Advances in Regenerative Medicine for Tendon Injuries: Stem Cells vs. PRP Therapies

Abdullah Mahmood
University of Faisalabad, Faisalabad, Pakistan
Correspondence to: Abdullah Mahmood, abdullah.mahmod828@gmail.com

DOI: https://doi.org/10.70389/PJSPS.100013

Additional information

• Ethical approval: N/a
• Consent: N/a
• Funding: No industry funding
• Conflicts of interest: N/a
• Author contribution: Abdullah Mahmood – Conceptualization, Writing – original draft, review and editing
• Guarantor: Abdullah Mahmood
• Provenance and peer-review:
  Unsolicited and externally peer-reviewed
• Data availability statement: N/a

Keywords: Regenerative medicine, Tendon repair, Platelet-rich plasma (PRP), Mesenchymal stem cells (MSCs), Orthobiologics.

Peer Review
Received: 25 May 2025
Last revised: 1 August 2025
Accepted: 1 August 2025
Version accepted: 6
Published: 29 August 2025

Plain Language Summary Infographic

Introduction

Injuries to tendons are prevalent among individuals who engage in sports and those who do not exercise regularly. Conditions of this nature account for up to 30% of all musculoskeletal medicine consultations and significantly contribute to health comorbidities. Injuries typically arise when the muscles are overloaded or subjected to excess loads, which often result from age-related changes.¹ As the population grows and sports become increasingly popular, such injuries are on the rise. Such conditions burden the economy, and people lose work time, which lengthens their recovery times and results in increased annual medical expenses. When joints are painful, individuals are generally treated with rest, NSAIDs, initiating physical therapy, receiving a corticosteroid injection, and, in extreme cases, surgery. These treatments can alleviate symptoms but do not address the underlying factors causing tendon pathology.² Since procedures do not always function optimally, active or older patients frequently develop retears and recurrent injuries.

Anti-inflammatory drugs may interfere with the body’s natural repair process by disrupting immune responses, leading to a move toward regenerative therapies, namely platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs). These treatments are designed to promote tendon repair by regulating inflammation and fostering cellular healing; however, comparisons are challenging to perform due to differences in protocol and patient outcomes.^3,4 The evaluation will be conducted based on the PEO framework to synthesize a body of evidence on the regenerative therapies in treating tendon injuries. The PEO Checklist was used for evaluating the studies (Appendix 1). Population (P) covers patients and animal models with different tendon injuries, including the Achilles, patellar, rotator cuff, or digital flexor tendon injuries. The exposure (E) is the application of the regenerative modalities, namely, the PRP and/or MSCs, either alone or in combination. The outcome (O) pays attention to signs of tendon recovery, such as pain reduction, functional restoration or improvement, histological regeneration, structural alterations visible by imaging technologies, and the improvement of biomechanical performance. Based on this framework, the formulated research question is: “In patients or animal models with tendon injuries, how do regenerative therapies involving PRP and/or MSCs compare in enhancing pain relief, functional outcomes, and tendon healing, relative to standard treatments or each other?”

Methodology

This systematic literature review was undertaken by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to investigate and summarize the comprehensive knowledge of the existing body of literature using the database and a keyword search strategy that guaranteed reliability and repeatability of the review.⁵ The relevant literature was searched via multiple databases, including PubMed, Embase, and Cochrane Library. The checklist of the PEO framework comprises criteria that determine the selection of the studies (Appendix 1).⁶ Included articles in the literature search involved human or animal models using clinically or experimentally diagnosed tendon injuries like Achilles tendon injury, rotator cuff injury, patellar tendon injury, or lateral epicondyle injury. The studies have evaluated the application of the regenerative agent or regenerative therapy practices in PRP, MSCs, or a combination of regenerative avenues administered by injection, surgical augmentation, or scaffold transport. In addition to that, the studies have described at least one of the relevant outcomes, such as pain reduction, histological repair, biomechanical properties, imaging-based healing conclusions, or functional restoration scores. Moreover, the included studies have used primary research designs as randomized controlled trials, cohort studies, controlled preclinical trials, or meta-analyses, which have taken the effectiveness of PRP and/or MSC-based therapy into consideration in the process of tendon regeneration and wound healing.

