ORTHOPAEDICS / SPORTS MEDICINE

Our musculoskeletal system is a sophisticated system of various complex structures. We take it for granted that it enables us to move purposefully and withstand physical strains. At least until an injury, sudden pain, or reduced joint mobility limits our quality of life. Such limitations may have many causes. They can be temporary or permanent. Injuries to ligaments, tendons, or muscles do not only affect athletes, but can also be caused by accidents or overstrain in everyday life. Other patients are affected by painful joints or back pain.

For all these so-called soft tissue defects, autologous blood derivatives may be a treatment option to specifically target and support the body‘s own healing mechanisms to alleviate symptoms.

PRP, ACS & CO USE THE BODY’S OWN HEALING IMPULSE

Autologous blood and tissue derivatives, also called orthobiologics, are biological substances used by orthopaedic surgeons to help injuries heal more quickly. They are increasingly used in both orthopaedic and sports medicine settings to promote tissue regeneration and reduce inflammation.

In orthopaedics and sports medicine, orthobiologics are highly valued for their regenerative capabilities and minimal invasiveness when applied as injection therapies: For tendon and ligament injuries, PRP and BMAC are often injected to promote faster, more complete healing. Overuse injuries (e.g., tennis elbow, Achilles tendinopathy) are treated with orthobiologics to reduce inflammation, which may reduce or postpone the need for surgery. Cartilage damage and early osteoarthritis are addressed with orthobiologics with the aim to restore joint health and delay the need for joint replacement.

Beyond injection therapies, in orthopaedic surgery, autologous blood derivatives are applied to enhance fracture healing and bone fusion, especially in spinal surgery, to accelerate recovery in joint reconstructions (e.g., ACL reconstruction) or to improve outcomes in rotator cuff repairs, meniscal repairs, and cartilage regeneration.

Orthobiologics represent an exciting and evolving frontier in both orthopaedics and sports medicine, aiming to harness the body’s natural healing potential. While some applications are well-supported, others remain investigational. The future of orthobiologics lies in:

• Standardization of products
• Stronger clinical evidence
• Integration into personalized treatment plans

Osteoarthritis

Muscolosceletal disorders

Bone injuries

Post – OP

Osteoarthritis

ACS in Joint degeneration

Inflammatory processes play a significant role in the onset and development of osteoarthritis. In degenerative and inflammatory joint diseases, there is an increased release of pro-inflammatory cytokines that damage cartilage in the joint. Cytokines are proteins that regulate cell growth and differentiation. Some cytokines are therefore referred to as growth factors, while others play an important role in immunological reactions. Cytokines are best studied among the mediators of inflammatory processes. Cytokines such as TNF-a, IL-1ß, IL-6, IL-15, IL-17, IL-18 and IL-21 are associated with the pathology of osteoarthritis.1 Even though the connections at the molecular level are still unclear, these cytokines are thought to have a cartilage-destroying effect and a negative influence on cartilage metabolism.2 This can create an imbalance in the joint affected by osteoarthritis: there is an excess of pro-inflammatory cytokines.

Autologous blood derivatives are an evidence-based treatment option for osteoarthritis that has been proven over many years and recommended by leading professional societies.

Still, current treatment approaches for osteoarthritis (OA) only help control the symptoms – to date there is no approved treatment to prevent or stop the progression of the disease. Despite the diversity of osteoarthritis, it is understood that controlling the chronic inflammatory response in the joint as early as possible may be an important component of treatment. It is assumed that various cytokines, such as IL-1 Ra or IL-10, have an inflammation-solving influence on certain aseptic inflammatory processes.3

This is where the autologous blood derivative “Autologous Conditioned Serum (ACS)” comes in. By following a specific ACS preparation protocol at the point-of-care, the release of anti-inflammatory cytokines is stimulated and the serum is also enriched with growth factors.4 ACS is injected into the affected joints or, for example, also into mechanically compressed spinal roots, where it can exert a correspondingly positive effect. The body’s own beneficial proteins can have an inflammation-solving, pain-relieving and cartilage-protecting effect.5, 6

Beyond classic OA in knee and hip, a positive effect of ACS has also been shown for degenerative spinal diseases (e.g. spondylarthrosis, osteochondrosis, spondylosis, degenerative spinal stenosis), nerve compression syndrome (e.g. intervertebral disc protrusion, intervertebral disc prolapse, degenerative neuroforaminal stenosis) and back pain.

