Orthobiologics: Current Evidence and What Lies Beyond the Horizon?

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.