1 Ivana Čulo
1 Dalibor Kiseljak
1,2,3,6 Miljenko Franić
1,3,4,5 Alan Ivković
1 University of Applied Health Sciences, Zagreb, Croatia
2 University Hospital Dubrava, Zagreb, Croatia
3 School of Medicine, University of Zagreb, Zagreb, Croatia
4 University Hospital Sveti Duh, Zagreb, Croatia
5 Polyclinic Ivković, Zagreb, Croatia
6 Faculty of Dental Medicine and Health Osijek, University of Osijek, Osijek, Croatia
Article received: 27.12.2024.
Article accepted: 13.03.2025. https://doi.org/10.24141/2/9/1/12 Author for correspondence:
Alan Ivković
“Sveti Duh” University Hospital, Zagreb, Croatia E-mail: alan.ivkovic@gmail.com
Keywords: cell therapy, injection, osteoarthritis, physiotherapy, platelet-rich plasma
The integration of orthobiologic injection modali- ties with structured physiotherapy regimens has emerged as a promising avenue for optimizing re- covery trajectories in patients affected by osteoar- thritis (OA). While these interventions demonstrate therapeutic potential, the existing research exhibits substantial variability in patient demographics, in- jection methodologies, study duration, and outcome assessment. Furthermore, despite the recognized importance of post-injection rehabilitation, compre- hensive documentation of physiotherapy protocols remains scarce, precluding a definitive understand- ing of their complementary effects with orthobio- logic treatments.
This study evaluates and synthesizes the current evidence on the therapeutic efficacy of orthobio- logic injections, platelet-rich plasma (PRP) and other cell-based regenerative therapies when implemented alongside physiotherapeutic interventions in patients with knee OA. The absence of standardized post-in- jection physiotherapy protocols, coupled with incon- sistent methodological frameworks, impedes the for- mulation of evidence-based rehabilitation guidelines. Accordingly, future research must prioritize longitudi- nal, well-controlled investigations that delineate the optimal integration of physiotherapy with orthobio- logic therapies to maximize functional restoration and long-term symptom management in OA.
A structured literature search was conducted via PubMed, utilising a strategic combination of Medical Subject Headings (MeSH) and targeted keywords to
ensure thorough retrieval of relevant studies. A to- tal of sixteen studies met the inclusion criteria, all of which reported favourable outcomes following orthobiologic injections. Interestingly, only one trial incorporated a general physiotherapy program, thus emphasizing the noticeable gap in literature regard- ing the integration of orthobiologic injections with standard rehabilitative strategies.
Osteoarthritis (OA) is a multifactorial degenerative joint disorder characterised by the progressive deg- radation of articular cartilage, which leads to the involvement of surrounding joint structures such as the subchondral bone, ligaments, and synovium (1, 2). The management of OA requires a multimodal approach encompassing pharmacological, non-phar- macological, and surgical strategies (3). While con- servative therapies are often effective in mitigating symptoms, certain cases progress to advanced stag- es where these interventions become insufficient, necessitating surgical options. It is therefore not sur- prising that the development of minimally invasive surgical techniques has transformed OA manage- ment by offering the potential to regenerate dam- aged joint structures, alleviate symptoms, and slow disease progression (4).
Among emerging non-surgical approaches, ortho- biological products have gained prominence for their ability to enhance tissue repair and reduce pain across various musculoskeletal pathologies, includ- ing cartilage, ligament, tendon, and bone injuries. Frequently orthobiologic treatments applied in OA management include hyaluronic acid, platelet-rich plasma (PRP), mesenchymal stem cells (MSCs) deliv- ered as bone marrow aspirate concentrate (BMAC), and stromal vascular fraction (SVF) (5).
The therapeutic effects of orthobiologic injections are closely linked to mechanobiology, as biomechani- cal processes play a key role in stimulating tissue re- pair and functional recovery (6). Physiotherapy works within the same framework, aiming to reduce pain, improve mobility, and enhance overall function by us- ing targeted interventions (7). This includes manual
therapy, thermotherapy, therapeutic ultrasound, la- ser therapy, and magnetotherapy, all of which sup- port joint health and promote healing (8). To effec- tively integrate these treatments into a rehabilitation program, a thorough understanding of the biological/ physiological mechanisms that drive musculoskeletal regeneration is essential, allowing interventions to be tailored for optimal recovery (6).