Search Strategy

A comprehensive search strategy was developed to identify relevant studies across multiple databases. The following keywords and phrases were utilized in the search: “tendon injury,” “regenerative medicine,” “mesenchymal stem cells,” “platelet-rich plasma,” “PRP,” “MSC therapy,” “tendon healing,” “rotator cuff tear,” “Achilles tendon,” “tendinopathy,” “tendon regeneration,” “pain reduction,” “functional outcomes,” and “histological repair.” Boolean operators (AND, OR) were used to combine these terms effectively. The search was limited to articles published between January 2010 and April 2024, to ensure the inclusion of recent advancements in regenerative therapies for tendon injuries. A complete and detailed search strategy is added in Appendix 2.

Inclusion and Exclusion Criteria

Table 1: Inclusion and exclusion criteria.
Category	Inclusion Criteria	Exclusion Criteria
Population	Human or animal models with clinically or experimentally diagnosed tendon injuries	Studies involving nontendinous musculoskeletal conditions
Intervention	Use of regenerative therapies including MSCs, PRP, or both	Studies involving nonregenerative treatments or therapies unrelated to PRP or MSCs
Therapy Administration	Therapies delivered via injection, surgical augmentation, or scaffold-based methods	Studies without a clear application method of regenerative therapy
Outcomes	At least one outcome measure reported: pain reduction, histological repair, biomechanical analysis, imaging, or functional recovery	Studies lacking outcome evaluation at the patient or model level
Study Type	Primary research: randomized controlled trials, cohort studies, controlled preclinical trials, or meta-analyses	Reviews, editorials, case reports, letters, or protocols without outcome data
Language and Availability	Full text available in English	Non-English publications or those without accessible full texts

Study Selection

The study selection was done in a systematic manner, whereby all the identified articles were first imported into the reference management software, such as EndNote, to eliminate the duplication of the records. Two reviewers served as independent reviewers in accordance with the principles and guidelines shared.⁷ In addition, the Cochrane Risk of Bias 2 (RoB 2) tool was considered in evaluating the quality of randomized controlled trials, focusing on key domains such as randomization, deviations from intended interventions, and outcome reporting (Appendix 3).⁸ Abstracts and titles were filtered expressly according to a definite set of eligibility criteria. The reviewers would further evaluate the selected full-text articles by their title and abstract against the inclusion and exclusion criteria. In any discrepancy between the two reviewers on the screening or selection process, a consensus was arrived at by discussion, and where a compromise could not be found, a third reviewer was sought to advise on the final decision (Figure 1). Cohort study quality was assessed using the Newcastle-Ottawa Scale, which included selection, comparability, and outcome reporting (Appendix 4), whereas the nonrandomized intervention was graded using the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool (Appendix 5). The detailed results of these assessments are presented in Appendix 6 and were used to inform the interpretation and synthesis of findings.

The process of selecting studies followed the PRISMA 2020 protocol and is outlined in Figure 1. Database searches identified 1,248 records at the outset. Before the screening, 236 duplicate records were deleted by EndNote, and 1,012 records were screened automatically using filtering with predetermined ineligibility criteria. This reduced the title and abstract screening to 1,012 records, with 847 excluded because they did not fit the inclusion criteria. The other 165 full-text articles were identified to be retrieved, but 682 of them were not able to be retrieved since they were either unavailable or their access was limited. Full-text eligibility was evaluated for these 165 articles, and 87 studies were excluded according to the predefined criteria. At the end of the process, 78 studies were located that fulfilled all the inclusion criteria and were used in the qualitative synthesis.

Data Extraction

Relevant information was collected using a standard data extraction form and included the following: study characteristics (author(s), year of publication, study design, and sample size), population characteristics (patient demographics, type of species in case of animal studies, and baseline characteristics of tendon injury), intervention details (description of the regenerative therapeutic technique used (mesenchymal stem cells, platelet-rich plasma, or a combination of both), including the method of delivery, dose and length of treatment), and outcome measures (functional recovery scores, histologic findings, imaging results, inflammatory indication. The data were extracted by two independent reviewers to guarantee the accuracy and reliability of the data and the risk of bias. To achieve consistency and transparency between studies, a standardized data extraction form was created in Microsoft Excel and attached in Appendix 6. This form was pretested before the complete extraction of the data to get clarity and consistency. Essential domains sought in the form included: study reference, year of publication, country, study design, sample size, type of intervention (e.g., PRP, MSCs, or combination), the target tendon, outcome measures (e.g., pain, function, histology, and imaging), follow-up duration, and main findings. A detailed summary of the key characteristics of the included study is provided in Table A1 in Appendix 7.

