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Mga Ineksyon ng Stem Cell at Regenerative

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What stem-cell and bone-marrow-derived injections claim to do for joints and tendons, what the evidence actually shows, and the safety and regulatory caveats.

Updated Jul 2026
Isang test tube sa tabi ng isang syringe.
Ang mga injeksyon ng stem cell at regenerative therapy ay malawak na iniadvertise; ang matibay na ebidensya para sa paggamit sa musculoskeletal system ay limitado pa rin. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ang nararamdaman mo

Maaaring mapansin mo ang sakit sa iyong tuhod, lalo na kung mayroon kang arthritis na dulot ng pagkasira o pagkasuot. Karaniwang mas malala ang hindi komportableng pakiramdam na ito pagkatapos ng aktibidad sa loob ng araw. Maaari ka ring makaramdam ng katigasan kapag ikaw ay gising sa umaga. Maaaring lumakas ang sakit sa gabi, na nagiging sanhi ng hirap sa paghahanap ng komportableng posisyon sa pagtulog.

Nagiging mahirap ang mga pang-araw-araw na gawain habang umuunlad ang kondisyon. Ang mga simpleng galaw tulad ng pagtayo mula sa upuan o pag-akyat ng hagdan ay maaaring magdulot ng matulis na sakit. Maaaring mahirapan kang lubos na yumuko sa iyong tuhod o panatilihin itong tuwid. May ilang tao ang nagsasabi na ang tuhod ay tila hindi matatag o parang magbibigay.

Kung mayroon kang synovitis, na pamamaga at pamamaga sa loob ng kasukasuan, maaaring mas matindi ang sakit. Ito ay lalo na totoo kung ang iyong sakit ay katamtaman hanggang malala. Ang pamamaga ay maaaring gawing mahigpit at mainit sa hawak ang tuhod. Maaaring mapansin mo na ang tuhod ay tila pamamaga o mas malaki kaysa karaniwan.

Aysusuri ng iyong doktor ang mga sintomas na ito upang maunawaan ang iyong partikular na sitwasyon. Habang pinag-aaralan ang mga injeksyon ng stem cell para sa mga isyung ito, kulang pa ang kasalukuyang ebidensya upang rekomendahan ang mga ito para sa karaniwang klinikal na gawain. Ang pinakamagandang epekto ng paggamot ng stem cell para sa posttraumatic arthritis ay madalas na napapansin sa ika-7 at ika-14 araw pagkatapos ng ilang mga prosedur, ngunit ito ay bahagi pa rin ng patuloy na pananaliksik.

Sa kasalukuyan, ang pokus ng iyong doktor ay pamamahala ng iyong sakit at pagpapabuti ng iyong kakayahan sa pamamagitan ng mga itinatag na paraan. Maaari kang payuhan na magpahinga, gumamit ng yelo, o kumuha ng gamot upang matulungan ang pamamaga at hindi komportableng pakiramdam. Ang pisikal na terapiya ay maaari ring tumulong upang palakasin ang mga kalamnan sa paligid ng tuhod upang mas mabuti itong suportahan.

Mahalagang malinaw na makipagkomunikasyon sa iyong doktor tungkol sa nararamdaman mo. Sabihin sa kanila kung kailan pinakamasakit ang sakit at anong mga aktibidad ang nagpapabuti o nagpapahina nito. Tumutulong ito sa kanila upang magtailor ng plano na angkop para sa iyo. Tandaan na ang mga bagong paggamot ay palaging sinusuri, ngunit ang kaligtasan at mga proven na resulta ay nananatiling pangunahing prioridad.

Ano ang nangyayari talaga

Ang iyong kasukasuan ng tuhod ay may patong ng makinis na kartilago. Ang tissue na ito ay gumagana bilang shock absorber at gasket. Pinapayagan nitong dumulas ang iyong mga buto sa isa’t isa nang walang friction. Sa osteoarthritis, ang patong na ito ay napapagod. Nangyayari ang pamamaga sa kasukasuan. Ang pamamagang ito ay tinatawag na synovitis. Ito ang nagdudulot ng sakit at stiffness.

