The Use of Biologics in NFL Athletes: An Expert Consensus of NFL Team Physicians.

Background: There is a lack of published information outlining the use of biologics in National Football League (NFL) athletes and limited data to guide biologic treatment strategies.
Purpose: To develop a consensus on the use of biologics among NFL team physicians.
Study Design: Consensus statement.
Methods: A working group of 6 experts convened a consensus process involving NFL team physicians using validated Delphi methodology. Physicians from 32 NFL teams as well as NFL London were invited to take part. This iterative process was used to define statements on the use of biologics in NFL athletes. A recent scoping review exploring biologics in professional athletes was used to inform the first of 3 rounds of surveys, with statements considered under 7 headings: biologics in general, challenges of treating NFL athletes, terminology/nomenclature, autologous blood products, cell-based therapies, guidance for NFL team physicians, and biologic research in the NFL. In addition to rating agreement, experts were encouraged to propose further items or modifications. Predefined criteria were used to refine item lists after each survey. For a consensus within the final round, defined a priori, items were included in the final information set if a minimum of 75% of respondents agreed and fewer than 10% disagreed.
Results: Physicians from 26 NFL teams and NFL London responded to the initial invitation to participate in the Delphi process; 88.9% of participating team physicians completed the round 1 survey, with response rates of 87.5% in round 2 and 95.2% in round 3. After 3 rounds, 47 statements reached a consensus. A consensus was achieved that platelet-rich plasma has a positive impact on patellar tendinopathy and on symptoms in early osteoarthritis but not for other indications. NFL team physicians agreed that while cell therapies have the potential to improve symptoms, the misrepresentation of uncharacterized preparations as "stem cells" has contributed to the widespread use of unproven therapies.
Conclusion: This study established an expert consensus on 47 statements relating to the use of biologics in NFL athletes. In addition to providing clinical guidance for the use of biologics in NFL athletes, this study identified key areas for future focus including the development of athlete education materials.
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: I.R.M. has received consulting fees from Arthrex and Stryker. F.S.H. has received research support from Smith & Nephew and Stryker; consulting fees from Smith & Nephew and Stryker; and royalties from Corin, MatOrtho, Smith & Nephew, and Stryker. S.A.R. has received consulting fees from Teladoc and has stock/stock options in Ortho RTI. G.D.A. has received education payments from Evolution Surgical; has received consulting fees from Endonovo Therapeutics, RubiconMD, and Sideline Sports Doc; has received royalties from Orthofix Medical; has received other financial/material support from Arthrex and Stryker; and has stock/stock options in Cytonics, Sparta Biomedical, and Sparta Biopharma. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
(© The Author(s) 2023.)