Data Analysis

The clinical and methodological heterogeneity was considered significant among the included studies, which encompassed differences in the study design (in vitro, animal, cohort studies), outcome definitions, intervention designs (e.g., PRP composition, cell types used), and variations in follow-up durations, thus making it infeasible to conduct a formal quantitative meta-analysis. This heterogeneity restricted the potential to pool data without bias. We did a structured narrative synthesis instead. To facilitate interpretation, we provided descriptive summaries and tabulated the main study characteristics and findings. Additionally, a direction-of-effects vote-counting strategy was used to point out consistency or variability in study results. These trends are graphically summarized in Appendix 7, providing an effect direction table showing the direction of effects reported as positive, negative, or neutral at relevant endpoints (Appendix 8).

Overview of Tendon Structure and Healing

Connective tissues called tendons help transmit the power of muscles to bones, supporting motion and protecting joints. The major component of tendons is fibrillar collagen type I, which is built up from fibrils into fascicles, each surrounded by endotenon, epitenon, and paratenon. Tendons contain mainly tenocytes, which produce and alter the extracellular matrix (ECM) of the tissue.⁹ As there are few cells and vessels and their metabolism is minimal, tendons are strong and tough but do not heal easily. Healing of a tendon takes place in three distinct and overlapping stages. (1) During the first 7 days, the body experiences the inflammatory phase, marked by the arrival of inflammatory cells, cytokine secretion, and the start of new blood vessel formation. Although this stage allows repair, improper regulation can bring on fibrosis. (2) During the first 6 weeks, fibroblasts and tenocytes multiply and release disorganized ECM, mainly containing type III collagen. Neovascularization is still happening, but the tendon does not heal properly. (3) During the remodeling phase (6 weeks to months), collagen forces itself in a single direction and is largely replaced by type I collagen.

Even so, it is usual for the new tendon tissue not to regain the properties of the native tendon.¹⁰ Proper regeneration is seldom possible, even after this type of repair is done. Such problems result from poor blood supply, limited progenitor cells, collagen scars, and “poor” fault lines where tendons connect to bones. In addition, the constant impact and chronic inflammation found in overuse tendinopathies reduce the chance of restored health. So, even though tendon damage can heal, it generally occurs with weaker tissue.¹¹ So, using stem cells and PRP provides more effective ways to aid in better regeneration. An overview of tendon healing phases is shown in Figure 2, which illustrates the sequential inflammatory, proliferative, and remodeling stages essential for tendon recovery.

Regenerative Medicine in Tendon Repair: A New Era

Regenerative medicine aims to reverse the condition of tissues using biological approaches, cell interventions, and tissue engineering. Regenerative therapies focus on addressing the biological issues in tissues instead of treatment that only alleviates symptoms or repairs body components.¹³ When tendon damage happens, this change in thought is most significant since tendons cannot have extensive healing by themselves, owing to their lack of cells and blood supply. Tendon ruptures and tendinopathies are the causes of a significant number of disabilities globally. Underhealing, scar tissue, and loss of strength can be caused by standard surgery. Regenerative medicine could assist in changing the healing environment, introducing additional cells, and reconstructing damaged tissue structures to enhance human recovery. Biologic therapies are among many choices and are key to repairing tendon tears and injuries.¹⁴ They are known as PRP, MSCs, growth factor cocktails, and scaffold-based systems. All biologics work differently, such as by signaling or modifying the matrix, but their application in practice still differs extensively.¹⁵ Much development is occurring in this space, and providing evidence of its effectiveness to reach its full potential.

Platelet-Rich Plasma (PRP) Therapy

PRP is a biologic from the patient’s whole blood, made by concentrating the platelets suspended in a minimal amount of plasma. After getting activated, platelets release different growth factors (e.g., PDGF, TGF-β, VEGF, and IGF-1) that take care of inflammation, encourage blood vessels to heal nearby tissues, and generate more cells and tendon ECM needed for healing the tendon. Various components and formats of PRP depend significantly on the number of blood cells and how the platelets were activated before use.¹⁶ Essentially, PRP falls into two major categories. LR-PRP is high in white blood cells; some experts believe it may enhance the immune response. However, it can also lead to more destructive inflammation in some cases. RL PRP leukocyte-poor platelet-rich plasma (LP-PRP) helps reduce inflammatory substances during treatment, supporting recovery. It is uniquely beneficial in chronic tendon illnesses. The use of PRP in tendon injuries has not been uniform because there is heterogeneity in PRP solutions and research approaches. It appears that rehabilitation combined with PRP is more effective than PRP alone in the treatment of chronic lateral epicondylitis, patellar tendinopathy, and rotator cuff injury.¹⁷ However, the findings from high-quality research on PRP follow-up are conflicting since there is no established set of parameters for preparing the solution or determining how much to use and when to inject. In the case of a severely ruptured tendon or following surgery, PRP can assist in healing the injury faster and minimizing pain. Still, long-term gains are not well substantiated by studies. The utilization of imaging studies (i.e., ultrasound and MRI) does not necessarily provide valuable hints as to how the patient will get better, contributing to the issue.¹⁸

