Au Naturel: How Orthobiologics Are Reshaping Care

Jaclyn Nordin used to dread mornings.

Not for the obvious reasons—sleep inertia, cortisol surges, misaligned circadian rhythms, or even everyday anxiety—but rather for the pain she felt immediately upon waking.

It didn’t take much to tip off the nociceptors; on most daybreaks, a simple stretch often was enough to dispatch distress signals to her still-groggy brain. “First thing in the morning, I noticed—that first stretch—took my breath away because the pain was so bad,” Nordin recalled in an online video. 

Nordin’s right knee bore the brunt of the pain, a souvenir of her days on the marathon circuit. 

“I started running when I was in middle school, and in high school, I did mostly long-distance running,” she explained. “I started running marathons when I was about 19, and I did a handful of half-marathons too. It’s just what I absolutely loved and enjoyed.”

Loved perhaps a bit too much: all those logged miles stripped the cartilage in Nordin’s knee, leading to patellofemoral arthritis. Sometimes referred to as “runner’s knee,” patellofemoral arthritis occurs when the articular cartilage along the trochlear groove (atop the femur) and on the patella underside wears down and becomes inflamed. It is the second most common kind of knee osteoarthritis, affecting 9% of symptomatic patients older than 40, 13.6% of women, and 15.4% of men older than 60, National Library of Medicine data indicate.

More common in women, patellofemoral arthritis causes pain in the front of the knee, making it difficult for those suffering from the condition to kneel, squat, and climb/descend stairs. 

All those innate movements (stretching, also) grew increasingly difficult for Nordin as she aged. She kept the pain at bay for nearly two decades through steroid and gel injections, but both treatments eventually stopped working, leaving Nordin with few options for relief. 

“It definitely wasn’t doing much for any of the pain I was experiencing, and I was restricted in doing the things that I love to do,” Nordin said. “My knee would feel painful, it would swell…so I started reaching out to some of the best orthopedic surgeons, just looking for a better option than getting a knee replacement at 40 years old.”

Nordin didn’t have to look far for that better option. 

She found it within her own body, in the very blood that coursed through her veins. 

Nordin’s treatment of choice was platelet-rich plasma (PRP), a therapy that has existed for at least four decades, but has gained significant traction in the last 10 or 15 years as patients like Nordin opt for non-surgical remedies for their worn-out joints. 

PRP is an autologous blood product containing a higher concentration of platelets (tiny, plate-shaped cell fragments) compared to whole blood. It is created by separating red blood cells from platelets through centrifugation. 

Although platelets are mainly responsible for stopping bleeding, they also contain growth factors and proteins that can induce cell reproduction and promote tissue regeneration. PRP also enhances collagen synthesis as well as bone and vessel remodeling for treating injured tendons, ligaments, muscles, and cartilage.

On its own, PMP is an effective treatment for mild injuries. But in more severe cases—like Nordin’s—PRP is used with bone marrow aspirate concentrate (containing bone marrow stem cells) to repair musculoskeletal damage. 

“I was pretty desperate and having a lot of pain,” Nordin stated. “I knew that I wanted a less invasive procedure, and when I found out that it was stem cells that were coming from my own body and being injected into my knee, I was willing to give it a shot to see if it worked.”

It did. It worked so well, in fact, that Nordin no longer has any pain or physical restrictions. 

“The simplest way [to heal arthritis] is by using your blood,” noted Jonathan Buchanan, M.D., a South Dakota-based sports medicine specialist who treated Nordin’s knee osteoarthritis. “The traditional orthopedic model is you do injections until it stops working, and then you replace the joint or do the surgery. But there’s more we can do than just steroids and surgery. I want to make sure people know there are other options out there, and for people to have respect for the cells God has given us and be able to use those to get rid of pain.”

Such respect appears to be growing, if market data are any indication. Grand View Research projects the global PRP market to more than double over the next seven years, going from $650.1 million last year to $1.75 billion in 2033 as sports participation increases (yielding more injuries) and cosmetic surgery steadily gains popularity.

Some of the same factors (sports injuries, mostly) are shaping the wider orthobiologics market during that same time frame. Worth $6.77 billion globally in 2024, the sector is expected to swell 4.7% annually over the next seven years to reach an estimated $10.34 billion by 2033, according to Grand View Research. Fueling that growth is an aging world population, escalating demand for minimally invasive treatments, rising rates of sports injuries and road traffic accidents, and an increase in bone-related diseases. 

“The way I see it,” Dr. Buchanan remarked, “orthobiologics is really the future of medicine.”

