Read the science we practice by.
Our library sorts the peer-reviewed literature by treatment and by condition — negative trials included. You deserve the whole ledger, not the highlight reel.
Why it can work
Orthobiologics aim at the healing process itself: concentrated platelets and cells carry the signaling molecules that recruit repair, settle inflammation and rebuild load-bearing tissue — a mechanism, not a mask.
From your own body
PRP and marrow concentrate are autologous — nothing off-the-shelf. Your tissue is sampled, concentrated and returned to the injury carrying growth factors such as PDGF, TGF-β and VEGF, the chemistry of collagen synthesis and new vessel growth.
Placed, not sprayed
Live ultrasound puts the biologic on the lesion itself. In this field, accuracy of placement is half the treatment.
The literature, grouped by treatment and condition
This field is promising and unfinished — both things are true. Every entry links to PubMed, and the trials that favored placebo sit beside the ones that didn't, because that's how we weigh the evidence in clinic too.
PRP — Knee Osteoarthritis
Effect of intra-articular platelet-rich plasma vs placebo injection on pain and medial tibial cartilage volume in knee osteoarthritis: the RESTORE randomized clinical trial
PRP was no better than saline placebo for symptoms or joint structure at 12 months. PubMed 34812863
Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial
One or two PRP injections beat saline for pain and function in early knee OA. PubMed 23299850
PRP injections for the treatment of knee osteoarthritis: the improvement is clinically significant and influenced by platelet concentration — a meta-analysis of randomized controlled trials
Pooled RCTs show clinically significant improvement vs placebo — larger with higher platelet concentrations, supporting precision dosing. PubMed 39751394
PRP — Elbow & Tendinopathy
Treatment of chronic elbow tendinosis with buffered platelet-rich plasma
In refractory elbow tendinosis, PRP produced large, durable pain reductions in a pilot cohort. PubMed 16735582
Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: PRP versus corticosteroid injection with a 1-year follow-up
PRP beat corticosteroid at one year (73% vs 51% success). PubMed 20448192
Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up
PRP's benefit persisted at two years while the steroid group returned to baseline. PubMed 21422467
Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial
Neither PRP nor glucocorticoid beat saline for pain at the 3-month primary endpoint. PubMed 23328738
Bone Marrow Concentrate & Intraosseous Delivery — Knee OA
A prospective, single-blind, placebo-controlled trial of bone marrow aspirate concentrate for knee osteoarthritis
In bilateral-knee patients, BMAC and saline produced similar pain relief — BMAC was not superior to placebo. PubMed 27566242
Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow-up
Subchondral bone marrow cell injection postponed or avoided knee replacement in most treated knees over ~15 years. PubMed 32322943
A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up
Image-guided BMC plus platelet products outperformed exercise therapy through two years. PubMed 30545387
Cell-Based & Adipose-Derived Therapy
Intra-articular injection of autologous adipose tissue-derived mesenchymal stem cells for the treatment of knee osteoarthritis: a phase IIb, randomized, placebo-controlled clinical trial
A single adipose-derived cell injection cut WOMAC scores ~55% at 6 months vs placebo, with no serious adverse events. PubMed 30835956
Adipose-derived mesenchymal stem cell therapy in the treatment of knee osteoarthritis: a randomized controlled trial
ADMSC injections improved pain and function in knee OA; imaging suggested disease modification. PubMed 30762487
Clinical efficacy and safety of the intra-articular injection of autologous adipose-derived mesenchymal stem cells for knee osteoarthritis: a phase III, randomized, double-blind, placebo-controlled trial
Phase III RCT: autologous adipose-derived cell injection improved pain and function vs placebo at 6 months. PubMed 37345256
Shockwave Therapy (ESWT)
Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study
Radial ESWT reduced heel pain significantly more than placebo (72% vs 45% pain reduction). PubMed 18832341
Extracorporeal shock wave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial
Both high- and low-energy ESWT beat sham for shoulder function and calcific resorption; high-energy was superior. PubMed 14625334
Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome
Shockwave beat corticosteroid injection at 4 and 15 months; the steroid helped only in the first month. PubMed 19439758
Focused Shockwave — Sexual Health (ED)
Can low-intensity extracorporeal shockwave therapy improve erectile function? A 6-month follow-up pilot study in patients with organic erectile dysfunction
First-in-human pilot: improved erectile function scores and penile hemodynamics at 6 months (uncontrolled pilot). PubMed 20451317
Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function? Short-term results of a randomized, double-blind, sham controlled study
Sham-controlled RCT: low-intensity shockwave improved erectile function and penile blood flow vs sham. PubMed 22425129
Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis
Meta-analysis of RCTs: Li-ESWT beat sham short-term; the authors note longer trials are needed. PubMed 28379665
EMTT — Electromagnetic Transduction Therapy
Electromagnetic transduction therapy and shockwave therapy in 86 patients with rotator cuff tendinopathy: a prospective randomized controlled trial
EMTT combined with shockwave gave greater pain and function gains than shockwave alone. PubMed 30183430
Electromagnetic transduction therapy in non-specific low back pain: a prospective randomised controlled trial
