While tennis star Rafael Nadal has achieved what many athletes won’t in a lifetime, he’s also experienced a fair share of injuries — and treatments for said injuries. For instance, after a 2016 injury, he received platelet-rich plasma therapy (PRP), a nonsurgical treatment that falls under the umbrella of orthobiologic treatments.
Orthobiologic procedures use substances naturally found in your body, like plasma, to repair broken bones, torn ligaments and injured muscles more quickly. These treatments aren’t just for elite competitors. They’re becoming increasingly popular among recreational athletes and everyday patients seeking treatment for everything from arthritis to tennis elbow.
Currently, musculoskeletal diseases are rampant in adults — around one in every two adults experience them. And according to the Centers for Disease Control and Prevention, osteoarthritis affects 32.5 million U.S. adults. That’s a deep well of patients whose pain affects their everyday lives and recreational pursuits. Many medical providers remain skeptical about the actual benefits of orthobiologic treatments. There’s no question that more research is needed in the area.
But at the moment, based on early evidence, many medical experts have embraced them and the American Academy of Orthopaedic Surgeons says the treatments “have promise.”
“Orthobiologics are largely the most exciting advancement of orthopedic surgery, particularly the sports medicine domain, of the last decade and the upcoming decade,” says Dr. Bryan Saltzman of OrthoCarolina. “We have gotten so technically good at what we do as ‘carpenters’ of the body, but what we are still working to improve on is how to optimize a patient’s biology and healing response.”
When Douglas Jantz, a 57-year-old Houstonian and tennis enthusiast, received his osteoarthritis diagnosis following surgery to repair a partial ACL tear, he was worried he’d have to give up his favorite sport. After volleying cortisone shots and physical therapy for two years with no improvement, he eagerly agreed to PRP injections when his physician suggested them. Since 2018, he’s received four treatments in each knee.
After his first three injections, he felt well enough to rejoin his tennis league. “I have lost a step, and I have learned to be careful not to try to turn sharply, but most days, I can play without feeling much pain,” he says. He experiences some next-day pain, but adds, “This pain is no worse than what I typically would have experienced 20 years ago, prior to the injury.”
Although there’s no official tally of how many procedures orthopedic doctors perform a year, Colorado-based Dr. Christopher J. Centeno of the Centeno Schultz Clinic estimates them in the tens of thousands. Below we’ve explained everything you need to know about them.
How do orthobiologics treat injuries?
Orthobiologics deploy the body’s own healing systems, including anti-inflammatory mediators, growth factors and adult stem cells, to enhance recovery. These procedures qualify as regenerative medicine because they heal and repair, rather than mask symptoms like steroid shots, which have long been orthopedists’ go-to nonsurgical solution.
What are the most common types?
The most common therapy is platelet-rich plasma. In this procedure, the patient’s plasma is spun in a centrifuge to concentrate the platelets, and PRP is then injected at the injury site to trigger soft tissue revival. Orthopedic doctors can employ PRP as a stand-alone injection for ailments such as osteoarthritis, tennis elbow or jumper’s knee, and muscle, tendon and ligament injuries.
Bone marrow aspirate concentrate (BMAC) follows PRP in popularity. Usually pulled from the pelvic bone, BMAC can help decrease inflammation, and can be used to ease rotator cuff tears or conditions like osteoarthritis.
Why is this type of injury treatment growing in popularity?
With orthobiologics, some patients can skip the operating room entirely, especially when used in conjunction with physical therapy. “The lack of invasive surgery aligns with the patient’s interest. No one wants to hear, ‘I’m going to amputate your joint and insert a prosthesis,’” Centeno says.
Although patients may have to wait to realize the treatments’ full effects, orthobiologics can pay long-term dividends. “The response to injection in these pathologies is more delayed than a cortisone injection tends to be; I tell my patients it may be weeks before they see any effect,” says Saltzman. “But the duration of relief can last for months to years, based on anecdotal experience and published studies on the topics.”
If used in conjunction with surgery, the injections may reduce healing time, and patients experience lower failure rates and report better overall outcomes, Dr. Saltzman says. This improved recovery can get athletes back on the court or field faster, which is especially important when time is of the essence, he adds.
Does insurance cover these treatments?
Many insurance companies still consider orthobiologic treatments experimental and most don’t cover them. (TriCare, which insures active-duty and retired military service members, recently expanded coverage to include platelet rich plasma.)
As the research is still growing surrounding these treatments, Doctors prescribe a hefty dose of homework prior to committing to a provider or a course of treatment. You may want to look for someone with a special certification in the therapies. For instance, the Interventional Orthobiologics Foundation offers an American Medical Association–approved certification in these regenerative treatments. “If it’s too good to be true, it probably is — especially if it costs $10,000,” Centeno says.