To peek into that future as well as understand the market forces impacting its fate, Orthopedic Design & Technology spoke to several orthobiologics experts over the past few weeks. Input came from:

• Husnu Ceylan, president/CEO of HC Biologics LLC
• Benjamin Holmes, CEO of Nanochon
• Orahn Preiss-Bloom, founder/chief innovation officer of OSSIO Inc.
• Michael Veldman, global strategic marketing manager of Invibio Biomaterial Solutions

Michael Barbella: What is driving current growth in the global orthobiologics market?

Husnu Ceylan: Growth in the orthobiologics market is being driven by a convergence of demographic, clinical, and structural factors. At a fundamental level, aging populations and the rising incidence of musculoskeletal disorders are increasing procedural volumes globally—particularly in spine, trauma, and joint reconstruction. However, the more meaningful shift is clinical: surgeons are no longer focused solely on mechanical stabilization. There is a clear and accelerating demand for biologic solutions that enhance healing, improve fusion rates, and support long-term functional outcomes.

At the same time, the scope of orthobiologics has expanded significantly. What was once considered a niche category is now embedded across multiple specialties, including spine, trauma, sports medicine, oncology-related reconstruction, and complex limb salvage procedures. This broader clinical integration is a key driver of sustained market growth.

From a structural standpoint, access is also expanding. Companies with established global infrastructure are enabling the distribution of high-quality biologics into regions that historically had limited availability. This is accelerating adoption beyond traditional markets and contributing to a more globally balanced demand profile.

Equally important is how orthobiologics are being applied. They are increasingly incorporated into coordinated surgical strategies, where multiple elements are combined within a single procedure—for example:

• Demineralized bone matrix (DBM) with structural grafts and fixation systems
• Soft tissue matrices integrated with PRP or extracellular matrix (ECM) scaffolds

This shift is redefining how value is created in the operating room. At HC Biologics, it has driven a strategic transition from individual product offerings toward procedure-based solutions, where biologics are integrated with implants, delivery systems, and adjunct technologies to support more predictable clinical outcomes. Ultimately, growth in this market is not just about increasing volumes—it is about the evolution of surgical thinking, where biology is becoming an essential component of standard orthopedic and spine care.

Benjamin Holmes: Several key factors, that interplay with each other. Simultaneously, there has been a rapidly aging population, a rise in incidences of sports and trauma injuries, and a need for solutions as patients demand minimally invasive options. In order to maximize treatments to address these factors, new and innovative regenerative and restorative technologies must be developed and commercialized. 

Orahn Preiss-Bloom: 1. Demand from patients to continue an active lifecycle even as they age by pursuing minimally invasive and natural solutions to reduce orthopedic pain and restore mobility.

2. Increased understanding by orthopedic surgeons of the benefits that they can offer their patients through improved biology to augment and complement traditional orthopedic repair principles.

3. Increased willingness of payors to reimburse orthobiologics to achieve improved patient results and reduce long-term complications.

Michael Veldman: Current growth in the global orthobiologics market is being driven primarily by the rising prevalence of musculoskeletal and spinal disorders, including degenerative disc disease, osteoarthritis, fractures, and traumatic injuries, particularly in aging populations who want to maintain an active, high-quality of life for as long as possible. Interestingly, from a market perspective, the orthobiologics market is very fragmented compared to other ortho markets. The top four ortho recon companies have over 70% market share, in trauma, the top five OEMs have almost 80% market share, for sports medicine, the top four OEMs have 80% share, and in spine, the top five OEMs have over 60% share. By contrast, the orthobiologics market is very fragmented, with no single OEM with more than 10% market share. That seems to indicate that there is a lack of consensus around what works best for orthobiologics, or at least around the cost-benefit of this product category. 

Barbella: What recent innovations have most impacted your operations/business, and in what ways?

Ceylan: Three areas have had the most meaningful impact on our operations and on the broader orthobiologics field.

1. Procedural integration: The role of orthobiologics has evolved significantly. Rather than being used in isolation, they are now applied as part of a coordinated, multi-component surgical approach. In practice, this means combining biologics with complementary technologies within a single procedure—for example:

• Demineralized bone matrix (DBM) alongside structural grafts and fixation systems
• Soft tissue matrices integrated with PRP or extracellular matrix (ECM) scaffolds
• Biologics supported by hemostatic agents to improve intraoperative efficiency

This shift has redefined how surgeons approach treatment planning. At HC Biologics, it has driven a strategic focus on procedure-based solutions, where multiple technologies are aligned to improve both surgical workflow and clinical outcomes.