Stem-Cell-Based Therapies

Stem cells can manage inflammation, stimulate cell growth, and help restore damaged tendons.19 Because of their capacity to adopt several cell types, their influence on the immune system, and their safety, MSCs have been researched the most out of all the stem cells. Bone-marrow-derived MSCs (BMSCs) and adipose-derived stem cells (ADSCs) are the source for clinics and laboratories. BMSCs are more readily differentiated into tenocytes in a culture dish; they are invasive and become scarcer with the individual’s age.²⁰ ADSCs have fewer inherent tenogenic capacities than pericytes, but can be obtained in larger amounts. Rather than differentiating into tendon tissue, stem cells have a regenerative function by interacting with the neighboring cells. Cytokines, growth factors, and extracellular vesicles released by these cells assist in modulating the immune response within the locality, aid in the growth of blood vessels, deter additional tissue growth, and assist in the reorganization of the matrix.²¹ The following beneficial effects are beneficial for cases of chronic tendinopathy, in which regular healing is hindered by degeneration and disturbed inflammation. Studies have shown that stem-cell therapy usually restores the strength of muscle and skin and enhances the nearby tissue’s structure.²²

Clinical studies using ADSCs and BMSCs in patients with lateral epicondylitis, Achilles tendinopathy, and rotator cuff tears report pain reduction and functional improvement, though results vary due to inconsistencies in cell sourcing, processing, and outcome measurement. There are few RCTs to date, and the majority of studies lack sufficient power to demonstrate long-term impact on cardiac structures. An injection or implantation of autologous MSCs with a tube typically begins with the procurement of the cells from fat or bone marrow by aspiration or liposuction. This is followed by the isolation of the cells and accurate deposition with a syringe or surgically placed.²³ The response of the tendon to therapy is determined by its biological and mechanical environment, which may be influenced by scaffolds or applied mechanical forces. Ethics and regulation are concerns in the field. The mechanisms of MSC action—ranging from paracrine signaling to immune modulation—are presented in Figure 3. Information was gathered based on the preclinical and clinical trials (BMSCs; ADSCs; TSPCs; umbilical cord mesenchymal stem cells [UC-MSCs]).^12,20,21,24 Invasiveness of harvesting methods on an ordinal scale based on the amount of procedure required: liposuction (little), bone marrow aspiration (lots), surgical biopsy (lots).

Comparative Efficacy: PRP vs. Stem Cells

PRP and MSCs are widely used regenerative treatments for tendon injuries, though they differ in procedure, outcome, and effectiveness. Studies suggest MSCs yield better long-term results, especially for chronic cases, while PRP offers short-term relief by managing inflammation and promoting healing. Imaging often shows MSCs enhance tendon structure more effectively. PRP’s early cell stimulation may be insufficient for full tendon remodeling, and leukocyte content can influence its inflammatory effects. MSCs help reorganize collagen and reduce fibrosis. Cost-wise, PRP is more affordable and suitable for outpatient settings, making it accessible for general use, whereas MSC therapy may be more appropriate for elite athletes or severe cases due to its higher regenerative capacity.^12,25–28 Notably, employing PRP to assist and facilitate MSCs is contemplated, and initial findings indicate beneficial outcomes, but additional evidence is required.²⁹ The severity of the injury a person sustains, expectations, cost, and legislation should be considered when determining whether to use PRP or MSCs. To provide clear guidelines for treating psychiatric disease, more precise and consistent trials are required.

Synthesized evidence of 12 comparative studies (ECM, LP-PRP, leukocyte-rich platelet-rich plasma [LR-PRP]).^12,25–29 Clinical onset is the time when measurable improvement of the symptoms occurs; structural healing requires imaging confirmation. Regulatory data presentation is based on the 2024 FDA/EMA labeling. Table 2 gives an overview of clinical evidence in PRP and MSC therapies in tendon repair.