The target population for this review includes adults aged 18 years and older diagnosed with osteoar- thritis who have undergone orthobiologic injections, followed by recommended physiotherapeutic inter- ventions such as exercise therapy, manual therapy, and physical agents to optimize clinical outcomes. To ensure the inclusion of high-quality, contemporary evidence, only randomized controlled trials published in English from 2014 to 2024 were considered.
A comprehensive literature search was conducted in PubMed utilising a combination of Medical Subject Headings (MeSH) and specific keywords to ensure thorough coverage. The search terms included: (Os- teoarthritis) AND (Injection) AND ((Physiotherapy) OR (Rehabilitation)); (Osteoarthritis) AND (Injection) AND (Postinjection); (Physiotherapy) OR (Physical Therapy) OR (Exercise); (Orthobiologics) OR (Platelet- rich plasma); (Orthobiologics) OR (Stem cell) OR (Stro- mal vascular fraction); and (Orthobiologics) OR (Bone marrow aspirate) OR (Stem cell). The filters were ap- plied to restrict results to randomized controlled tri- als published from 2014 to 2024, focusing on stud- ies relevant to the scope of this review.
The initial screening process involved a review of titles and abstracts to identify potentially relevant
studies, which were then retrieved for comprehen- sive evaluation. Data extraction was conducted using a standardised approach, capturing key details such as study design, population characteristics, ortho- biologic and physiotherapy interventions, and out- comes. A narrative synthesis was performed across all included studies, integrating critical character- istics, interventions, and observed outcomes into a cohesive summary.
The search strategy lacked a standardized query instead of relying on multiple searches, which may have led to gaps or inconsistencies in the search results. Without a uniform approach, there is no cer- tainty that all the relevant studies were identified, raising the possibility of missing key research or un- intentionally introducing selection bias. Any such in- consistency in search methodology could ultimately impact the completeness and reliability of the re- view’s findings.
Sixteen articles met the inclusion criteria, each re- porting positive effects of orthobiologic injections. Among them, only Mautner et al. implemented a gen- eral physiotherapy program that remained consist- ent regardless of the injection type. The remaining studies provided limited guidance, offering general recommendations on physiotherapy, physical activ- ity, exercise, or therapeutic modalities following or- thobiologic treatment. A comprehensive summary of the selected articles is presented in Table 1.
Platelets, anucleate cell fragments circulating within the blood, play a fundamental role in haemostasis by forming haemostatic plugs and releasing coagula- tion factors at injury sites, a process orchestrated by a diverse array of proteins, cytokines, and bioactive factors. Simultaneously, they regulate wound heal- ing through the secretion of growth factors such as PDGF, TGF-β, and VEGF, which drive angiogenesis, modulate inflammation, and recruit progenitor cells for tissue repair. Building on these biological proper- ties, PRP has emerged as a therapeutic modality as- sociated with enhanced tissue repair and regenera- tion. PRP is characterised by a platelet concentration significantly higher than baseline, requiring a mini- mum of 106 platelets per μL (or about 5 times the baseline) (25, 26).
Across multiple studies, PRP has consistently yielded significant improvements in VAS and WOMAC scores, indicating substantial reductions in pain, stiffness, and functional impairment (9 – 18). Notably, sus- tained benefits have been observed in both PRP and PRGF (Plasma Rich in Growth Factors) groups at 12 months, surpassing conventional treatments such as CST and HA. These outcomes are driven by the bio- logically active components of PRP, which modulate inflammation and facilitate tissue repair, offering not only immediate symptom relief but also long-term therapeutic effects. The additional evidence of last- ing improvements in VAS and Lequesne scores with PRGF, alongside higher patient satisfaction compared to HA, demonstrate the potential of growth factor- rich therapies for managing chronic conditions (14, 15, 17). Beyond symptom relief, PRP improves func- tional capacity and overall well-being, as suggested by higher IKDC and SF-36 scores (9 – 12, 16, 19).
Importantly, a three-injection PRP protocol has shown superior efficacy over single-injection PRP or CST, further supporting the importance of optimising treatment regimens to maximise results of clinical outcomes (17).
Compared to AAT (Adipose Autologous Tissue), PRP differs in efficacy, with AAT demonstrating greater
Table 1. Included articles
Injection
Study Population OA
grade
Study group
time protocol [week]
Number of injections
Duration of study
Post-injection intervention
Outcome measures
Cole et al. 2017 (9)
Elik et al.