2. Advanced processing and sterilization technologies: Processing innovation has become one of the most critical differentiators in orthobiologics. Through our collaboration with LifeLink Tissue Bank, proprietary Allowash technology enables deep cleansing, disinfection, and processing of allograft tissue—removing over 99% of bone marrow elements and lipids. This significantly enhances safety while reducing the risk of disease transmission. Combined with strict donor screening, ISO Class 5 cleanrooms, and targeted antibiotic treatments, this ensures highly controlled, high-quality musculoskeletal and birth tissue products. In parallel, through our partnership with Precision Allograft Solutions, innovations such as supercritical CO₂ (SCCO₂) processing (PASCO2) are redefining expectations around tissue preservation. These technologies preserve biomechanical strength and elasticity, maintain natural tissue structure and biocompatibility, and achieve high sterility assurance levels without compromising integrity. In addition, we offer a range of sterilization approaches tailored to clinical preference, including low-dose gamma irradiation, electron beam (e-beam) sterilization, and fully aseptic processing.

This flexibility is increasingly important, as top surgeons globally are becoming more selective about how tissues are processed and preserved.

3. Format optimization and surgical efficiency: Another important area of innovation is product format and usability. Surgeons today expect solutions that are not only biologically effective but also operationally efficient. This has led to increased demand for ready-to-use, application-specific formats, such as:

• DBM (Demineralized Bone Matrix) in multiple configurations (putty, gel, fiber, crunch)
• Pre-shaped tendon allografts for ligament reconstruction
• Structural grafts tailored for specific anatomical defects

These formats reduce operating room time, simplify preparation, and improve consistency across procedures.

Holmes: I think the most relevant is the approval of Agili-C, an off-the-shelf device for treating cartilage defects in the knee. We view it as a competitor, a new product, but also a legacy innovation that Nanochon improves upon, but also an established path to success for a regenerative implant device in the cartilage space, both in terms of clinical trials and FDA approval success, and post-market success by securing a new category I code. It gives us both a benchmark for performance and a path to success where there was not one previously.

Preiss-Bloom: OSSIO’s success in orthopedics is driven by innovations in two arenas:

Material science and engineering. Specifically, the OSSIOfiber technology that allows OSSIO to create strong orthopedic implants out of reinforcing fibers constructed from minerals that are present in native bone.

Minimally invasive and joint-preserving orthopedic surgery. Recent advances in surgical technique create the possibility of orthopedic repair that preserves the patient’s natural physiology. The benefit of orthobiologic implants—such as OSSIOfiber—are complementary to these surgical approaches since they can improve healing rather than impede healing.

Veldman: At Invibio, we’ve seen an increased interest in porous PEEK technology, specifically our HA Enhanced Porous PEEK. The 3D-printed titanium market is saturated with every company promoting their own lattice structure or special pore size. But a Clinical Spine Surgery publication from 2025 reported higher subsidence rates with 3D titanium (51.5%) vs. PEEK (45.5%) with equivalent fusion rates in both groups for single-level TLIF. 3D-printed porous HA PEEK offers bone-like modulus and superior imaging properties vs. 3D-printed metals that are radiopaque on X-ray and result in imaging artifacts on CT.

Barbella: How are advanced manufacturing technologies and synthetic materials impacting orthobiologic product performance and biological response?

Ceylan: Advanced manufacturing technologies are significantly improving precision, reproducibility, and scalability across the orthobiologics field. These advancements allow for tighter control over material composition, structure, and processing conditions—ultimately leading to more consistent clinical performance. Synthetic materials have played an important role in this progress. They offer advantages such as controlled architecture and porosity, predictable mechanical properties, and high manufacturing consistency. 

These characteristics are particularly valuable in applications where structural reliability and reproducibility are critical. However, biological response remains highly dependent on the origin and processing of the material. Human allografts continue to offer distinct advantages due to their native biological composition, including natural extracellular matrix, collagen framework and endogenous growth factors, and proven osteoconductive and osteoinductive potential.

For this reason, our primary focus at HC Biologics remains firmly centered on human-based grafting materials, where we see the strongest clinical alignment and long-term value for surgeons and patients. At the same time, we recognize that the field is evolving. As part of our ongoing R&D efforts, we are also exploring ways to combine the strengths of biologic and synthetic materials. This includes the development of next-generation composite grafts that integrate:

• Demineralized Bone Matrix (DBM) for biological signaling
• Synthetic bioactive ceramic 45S5 Bioglass for enhanced osteostimulation
• Nano-crystalline hydroxyapatite for structural support and controlled remodeling

The objective is not to replace biologics, but to enhance them—leveraging synthetic components where they add value while preserving the biological advantages of human tissue. The future of orthobiologics is therefore not binary. It lies in thoughtful integration, where biologic integrity remains the foundation, complemented by engineered materials that improve structure, delivery, and consistency. Companies that can successfully balance these elements—without compromising biological performance—will be best positioned to lead the next phase of innovation in this field.

