Orthobiology

Orthobiology refers to the use of biological substances and processes that are intended to favorably influence the body's own regeneration and inflammatory processes. The aim is not to “magic away” damage, but rather to improve the conditions for healing and resilience – for example in the case of tendon irritation, early stages of osteoarthritis or muscle injuries.

• Biological: Use of the patient's own preparations such as blood plasma (PRP/ACP) or viscoelastic substances such as hyaluronic acid.
• Targeted: Application where biology can have a healing effect - e.g. B. at tendon attachments, in the joint or in the fascial transition tissue.
• Integrated: Only makes sense in conjunction with diagnostics, training control, physiotherapy and everyday adjustments.

Orthobiology does not replace basic therapies, but can complement them. Not every complaint is suitable; the indication is made individually and based on evidence.

Orthobiological procedures are an option if conservative measures (load control, physiotherapy, self-exercises, possibly basic drug therapy) have been started and additional biological support appears to make sense.

• Early to moderate osteoarthritis (e.g. knee, hip, ankle) with pain on exertion and a tendency to swell.
• Tendinopathies/tendon attachment irritations: Achilles tendon, patellar tendon, tennis/golfer's elbow, gluteal tendons, adductors, plantar fascia.
• Muscle injuries (e.g. hamstrings, calf muscles) grade I–II.
• Circumscribed cartilage/articular cartilage irritations without severe instability.
• Irritable states after overexertion in sport when structural damage is minor to moderate.

Orthobiological injections are not suitable for advanced, severe joint destruction, severe tears that require surgical treatment, or acute infections. We clarify this as part of the diagnostics.

Which method makes sense depends on the symptoms, stage, comorbidities and the goals of therapy. Below is an overview.

• PRP/ACP (platelet-rich plasma): Plasma obtained from your own blood, enriched in platelets and growth factors. Use in tendinopathies, plantar fasciitis, early stages of osteoarthritis. Often 1-3 injections 1-4 weeks apart, ideally ultrasound targeted.
• Hyaluronic Acid Injection: Viscoelastic substance to improve joint lubrication and lubrication. Especially in the knee, sometimes in other joints too. Evidence shows symptomatic relief in select patient groups.
• Autologous conditioned serum (ACS): Blood-derived, cytokine-modulated serum that can influence inflammatory signaling pathways. The study situation is heterogeneous; Indication after careful consideration.
• Prolotherapy (e.g. dextrose): The aim is to stimulate connective tissue/tendon attachments in order to stimulate healing processes. Evidence moderate and application dependent; only if the findings are suitable.
• Combination approaches: In selected cases, the combination with targeted physiotherapy, shock waves or sensorimotor training can support the effect.
• Stem cell or cell therapies: Strictly regulated in Germany and not part of routine care outside of clinical studies. We do not offer such procedures as standard therapy.

Important: Orthobiological injections best develop their potential effect as part of a structured rehabilitation plan. All procedures are discussed with realistic expectations and transparent alternatives.

The path to appropriate therapy begins with a thorough assessment. Our location: Dorotheenstraße 48, 22301 Hamburg (Winterhude).

• Initial appointment: anamnesis, definition of goals (e.g. everyday stress, sport, time window).
• Clinical examination: functional and pain provocation tests, if necessary gait analysis and muscle function check.
• Imaging: On-site dynamic ultrasound; If necessary, referral for MRI/X-ray.
• Therapy plan: decision conservative-first; Consideration of whether and which orthobiological procedure is suitable.
• Implementation: Ultrasound-targeted injection under sterile conditions; short observation.
• Aftercare: load control, individually tailored exercise program, coordination with physiotherapy.
• Evaluation: Follow-up after 2-6 weeks, re-assessment after 6-12 weeks.

The number of studies on orthobiological procedures is growing, but is heterogeneous depending on the indication. Overall, there are significant, sometimes clinically relevant, symptom improvements in selected patient groups. The benefit is individual and depends on the diagnosis, stage and quality of rehabilitation.

• Knee osteoarthritis (early to moderate): For PRP/ACP and hyaluronic acid, meta-analyses show symptomatic improvements over placebo in certain patients. The effect is variable and limited in time.
• Tendinopathies: PRP may show advantages over placebo or long-term corticosteroid effects in selected protocols for tennis elbow, patellar tendon or plantar fascia.
• Muscle injuries: Initial data suggests faster symptom relief when combined with rehab; the quality of evidence here is limited.
• Comparison to cortisone: Corticosteroids can reduce pain in the short term, but have potential disadvantages with repeated use on tendon tissue. Orthobiology is more focused on medium/long-term tissue conditions.

No method works the same for everyone. We formulate clear goals, measure the progress and adapt the treatment.

Orthobiological injections are considered safe when indicated and carried out correctly. Side effects are usually mild and temporary.

• Common: Transient pain/swelling, feeling warm (24-72 hours).
• Rare: infection, bruising, allergic reaction (especially with hyaluronic acid), nerve/vascular irritation.
• Contraindications: Acute infections/fever, local skin infections, unexplained blood clotting disorders, severe uncontrolled systemic diseases. Be careful with anticoagulation, poorly controlled diabetes, pregnancy/breastfeeding - individual assessment.

We work under sterile conditions and – where appropriate – with ultrasound support. Every measure is explained in advance, including alternatives.

• Preparation: Drink enough; bring existing findings/MRI; Discuss the use of blood thinners and anti-rheumatic drugs in advance.
• PRP-specific: If possible, no classic NSAIDs (e.g. ibuprofen, diclofenac) 3–7 days before the injection - individual consultation necessary.
• Immediately after the injection: 24-48 hours of protection, cooling as needed, then gradually increasing the load.
• Rehabilitation: Targeted physiotherapy/home exercises are key. Training plan is adjusted and progressively increased.
• Return to Sport/Work: Depends on structure, pain, functional tests; usually staged over 2-8 weeks.

Orthobiology is not an abbreviation. It complements basic pillars such as movement therapy, load management, coordination training and - if necessary - orthoses, taping or short-term medication support.

• Physiotherapy: strength, tendon resilience, mobility, neuromuscular control.
• Load control: Adjustment of training scope, intensity and technique.
• Supplements: manual therapy, shock waves, sensorimotor training, educational measures.
• Medication: Possible in the short term; We generally avoid repeated cortisone injections into tendons.

Some orthobiological procedures are not a standard service provided by statutory health insurance companies and are offered as a self-pay/IGeL service. Private insurers and subsidies reimburse depending on the tariff. Before you start, you will receive transparent information about options and expected costs. If necessary, please clarify reimbursement questions with your insurance company in advance.

Orthobiology develops its strengths in an interdisciplinary setting. Depending on the goal and complaint, we work closely with other areas.

• Sports orthopedics: load analyses, return-to-sport concepts, prevention.
• Institute for Regenerative Movement Medicine: Research and translational procedures within the framework of the applicable regulations.
• Physiotherapy: Individual rehabilitation plans and progressive training programs.
• TCM: Complementary procedures such as acupuncture for pain modulation.
• Neuroorthopaedics: When nerve or coordination aspects play a role.
• Atlas Back Center: Cervical spine and back problems with musculoskeletal reference chain.