Introduction to Orthobiologics

Many of my patients ask me about orthobiologic therapies. Most have heard about these innovative treatments, but few know much about them. That is the reason I’ve launched this new blog series, to not only to help people understand what orthobiologics are, but also the various kinds of orthobiologic treatments that are available. 

Simply put, orthobiologic therapies are a modern approach to treating musculoskeletal pain. They have proven effective for a great number of patients, particularly when it comes to managing pain and reducing inflammation. Orthobiologic therapies use a patient’s own cells to stimulate natural healing and can be a powerful alternative to traditional treatments.

Orthobiologic treatments are minimally invasive. They can be performed with local anesthetics during office visits and can take as little as a few minutes. Among the most common treatments are:

• Platelet-rich plasma (PRP) treatments. PRP is a substance obtained from the blood. A small amount of blood is drawn and processed in a centrifuge, which separates and purifies the platelets. These platelets contain growth factors that help promote tissue repair and healing. PRP injections are used to treat conditions like tendinitis and sports-related injuries.

• Bone marrow-derived stem cells. For patients with arthritic conditions where joint cartilage has degenerated, bone marrow-derived stem cells can be very effective. The bone marrow is taken from the pelvis using a needle, and the stem cells in the marrow are harvested and purified in a centrifuge. Stem cells can be used to regenerate damaged tissues and reduce inflammation, potentially slowing the progression of arthritis.

• Fat tissue. Fat cells can be an effective treatment for conditions like osteoarthritis, cartilage damage, and soft tissue injuries. The fat cells are obtained from the patient’s flank using a minimally invasive method. Once collected, the fat is purified and combined with platelets to encourage healing.

• Many patients ask how orthobiologic treatments differ from steroid injections. The answer is that unlike steroid injections, which can provide short-term pain relief, orthobiologic treatments do not contribute to tissue breakdown. In fact they do the opposite, reducing pain while working to promote healing and regenerate tissue, including tendons and ligaments.

This regenerative process can delay surgery, or in some instances even provide an alternative for surgery. Orthobiologic treatments also have a high success rate, providing long-lasting relief and improved function.

For more information on specific applications of orthobiologic technology, see my other blog posts.

Orthobiologic Treatment for Pain Relief

Musculoskeletal pain is something that a great number of people experience, and for that reason is an ongoing area of interest for many of my patients. A frequent question is: what’s the most effective treatment for my particular pain issue and how long will it last?

There is no straightforward answer to this question since different patients respond differently to the same therapies. This is as true for orthobiologic treatments as it is for conventional treatments. What can be said, however, is that the benefits of orthobiologic treatments can be every bit — or even more — effictive than standard treatments when it comes to reducing pain, improving function, and delaying or avoiding surgery. 

But let’s take a quick look at orthobiologic treatments for pain and the typical duration of results.

• Platelet-Rich Plasma (PRP) Injections. Typically used to support healing and regeneration after traumas like tendon or joint injuries, the pain-relieving benefits of PRP injections typically last for six to twelve months, though some patients can experience relief for up to 2 years after a series of treatments.

• Bone marrow stem cell therapy. Results of this type of therapy, especially for arthritic conditions, can be highly effective with pain relief lasting from one to five years depending on the severity of the condition and how well the body responds. Some patients can experience long-term relief, while others may require repeat treatments.

• Hyaluronic acid (HA) injections. Hyaluronic acid injections are an increasingly common treatment for osteoarthritis of the knee. They typically provide pain relief for between three and twelve months, though are most effective for mild to moderate osteoarthritis. In more severe cases repeat treatments may be necessary.

All of which raises the question: how do these treatments compare to a conventional pain relief therapy like cortisone injections? The answer is that orthobiologic treatments, when successful, can last a good deal longer than cortisone injections, which typically provide relief for anywhere from a few weeks to a few months (effects of course will vary depending on the severity of the inflammation and the patient’s response).

A critical differentiator, however, is that while cortisone use eventually leads to diminished benefits — and can potentially lead to tissue breakdown — orthobiologic treatments do not. In fact, orthobiologic treatments often have regenerative effects on tissue.

All of which means that orthobiologic treatment should be a serious consideration depending on the nature of your condition or injury. For more on orthobiologic treatments and their effects on specific conditions, look at my other posts!

Orthobiologics: A Track Record of Success

One question that often comes up in discussions about orthobiologic treatments is: what is the track record of these treatments? Are they a new thing? Are they experimental?

The answer is that while it may seem as though orthobiologic treatments are new, they’ve actually been around for quite a while. Treatments like platelet-rich-plasma (PRP) injections have been used in clinical practices for decades, where they have proved their effectiveness in treating a range of musculoskeletal conditions.

As I’ve discussed in other posts, PRP is a substance that’s derived from a patient’s own blood. It contains a high concentration of platelets, which release growth factors that promote tissue healing, reduce inflammation, and enhance cell proliferation. As demand for non-surgical and minimally invasive therapies as grown in recent years, PRP has emerged as a promising option. But let’s take a look at some of the research.

PRP for Osteoarthritis

One of the most studied applications of PRP is in the management of knee osteoarthritis (OA). Several randomized controlled trials (RCTs) and meta-analyses support its effectiveness.

For example, a 2021 meta-analysis in The American Journal of Sports Medicine found that PRP injections provided significant pain relief and functional improvement in knee OA compared to both hyaluronic acid and placebo treatments.

A further study in Arthroscopy: The Journal of Arthroscopic & Related Surgery in 2020 demonstrated that PRP injections delivered greater long-term pain reduction and functional improvement compared to corticosteroids.