Table 2: Clinical evidence for prp and msc therapies in tendon repair.
Study Design	Sample Size	Modality	Key Outcome	Follow-up	Effect Size	References
RCT	n = 50	PRP	Pain reduction	6 months	d = 0.8	26
Cohort	n = 32	BMSCs	Improved collagen organization	12 months	NR	22
Meta-analysis	8 studies	PRP + MSCs	Functional improvement	3–24 months	SMD = 0.71	29
RCT	n = 41	ADSCs	Tendon thickness reduction	6 months	h2 = 0.34	24
NR = unreported; SMD = standardized mean difference; h2 = partial eta squared. Data compiled from clinical studies cited in this review.

Clinical Decision Framework for Tendon Repair

The choice of PRP or MSC interventions should be informed by injury-specific, chronicity, and resource availability (Figure 4). In the case of acute tendon injuries (<6 weeks) or early-stage tendinopathy, one is advised to use LR-PRP (leukocyte-rich PRP) because, during the early healing phase, pro-inflammatory factors in PRP (e.g., PDGF, TGF-β) stimulate healing.^17,26 LP-PRP or MSC treatment is used in chronic ones (>3 months) or degenerative tendinopathies because they normalize chronic inflammation and stimulate reorganization of the matrix.^12,21 Traumatic or recurrent tears may respond to injection of MSCs (e.g., BMSCs or ADSCs) because of their pro-regenerative paracrine effect.^24,29 There is evidence of the beneficial effect of combined PRP + MSC in recalcitrant cases, but the evidence is limited to small cohorts.²⁹ The restraints of cost and regulation are to be taken into consideration as well: PRP is a common practice available to anyone, whereas the use of MSC may be limited to research or specially profiled clinics.¹² The framework has been provided in Figure 4 as a step algorithm, including injury severity, length of symptoms, and treatment objectives. PRP preparation: PRP should be standardized based on the protocols published in the literature (e.g., 3–5x platelet concentration, calcium activation using PRP preparation apparatus),^16,23 and the same should be true of MSC dosing (e.g., 10–50 million cells).

Challenges, Limitations, and Safety Considerations

Although interest in employing regenerative therapies to heal torn tendons is still greater, getting PRP and stem-cell therapies accepted on a large scale is challenging because of several technical, clinical, and regulatory challenges. A significant issue is the lack of uniformity in this area.³⁰ Since PRP is prepared using diverse methods, the effects observed in clinical applications are not predictable. Similarly, therapy that comes from stem cells differs according to their source of cells, processing method, number of passages, and how they are delivered. Due to such variability, comparing research and giving doctors clear guidelines is hard. It is also hard to identify when and how much medicine to administer. How much, when, and how often to administer PRP to an injured athlete has yet to be determined.³¹ Scientists are testing the ideal number of MSCs, how to deliver them (scaffold or injection), and which is safer, autologous, or allogeneic MSCs. While PRP is generally safe aside from mild post-injection swelling or pain, MSC therapies pose potential risks, including immune reactions or rare tumor formation, especially in genetically modified or cultured cells. The long-term fate of transplanted MSCs remains unclear. Current research lacks clarity on long-term outcomes, patient selection, and how these therapies compare to standard treatments. Few studies assess critical endpoints like tendon rupture, and high-quality trials with extended follow-up are limited. Regulatory hurdles make clinical application more complex, as MSCs fall under strict ATMP regulations, unlike the more easily accessible PRP.^30–33

Future Directions and Emerging Technologies

The next step in tendon regeneration will result from applying innovative biotechnology and personalized medicine. Biocompatible material scaffolds in 3D shape assist with cell organization and facilitate the structure of the tendon material. Incorporating hydrogels and nanofibers in biomaterials allows for the modulation of growth factor release and enhances the toughness of existing biologic therapy.³⁴ The selective modification of stem cells and tendon-related genes that CRISPR-Cas9 can accomplish could enhance the therapeutic effect of tissue repair without incurring many problems. Stem cells also give rise to exosomes, which are utilized as treatment vehicles for tissue repair because they circumvent the danger associated with transplanting stem cells.^35,36 For various reasons, AI is increasingly being applied in regenerative medicine to help with planning, outcomes, and patient grouping. ML techniques can facilitate choosing the optimum treatment by considering the massive data available regarding patients and injuries. All these technologies can make treatment personalized based on aspects such as genes, mechanical processes, and medical histories, enhancing treatment and reducing risks involved.³⁶ To help this vision become a reality, researchers, regulators, and other specialists must work together, and the rules should be adaptable.

