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Stem Cell and Regenerative Injections

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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 Sep 202617 citations
A test tube next to a syringe.
Stem-cell and regenerative injections are widely advertised; robust evidence for musculoskeletal use remains limited. Kieran Hirpara 4.0

What it is

Stem cell injections are a type of regenerative treatment. The idea is to use the body's own repair cells to help damaged tissue heal. The most studied cells are called mesenchymal stem cells (MSCs). These are found in bone marrow and fat, and they can turn into other tissue types such as bone or cartilage.

This is a growing area of research in orthopaedics and trauma care [1]. It is considered for problems like wear-and-tear arthritis (osteoarthritis), tendon injuries, and fractures that have failed to heal. Some related treatments use platelet-rich plasma (PRP), which is a concentrate made from your own blood. Others use exosomes, which are tiny particles released by stem cells. Exosomes may work without needing to take cells from your body, so they avoid some drawbacks of stem cell therapy, such as pain at the collection site [2].

Researchers think these treatments work in a few ways. The cells may calm inflammation, encourage repair, and support new tissue growth [3]. Some approaches combine treatments, for example PRP with fat-derived stem cells, which showed better results for osteoarthritis in research settings [4].

It is important to know where the science stands. There is not enough evidence yet to recommend stem cell injections as a routine treatment [5]. More needs to be learned about how these cells behave before they can be used widely [3]. Some studies are promising. For example, one study of knee osteoarthritis with joint lining inflammation (synovitis) found improvement, especially in people with moderate to severe pain [6]. But much of this work is early stage.

If your doctor discusses this option with you, it will be in that context: an evolving treatment, offered within government health regulations [7], and only where the evidence supports it for your specific condition.

Does it work?

The honest answer is that it depends on the condition, and the evidence is still developing. For knee wear-and-tear arthritis, some trials found improvement in pain, especially in people who started with moderate to severe pain [1]. But there is a catch. A review of these trials found that many reported results in a way that made the treatment look better than it was [2] [3]. That makes it hard to know how well the treatment truly works.

For tendon and ligament problems, the picture is mixed. When stem cell treatment was added to keyhole surgery for rotator cuff tears, the repaired tendon looked better on scans than with surgery alone [4]. For knee ligament reconstruction, adding a bone marrow concentrate appeared safe, and people did well for up to 2 years afterwards [5]. But the same study found the added cells made no difference to how well the new ligament healed into bone [5]. In other words, safe, but no clear added benefit so far.

There are also things researchers still do not know. Different ways of preparing and delivering the cells can change the result [6]. Some cell-based treatments cannot yet be compared fairly against each other, because the studies that exist point in different directions [7]. Newer options, such as exosomes, are early in testing [8].

So where does that leave you? Stem cell injections are not a proven, routine treatment for most orthopaedic problems [9]. They may help some people with some conditions. If your doctor discusses this option with you, they should be clear about which parts of the evidence are strong and which are not.

What are the risks?

The honest answer is that researchers are still working out the full risk picture. Most studies so far have been small, and some reported their results in a way that made the treatment look better than it was [1] [2]. That makes it harder to get a clear read on how often problems happen.

What researchers have looked at so far is mostly about safety signals rather than counted harms. When a bone marrow concentrate was added to knee ligament reconstruction surgery, the study reported it appeared to be safe [3]. For a treatment made from the signalling particles of fat-derived stem cells, early work found it may be well tolerated [4]. But those findings come with a caveat. The same research noted that more studies are needed before we know the real benefits [4].

There are also open questions about how the treatment is prepared and delivered. The way cells are handled, from the moment they are collected to the moment they are put back in your body, can change the result [5]. In one animal study, a bone marrow concentrate applied on its own, without a carrier material to hold it in place, did not help tendon heal to bone [6]. That matters because it suggests the technique and the setting are part of whether the treatment works as intended, not just the cells themselves.

One more thing worth knowing. Because these treatments are still being studied, they should only be offered within government health regulations, with the choice guided by the specific condition being treated [7]. If your doctor raises this option, ask what is known about safety for your particular problem, and what is not.

Is it right for you?

These injections are considered for wear-and-tear arthritis, and for some tendon, ligament and fracture healing problems [1]. Research has looked at them most in knee arthritis, including people with joint lining inflammation [2]. They have also been studied alongside knee ligament reconstruction surgery [3].

You may be someone they suit if you have moderate to severe arthritis pain, because that is the group where improvement showed up most clearly [2]. They may also be considered when a fracture has failed to heal in the usual way [4].

They are probably not right for you if you expect a proven, routine treatment. The evidence does not yet support that [5]. Some newer options, such as exosomes, are still early in testing [6]. And one study found the added cells made no difference to how well a new knee ligament healed into bone [3], so added treatment does not always add benefit.

