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Autologous biologics, defined as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC), are cell-based therapy treatment options in regenerative medicine practices, and have been increasingly used in orthopedics, sports medicine, and spinal disorders. These biological products are produced at point-of-care; thereby, avoiding expensive and cumbersome culturing and expansion techniques.Numerous commercial PRP and BMC systems are available but reports and knowledge of bio-cellular formulations produced by these systems are limited. This limited information hinders evaluating clinical and research outcomes and thus making conclusions about their biological effectiveness. Some of their important cellular and protein properties have not been characterized, which is critical for understanding the mechanisms of actions involved in tissue regenerative processes. The presence and role of red blood cells (RBCs) in any biologic has not been addressed extensively. Furthermore, some of the pathophysiological effects and phenomena related to RBCs have not been studied. A lack of a complete understanding of all of the biological components and their functional consequences hampers the development of clinical standards for any biological preparation.This paper aims to review the clinical implications and pathophysiological effects of RBCs in PRP and BMC; emphasizes hemolysis, eryptosis, and the release of macrophage inhibitory factor; and explains several effects on the microenvironment, such as inflammation, oxidative stress, vasoconstriction, and impaired cell metabolism. Keywords: Platelet-rich plasma, Bone marrow mesenchymal cells, Plasma free hemoglobin, Eryptosis, Macrophage migration inhibitor factor, Oxidative stress, Inflammation

A 13-year-old female competitive tap dancer with subacute on chronic lateral foot pain is diagnosed with calcaneocuboid instability and undergoes successful reconstruction. This case report supports the use of dynamic ultrasound evaluation of CC joint for the diagnosis of CC instability causing pain. We also provide an innovative surgical technique for CC ligament repair with an internal brace kit supplemented with periosteal augmentation.