Also, a systematic review in The Journal of Bone and Joint Surgery in 2022 indicated that PRP may delay the need for knee replacement surgery in patients with mild-to-moderate OA.

PRP for Tendon and Ligament Injuries

Tendon and ligament injuries are notoriously slow to heal due to limited blood supply. Even in these cases, PRP has shown promise in enhancing recovery.

A 2020 study in JAMA reported that PRP injections improved pain and function in tennis elbow (chronic lateral epicondylitis), outperforming placebo treatments. Research in The American Journal of Sports Medicine in 2019 further found that PRP accelerated healing in Achilles tendinitis, delivering better collagen organization and improved structural integrity.

Further, a randomized controlled trial in The Orthopaedic Journal of Sports Medicine in 2021 demonstrated that PRP was beneficial in treating partial anterior cruciate ligament (ACL) tears, reducing recovery time and improving ligament strength.

PRP for Muscle Injuries

Athletes and other active individuals frequently seek PRP therapies when they experience muscle strains and tears. A 2021 British Journal of Sports Medicine study found that PRP injections in hamstring injuries reduced return-to-play time compared to conventional rehabilitation.

A systematic review in Sports Medicine in 2022 concluded that PRP therapies improved muscle regeneration in acute injuries (but also noted some variability in outcomes depending on the PRP preparation techniques that were used). Some evidence also suggests PRP may reduce re-injury rates, as seen in a 2023 Clinical Journal of Sport Medicine trial that examined recurrent quadriceps strains.

PRP Compared to Other Treatments

When compared to traditional treatments like corticosteroids and hyaluronic acid, PRP shows superior long-term outcomes. Unlike corticosteroids which provide short-term symptom relief but may weaken tissue over time, PRP supports both tissue healing and regeneration.

PRP frequently provides longer-lasting benefits than hyaluronic acid in knee osteoarthritis in head-to-head trials. Compared to physical therapy alone, PRP may enhance recovery speed in certain musculoskeletal conditions, though it’s often used in conjunction with rehabilitation programs.

All of which is to say that the evidence is in: clinical studies clearly support the effectiveness orthobiologic treatments when it comes to promoting healing and reducing pain. And in fact they often outperform traditional treatments, particularly in long-term outcomes.

Research will of course continue, however PRP will almost certainly play an increasingly important role in regenerative medicine, offering patients an alternative to surgery and chronic pain management. For more on orthobiologic treatments and their effects on specific conditions, look at my other posts!

Orthobiologics vs. Surgery for Tennis Elbow

So how do orthobiologics compare to traditional treatments for common conditions or injuries? To answer that question it’s often helpful to look at some examples, in this instance a typical scenario involving a 45-year-old male patient named John who was suffering from tennis elbow (lateral epicondylitis).

When John came to see me he was frustrated. Despite multiple conventional treatments — which included bracing, massage, physical therapy, and corticosteroid injections — he had seen little relief from his symptoms. In cases like John’s, there are two options. One is traditional surgery, which follows these general steps:

1. The patient receives a local anesthetic to numb the area.
2. A small incision is made over the lateral elbow.
3. The damaged tendon attachment is surgically treated — either by removing the degenerative tissue, by thermal treatment, or, in some cases, removal of a small amount of bone.
4. The incision is then closed, and the elbow is immobilized in a splint for 10–14 days.
5. Following removal of the splint, the patient undergoes physical therapy to restore strength and mobility.

Full recovery from this procedure generally takes about twelve weeks.  While this approach has been proven effective, the downsides are obvious. The procedure itself is invasive (presenting risks like infection, scarring and stiffness), and the process is time-intensive, requiring structured rehabilitation that can take up to twelve weeks.

Now let’s compare that to the orthobiologic approach. In this case, instead of conventional invasive surgery, the treatment consists of a minimally invasive process that uses the body’s own mechanisms to spur healing and tissue regeneration. A typical treatment for tennis elbow proceeds like this:

1. A small amount of fat is harvested from John’s flank through a tiny incision, collecting the fat in a syringe.
2. 60cc’s of blood is drawn and processed in a centrifuge to concentrate platelet-rich plasma (PRP).
3. Using ultrasound guidance, the damaged elbow tendon is precisely identified.
4. A combination of the patient’s own fat and platelet rich plasma (PRP) is injected directly into the affected area to stimulate healing.
5. The patient returns home the same day with minimal restrictions.

Recovery from this procedure is very different relative to the conventional approach. While there is typically some short-lived soreness (lasting up to 72 hours), there are no stitches or bandages, and no splint is required.

Instead of waiting up to twelve weeks, most patients begin noticing improvements at around four weeks and can return to full activity within about six weeks as symptoms allow. The approach boasts a success rate of 90% or greater success rate, and better still it promotes true tendon regeneration and healing versus tissue removal through surgery.

In this instance, the choice is clears. Compared to the traditional surgical approach, orthobiologic treatment offers several key benefits:

• It’s minimally invasive. No large incisions or prolonged downtime.

• It provides faster recovery. The patient returns to activity sooner, with little to no physical therapy.

• It fosters natural healing. The damaged tendon is repaired, not removed or thermally treated.

• It reduces risk. Surgical complications such as infection, scarring, and stiffness are avoided.

No surprise then that John ultimately chose orthobiologic treatment, which provided not only a highly effective alternative to surgery, but an excellent outcome with fewer risks and a quicker return to daily activities.

For more on orthobiologic treatments and their effects on specific conditions, look at my other posts!