Ang mga stem cell ay ang repair crew ng katawan. Partikular, ang mga mesenchymal stem cells ay maaaring magbago maging buto, kartilago, o taba. Tumutulong sila upang paitaas ang pamamaga at hikayatin ang paggaling. Maaaring gamitin ng iyong surgeon ang mga cell mula sa iyong sariling bone marrow o taba. Maaari rin silang gumamit ng mga cell na galing sa umbilical cord. Layunin ng mga treatment na ito na ibalik ang likas na function ng kasukasuan.

Mahalaga ang timing ng mga injection na ito. Para sa posttraumatic osteoarthritis, pinakamaganda ang epekto sa ika-7 at ika-14 araw pagkatapos ng sugat. Ang schedule ng treatment ay may malaking kinalaman sa kung gaano ito epektibo. Ang pagsasama ng stem cells at platelet-rich plasma ay maaaring palakasin ang therapeutic efficacy. May potensyal ang mix na ito bilang isang opsyon sa treatment para sa osteoarthritis.

Gayunpaman, kailangan nating maging malinukoy tungkol sa kasalukuyang estado ng paggamot. Kulang ang ebidensya upang irekomenda ang stem cell injections para sa knee osteoarthritis sa clinical practice sa kasalukuyan. Ang mga injection ng mesenchymal stem cells ay kumakatawan sa lumalaking larangan ng pananaliksik. Dapat silang patuloy na pag-aralan sa mga mahigpit na trial.

May ilang pag-aaral na nagpapakita ng pangako. Ang intra-articular injection ng umbilical cord–derived mesenchymal stem cells ay ligtas at epektibo para sa moderate hanggang severe knee osteoarthritis na may synovitis. Nakita ang clinical improvement sa dulo ng follow-up. Ang mga pasyenteng may moderate hanggang severe na sakit ay nakaranas ng partikular na pagpapabuti.

Ngunit magkakaiba-iba ang ibang resulta. Hindi maia-assess ang superioridad ng bone marrow aspirate concentrate kumpara sa ibang orthobiologic treatments dahil sa magkasalungat na mga resulta na kasalukuyang available. Mayroon ding malaking risk ng reporting bias sa mga trial. Madalas na mas maganda ang mga resulta sa mga abstract kumpara sa mga pangunahing teksto.

Ang paggamit ng mga cell na ito ay dapat gabayan ng pathophysiology ng target na sakit. Dapat itong sumunod sa mga regulatory framework upang matiyak ang ligtas at epektibong paggamit. Habang ang mga exosome-based strategies ay nagpapakita ng teoretikal na pangako, hindi pa ito karaniwang pamamaraan ng paggamot. Ang iyong surgeon ang gabay sa iyo batay sa kung ano ang proven at ligtas ngayon.

Ano ang inaasahan

Ang mga injeksyon ng stem cell para sa arthritis na dulot ng pagkasira ng tuhod ay nananatiling isang larangan ng aktibong pananaliksik. Kasalukuyang kulang ang ebidensya upang rekomendahan ang mga injeksyon na ito para sa karaniwang klinikal na gawain. Maaaring patuloy na pag-aralan ng iyong surgeon ang mga tratamientong ito sa mga mahigpit na pagsubok upang mas maunawaan ang kanilang papel.

Ang mga mesenchymal stem cells ay isang lumalaking pokus sa orthopaedics at trauma care. Ginagamit ang mga selulang ito sa klinikal na gawain ayon sa mga regulasyon ng kalusugan ng pamahalaan. Dapat sundin ng kanilang paggamit ang mga mahigpit na framework ng regulasyon upang matiyak ang kaligtasan at kahusayan. Dapat gabayan ang aplikasyon ng mga selulang ito ng tiyak na katangian ng sakit ng iyong kasu-kasuan.

Kung mayroon kang post-traumatic arthritis, mahalaga ang oras ng paggamot. Ang iskedyul ng mga injeksyon ay malaki ang ugnayan sa kung gaano kagaling ang paggamot. Sa ilang pasyente, pinakamagandang epekto ang nakikita sa ika-7 at ika-14 na araw pagkatapos ng pinsala. Ilang pag-aaral ay nag-iisang platelet-rich plasma sa adipose-derived mesenchymal stem cells. Ang kombinasyong ito ay nagpakita ng pinahusay na therapeutic efficacy at potensyal bilang isang pagpipilian sa paggamot.

