Orthobiologics for hand and wrist disorders: An indication-specific systematic review and evidence-gap synthesis

Orthobiologics are increasingly used in hand and wrist disorders; however, their clinical effectiveness remains uncertain due to heterogeneity in indications, formulations, and outcome reporting.

This systematic review was reported in accordance with PRISMA 2020 and prospectively registered in PROSPERO (CRD420261359867). PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science were searched from inception through March 31, 2026. Primary clinical studies evaluating locally delivered orthobiologics for hand or wrist disorders were eligible. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for nonrandomized comparative studies and the Joanna Briggs Institute checklist for uncontrolled case series; certainty was evaluated using GRADE. Because the studies differed substantially in indication, biologic formulation, comparator, follow-up, and outcome definition, meta-analysis was not clinically appropriate; a structured qualitative synthesis was performed.

Ten primary clinical studies were included: three studies of carpal tunnel syndrome, one of de Quervain tenosynovitis, three of trapeziometacarpal osteoarthritis, one of distal-radius fracture, and two of scaphoid nonunion. No meta-analysis was performed. Evidence for carpal tunnel syndrome was inconsistent across comparators and follow-up durations. In de Quervain tenosynovitis, PRP produced outcomes comparable to corticosteroid injection, with fewer reported local adverse effects. Evidence for trapeziometacarpal osteoarthritis was limited and comparator-dependent. In scaphoid nonunion, the primary BMP studies suggested possible osteoinductive benefit but also identified complications, including heterotopic ossification, persistent nonunion, and reoperation. Overall certainty ranged from moderate to very low.

Orthobiologic effectiveness for hand and wrist disorders appears indication-specific but is supported by limited and heterogeneous evidence. Routine PRP use in osteoarthritis is not supported, and application in other conditions should remain selective and context-dependent. Larger, adequately powered, placebo-controlled trials with standardized biologic characterization and outcome reporting are required. These findings should be interpreted as an evidence-gap map rather than proof of comparative efficacy.

Level IV (systematic review of predominantly small randomized and nonrandomized studies with heterogeneous designs and limited sample sizes).