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Goulian AJ, Goldstein B, Saad MA. Advancements in Regenerative Therapies for Orthopedics: A Comprehensive Review of Platelet-Rich Plasma, Mesenchymal Stem Cells, Peptide Therapies, and Biomimetic Applications. J Clin Med 2025; 14:2061. [PMID: 40142869 PMCID: PMC11943164 DOI: 10.3390/jcm14062061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 03/09/2025] [Accepted: 03/12/2025] [Indexed: 03/28/2025] Open
Abstract
Background/Objectives: Regenerative therapies have gained interest in orthopedic applications for their potential to enhance tissue regeneration, functional recovery, and pain modification. This review evaluates the clinical efficacy of platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), peptide-based treatments, and biomimetic materials in orthopedic care, with a focus on pain reduction and functional outcomes. Methods: A structured literature search in PubMed (January 2009-January 2025) identified 160 studies. After applying inclusion criteria prioritizing randomized controlled trials (RCTs) and clinical trials, 59 studies were included: 20 on PRP, 20 on MSCs, 10 on peptide therapies, and 7 on biomimetics. Data extraction focused on pain reduction and functional recovery, with risk of bias assessed using the Cochrane Risk of Bias (RoB) tool and ROBINS-I tool. A random-effects meta-regression analysis was conducted to evaluate the impact of therapy type, sample size, and risk of bias on reported pain reduction outcomes. Results: Meta-regression analysis identified MSC therapy as the most effective intervention for pain reduction (β = 8.45, p < 0.05), with PRP and peptide-based therapies showing moderate improvements, and biomimetic therapies demonstrating the lowest effect. PRP provided short-term pain relief, particularly in acute injuries and tendon repair, though inconsistencies in preparation methods limited success in chronic conditions. MSC therapies demonstrated cartilage regeneration and early osteoarthritis improvement, but high costs and ethical concerns remain barriers to widespread adoption. Peptide-based therapies and biomimetic materials, including engineered scaffolds and autologous protein solutions, showed promise for infection control and wound healing, though further research is needed to optimize dosing, delivery methods, and long-term safety. Conclusions: Regenerative therapies offer significant potential in orthopedic care, with MSC therapies demonstrating the most reliable regenerative effects, PRP providing short-term symptomatic relief, and peptide-based and biomimetic treatments emerging as promising adjuncts. However, standardized protocols and large-scale clinical trials are needed to establish long-term efficacy and improve clinical translation for broader adoption.
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Affiliation(s)
- Andrew J. Goulian
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (A.J.G.); (B.G.)
| | - Brielle Goldstein
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA; (A.J.G.); (B.G.)
| | - Maarouf A. Saad
- Department of Orthopaedic Surgery, University of California, Sacramento, CA 95817, USA
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Demeco A, de Sire A, Salerno A, Marotta N, Comuni B, Gabbi M, Lippi L, Invernizzi M, Ammendolia A, Costantino C. Effects of Autologous Tenocyte Injection for Overuse and Degenerative Tendinopathies: A Systematic Review. J Funct Morphol Kinesiol 2025; 10:95. [PMID: 40137347 PMCID: PMC11942842 DOI: 10.3390/jfmk10010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 03/01/2025] [Accepted: 03/14/2025] [Indexed: 03/27/2025] Open
Abstract
Background: The term tendinopathy commonly describes a series of alterations in the tendon, leading in functional impairment and pain, treated with several approaches, including exercises, physical agents, and injection therapies. Among the latter, autologous tenocyte injection (ATI) involves harvesting tenocytes from a healthy tendon of the patients and then isolating the tenocytes and culturing for 4-5 weeks. To date, there is still a lack of consensus about the efficacy of ATI in improving pain and function; therefore, the present review aimed to assess the role of ATI in the treatment of chronic tendinopathies. Methods: Two authors conducted a comprehensive search across PubMed Medline, Web of Science, Scopus, Cochrane Library, and Google Scholar (PROSPERO: CRD42024565211). From 174 articles, we finally included 5 articles. Results: The main effect obtained was the pain relief and, consequently, the improvement of patients' quality of life. The clinical improvement is also evident at MRI in which it is possible to see a progressive reduction with a general disappearance of the T2 signal hyperintensity between 4 months and 1 year. All the articles agree on the safety of ATI in chronic tendinopathies. Conclusions: ATI might represent a safe and valuable option in the management of chronic tendinopathies as a second line treatment in the case of resistant tendinopathies, with a minimal risk of side effects.
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Affiliation(s)
- Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.S.); (B.C.); (M.G.); (C.C.)
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Antonello Salerno
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.S.); (B.C.); (M.G.); (C.C.)
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Beatrice Comuni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.S.); (B.C.); (M.G.); (C.C.)
| | - Matteo Gabbi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.S.); (B.C.); (M.G.); (C.C.)
| | - Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, 1071 Budapest, Hungary;
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy;
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.D.); (A.S.); (B.C.); (M.G.); (C.C.)
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