Para sa moderate to severe knee osteoarthritis na may pamamaga, tila ligtas at epektibo ang mga injeksyon ng umbilical cord–derived mesenchymal stem cells. Maaaring makita ang klinikal na pag-unlad hanggang sa dulo ng follow-up. Ang mga pasyente na may moderate to severe na sakit ay madalas na nagpapakita ng partikular na pag-unlad.

Ang ibang mga pamamaraan, tulad ng bone marrow aspirate concentrate, ay may magkasalungat na resulta. Hindi maaaring sabihin kung ito ay mas mahusay kaysa sa ibang orthobiologic treatments sa kasalukuyan. Tinatalakay din ng pananaliksik ang pagmumobilize ng sariling stem cells ng katawan o paggamit ng exosomes. Nagbibigay ang mga natuklasan na ito ng teoretikal na rason para sa mga hinaharap na terapya.

Magkaroon ng kamalayan na may malaking panganib ng reporting bias sa kasalukuyang mga pagsubok. Madalas na nagpapakita ang mga abstract ng mga pagsubok na ito ng mas positibong resulta kaysa sa ulat ng pangunahing teksto. Ibig sabihin, maingat na dapat mong pamahalaan ang iyong mga inaasahan. Nag-iiba ang mga resulta, at hindi pa sapat ang lakas ng ebidensya upang garantiyahan ang tagumpay. Tutulungan ka ng iyong surgeon na bigyang-kahulugan ang mga hindi tiyak na ito laban sa iyong mga tiyak na pangangailangan.

Reviewed by Kieran Hirpara · 13 June 2026.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • There is insufficient evidence to recommend stem cell injections in clinical practice for osteoarthritis of the knee at this time [1].
  • Stem cell injections for osteoarthritis of the knee should continue to be studied in rigorous trials [1].
  • Mesenchymal stem cell injections represent a growing area of research in traumatology and orthopaedics [2].
  • There is a significant risk of reporting bias in randomized controlled trials and clinical trials of mesenchymal stromal cells for the treatment of knee osteoarthritis, with abstracts showing a significantly higher proportion of significant P values compared to main texts [9].
  • The superiority of bone marrow aspirate concentrate over other orthobiologic treatments for knee osteoarthritis cannot be assessed given the conflicting results presently available [6].
  • Mesenchymal stem cells have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations [5].
  • The application of mesenchymal stem cells in clinical practice should be guided by the pathophysiology of the target disease [5].
  • The application of mesenchymal stem cells in clinical practice should follow regulatory frameworks to ensure safe and effective use [5].
  • The intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for posttraumatic osteoarthritis, with the best effects observed on days 7 and 14 after anterior cruciate ligament transection in a rat model [3].
  • The combination of adipose-derived mesenchymal stem cells and platelet-rich plasma demonstrated enhanced therapeutic efficacy for the treatment of osteoarthritis [4].
  • Intra-articular injection of umbilical cord-derived mesenchymal stem cells is safe and effective for moderate to severe knee osteoarthritis with synovitis [7].
  • Treatment with umbilical cord-derived mesenchymal stem cells showed clinical improvement at the end of follow-up, especially in patients with moderate to severe pain [7].
  • Endogenous mesenchymal stromal cells can be pharmacologically mobilized into peripheral blood and recruited to the site of rotator cuff repair via local delivery of MCP-1 [8].
  • Mesenchymal stem cell-derived miR-125b-1-3p-abundant exosomes alleviate osteoarthritis by modulating the KDM6B-H3K27me3-FOXM1 axis [10].
  • Findings regarding mesenchymal stem cell-derived miR-125b-1-3p-abundant exosomes provide a theoretical rationale for the development of exosome-based therapeutic strategies against osteoarthritis [10].
  • These findings identify promising therapeutic targets for the development of exosome-based therapeutic strategies against osteoarthritis [10].