(1) Robinson W et al (2016): Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis; Nat Rev Rheumatol. 2016 Oct; 12(10):580-592
(2) Molnar et al (2021): Cytokines and chemokines involved in osteoarthritis pathogenesis, Int J Mol Sci 2021 Aug 26,22 (17):9208
(3) Baltzer A et al (2013): A new treatment for hip osteoarthritis: clinical evidence for the efficacy of autologous conditioned serum; Orthopedic Reviews 2013, 5:e13: 5964
(4) Wehling P et al (2007): Autologes Conditioniertes Serum in der Behandlung orthopädischer Erkrankungen. Biodrugs 2007;21(5):323-332
(5) Tohidnezhad et al (2017): Platelet-Released Growth Factors Modulate the Secretion of Cytokines in Synoviocytes under Inflammatory Joint Disease. Mediators Inflamm:1046438
(6) Baltzer A et al (2009): Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage 2009; 17 (2): 15260

Evidence based and recommended therapy

Based on the present evidence on the use of blood derived products, ESSKA consensus group clearly recommends the use of blood derived products in knee OA in their 2022 ORBIT consensus paper.
https://esskajournals.onlinelibrary.wiley.com/doi/10.1002/ksa.12077

ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) is Europe´s largest association of muscoskeletal specialities.

MUSCOLOSCELETAL DISORDERS

Autologous blood derivatives can help control inflammation and support the healing process in tendons, ligaments, muscles and bones
after acute accidents or surgery.

Tendons, ligaments and muscles injuries

PLATELETS = MEDIATORS OF HEALING RESPONSE
The platelets (thrombocytes) mediate healing processes in the body and are activated in case of injuries. Platelets release growth factors and moderate the first stages of the healing cascade. As part of a PRP platelets can be specifically injected into defective tendon, ligament or muscle tissue.1, 2, 3

OPTIMAL COMPOSITION OF PRP
The composition of PRP should be adapted depending on the type of injury and in particular whether it is acute or chronic. Not all PRP is the same. PRP variants vary in Leukocyte content as well as in platelet concentration. The experienced physician chooses the PRP-variant best suited to treat a specific muscolosceletal condition.

(1) Jeong D et al (2014): Clinical applications of platelet-rich plasma in patellar tendinopathy; Biomed Res Int. 2014: 249498(1)
(2) Ye et al. (2025):Platelet-rich plasma and corticosteroid injection for tendinopathy: a systematic review and meta-analysis; BMC Musculoskeletal Disorders 2025: 26:339
(3) Fitzpatrick J et al (2017): The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. Am J Sports Med. 2017 Jan;45(1):226-233

Bone injuries

Fractures of the long bones as well as post-traumatic complications such as non-healing or delayed healing fractures are regular challenges in clinical practice.1 Bone healing is a unique repair process in which the processes of endochondral and intramembral bone formation follow a very specific time sequence. If these are disrupted, incomplete bone healing can occur.2

A common adjunct in the treatment of bone fractures is the use of platelet-rich plasma (PRP), particularly to prevent complications in bone healing. The platelets (thrombocytes) concentrated in PRP contain a variety of different growth factors that support healing processes and new tissue formation. In addition, PRP contains the proteins fibroconectin, fibrin as well as vitronectin for cellular adhesion and stimulates osteoblastic differentiation. It has been shown that the use of PRP could increase the healing rate without affecting the inflammatory process and without leading to calcification.3

(1) Gomez-Barrena et al (2015): Bone fracture healing: cell therapy in delayed unions and nonunions. Bone. 70:93-101
(2) Einhorn (2015): The science of fracture healing. J Orthop Trauma. 19(10Suppl):4-6
(3) Zhang et al (2013): Research progress in the mechanism of effect of PRP in bone deficiency healing. Sci World J. 2013:134582

POST – OP

ACS may help speed up healing and reduce inflammation after surgery. Pro-inflammatory cytokines play an important role in the inflammatory response to trauma, be it by surgery or injury. Essentially, the cytokines interleukin-1 (IL-1), tumor necrosis factor-A (TNF-a) and IL-6 are released at the local site after surgical interventions.1 The inflammatory response caused by this trauma attack the cartilage tissue in the joint, which is often already damaged. Thus, anti-inflammatory treatments can have a beneficial effect.

Cooling, elevation and the use of painkillers such as NSAR are already effective against the inflammatory reaction. In addition, a few days after the surgical intervention, treatment with inflammation-relieving endogenous proteins can provide a positive counter stimulus and assist in quickly getting the joint out of the acute inflammatory phase. Autologous conditioned serum (ACS) may be an option here to use the body’s own protective proteins to relieve surgery-related inflammatory reaction.

(1) Finnerty et al (2013): The surgically induced stress response. JPEN J Parenter Enternal Nutr. September; 37(5 0): 21S-29S.