Conclusion

Regenerative medicine has changed the treatment of tendon injuries by focusing on tissue regeneration through therapies such as PRP and stem-cell therapy instead of symptomatic management. Although PRP provides easy application of the growth factors, stem cells can contribute to a sustained recovery process. There is a lack of standardized procedures, the reliability of outcomes, and regulatory issues; however, possible future developments such as 3D scaffolds, gene modifications, and artificial intelligence have the potential to generate more exact tendon regeneration. Despite its effective results, the review used a narrative synthesis, which can infuse subjective interpretation without providing meta-analytic quantification. There is heterogeneity of included studies, including stem-cell source, PRP formulation, site of injury, and outcome measurement, which limits the comparison of findings. Moreover, it cannot be ruled out that there may be a publication bias, where researchers reporting either negative or null findings are underrepresented in the body of literature. These are the factors that need to be taken into consideration when investigating the therapeutic effect of PRP and MSCs on tendon repair.

References

1. Andia I, Martin JI, Maffulli N. Advances with platelet-rich plasma therapies for tendon regeneration. Expert Opin Biol Ther. 2018;18(4):389–98. https://doi.org/10.1080/14712598.2018.1424626
2. DeChellis DM, Cortazzo MH. Regenerative medicine in pain medicine: prolotherapy, platelet-rich plasma therapy, and stem cell therapy—theory and evidence. Tech Reg Anesth Pain Manag. 2011;15(2):74–80. https://doi.org/10.1053/j.trap.2011.05.002
3. Taylor DW, Petrera M, Hendry M, Theodoropoulos JS. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med. 2011;21(4):344–52. https://doi.org/10.1097/JSM.0b013e31821d0f65
4. Wang JH, Nirmala X. Application of tendon stem/progenitor cells and platelet-rich plasma to treat tendon injuries. Oper Tech Orthop. 2016;26(2):68–72. https://doi.org/10.1053/j.oto.2015.12.008
5. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71
6. Bettany-Saltikov J, McSherry R. How to do a systematic literature review in nursing: a step-by-step guide. 3rd ed. McGraw Hill; 2024.
7. Polanin JR, Pigott TD, Espelage DL, Grotpeter JK. Best practice guidelines for abstract screening large-evidence systematic reviews and meta-analyses. Res Synth Methods. 2019;10(3):330–42. https://doi.org/10.1002/jrsm.1354
8. Cochrane Methods. RoB 2: a revised Cochrane risk-of-bias tool for randomized trials. Cochrane; n.d. [Retrieved 25 Jul 2025]. Available from: https://methods.cochrane.org/risk-bias-2
9. Alderman DD, Alexander RW. Advances in regenerative medicine: high-density platelet-rich plasma and stem cell prolotherapy for musculoskeletal pain. Pract Pain Manag. 2011;11(8):49–52.
10. Goulian AJ, Goldstein B, Saad MA. Advancements in regenerative therapies for orthopaedics: a comprehensive review of platelet-rich plasma, mesenchymal stem cells, peptide therapies, and biomimetic applications. J Clin Med. 2025;14(6):2061. https://doi.org/10.3390/jcm14062061
11. Guevara-Alvarez A, Schmitt A, Russell RP, Imhoff AB, Buchmann S. Growth factor delivery vehicles for tendon injuries: mesenchymal stem cells and platelet-rich plasma. Muscles Ligaments Tendons J. 2014;4(3):378. https://doi.org/10.32098/mltj.03.2014.18
12. Pas HI, Moen MH, Haisma HJ, Winters M. No evidence for the use of stem cell therapy for tendon disorders: a systematic review. Br J Sports Med. 2017;51(13):996–1002. https://doi.org/10.1136/bjsports-2016-096794
13. Wang JHC, Zhang J, Nirmala X. Advancements in the treatment and repair of tendon injuries. Curr Tissue Eng (Discontinued). 2014;3(2):71–81. https://doi.org/10.2174/2211542003666140922225635
14. van den Boom NA, Winters M, Haisma HJ, Moen MH. Efficacy of stem cell therapy for tendon disorders: a systematic review. Orthop J Sports Med. 2020;8(4):2325967120915857. https://doi.org/10.1177/2325967120915857
15. Zhou Y, Zhang J, Wu H, Hogan MV, Wang JH. The differential effects of leukocyte-containing and pure platelet-rich plasma (PRP) on tendon stem/progenitor cells: implications of PRP application for the clinical treatment of tendon injuries. Stem Cell Res Ther. 2015;6:1–3. https://doi.org/10.1186/s13287-015-0172-4
16. Malanga G, Nakamura R. The role of regenerative medicine in treating sports injuries. Phys Med Rehab Clin. 2014;25(4):881–95. https://doi.org/10.1016/j.pmr.2014.06.007