Holmes: The combination of next-generation synthetics, married with advanced manufacturing, can precisely target and mimic natural properties (pore size and distribution, mechanical properties, surface topographies) that efficiently guide positive biological responses. At the same time, this precise control of implant design also offers manufacturing control and true scale, which has plagued the world of naturally derived biologics and materials for decades. It means a product like Chondrograft can be manufactured in mass at a much lower cost, and have predictable and repeatable clinical results when used. 

Preiss-Bloom: OSSIO is able to manufacture orthobiologic implants with engineering properties customized for each particular orthopedic indication that also have a predictable biological response. This is achieved through advanced manufacturing technology that can take a single biomaterial composition (i.e. predictable biological response) but manufacture it into a wide variety of implant geometries and structures by shifting internal mineral fiber structure at the micrometer level.

Veldman: Advanced manufacturing technologies like 3D printing are reshaping orthobiologic performance in spinal fusion by enabling implants with engineered porosity and optimized mechanics that actively influence the biological response. In additively manufactured spinal fusion cages—particularly porous PEEK—pore structures support bone in-growth, improve load sharing, and promote more natural graft remodeling. When combined with advanced synthetic materials, such as PEEK reinforced with osteoconductive hydroxyapatite, these cages create a more favorable environment for protein adsorption, cell attachment, and sustained bone formation. Rather than relying solely on high-dose biologics, this approach shifts biological performance toward a structure-driven response, where implant design, material properties, and surface chemistry all work in concert to support reliable spinal fusion. Unlike porous metals, with porous PEEK you can actually see the bone grow into the cage surface on CT and radiograph.

Barbella: What breakthroughs could significantly change the field in the next several years?

Ceylan: Several developments are likely to define the next phase of orthobiologics, with a clear shift toward greater precision, personalization, and accountability. One of the most important advancements will be increased biologic specificity. The field is moving away from broadly positioned products toward solutions tailored to specific indications, patient profiles, and biological objectives. This includes a more refined understanding of factors such as bone quality, defect size, underlying health conditions, and surgical context—enabling more patient-specific orthobiologic strategies rather than one-size-fits-all approaches.

Another key area is the continued evolution of hybrid and composite materials, where biologic and engineered components are combined to better balance structural support and biological activity. These approaches allow for more controlled and targeted healing environments, particularly in complex or high-risk cases.

Equally important is the role of data. As the field matures, data-driven validation will become a central driver of adoption. This includes stronger clinical evidence, real-world outcome data, and more structured decision-making frameworks for surgeons. These factors will increasingly influence not only clinical preference but also reimbursement, standard-of-care development, and institutional purchasing decisions.

Ultimately, the next wave of innovation in orthobiologics will not be defined solely by new materials but by how effectively companies can align biological science, patient-specific application, and data-driven validation. Organizations that can integrate these elements into consistent and clinically meaningful solutions will be best positioned to lead the field.

Holmes: Continued work to show that synthetic biomimetic materials, synthetically produced molecules, and growth factor analogues, and mass-produced stem cell-based products hold the key to unlocking the long-standing issues of reproducibility and scale in the orthobiologic industry. The ability to create highly effective products with superior and repeatable clinical results, but that are cheaper, easier to distribute, and easier for clinicians to adopt and use, will no doubt set new clinical standards in many indications across the industry. 

Preiss-Bloom: The breakthrough is already happening. The combination of AI-powered early injury detection, advancements in orthobiologic material science, and the robotic optimization of minimally invasive surgical techniques will allow us to keep patients highly active and hardware-free well into their golden years. Already within this decade, we will see the patient age at joint arthroplasty trend later and later as patients are able to preserve their natural joints longer. The Kneebar procedure using OSSIOfiber trimmable nails is a great example of this. 

Veldman: There will always be a need for balance between implants that provide biomechanical structure and biologics that provide biological response. Currently, the osteobiologics market and the implantable device market are working in silos with little collaboration on what the ideal solution might look like. Orthobiologics are positioned to work with any implant, while 3D porous implants are positioned to work with any biologic solution. The truth lies somewhere in the middle. The ideal balance between porous structure, surface chemistry, and interaction with biologics and bone graft substitutes has yet to be determined. The company that generates compelling evidence to address the total solution will be well-positioned for future growth. I’m optimistic about the potential for regenerative biologics, but the timeframe for those solutions may not fall under the definition of “next several years.”