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Semin Musculoskelet Radiol 2026; 30(01): 014-027
DOI: 10.1055/a-2724-9777
Review Article

Orthobiologics: Current Evidence and What Lies Beyond the Horizon?

Authors

  • Prableen Kaur Chatha 

    1   Jaipur Institute of Pain and Sports Injuries (JIPSI), Jaipur, Rajasthan, India

  • Saavi Reddy Pellakuru

    2   Department of Radiology, Apollo Institute of Medical Sciences and Research, Hyderabad, India

  • Rajesh Botchu

    3   Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom

  • Rajesh Sasidharan

    4   Department of Interventional Radiology, Rajagiri Hospital, Kochi, Kerala, India

  • Amit Thakur

    1   Jaipur Institute of Pain and Sports Injuries (JIPSI), Jaipur, Rajasthan, India

  • Shashank Chapala

    5   Department of Radiology, AIG Hospital, Hyderabad, India

  • Prashant Sarda

    6   Department of Radiodiagnosis, SGRR Medical College and Hospital, Dehradun, Uttarakhand, India

  • Meemansa Jindal

    1   Jaipur Institute of Pain and Sports Injuries (JIPSI), Jaipur, Rajasthan, India

  • Gaurav Kant Sharma 

    1   Jaipur Institute of Pain and Sports Injuries (JIPSI), Jaipur, Rajasthan, India
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Abstract

Orthobiologics, a subset of regenerative medicine, involves autologous or allogeneic cells and bioactive molecules to promote musculoskeletal tissue repair and regeneration. This review examines the evolution, clinical applications, limitations, and future directions of orthobiologic therapies. Modalities such as mesenchymal stromal cells, platelet-rich plasma, extracellular vesicles, and growth factors have shown promise in managing tendinopathy, partial tears of ligaments and tendons, osteoarthritis, avascular necrosis, and other soft tissue injuries. These therapies can modulate inflammation, enhance healing, and potentially delay disease progression.

However, clinical translation is hindered by donor variability, lack of preparation and procedural standardization, safety concerns with stem cell use, inconsistent evidence, and the absence of consensus guidelines. The unregulated market has also led to widespread use of unproven biologics. Future integration into core clinical practice requires standardized protocols, regulatory oversight, and robust clinical trials. Advances in gene therapy and endogenous stem cell mobilization may further enhance therapeutic outcomes and position orthobiologics as a key component of joint preservation and regenerative musculoskeletal care.

Keywords

orthobiologics - regenerative medicine - mesenchymal stromal cells - platelet-rich plasma - musculoskeletal tissue repair

Data Availability Statement

The data supporting the images in this review article are available upon request from the corresponding author.




Publication History

Received: 31 July 2025

Accepted: 09 October 2025

Article published online:
20 February 2026

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