17. Migliorini F, Tingart M, Maffulli N. Progress with stem cell therapies for tendon tissue regeneration. Expert Opin Biol Ther. 2020;20(11):1373–9. https://doi.org/10.1080/14712598.2020.1786532
18. Mautner K, Blazuk J. Where do injectable stem cell treatments apply to muscle, tendon, and ligament injuries?. PM&R. 2015;7(4):S33–40. https://doi.org/10.1016/j.pmrj.2014.12.012
19. Augustin G, Jeong JH, Kim MK, Hur SS, Lee JH, Hwang Y. Stem cell-based therapies and tissue engineering innovations for tendinopathy: a comprehensive review of current strategies and future directions. Adv Ther. 2024;7(6):2300425. https://doi.org/10.1002/adtp.202300425
20. Ajibade DA, Vance DD, Hare JM, Kaplan LD, Lesniak BP. Emerging applications of stem cells and regenerative medicine to sports injuries. Orthop J Sports Med. 2014;2(2):2325967113519935. https://doi.org/10.1177/2325967113519935
21. Lui PP. Stem cell technology for tendon regeneration: current status, challenges, and future research directions. Stem Cells Cloning. 2015;8:163–74. https://doi.org/10.2147/SCCAA.S60832
22. Beerts C, Suls M, Broeckx SY, Seys B, Vandenberghe A, Declercq J, et al. Tenogenically induced allogeneic peripheral blood mesenchymal stem cells in allogeneic platelet-rich plasma: 2-year follow-up after tendon or ligament treatment in horses. Front Vet Sci. 2017;4:158. https://doi.org/10.3389/fvets.2017.00158
23. Reddy SH, Reddy R, Babu NC, Ashok GN. Stem-cell therapy and platelet-rich plasma in regenerative medicine: a review on the pros and cons of the technologies. J Oral Maxillofac Pathol. 2018;22(3):367–74. https://doi.org/10.4103/jomfp.JOMFP_93_18
24. LaPrade RF, Geeslin AG, Murray IR, Musahl V, Zlotnicki JP, Petrigliano F, et al. Biologic treatments for sports injuries II think tank—current concepts, future research, and barriers to advancement, part 1: biologics overview, ligament injury, tendinopathy. Am J Sports Med. 2016;44(12):3270–83. https://doi.org/10.1177/0363546516634674
25. Sánchez M, Andia I, Anitua E, Sánchez P. Platelet-rich plasma (PRP) biotechnology: concepts and therapeutic applications in orthopaedics and sports medicine. In: Agbo EC, editor. Innovations in biotechnology. IntechOpen; 2012. p. 113–38. https://doi.org/10.5772/28908
26. Chiou GJ, Crowe C, McGoldrick R, Hui K, Pham H, Chang J. Optimisation of an injectable tendon hydrogel: the effects of platelet-rich plasma and adipose-derived stem cells on tendon healing in vivo. Tissue Eng Part A. 2015;21(9–10):1579–86. https://doi.org/10.1089/ten.tea.2014.0490
27. Lana JF, Santana MH, Belangero WD, Luzo AC, editors. Platelet-rich plasma: regenerative medicine: sports medicine, orthopaedic, and recovery of musculoskeletal injuries. Springer Science & Business Media; 2013. https://doi.org/10.1007/978-3-642-40117-6
28. Citro V, Clerici M, Boccaccini AR, Della Porta G, Maffulli N, Forsyth NR. Tendon tissue engineering: an overview of biologics to promote tendon healing and repair. J Tissue Eng. 2023;14:20417314231196275. https://doi.org/10.1177/20417314231196275
29. Kim SE, Kim JG, Park K. Biomaterials for treating tendon injury. Tissue Eng Regen Med. 2019;16:467–77. https://doi.org/10.1007/s13770-019-00217-8
30. Leong NL, Kator JL, Clemens TL, James A, Enamoto-Iwamoto M, Jiang J. Tendon and ligament healing and current approaches to tendon and ligament regeneration. J Orthop Res. 2020;38(1):7–12. https://doi.org/10.1002/jor.24475
31. Xu J, Du W, Xue X, Chen M, Zhou W, Luo X. Global research trends on platelet-rich plasma for tendon and ligament injuries from the past two decades: a bibliometric and visualised study. Front Surg. 2023;10:1113491. https://doi.org/10.3389/fsurg.2023.1113491
32. Costa-Almeida R, Calejo I, Gomes ME. Mesenchymal stem cells empowering tendon regenerative therapies. Int J Mol Sci. 2019;20(12):3002. https://doi.org/10.3390/ijms20123002
33. Zhang J, Wang JH. Platelet-rich plasma releasate promotes differentiation of tendon stem cells into active tenocytes. Am J Sports Med. 2010;38(12):2477–86. https://doi.org/10.1177/0363546510376750
34. Yu X, Cui J, Shen Y, Guo W, Cai P, Chen Y, et al. Current advancements and strategies of biomaterials for tendon repair: a review. Front Biosci Landmark. 2023;28(4):66. https://doi.org/10.31083/j.fbl2804066
35. Freedman BR, Mooney DJ, Weber E. Advances toward transformative therapies for tendon diseases. Sci Transl Med. 2022;14(661):eabl8814. https://doi.org/10.1126/scitranslmed.abl8814
36. Gentile P, Garcovich S. Systematic review—the potential implications of different platelet-rich plasma (PRP) concentrations in regenerative medicine for tissue repair. Int J Mol Sci. 2020;21(16):5702. https://doi.org/10.3390/ijms21165702