111 patients KL 1-3
G1: HA 0, 1, 2 3
G2: PL 0 1
G2: PRP 0, 1, 2 3
G1: PRP 0, 4, 24 3
52 weeks
Weight bearing restrictions, ice/ cold therapy, exercise
No NSAID;
VAS, WOMAC, IKDC, ELISA
VAS, WOMAC,
2020 (10) 60 patients KL 1-3
Kaszy´nski
G1: AAT 0, 1, 2 3
6 months
paracetamol, exercise
Weight bearing
SF-36,
Ultrasonography
VAS, KOOS, WOMAC, IKDC,
et al. 2022
(11)
Raeissadat et al. 2015
(12)
Raeissadat et al. 2020
(13)
Raeissadat et al. 2020
(14)
Raeissadat et al. 2021
(15)
60 patients KL 1-3
160 patients KL 2,3
23 patients KL 1-3
(46 knees)
102 patients KL 2,3
238 patients KL 2,3
G3:
Control
G1: HA 0, 1, 2 3
G1: PRP 0, 4 2
G1: HA 0, 1, 2 3
G1: HA 0, 1, 2 3
G3: PRGF 0, 3 2
12 months
G2: PRP 0, 4 2
G2: PRP 0 1
12 months
G2: EX
8 months
G2: PRGF 0, 3 2
12 months
G4: OZ 0, 1, 2 3
G2: PRP 0, 3 2
12 months
restrictions, exercise
Rest, No NSAID; paracetamol, ice/cold therapy, weight bearing restrictions, exercise
No NSAID;
paracetamol, exercise
Rest, active knee flexion and extension after a 20-min rest for the injected fluid dispersion,
no NSAID;
acetaminophen, exercise
Rest, active knee flexion and extension after a 20-min rest for the injected fluid dispersion,
no NSAID;
paracetamol, ice/cold therapy, exercise
EQ-5D-5L; TUG
test, 5xSTS; 10mWT
WOMAC, SF - 36
VAS, WOMAC, MRI
VAS, WOMAC,
Lequesne index
VAS, WOMAC,
Lequesne index
Rayegani et al. 2014(16)
62 patients KL 1-4
G1: PRP, EX
0, 4 2
G2: EX
6 months
Rest, active knee flexion and extension after a 20-min rest for the injected fluid dispersion,
no NSAID;
acetaminophen, ice/cold therapy, exercise
WOMAC, SF-36, QOL
Uslu Güvendi et al. 2018
(17)
50 patients KL 3
G1: CST 0 1
G1: PRP
0, 1, 2
(months)
3
G2: PEMF
Xu et al. 2024 (18)
48 patients
KL 1-3
12 weeks
G3: PRP, PEMF
0, 1, 2
3
Low-frequency PEMFs
irradiation
therapy with VAS, WOMAC,
a frequency Lequesne Index, of 30 Hz and ROM intensity of 1.5
mT, once daily,
5 times a week for 12 weeks
G2: PRP 0 1
G3: PRP 0, 1, 2 3
6 months
Immobilization, rest, ice/cold or heat therapy, paracetamol, exercise
VNS, WOMAC,
Lequesne index, HAD
Anz et al. 2020 (19)
Freitag et al. 2019
(20)
90 patients KL 1-3
30 patients KL 2,3
G1: PRP 0 1
G2: ADMS 0 (months) 1
G2: BMAC 0
G1: control
G3: ADMS 0, 6 2
Garza et al. 2020 (21)
G1: hd SVF
0
1
39 patients KL 2,3
12 months
Weight bearing restrictions, exercise
WOMAC, MRI
G3: PL
0
1
G2: ld SVF 0 1
(months)
12 months
12 months
No NSAID,
weight bearing restrictions, physiotherapy
Weight bearing restrictions, crutches, exercise
WOMAC, IKDC
NPRS, KOOS, WOMAC, MRI
Hong et al. 2018 (22)
16 patients KL 2,3
(32 knees)
G1: SVF, HA
0 1
G2: HA, SVF
0
1
12 months
Weight bearing restrictions, physical activity, Celebrex
WOMAC, ROM, MRI
Mautner et al. 2023
(23)
480 patients KL 2-4
G1: BMAC 0 1
G4: CST 0 1
G2: SVF 0 1
G3: UCT 0 1
12 months
Weight bearing restrictions, physiotherapy
VAS, KOOS, EQ- 5D, PROMIS-29
scores
AAT – Autologus adipose tissue, ADMS – Adipose-derived mesenchymal stem cell, BMAC –Bone marrow aspirate concentrate, CST – Corticosteroids, ELISA – Enzyme- linked Immunosorbent Assay, EQ-5D-5L – Health Questionnaire EQ-5D-5L, HA – Hyaluronic acid, HAD – Hospital Anxiety and Depression Scale, hd, PRP –High dose stromal vascular fraction, IKDC – International Knee Documentation Committee, KL – Kellgren–Lawrence, KOOS – Knee Injury and Osteoarthritis Outcome Score, ld
