APEX Biologix | Webinar Highlight
Orthobiologic therapies such as platelet-rich plasma (PRP), bone marrow concentrate (BMC), and microfragmented adipose tissue (MFAT) are becoming increasingly integrated into modern musculoskeletal care. While much of the clinical conversation focuses on the biologic preparation itself, an equally important question remains:
What happens after the procedure?
During a recent educational webinar, Ryan Kruse, MD, board-certified Physical Medicine and Rehabilitation physician and sports medicine specialist, explored the role of post-orthobiologic rehabilitation protocols and their impact on tissue healing and clinical outcomes.
Joining the session was Ariana DeMers, DO, Chief of Medical Education at APEX Biologix, who expanded on how treatment success depends not only on the biologic therapy itself but also on the rehabilitation strategy, patient education, and clinical integration.
Together, the discussion highlighted an essential principle in regenerative medicine:
Orthobiologic procedures do not function in isolation.
Clinical outcomes are influenced by the entire treatment framework, including rehabilitation protocols.
Before discussing rehabilitation strategies, Dr. Kruse provided a brief overview of several orthobiologic preparations commonly used in musculoskeletal medicine.
PRP remains the most widely utilized orthobiologic therapy in sports medicine and musculoskeletal care. PRP is created by concentrating platelets above baseline levels, delivering signaling molecules and growth factors that may support tissue repair.
Platelets contain alpha granules rich in cytokines and biologically active mediators that help reinitiate the healing cascade and support tissue recovery.
BMAC is typically harvested from the iliac crest and contains a mixture of biologically active components, including:
While patients often associate bone marrow procedures with “stem cells,” Dr. Kruse emphasized that the therapeutic benefit likely comes from the broader biologic signaling environment within bone marrow, rather than a single cell population.
Adipose-derived biologics represent another approach within regenerative medicine.
Fat tissue contains a variety of regenerative signaling molecules and structural components that may support tissue repair. When injected into damaged structures such as tendons or joints, adipose tissue may also act as a structural scaffold that supports healing.
Additionally, adipose-derived cells appear less susceptible to age-related cellular senescence.
The webinar also highlighted newer biologic preparations gaining attention in regenerative medicine.
PPP is increasingly being studied for its potential role in muscle regeneration, particularly through its influence on myoblast differentiation.
Research suggests PPP may help guide precursor cells to mature into functional muscle cells, supporting tissue recovery following muscle injury.
Protein concentrate can be created by filtering PPP to extract excess water content, which increases the concentration of biologically active cytokines and proteins.
This process allows clinicians to isolate a more concentrated therapeutic solution from blood-derived preparations.
Despite the rapid growth of orthobiologic research, Dr. Kruse highlighted a significant gap in the scientific literature:
Rehabilitation protocols are often poorly reported in orthobiologic studies.
Many clinical trials evaluating PRP or other biologics fail to include key peri-procedural factors such as:
Without this information, interpreting study outcomes or reproducing successful protocols becomes significantly more difficult.
One of the central messages of the webinar was clear:
Rehabilitation is critical to optimizing orthobiologic outcomes.
After a biologic procedure, tissues require carefully controlled mechanical loading to promote optimal healing.
Suboptimal mechanical loading may result in:
Conversely, excessive loading may compromise the repair process and increase reinjury risk.
Optimal rehabilitation requires:
Another key takeaway from the session is that rehabilitation protocols should be individualized.
Different tissues require different rehabilitation approaches.
For example:
| Tissue | Orthobiologic Used | Rehabilitation Approach |
|---|---|---|
| Tendon | PRP | Gradual progressive loading |
| Muscle | PPP / PC | Faster recovery timeline |
| Intra-articular structures | PRP | Controlled early motion |
Dr. Kruse emphasized that rehabilitation should consider:
Orthobiologic procedures represent an important advancement in musculoskeletal care, but procedural success depends on more than the injection itself.
Optimizing outcomes requires attention to several key factors:
• Accurate diagnosis and patient selection
• Appropriate biologic preparation
• Structured rehabilitation protocols
• Ongoing patient education and follow-up
When these elements work together, clinicians can better support the body’s natural healing processes.
This article highlights key insights from the full APEX webinar featuring Dr. Ryan Kruse and Dr. Ariana DeMers.
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Clinicians interested in advancing their regenerative medicine skills can participate in immersive training programs at the XCELL Learning Center in Clearwater, Florida.
Programs include:
• Hands-on procedural training
• Cadaver-based workshops
• Faculty-led education from leaders in orthobiologics
Explore upcoming training opportunities designed to support responsible adoption of regenerative medicine.
Kruse, R., et al. Postprocedure protocols after intraarticular orthobiologic injections—A scoping review. PM&R. 2024;17(4):463-468. doi:10.1002/pmrj.13271
Honbo, E., et al. Clinical rationale and rehabilitation guidelines for post biologic therapy. Phys Med Rehabil Clin N Am. 2023;34(1):239-263. doi:10.1016/j.pmr.2022.08.014
Sussman, W., et al. The role of rehabilitation after regenerative and orthobiologic procedures for the treatment of tendinopathy: a systematic review. Regen Med. 2018; 13(2):249-263. doi:10.2217/rme-2017-0110
Townsend, C., et al. Post-procedure protocols following platelet-rich plasma injections for tendinopathy: a systematic review. PM&R. 2020;12(9):904-915. doi:10.1002/pmrj.12347