How It Works

  • There is insufficient evidence to recommend stem cell injections in clinical practice at this time [1].
  • Stem cell injections should continue to be studied in rigorous trials [1].
  • Mesenchymal stem cell (MSC) injections represent a growing area of research in traumatology and orthopaedics [2].
  • MSC application in clinical practice should be guided by the pathophysiology of the target disease [5].
  • MSC application in clinical practice should follow regulatory frameworks to ensure safe and effective use [5].
  • The superiority of bone marrow aspirate concentrate (BMAC) over other orthobiologic treatments cannot be assessed given conflicting results [6].
  • Treatment with umbilical cord-derived mesenchymal stem cells (UC-MSCs) is a viable therapeutic option for knee osteoarthritis (KOA) combined with synovitis [7].
  • UC-MSC treatment shows clinical improvement at the end of follow-up, especially in patients with moderate to severe pain [7].
  • The combination of platelet-rich plasma (PRP) and adipose-derived stem cells (ADSCs) demonstrates enhanced therapeutic efficacy for osteoarthritis [4].
  • Endogenous MSCs can be pharmacologically mobilized into peripheral blood [8].
  • Endogenous MSCs can be recruited to the site of rotator cuff repair via local delivery of MCP-1 [8].
  • MSC-derived miR-125b-1-3p-abundant exosomes alleviate osteoarthritis by modulating the KDM6B-H3K27me3-FOXM1 axis [10].
  • Local delivery of MSC-derived extracellular vesicles (MSC-EVs) embedded within an injectable collagen scaffold enhances tendon regeneration in a rat model of collagenase-induced tendinopathy [11].
  • Local application of BMAC without appropriate carriers could not enhance bone-tendon interface healing in a rabbit model of chronic rotator cuff tear [12].
  • Adipose-derived stem cell (ASC) interactions with the immune system are complex [13].
  • ASC secretome may be a well-tolerated treatment for osteoarthritis, though further studies are needed to determine its potential therapeutic benefits [13].
  • Hypoxic MSCs might exert therapeutic effects mediated by stimulating TGF-β [16].
  • Hypoxic MSCs promote the expression of COL II [16].
  • Hypoxic MSCs inhibit the expression of COL X [16].

What the Evidence Shows

  • Spin bias was present in most mesenchymal stromal cell-related trials for knee osteoarthritis, with a higher frequency among trials that utilized adipose-derived mesenchymal stem cells [14].
  • Mesenchymal stem cells have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations, but their application should be guided by the pathophysiology of the target disease and follow regulatory frameworks to ensure safe and effective use [5].
  • The combination of platelet-rich plasma and adipose-derived stem cells demonstrated enhanced therapeutic efficacy for the treatment of osteoarthritis [4].
  • Treatment with umbilical cord-derived mesenchymal stem cells was shown to be a viable therapeutic option for knee osteoarthritis combined with synovitis, showing clinical improvement at the end of follow-up, especially in those with moderate to severe pain [7].
  • Local delivery of mesenchymal stem cell-derived extracellular vesicles embedded within an injectable collagen scaffold enhanced tendon regeneration in a rat model of collagenase-induced tendinopathy [11].
  • Local application of bone marrow aspirate concentrate without appropriate carriers could not enhance bone-tendon interface healing in a rabbit model of chronic rotator cuff tear [12].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate appeared to be safe, and clinical outcomes were favorable up to 2 years postoperation despite having no quantifiable effect on graft maturation [15].
  • Arthroscopic surgical repair combined with mesenchymal stem cell augmentation reported better structural outcomes compared to isolated surgical repair for rotator cuff tears [17].

