Design: three-round international Delphi consensus, 100% participation each round
Population: 24-member international expert panel; 77 initial statements reduced to 62
Primary outcome: consensus, defined as ≥70% agreement with <20% disagreement
Effect: consensus rose from 37 of 77 statements in round 1 to 60 of 62 in round 3; no consensus on PRP for rotator cuff repair augmentation or on autologous cell-based therapies

Twenty-four international experts worked through 77 statements on orthobiologics over three Delphi rounds with full participation, refining them to 62 and agreeing on 60. Consensus required at least 70% agreement with under 20% disagreement.

Consensus was reached on platelet-rich plasma for knee, hip and glenohumeral osteoarthritis, for Achilles tendinopathy, for lateral epicondylitis and rotator cuff tendinitis, and for meniscal repair augmentation, and on general statements covering bone marrow aspirate concentrate, autologous conditioned serum, amniotic derivatives, gene therapy, exosomes and delivery methods. Two areas did not reach consensus: platelet-rich plasma for rotator cuff repair augmentation, and autologous cell-based therapies. The panel was explicit that many of the agreed statements carry qualifying language, and that preparation method, dosing and quality control remain inconsistent enough to undermine reproducibility.

That last point is the one that matters most in Indian practice, where platelet-rich plasma is widely offered, variably prepared and often paid for out of pocket. A consensus that an indication is reasonable is not a statement that any particular preparation delivers the studied effect - two centres calling something platelet-rich plasma may be injecting materially different products. The useful output of this document for a clinic is the list of what the field will not yet stand behind: stem cell and other autologous cell-based therapies, and platelet-rich plasma as an augment to rotator cuff repair.

Where you offer platelet-rich plasma, know and record the preparation protocol - spin, volume, leucocyte content - because the evidence does not transfer across preparations
Do not offer autologous cell-based or stem cell therapies as established care; the panel could not agree on them
Do not add platelet-rich plasma to a rotator cuff repair on the basis of consensus - there is none
Quote the indications with consensus specifically: knee, hip and glenohumeral osteoarthritis, Achilles tendinopathy, lateral epicondylitis, rotator cuff tendinitis
Be explicit about cost with the patient, especially where the treatment is self-funded

Why it matters

It names the orthobiologic uses that experts will not endorse, which is the half a patient asking about stem cell injections needs to hear.

Don't overread it

Delphi consensus is structured expert opinion, not evidence of efficacy - agreement that an indication is appropriate does not mean a trial has shown benefit.