PRP – Low dose stromal vascular fraction, 10mWT –10 m Walk Test, NPRS – Numeric pain rating scale, OZ – Ozone, PEMF – Pulsed electromagnetic fields, PL – Placebo, PRGF-PRP – derived growth factor, PRP – Platelet-rich plasma, QOL – Quality of life score, ROM – Range of motion, SF 36 – Short Form Health Survey, 5*STS – 5 Times Sit to Stand Test, SVF – Stromal vascular fraction, TUG – The Timed Up and Go test, UCT – Allogeneic human umbilical cord tissue-derived mesenchymal stromal cells, VAS – Visual analog scale, VNS – Visual numeric scale, WOMAC – Western Ontario and McMaster Universities Osteoarthritis Index, G1– Group 1, G2 – Group 2; G3 – Group 3; G4 – Group 4.
3
0, 1, 2
(months)
G2: HA
Zhang et al. 2022
(24)
126 patients KL 2,3
G1: SVF 0, 1, 2 3
(months)
5 years
Weight bearing restrictions, physical activity
VAS, WOMAC,
Radiography, MRI
Table 1. Included articles
Injection
Study Population OA
grade
Study group
time protocol [week]
Number of Duration of Post-injection injections study intervention
Outcome measures
improvements in functional assessments such as TUG (Timed Up and Go), STS (Sit-to-Stand), and MWT (6-Minute Walk Test). This suggests that AAT may be more appropriate in cases where mobility restoration is the primary concern, either as a standalone treat- ment or in conjunction with PRP. To that degree, the adaptability of biological therapies in alleviating pain and inflammation while enhancing physical function points to the necessity of more tailored and patient- specific treatment approaches (11).
In contrast to commonly used outcome measures such as VAS and WOMAC, measure like MRI offers a detailed visualisation of joint structures, enabling the detection of early osteoarthritic changes and the as- sessment of cartilage integrity (27). A trial conducted by Raeissadat et al. (13) demonstrated the positive effects of PRP on MRI findings, including increased patellofemoral cartilage volume and reduced syno- vitis, whereas Elik et al. (10) found no statistically significant difference in distal femur cartilage thick- ness via ultrasonography. Additionally, biochemical methods analyse metabolic processes in OA, aiding in the identification of molecular markers associated with disease progression (27). Biochemical analyses showed reduced pro-inflammatory cytokine levels in the PRP-treated group, which may account for the symptomatic improvements in clinical outcomes (9).
Mesenchymal stem cells (MSCs) are multipotent pro- genitor cells capable of differentiating into a variety of mesenchymal lineages (7, 28). These cells exhibit remarkable self-renewal capacity and plasticity, pos- sessing notable immunosuppressive and anti-inflam- matory properties. MSCs can be derived from a range of tissue sources, including bone marrow, adipose tissue, peripheral blood, and synovial membranes
(29). Among these sources, bone marrow is a well- established source of MSCs. Its extraction typically involves aspirating marrow, which is then processed to yield BMAC, a concentrated formulation of bone marrow-derived cells (30). Similarly, adipose tissue serves as a significant source of regenerative and im- munomodulatory cells, primarily contributing to the SVF (31).
Given the potential of MSCs in regenerative medi- cine, extensive investigations into the efficacy and safety of intra-articular cellular injections have been conducted. Mauetner et al. evaluated 480 patients
with KL grades 2 – 4 OA. Following the injection, all trial groups adhered to a physiotherapy protocol. One year later, VAS and KOOS assessments revealed sig- nificant pain reduction across all groups, where none of the orthobiologic injections demonstrated supe- rior efficacy compared to CST, and no serious adverse events related to the procedure were reported (23).