EMTT improved pain and function in non-specific low back pain vs control. PubMed 28736490
Extracorporeal magnetotransduction therapy as a new form of electromagnetic wave therapy: from gene upregulation to accelerated matrix mineralization in bone healing
In vitro: EMTT upregulated osteogenic genes and accelerated matrix mineralization (preclinical). PubMed 39457582
Ozone Injection Therapy
Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: a randomized, double-blinded, placebo-controlled study
Intra-articular ozone beat placebo for pain, stiffness, function and quality of life at 8 weeks. PubMed 28738079
Efficacy of two doses of intra-articular ozone therapy for pain and functional mobility in knee osteoarthritis: a double-blind randomized trial
Both tested ozone doses reduced pain and improved mobility vs oxygen control. PubMed 40050950
Hyperbaric Oxygen
Stem cell mobilization by hyperbaric oxygen
HBOT mobilized CD34+ stem/progenitor cells from bone marrow via a nitric-oxide-dependent mechanism (mechanistic study). PubMed 16299259
Hyperbaric oxygen therapy in femoral head necrosis
Randomized trial in femoral head osteonecrosis: HBOT relieved pain and improved range of motion, with treated patients avoiding hip replacement at 7-year follow-up. PubMed 20637561
IRAP & Autologous IL-1Ra — the Plasma-Protein Class
Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis: a randomized controlled trial
In 376 patients, autologous conditioned serum beat both hyaluronan and saline for knee OA, with benefit persisting to two years. PubMed 18674932
Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression: an investigator-initiated, prospective, double-blind, reference-controlled study
Epidural autologous conditioned serum outperformed triamcinolone for lumbar radicular pain from week 12 onward. PubMed 17762286
Intraarticular injection of anakinra in osteoarthritis of the knee: a multicenter, randomized, double-blind, placebo-controlled study
A single intra-articular injection of recombinant IL-1Ra (anakinra) was no better than placebo in established knee OA — dosing and timing of IL-1 blockade matter. PubMed 19248129
Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial
ACS improved KOOS symptom and sport scores vs placebo, though the primary WOMAC endpoint was not met. PubMed 17825587
The efficacy and safety of autologous conditioned serum (ACS) injections compared with betamethasone and placebo injections in the treatment of chronic shoulder joint pain due to supraspinatus tendinopathy: a prospective, randomized, double-blind, controlled study
ACS beat both betamethasone and placebo for supraspinatus tendinopathy at 24 weeks. PubMed 30167587
Injection with autologous conditioned serum has better clinical results than eccentric training for chronic Achilles tendinopathy
ACS outperformed eccentric training for chronic Achilles tendinopathy — retrospective comparison, not a randomized trial. PubMed 30900032
Treatment of muscle injuries by local administration of autologous conditioned serum: a pilot study on sportsmen with muscle strains
In a pilot of athletes with muscle strains, ACS shortened return-to-play from 22.3 to 16.6 days (non-randomized pilot). PubMed 15532001
After ACL Injury — Blunting Post-Traumatic Inflammation
Effects of intraarticular IL1-Ra for acute anterior cruciate ligament knee injury: a randomized controlled pilot trial
IL-1Ra injected about two weeks after ACL rupture improved pain and function over the following two weeks in a small pilot RCT (n=11). PubMed 22273632
A multicenter study of early anti-inflammatory treatment in patients with acute anterior cruciate ligament tear
Early intra-articular corticosteroid after ACL tear didn't change patient-reported outcomes — but the rise in CTX-II cartilage-breakdown markers was significantly greater in the placebo group, supporting the early anti-inflammatory window. PubMed 28146402
Acute and late changes in intraarticular cytokine levels following anterior cruciate ligament injury
Documents the synovial surge of IL-1β, IL-6, IL-8 and TNF-α after acute ACL rupture — the inflammatory chemistry plasma-protein therapy targets. PubMed 22886741
Role of interleukins in the articular environment after anterior cruciate ligament injury
Shows intra-articular cytokines remain elevated for months after ACL tear in adolescents — the window for intervention is longer than the swelling. PubMed 30245587
High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury
Twelve years after ACL injury, 82% of knees showed radiographic changes and 51% had radiographic OA — and reconstruction alone was not protective. This is the problem the peri-surgical protocol exists to address. PubMed 15476248
A2M — Alpha-2-Macroglobulin
Identification of α2-macroglobulin as a master inhibitor of cartilage-degrading factors that attenuates the progression of posttraumatic osteoarthritis
A2M neutralizes multiple cartilage-degrading enzymes and slowed post-traumatic OA progression in vivo (preclinical). PubMed 24578232
α2-macroglobulin-rich serum as a master inhibitor of inflammatory factors attenuates cartilage degeneration in a mini pig model of osteoarthritis
Autologous A2M-rich serum injections reduced inflammatory markers and cartilage degeneration after ACL reconstruction in mini pigs (preclinical). PubMed 36133821
We help train the field
Dr. DeWald serves as faculty at the Regenerative Medicine Training Institute and the American Shockwave Training Institute, teaching musculoskeletal ultrasound, regenerative technique and shockwave medicine to physicians — and the practice team has co-authored peer-reviewed publications and presented at international regenerative medicine conferences.
Match the evidence to your case.
A concierge evaluation reads your diagnosis against this literature — and tells you plainly when the data isn't there.