Compared with the main alternatives, such as standard surgery or established non-surgical care, these injections sit in a different space. They are still being studied, so they are offered within government health regulations and guided by your specific condition [7].

The risks have their own section above, so read that before deciding.

This should be a shared decision with your doctor. Ask which parts of the evidence are strong for your condition, and which are not. If the answer is unclear, a well-established treatment may serve you better.

The bottom line

Stem cell injections are still being studied, not routine care. They may be worth considering for wear-and-tear arthritis, especially if your pain is moderate to severe [1]. Some newer options, such as exosomes, are early in testing [2]. Go in with a realistic expectation: they may help some people with some conditions, and the way results have been reported in trials makes it hard to know how well they truly work [3] [4]. The single most important caveat is this. If your doctor discusses this option, it should be within government health regulations and guided by your specific condition [5]. If the evidence for your problem is unclear, a well-established treatment may serve you better.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References
  1. Mesenchymal stem cells injections in traumatology and orthopaedics: common practice or still a promising area with many uncertainties?. *BMC Musculoskeletal Disorders*. 2025. 10.1186/s12891-025-09123-8
  2. The Role of Exosomes in Upper-Extremity Tissue Regeneration. *The Journal of Hand Surgery*. 2024. 10.1016/j.jhsa.2023.11.016
  3. Biological considerations of mesenchymal stem cells and endothelial progenitor cells. *Injury*. 2008. 10.1016/s0020-1383(08)70012-3
  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. 10.1186/s13018-024-05396-2
  5. Cochrane in CORR ®: Stem Cell Injections for Osteoarthritis of the Knee. *Clinical Orthopaedics & Related Research*. 2025. 10.1097/corr.0000000000003593
  6. 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. 10.1186/s12891-025-09440-y
  7. Clinical application of mesenchymal stem cells in orthopaedics and traumatology in daily practice. *EFORT Open Reviews*. 2026. 10.1530/eor-2026-0056
  8. 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. 10.1177/03635465241274155
  9. Analysis of
  10. 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. 10.1016/j.jseint.2025.03.017
  11. 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. 10.1016/j.asmr.2025.101209
  12. Mesenchymal stem cell tissue engineering: Techniques for isolation, expansion and application. *Injury*. 2007. 10.1016/s0020-1383(08)70006-8
  13. Progress in the clinical use of bone marrow aspirate concentrate for knee osteoarthritis: an expert opinion. *Journal of Orthopaedic Surgery and Research*. 2025. 10.1186/s13018-025-06509-1
  14. Impact of adipose-derived mesenchymal stem cells and their secretome on osteoarthritis in a rat model. *BMC Musculoskeletal Disorders*. 2025. 10.1186/s12891-025-08642-8
  15. 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. 10.1177/03635465241313124
  16. Degenerative osteoarthritis a reversible chronic disease. *Regenerative Therapy*. 2020. 10.1016/j.reth.2020.07.007
  17. Evaluation of mesenchymal stem cells’ bone repair capacity via osteogenic lineage differentiation in experimental nonunion fractures. *BMC Musculoskeletal Disorders*. 2026. 10.1186/s12891-026-10114-6
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 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].
  • More knowledge regarding the biological properties of MSCs and endothelial progenitor cells (EPCs) is required before using these cells as a routinely applied therapy in the clinical setting [3].
  • The intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for posttraumatic osteoarthritis (PTOA) [4].
  • The best effects of stem cell treatment for PTOA are observed on days 7 and 14 after anterior cruciate ligament transection (ACLT) [4].
  • Exosomes offer a promising cell-free alternative to mesenchymal stem cell therapies for upper-extremity tissue regeneration [5].
  • Exosomes overcome limitations such as donor-site morbidity and tumorigenesis associated with mesenchymal stem cell therapies [5].
  • A better understanding of exosome mechanisms and standardized isolation methods is required before clinical application [5].
  • Mesenchymal stem cells (MSCs) have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations [6].
  • The application of MSCs should be guided by the pathophysiology of the target disease [6].
  • The application of MSCs should follow regulatory frameworks to ensure safe and effective use [6].
  • Interventions employing platelet-rich plasma (PRP), MSCs, and exosomes are considered in the context of degenerative osteoarthritis as a reversible chronic disease [7].
  • The outcome of MSC tissue engineering approaches is influenced by the methodologies and materials used during the cycle from the isolation of MSCs to their re-implantation [10].
  • Cells with the characteristics of stromal stem cells were isolated from irrigation fluid, which is normally discarded [22].

