed a technique for using PRP as an augmentation in arthroscopic rotator cuff repair.

Membership in the CBOS will be by invitation only and will consist primarily of researchers who have been successful in publishing their work, Davis told MDD.

Others participants in the organization will be "tiered," and Mishra said that the society is still working out the specifics for various types of participation.

Besides its website, at, CBOS also has plans to launch an online journal. The society said that in its initial stage it is privately funded.

In addition to Mishra and Randelli, the other founding members of the society include Steven Arnoczky, DVM, Michigan State University (East Lansing); Scott Boden, MD, Emory University (Atlanta); Neal El Attrache, MD, Kerlan-Jobe Clinic (Los Angeles); Lisa Ann Fortier, DVM, PhD, Cornell University (Ithaca, New York); Mary Beth McCarthy, University of Connecticut Health Center (Farmington); William Maloney, MD, Stanford University Medical Center (Stanford, California); Augustus Mazzocca, MD, University of Connecticut Health Center (Farmington); Mitsuo Ochi, MD, PhD, Hiroshima University (Japan); Scott Rodeo, MD, Hospital for Special Surgery (New York); Anthony Romeo, MD, Rush University Medical Center (Chicago); Vijay Shetty, Dr. L.H. Hiranandani Hospital (Mumbai); and Yuji Yasunaga, MD, PhD, Hiroshima University (Hiroshima, Japan).

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