Cellular preparations derived from SVF have shown significantly better outcomes compared to hyaluron- ic acid injections (22, 24). Moreover, repeated injec- tions have proven more effective than control treat- ments in enhancing joint function, relieving pain, and slowing OA progression (20, 21).
Despite these clinical improvements, MRI assess- ments have provided inconsistent findings regard- ing structural changes in the joint. Muetner et al. observed no significant differences in joint health or cartilage condition among groups treated with BMAC, SVF, UCT, or CST after one year (23). However, other studies reported mixed results; while SVF injections led to functional improvements, MRI evaluations re- vealed no measurable changes in the modified Out- erbridge classification or chondral thickness, a limita- tion that may stem from the resolution constraints of MRI imaging (21).
SVF treatment improved cartilage repair and reduced bone marrow abnormalities in some cases, but the results were worse in knees with severe cartilage damage, making advanced structural degeneration difficult to treat. Control groups, especially those re- ceiving HA, showed little effect on cartilage repair (22).
While SVF treatment led to functional improvements, its long-term impact on structural changes remains unclear. Zhang et al. found no improvements in bone marrow lesions (BMLs) after SVF injections, sug- gesting that the therapy may relieve symptoms or aid superficial repair, but it does not address deeper bone-related changes in OA. A five-year follow-up showed no significant differences in BMLs between SVF-treated groups and controls, indicating its limi- tations in reversing bone damage. Final radiological evaluations showed that total cartilage volume loss was reduced in both the SVF and HA groups. More pa- tients in the SVF group maintained or improved full- thickness cartilage defects, with fewer experiencing progression compared to the HA group (24).
A study comparing injection regimens found that two injections were most effective, with 89% of partici-
pants maintaining or improving cartilage health and no osteophyte progression. Single injections pro- vided moderate benefits, while the control group ex- perienced significant cartilage loss and osteophyte development. Synovitis, meniscus damage, and pop- liteal cysts remained unchanged across all groups, showing the complexity of OA and the need for more targeted treatments (20).
Physiotherapy treatment should be structured ac- cording to the phases of the regenerative process: inflammation, proliferation, and maturation. While these phases have general timeframes, their dura- tion varies between individuals. Age, sex, comorbidi- ties, and the extent of structural damage influence the progression of each phase (6). Treatment is per- sonalized, with goals and plans developed in col- laboration with the patient to match their functional needs and priorities (8).
Orthobiological injections often cause inflammation and pain, requiring immobilization or support, the ap- plication of ice, elevation, and medication for man- agement (17). It is commonly advised to avoid tak- ing NSAIDs before and after treatment in the early stages, as they interfere with platelet function and reduce growth factor release. Other analgesics can be prescribed instead. Cryotherapy may help manage pain, but concerns remain that reduced blood flow could slow healing (9-24).
Swelling can be addressed through lymphatic drain- age, which improves circulation, intercellular signal- ling mechanisms, and the release of growth factors. Additionally, the injection site needs to be protected by reducing the load on the treated segment through rest or immobilization. Although initial immobilization is recommended, small range-of-motion movements can be performed after the first day of treatment (9, 11, 19 – 22, 32).
The resolution of inflammation marks the transition into the second phase of healing, typically occurring between 3 and 14 days following treatment (32). During this phase, it is recommended to focus on in- creasing the range of motion, enhancing circulation in the treated area, and improving tissue resilience through therapeutic exercises. The intensity and type of physiotherapy interventions during this pe- riod should be guided by the patient’s tolerance to activity. A practical guideline is to avoid exercises
or activities that elicit pain exceeding 3/10 on a nu- merical rating scale either during or after the activity (10, 33).
As healing progresses, controlled mechanical load- ing through therapeutic exercises becomes essen- tial for collagen reorganization and tissue recovery. Strengthening and stretching exercises performed in water are particularly beneficial during this phase
(32). Water-based exercises minimise mechanical stress on the joints while providing resistance to support muscle strengthening. For intra-articular in- jections, strengthening programmes may be initiated earlier than for tendons or ligaments, given the dif- ferences in healing dynamics (33).