How It Works

  • Exosomes overcome limitations of mesenchymal stem cell therapies such as donor-site morbidity and tumorigenesis [5].
  • Repeated intra-articular injections of PRP and adipose-derived stem cells (ADSCs) alleviated inflammation and pain in rats with surgically induced osteoarthritis [8].
  • Repeated intra-articular injections of PRP and ADSCs promoted tissue repair in rats with surgically induced osteoarthritis [8].
  • Repeated intra-articular injections of PRP and ADSCs modulated immune responses in rats with surgically induced osteoarthritis [8].
  • Mesenchymal stem cell-derived exosomes (MSC-Exos) from diverse tissue sources are used in the treatment of osteoarthritis [9].
  • Endogenous MSCs can be pharmacologically mobilized into peripheral blood [11].
  • Endogenous MSCs can be recruited to the site of rotator cuff repair via local delivery of MCP-1 [11].
  • Osteogenically pre-differentiated adipose-derived stem cells (ASCs) demonstrated enhanced bone regenerative capacity compared with undifferentiated ASCs in experimental nonunion fractures [12].
  • Local delivery of MSC-derived extracellular vesicles (MSC-EVs) embedded within an injectable collagen scaffold enhanced tendon regeneration in a rat model of collagenase-induced tendinopathy [13].
  • Mesenchymal stem cell-derived miR-125b-1-3p-abundant exosomes alleviate osteoarthritis by modulating the KDM6B-H3K27me3-FOXM1 axis [17].
  • Local application of bone marrow aspirate concentrate (BMAC) without appropriate carriers could not enhance bone-tendon interface healing in a rabbit model of chronic rotator cuff tear [18].

What the Evidence Shows

  • Stem cell injections for osteoarthritis of the knee should continue to be studied in rigorous trials [1].
  • More knowledge regarding the biological properties of MSCs and endothelial progenitor cells is required before using these cells as a routinely applied therapy in the clinical setting [3].
  • The best effects of stem cell treatment for PTOA were observed on days 7 and 14 after anterior cruciate ligament transection (ACLT) in a rat model [4].
  • Mesenchymal stem cells have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations [6].
  • The application of mesenchymal stem cells should be guided by the pathophysiology of the target disease [6].
  • The application of mesenchymal stem cells should follow regulatory frameworks to ensure safe and effective use [6].
  • Interventions employing platelet-rich plasma (PRP), mesenchymal stem cells, and exosomes are considered in the context of degenerative osteoarthritis as a reversible chronic disease [7].
  • Mesenchymal stem cell-derived exosomes (MSC-Exos) from diverse tissue sources are being researched for the treatment of osteoarthritis [9].
  • The outcome of mesenchymal stem cell tissue engineering approaches is influenced by the methodologies and materials used during the cycle from isolation to re-implantation [10].
  • Endogenous mesenchymal stem cells can be pharmacologically mobilized into peripheral blood [11].
  • Endogenous mesenchymal stem cells can be recruited to the site of rotator cuff repair via local delivery of MCP-1 [11].
  • Osteogenically pre-differentiated adipose-derived stem cells demonstrated enhanced bone regenerative capacity compared with undifferentiated adipose-derived stem cells in experimental nonunion fractures [12].
  • Local delivery of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) embedded within an injectable collagen scaffold enhanced tendon regeneration in a rat model of collagenase-induced tendinopathy [13].
  • Spin bias was present in most mesenchymal stem cell-related trials for knee osteoarthritis [14].
  • Spin bias was more frequent among trials that utilized adipose-derived mesenchymal stem cells [14].
  • The superiority of bone marrow aspirate concentrate (BMAC) over other orthobiologic treatments cannot be assessed given the conflicting results presently available [15].
  • Treatment with umbilical cord-derived mesenchymal stem cells (UC-MSCs) was shown to be a viable therapeutic option for knee osteoarthritis combined with synovitis [16].
  • Treatment with UC-MSCs showed clinical improvement at the end of follow-up for knee osteoarthritis combined with synovitis [16].
  • Clinical improvement with UC-MSCs was especially observed in patients with moderate to severe pain [16].
  • Arthroscopic surgical repair combined with mesenchymal stem cell augmentation reported better structural outcomes compared to isolated surgical repair for rotator cuff tears [19].

Practical Considerations

  • The best effects for stem cell treatment of PTOA are observed on days 7 and 14 after anterior cruciate ligament transection [4].
  • Interventions employing platelet-rich plasma (PRP), mesenchymal stem cells, and exosomes are considered for degenerative osteoarthritis [7].
  • Mesenchymal stem cell-derived exosomes from diverse tissue sources are being researched for the treatment of osteoarthritis [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 stromal cells [14].
  • Treatment with umbilical cord-derived mesenchymal stem cells (UC-MSCs) is a viable therapeutic option for knee osteoarthritis combined with synovitis [16].
  • UC-MSC treatment showed clinical improvement at the end of follow-up for knee osteoarthritis combined with synovitis [16].
  • UC-MSC treatment showed clinical improvement especially in patients with moderate to severe pain [16].
  • Certain local anesthetics, corticosteroids, and anticoagulants should be avoided when possible to preserve mesenchymal stem cell viability for BMAC procedures [21].

