Regenerative medicine now sits in a complicated place in orthopedic care.
Patients ask about it routinely. Clinics promote it aggressively. Stories of injections replacing surgery circulate widely online. Platelet-rich plasma and stem cell-based therapies have become part of the orthopedic conversation, even as the evidence base remains uneven.
Drew Lansdown, MD, an orthopedic surgeon and sports medicine physician at UCSF Health in San Francisco, said the field is still evolving, with real promise but significant unanswered questions.
“I think it’s an emerging option,” Dr. Lansdown said. “There’s definitely a lot of excitement around it. … But the science largely is not quite there yet for routine clinical practice.”
That gap, between public expectation and clinical reality, is becoming one of the defining tensions in musculoskeletal medicine.
Where PRP is strongest — and where it isn’t
Among biologic treatments, Dr. Lansdown said PRP has a few areas where evidence is more established.
“I think the best data has been in mild to moderate arthritis,” he said, pointing to randomized research showing patients can maintain higher activity levels with fewer symptoms compared to other injection options.
PRP may also have a role in certain tendon conditions, such as tennis elbow, though outcomes are less consistent, and it is generally considered more appropriate after other treatments have failed.
But beyond those indications, he said, claims often begin to outpace data.
One of the clearest examples is advanced arthritis, where biologics are sometimes framed as reversal tools rather than symptom management.
“In more advanced arthritis, … [t]hese treatments are presented as, ‘This will reverse the degenerative changes,’ or ‘This will rebuild cartilage,’” Dr. Lansdown said. “And I think those are claims that we don’t have evidence to support.”
For patients in pain and hoping to avoid surgery, overstating benefit can become especially misleading.
The mechanical problems biology cannot solve
Dr. Lansdown also cautioned against promoting biologics for injuries that are fundamentally structural. There are orthopedic problems where an injection cannot substitute for anatomy.
He pointed to “more mechanical-type issues,” including complete tendon tears and ligament ruptures, where expectations can become unrealistic. “For example, like expecting the biologic to reattach the tendon,” he said, “I don’t think we have the science that it would do that, and I don’t think it makes a lot of logical sense that could happen.”
Patients understandably want something less invasive than surgery, he added, but the alternative has to be grounded in reality.
The hardest thing to counter is anecdote
One of the biggest challenges, Dr. Lansdown said, is that regenerative medicine rarely enters the exam room neutrally. It arrives through testimonials, social media narratives and high-profile stories that shape expectations before a physician can offer context. Patients often come in convinced they have already seen proof.
“They’ll see reports of before and after, or hear testimonials,” he said.
Some hear about elite athletes traveling to clinics and returning quickly to sport. “I think the anecdotal evidence is always hard to counter,” he said. “I heard of a friend of a friend of a friend who said that it worked.”
Why standardization may be the next frontier
Another barrier to clearer evidence, Dr. Lansdown said, is that biologics are not standardized like traditional medications.
“It’s not like a standardized medication that’s manufactured with the same process every time,” he said. “There will be variability depending on the patient and their physiology and the time of day and all these other things.”
In his own research, Dr. Lansdown has examined how platelet concentration may influence clinical outcomes, an effort to better understand what is actually being delivered. That kind of quantification, he believes, will be essential for the field to mature.
Right now, administration remains imprecise. “What we administer is still a little crude,” he said. “It’s like, ‘Well, we’ll just give it all.’”
The future may depend on tailoring biologic composition to specific conditions rather than treating PRP as a one-size-fits-all answer.
The cost problem patients are paying for directly
Unlike many established orthopedic treatments, most biologic therapies remain cash-pay, creating a new layer of uncertainty for patients: What is a fair price for a therapy that is still evolving?
“Most of these are paid out of pocket,” Drew Lansdown, MD, said. “There aren’t good recommendations on what that cost to the patient should be.”
In one study, Dr. Lansdown compared the benefit of biologic injections with other covered treatments, using CMS benchmarks as a reference point. “That was an interesting way to look at it,” he said, and it can be helpful in counseling patients about what to expect.
What responsible use should look like
Asked what the next five years should demand from regenerative medicine, Dr. Lansdown emphasized rigor and transparency. “I think the most responsible thing is research studies done in this direction,” he said.
For now, he added, that also requires honesty with patients about what these therapies actually are. “This is an experimental treatment,” he said. “You have to understand that this is a research study.”
Moving the field forward, he said, will depend on controlled trials, defined endpoints and clearer indications. “I think that’s really how the field will keep moving forward,” he said, “to understand where the role is and what can be done.”
Only then, he said, will physicians be able to offer recommendations grounded in outcomes rather than hype.