Practical Considerations

  • The intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for posttraumatic osteoarthritis [3].
  • The best effects of stem cell treatment for posttraumatic osteoarthritis are observed on days 7 and 14 after anterior cruciate ligament transection [3].
  • The combination of platelet-rich plasma and adipose-derived mesenchymal stem cells demonstrated enhanced therapeutic efficacy for osteoarthritis [4].
  • The application of mesenchymal stem cells should be guided by the pathophysiology of the target disease [5].
  • The application of mesenchymal stem cells should follow regulatory frameworks to ensure safe and effective use [5].
  • The superiority of bone marrow aspirate concentrate over other orthobiologic treatments cannot be assessed given the conflicting results presently available [6].
  • Treatment with umbilical cord-derived mesenchymal stem cells is a viable therapeutic option for knee osteoarthritis combined with synovitis [7].
  • Umbilical cord-derived mesenchymal stem cell treatment showed clinical improvement at the end of follow-up, especially in patients with moderate to severe pain [7].
  • There is a significant risk of reporting bias in randomized controlled trials and clinical trials of mesenchymal stromal cells for the treatment of knee osteoarthritis [9].
  • Abstracts of mesenchymal stromal cell trials for knee osteoarthritis show a significantly higher proportion of significant P values compared to main texts [9].
  • Spin bias was present in most mesenchymal stromal cell-related trials for knee osteoarthritis [14].
  • Spin bias had a higher frequency among trials that utilized adipose-derived mesenchymal stem cells [14].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate appeared to be safe [15].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate produced favorable clinical outcomes up to 2 years postoperation [15].
  • Augmenting hamstring allograft anterior cruciate ligament reconstruction with an amnion collagen matrix and injecting bone marrow aspirate concentrate had no quantifiable effect on graft maturation [15].
  • Adipose-derived stem cell interactions with the immune system are complex [13].
  • The secretome of adipose-derived stem cells may be a well-tolerated treatment for osteoarthritis [13].
  • Further studies are needed to determine the potential therapeutic benefits of adipose-derived stem cell secretome [13].

Key Evidence

  • [L1] There is insufficient evidence to recommend stem cell injections in clinical practice at this time, but they should continue to be studied in rigorous trials. [1] (10.1097/corr.0000000000003593)
  • [L2] MSC injections represent a growing area of research in traumatology and orthopaedics. [2] (10.1186/s12891-025-09123-8)
  • [L5] The intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for PTOA, with the best effects observed on days 7 and 14 after ACLT. [3] (10.1177/03635465251326499)
  • [L5] The combination of PRP and ADSCs demonstrated enhanced therapeutic efficacy, suggesting its potential as a treatment option for OA. [4] (10.1186/s13018-024-05396-2)
  • [L5] Mesenchymal stem cells (MSCs) have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations, but their application should be guided by the pathophysiology of the target disease and follow regulatory frameworks to ensure safe and effective use. [5] (10.1530/eor-2026-0056)
  • [L2] However, the superiority of BMAC over other orthobiologic treatments cannot be assessed given the conflicting results presently available. [6] (10.1186/s13018-025-06509-1)
  • [L1] Treatment with UC-MSCs was shown to be a viable therapeutic option for KOA combined with synovitis, showing clinical improvement at the end of follow-up, especially in those with moderate to severe pain. [7] (10.1186/s12891-025-09440-y)
  • [L5] Endogenous MSCs can be pharmacologically mobilized into peripheral blood and recruited to the site of rotator cuff repair via local delivery of MCP-1. [8] (10.1177/03635465251341439)
  • [L2] The study highlights a significant risk of reporting bias in RCTs and CTs of MSCs for the treatment of knee OA, with abstracts showing a significantly higher proportion of significant P values compared to main texts. [9] (10.1177/23259671251374306)
  • [L5] These findings provide a theoretical rationale and identify promising therapeutic targets for the development of exosome-based therapeutic strategies against OA. [10] (10.1186/s13018-026-06765-9)
  • [L5] Local delivery of MSC-EVs embedded within an injectable collagen scaffold enhanced tendon regeneration in a rat model of collagenase-induced tendinopathy. [11] (10.1177/03635465261421555)
  • [L5] Local application of BMAC without appropriate carriers could not enhance bone-tendon interface healing. [12] (10.1177/03635465241313124)
  • [L5] This study highlights the complexity of ASC interactions with the immune system, while secretome may be a well-tolerated treatment, further studies are needed to determine its potential therapeutic benefits. [13] (10.1186/s12891-025-08642-8)
  • [L2] Spin bias was present in most MSC-related trials for knee osteoarthritis, with a higher frequency among those that utilized adipose-derived MSCs. [14] (10.1177/03635465241274155)
  • [L4] This case series demonstrated that augmenting hamstring allograft ACL reconstruction with an amnion collagen matrix and injecting BMAC appeared to be safe, and clinical outcomes were favorable up to 2 years postoperation despite having no quantifiable effect on graft maturation. [15] (10.1016/j.asmr.2025.101209)
  • [L5] Hypoxic MSCs might exert therapeutic effects mediated by stimulating TGF-β and subsequently promote and inhibit the expressions of COL II and COL X respectively. [16] (10.1186/s13018-025-06184-2)
  • [L1] Arthroscopic surgical repair combined with MSC augmentation reported better structural outcomes compared to isolated surgical repair for RCT. [17] (10.1016/j.jseint.2025.03.017)