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] Even though MSCs and EPCs constitute a powerful candidate cell type for regenerative medicine, more knowledge in terms of their biological properties is required before using these cells as a routinely applied therapy in the clinical setting. [3] (10.1016/s0020-1383(08)70012-3)
  • [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. [4] (10.1177/03635465251326499)
  • [L5] Exosomes offer a promising cell-free alternative to mesenchymal stem cell therapies for upper-extremity tissue regeneration by overcoming limitations such as donor-site morbidity and tumorigenesis, though a better understanding of their mechanisms and standardized isolation methods is required before clinical application. [5] (10.1016/j.jhsa.2023.11.016)
  • [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. [6] (10.1530/eor-2026-0056)
  • [L5] Interventions employing PRP, MSCs and exosomes are considered in this article. [7] (10.1016/j.reth.2020.07.007)
  • [L5] Repeated intra-articular injections of PRP and ADSCs alleviated inflammation and pain, promoted tissue repair, and modulated immune responses in rats with surgically induced OA. [8] (10.1186/s13018-024-05396-2)
  • [L5] This article provides a synopsis of the research progress and mechanisms of mesenchymal stem cell-derived exosomes (MSC-Exos) from diverse tissue sources in the treatment of osteoarthritis. [9] (10.1186/s13018-026-06907-z)
  • [L5] The outcome of these approaches is influenced by the methodologies and materials used during the cycle from the isolation of MSCs to their re-implantation. [10] (10.1016/s0020-1383(08)70006-8)
  • [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. [11] (10.1177/03635465251341439)
  • [Paper] Osteogenically pre-differentiated ASCs demonstrated enhanced bone regenerative capacity compared with undifferentiated ASCs. [12] (10.1186/s12891-026-10114-6)
  • [L5] Local delivery of MSC-EVs embedded within an injectable collagen scaffold enhanced tendon regeneration in a rat model of collagenase-induced tendinopathy. [13] (10.1177/03635465261421555)
  • [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)
  • [L2] However, the superiority of BMAC over other orthobiologic treatments cannot be assessed given the conflicting results presently available. [15] (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. [16] (10.1186/s12891-025-09440-y)
  • [L5] These findings provide a theoretical rationale and identify promising therapeutic targets for the development of exosome-based therapeutic strategies against OA. [17] (10.1186/s13018-026-06765-9)
  • [L5] Local application of BMAC without appropriate carriers could not enhance bone-tendon interface healing. [18] (10.1177/03635465241313124)
  • [L1] Arthroscopic surgical repair combined with MSC augmentation reported better structural outcomes compared to isolated surgical repair for RCT. [19] (10.1016/j.jseint.2025.03.017)
  • [Paper] These findings demonstrate that certain local anesthetics, corticosteroids, and anticoagulants should be avoided when possible to preserve MSC cell viability for BMAC procedures. [21] (10.1177/2325967126s00427)
  • [Paper] Even in the irrigation fluid, which is normally discarded, cells with the characteristics of stromal stem cells were isolated. [22] (10.1016/s0020-1383(15)30051-6)

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] Biological considerations of mesenchymal stem cells and endothelial progenitor cells. Injury. 2008. DOI: 10.1016/s0020-1383(08)70012-3

[4] 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

[5] The Role of Exosomes in Upper-Extremity Tissue Regeneration. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.11.016

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

[7] Degenerative osteoarthritis a reversible chronic disease. Regenerative Therapy. 2020. DOI: 10.1016/j.reth.2020.07.007

[8] 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

[9] Application of exosomes derived from mesenchymal stem cells in osteoarthritis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-026-06907-z

[10] Mesenchymal stem cell tissue engineering: Techniques for isolation, expansion and application. Injury. 2007. DOI: 10.1016/s0020-1383(08)70006-8

[11] 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

[12] Evaluation of mesenchymal stem cells’ bone repair capacity via osteogenic lineage differentiation in experimental nonunion fractures. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-10114-6

[13] 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

[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] 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

[16] 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

[17] 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

[18] 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

[19] 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

[21] Poster 123. Characterization of Human Bone Marrow Aspirate Concentrate Derived Mesenchymal Stem Cells and the Effect of Commonly Used Clinical Drugs on Their Viability and Proliferation. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00427

[22] RIA fractions contain mesenchymal stroma cells with high osteogenic potency. Injury. 2015. DOI: 10.1016/s0020-1383(15)30051-6

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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.