At a Glance

• Team physicians use orthobiologics across professional, collegiate, Olympic, and Paralympic sports.
• Athletes often seek newer treatments, but evidence and regulations vary by therapy.
• Experts emphasized patient safety, education, and realistic expectations when considering orthobiologics.

Estimated read time: 5 minutes

Elite athletes are often the first to seek newer treatments that can preserve peak performance, accelerate recovery, and improve outcomes. As interest in orthobiologics grows, physicians who treat top-tier athletes must focus on evidence, patient safety, careful clinical judgment, and long-term health effects, according to panelists at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM) in Seattle.

Those issues and more were explored during a day-long symposium, “The Next Generation of Biologics: Orthobiologics and the Modern Athlete,” hosted by AAOS and co-chaired by Jason Dragoo, MD, FAAOS, and Scott Rodeo, MD, FAAOS. The symposium drew leading experts from around the country to explore evidence, regulatory concerns, emerging technologies, and real-world application of orthobiologics across multiple sports.

A featured session, “Orthobiologics in the High-Performing Athlete,” brought together physicians who care for elite athletes to share how orthobiologics are being used and the factors that influence treatment decisions.

Panelists noted that some therapies, such as platelet-rich plasma (PRP), have greater proof of effectiveness than others. However, differences among orthobiologic formulations can make it difficult to generalize results. Regardless of the therapy under consideration, patient outcomes depend on the athlete’s unique case and shared decision-making that aligns patients with providers. Physicians should set realistic expectations and take all necessary steps to ensure the athlete’s long-term health.

Responsibility to the athlete 
Panelists noted that caring for elite athletes can be a delicate balancing act. Many will pursue every available option to aid recovery or extend performance. This is understandable, since a top athlete’s livelihood depends on peak performance throughout a career that may last only a few years.

“As doctors, we need to respect the athletes’ limited career duration,” said Timothy S. McAdams, MD, team physician for the San Francisco 49ers. “For example, the average career of an NFL athlete is 3.3 years.”

Keynote speaker Thom Mayer, MD, medical director of the NFL Players Association, also stressed the physician’s duty to the player-patient. He encouraged physicians to think beyond an athlete’s playing career to their quality of life after retirement.

Introducing biologics early in the game
Whenever possible, physicians should talk with elite athletes about orthobiologics early in treatment, panelists said. Without early guidance, athletes may seek answers from less reliable sources or pursue treatment through medical tourism without knowing the possible risks and outcomes. As athletes travel outside the United States for treatments that may not be approved or regulated domestically, physicians are left reacting to what has already been done rather than shaping the treatment plan upfront.

Many athletes may feel mystified by their choices. “Some Olympic and Paralympic athletes may not have a team physician to bounce ideas off,” said Casey Batten, MD, chief medical officer of the Los Angeles 2028 Olympic and Paralympic Games.

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Dr. Batten always recommends that athletes consult with physicians who understand orthobiologics. World Anti-Doping Agency (WADA) regulations can also help athletes navigate treatment options while reducing risks to their health and eligibility.

Asheesh Bedi, MD, FAAOS, head orthopaedic team physician for the University of Michigan, stressed the importance of clear communication when counseling athletes. Physicians need to break down the different types of biologics in simple terms and explain the nuances for each patient. Student athletes need to know which treatments may violate regulations in their sport.

Every athlete is different
Though clinical demands vary across sports, panelists said many of the same principles apply when recommending orthobiologics. Injury patterns, busy player schedules, anti-doping requirements, and career duration all influence treatment choices. Each sport, however, presents its own challenges, and panelists outlined the unique considerations by sport and league.

NCAA
Dr. Bedi noted that collegiate sports increasingly resemble professional athletics, with parents, agents, coaches, and athletic trainers influencing treatment decisions. On average, approximately seven people may be involved in a single medical decision, he said. He emphasized that many student athletes view PRP, stem cells, and peptides as interchangeable therapies for regeneration, making physician education essential to every discussion.

Olympics and Paralympics
Dr. Batten explained that many Olympic and Paralympic athletes are at the pinnacle of their sport yet have just one shot at a medal every four years. Around 50% of these athletes turn over each Olympic cycle. As a result, treatment timing and the ability to explore alternative options are crucial. Physicians must carefully balance potential health benefits against WADA regulations in this patient group.

International soccer
Orthobiologics are widely used to treat common soccer injuries such as muscle, hamstring, tendon, and calf injuries. Panelist Bert R. Mandelbaum, MD, FAAOS, chief medical officer of U.S. Soccer, said the best approach blends key learnings from load progression, maximal oxygen uptake (VO2 max), recovery, sleep, nutrition, cognition, injury risk prevention, and orthobiologics. This thoughtful approach can preserve a professional soccer player’s capabilities across a career that may span decades.

MLB
Christopher Ahmad, MD, FAAOS, head team physician for the New York Yankees, explained that advances in pitching and hitting velocity, ball movement, and bat technology now place severe demands on MLB players’ bodies. These changes have contributed to more overuse injuries, including oblique strains and shoulder or elbow conditions. Orthobiologics show promise in treating new injuries and preserving career-long performance.

NBA
Data show that nearly 100% of NBA team physicians use PRP in some fashion, with hamstring injuries among the most common indications for it. But questions about optimal indications, formulation, and timing remain, said panelist Brian Cole, MD, MBA, FAAOS, head team physician for the Chicago Bulls. Dr. Cole stressed the need to balance innovation with evidence-based medicine and patient safety, noting the NBA is updating its orthobiologic consensus statement. The revised statement is expected to focus on the regulatory landscape, medical tourism, ethics, and risk management. It will also provide new, injury-specific recommendations that differ from the current consensus statement.

NFL
NFL physicians described a unique environment in which the high volume and severity of musculoskeletal injuries create strong demand for orthobiologics, while also reinforcing the importance of protecting athletes’ long-term health.

Dr. Mayer noted there are more than 6,000 NFL injuries annually, including approximately 3,000 lost-time injuries. Most involve the lower extremities and often have health consequences long after players retire. Dr. McAdams added that decisions regarding orthobiologic treatments are driven primarily by player preferences and the timing of injuries during the playing season.

Evidence vs. enthusiasm 
“There is a lot of hype around orthobiologics, and my general position is we maintain an open mind because as soon as you don’t, the athlete starts to get suspicious,” said Dr. Cole. “It is our obligation as team physicians to ensure their safety.”

While medical tourism has driven athletes to Panama, Germany, Costa Rica, South Korea, and other places to pursue treatment, the panel cautioned about the inherent risks of nonregulated treatments.

“We’ve had athletes travel abroad for biologic infusions, and some returned with cellulitis and septic joints or received banned substances,” said Dr. Bedi. “It is an assumed risk for which you are managing the complication, but it is important to counsel your athlete on the risk and document if you’re aware of that treatment.”

In the future, Dr. Mandelbaum explained that orthobiologics will move beyond selecting single biologics and evolve with precision medicine. Physicians will identify which athletes will benefit from certain therapies based on biomarkers, immune profiles, proteomics, and other biological characteristics.

“The devil is in the details,” he added. “As we dive into all biologic options, we get better at stratification. In the end, it is going to be about biologic combinations that will help our athletes perform better.”

The symposium content is available through an OnDemand course in the AAOS Store.

Jennifer Lefkowitz is a freelance writer for AAOS Now.