Orthobiologic agents are a broad and diverse class of treatments derived from biological sources that are utilized to positively affect musculoskeletal tissue healing.1, 2, 3 These agents are currently under investigation or used clinically for the treatment of a wide range of musculoskeletal pathologies.1,4,5 The current application of orthobiologic treatments is for the nonoperative treatment of musculoskeletal pathologies and the augmentation of surgical treatment by addressing biologic deficiencies at the cellular or molecular level in the respective disease or tissue healing process. Presently, orthobiologic agents are classified as being ‘symptom-modifying’ rather than ‘structure-modifying’ treatments, as they may improve function or reduce pain, but a lack of evidence exists to prove they regenerate tissue in humans.6

Academic interest and utilization of orthobiologics have grown substantially in recent years. In orthopaedic sports medicine, a survey by Noback et al. reported that 66% of respondents from the American Orthopaedic Society for Sports Medicine (AOSSM) utilized orthobiologics, with the majority indicating an intention to further increase their use.5 Similarly, a systematic review of literature conducted by Obana et al. demonstrated a rising trend in publications related to well-established orthobiologic treatments across several major orthopaedic journals over 11 years beginning in 2009.7 Despite this enthusiasm, numerous challenges currently exist in the investigation and clinical application for orthobiologic treatments. Commonly identified challenges to the application of orthobiologic treatments include the inconsistent use of terminology and use of misleading nomenclature, inconsistencies in the techniques reported in existing basic science and translational research studies that create difficulty in the understanding of clinical outcomes, wide variabilities in the composition and biologic properties of orthobiologic agents, and a limited understanding of how to best match the appropriate orthobiologic agent with the specific tissue or pathology being treated.8,9 Furthermore, existential barriers to the use of orthobiologic agents are present, specifically with regard to regulatory processes and the cost of use, as many orthobiologic treatments are not covered by commercial insurance.10

This review article seeks to provide a summary review of currently available and commonly utilized orthobiologic treatments. Additionally, a description of clinical recommendations for these agents based on existing and emerging evidence is also provided. Future directions and technologies in orthobiologics are also provided, given the evolving status of these therapies.