To optimize healing and rehabilitation outcomes, incorporating physical agents into treatment may be beneficial. For instance, pulsed electromagnetic fields (PEMF) have been shown to enhance the bio- availability of PRP growth factors by stimulating cel- lular uptake and activation, thereby improving tissue repair and functional recovery. Xu et al. investigated the use of PEMF applied five times per week over 12 weeks, reporting significant improvements in pain measured via VAS, function via WOMAC, and mobility compared to standalone PRP or PEMF therapy (18). Additionally, extracorporeal shock wave therapy (ES- WT) has shown promising results in treating OA com- bined with intraarticular injections, as a non-invasive therapy that applies mechanical force to tissue cells by passing through different mediums. When sub- jected to mechanical force, cells generate biological signals that stimulate anti-inflammatory responses, angiogenesis, immune modulation, cell proliferation, and cartilage protection (34 – 36).
During healing, exercise programs should progress from single-joint to multi-joint movements. Isometric contractions are the safest option at this stage due to restricted joint mobility and provide short-term pain relief. In knee OA, the focus is on strengthening the locomotor chain, including the hip, knee, and an- kle joints (32). Raeissadat et al. proposed a protocol with multi-angle isometric strengthening exercises for the quadriceps femoris, hip adductors, and abduc- tors, along with hamstring stretching. Participants performed these exercises three times daily, hold- ing each stretch for 10 seconds and repeating it 10 times (13). As patients progress, simple knee flexion and extension exercises can be advanced to more complex movements such as lunges, squats, and seated holds (33).
Stretching exercises are recommended between 24 hours and one week post-treatment, but the optimal modality, whether dynamic, static, or proprioceptive neuromuscular facilitation (PNF), remains unclear. Stretching improves flexibility and joint range of mo- tion. Exercises should be pain-free and adapted to the patient’s needs and tolerance (37).
Eccentric contractions are typically avoided in the early stages of healing due to concerns that they may impair the healing cascade by reducing vas- cularisation. Consequently, eccentric exercises are more appropriately introduced during the late prolif- erative or remodelling phases (37). To manage pain alongside exercise, transcutaneous electrical nerve stimulation (TENS) may be employed. By the end of the second phase, low-impact aerobic activities such as cycling, swimming, and walking can be gradually introduced to maintain or improve cardiorespiratory fitness (23, 32).
In the early third phase (weeks 3 to 4), pain typically subsides, and full joint range of motion should be re- stored. The focus shifts to increasing activity levels, progressively building muscle strength and endur- ance. If not started earlier, eccentric strengthening exercises begin at this stage, along with propriocep- tive and stability training. Water-based exercises should increase in duration and intensity to improve aerobic capacity.
In the later third phase (weeks 5 to 10), exercises become more complex, incorporating multi-plane movements and adjusting loads based on progress. High-intensity resistance training may be introduced when appropriate. Aerobic activities such as cycling, swimming, and running continue to support overall fitness. Monitoring pain, joint mobility, and motor control ensures safe and effective progression (32).
Orthobiologic injections have shown positive re- sults in OA management, with most studies evaluat- ing outcomes using VAS and WOMAC scores, where these measures consistently indicate pain relief and functional improvement. However, MRI find-
ings remain inconsistent, suggesting that structural changes may not always align with symptomatic benefits. Variability in patient populations, OA sever- ity, injection protocols, and administration intervals further complicates comparisons. Multiple injections are administered at intervals ranging from weeks to months, with no clear consensus on the optimal dos- ing schedule.
Despite the potential benefits of orthobiologic thera- pies, post-injection rehabilitation protocols are poorly defined. While many studies acknowledge the impor- tance of physiotherapy, this review identifies one study that provides guidelines on exercise selection, progression, or timing relative to injection adminis- tration. Most rehabilitation programs are briefly men- tioned or entirely undocumented, limiting the ability to assess their role in treatment outcomes, which shows a significant gap in the literature.
The relationship between orthobiologic injections and physiotherapy remains unclear due to the lack of standardized rehabilitation protocols. Future re- search should focus on developing evidence-based post-injection rehabilitation strategies and establish- ing standardized outcome measures beyond self-re- ported pain and function scores. More comprehensive assessments, including objective imaging and long- term follow-up studies, are needed to determine the true impact of orthobiologic therapies following physiotherapy on OA progression and recovery.
Conceptualization (IČ, AI, MF); Data Curation (DK), Formal Analysis (IČ, DK); Writing – Original Draft (IČ), Writing – Review & Editing (IČ, AI, MF, DK). All authors reviewed and approved the final version of the man- uscript.
The authors declare no conflicts of interest.
Not applicable.
This research received no external funding.
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