References

[1] Cochrane in CORR ®: Stem Cell Injections for Osteoarthritis of the Knee. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003593

[2] Mesenchymal stem cells injections in traumatology and orthopaedics: common practice or still a promising area with many uncertainties?. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09123-8

[3] Days 7 to 14 May Represent an Optimal Window for Stem Cell–Based Treatment in a Rat Model of Anterior Cruciate Ligament Transection–Induced Posttraumatic Osteoarthritis. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251326499

[4] Adipose-derived mesenchymal stem cells combined with platelet-rich plasma are superior options for the treatment of osteoarthritis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05396-2

[5] Clinical application of mesenchymal stem cells in orthopaedics and traumatology in daily practice. EFORT Open Reviews. 2026. DOI: 10.1530/eor-2026-0056

[6] Progress in the clinical use of bone marrow aspirate concentrate for knee osteoarthritis: an expert opinion. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06509-1

[7] Intra-articular injection of umbilical cord–derived mesenchymal stem cells is safe and effective for moderate to severe knee osteoarthritis with synovitis: a double‑blinded and randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09440-y

[8] Pharmacologic Mobilization and Chemokine-Directed Recruitment of Mesenchymal Stromal Cells to the Surgically Repaired Rotator Cuff. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251341439

[9] Analysis of

        <i>P</i>
        Values in the Abstract Compared With the Main Text of Randomized Controlled Trials and Clinical Trials of Mesenchymal Stromal Cells for the Treatment of Knee Osteoarthritis. *Orthopaedic Journal of Sports Medicine*. 2025. DOI: 10.1177/23259671251374306

[10] Mesenchymal stem cell-derived miR-125b-1-3p-abundant exosomes alleviate osteoarthritis by modulating the KDM6B-H3K27me3-FOXM1 axis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06765-9

[11] Regenerative Effect of Injectable Collagen Loaded With Mesenchymal Stem Cell–Derived Extracellular Vesicles in a Collagenase-Induced Tendinopathy Rat Model. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261421555

[12] Bone Marrow Aspirate Concentrate Combined With an Appropriate Carrier Effectively Promotes Bone-Tendon Interface Healing in a Rabbit Model of Chronic Rotator Cuff Tear. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241313124

[13] Impact of adipose-derived mesenchymal stem cells and their secretome on osteoarthritis in a rat model. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08642-8

[14] Evaluation of Spin in Clinical Trials of Mesenchymal Stromal Cells for the Treatment of Knee Osteoarthritis: A Systematic Review. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241274155

[15] Augmenting an Allograft for Anterior Cruciate Ligament Reconstruction With a Collagen Matrix and Bone Marrow Aspirate Concentrate Injection Appears Safe and Produces Favorable Clinical Outcomes at 2‐Year Follow‐Up. Arthroscopy, Sports Medicine, and Rehabilitation. 2025. DOI: 10.1016/j.asmr.2025.101209

[16] Roles of TGF-β in the therapeutic potential of hypoxic mesenchymal stem cells for treating osteoarthritis in a Rabbit model. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06184-2

[17] Combined arthroscopic rotator cuff repair with mesenchymal stem cell augmentation shows similar functional outcomes but a higher structural integrity rate compared with isolated repair: a meta-analysis of comparative studies. JSES International. 2025. DOI: 10.1016/j.jseint.2025.03.017

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h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.