Appendices

Appendix 1: PEO Checklist

• P: Who are the affected population—patients, family, practitioners, or community? What are their symptoms, condition, health status, age, gender, ethnicity? What is the setting e.g., acute care, community, mental health?
• E: Is the population exposed to a condition or illness (e.g., dementia), to a risk factor (e.g., smoking), to screening, to rehabilitation or to a service?
• O: What are the outcomes or theme? Consider the experiences, attitudes, feelings, changes in condition, mobility, response to treatment, quality of life or daily living.

Adapted from Bettany-Saltikov.6
PEO—database search strategy example
What are the attitudes (O) of health professionals (P) toward caring for older patients with dementia (E) in an acute setting (P)?
The PEO statement contains three key concepts (the P, the E and the O), but in this case the P and the E have two parts.
The database search strategy could look like:

• Search 1 (P): Acute care OR acute setting OR hospital
• Search 2 (P): Nurse OR professional OR practitioner OR staff OR personnel
• Search 3 (E): Older patient OR older person OR elderly OR geriatric
• Search 4 (E): Dementia OR Alzheimer
• Search 5 (O): Attitude OR opinion OR perception OR perspective OR belief
• Search 6: Search 1 AND Search 2 AND Search 3 AND Search 4 AND Search 5

Appendix 2: Search summary.
Database	Date Searched	Search String (Boolean/MeSH/EMTREE)	Filters/Limits Applied	Notes
PubMed	10 June 2024	(“Tendon Injuries”[MeSH] OR “tendinopathy” OR “tendon rupture” OR “rotator cuff injury” OR “Achilles tendon”) AND (“Regenerative Medicine”[MeSH] OR “Platelet-Rich Plasma”[MeSH] OR “Stem Cells”[MeSH] OR “mesenchymal stem cells” OR “PRP” OR “MSC” OR “cell-based therapy”)	English, Humans, Publication date: 2014–2024	Used MeSH for structured indexing
Scopus	11 June 2024	TITLE-ABS-KEY(“tendon injury” OR “tendinopathy” OR “tendon rupture”) AND TITLE-ABS-KEY(“regenerative medicine” OR “platelet-rich plasma” OR “PRP” OR “stem cell therapy” OR “MSC” OR “mesenchymal stem cells”)	Language: English; Document type: Article; Year: 2014–2024	Searched titles, abstracts, and keywords
Web of Science	11 June 2024	TS=(“tendon injury” OR “tendinopathy” OR “Achilles tendon” OR “rotator cuff injury”) AND TS=(“platelet-rich plasma” OR “PRP” OR “mesenchymal stem cells” OR “MSC” OR “regenerative medicine” OR “stem cell therapy”)	Research Articles, English, Timespan: 2014–2024	“TS” = Topic Search (title, abstract, keywords)
Cochrane Library	12 June 2024	(“Tendon Injuries” OR “Rotator Cuff Injuries” OR “Achilles Tendon”) AND (“Platelet-Rich Plasma” OR “PRP” OR “Stem Cell Therapy” OR “Mesenchymal Stem Cells”)	Trials only; English	Focused on Cochrane Controlled Trials and Reviews
Embase	12 June 2024	(“tendon injury”/exp OR “tendinopathy”/exp OR “tendon rupture”/exp) AND (“regenerative medicine”/exp OR “platelet-rich plasma”/exp OR “mesenchymal stem cell”/exp OR “stem cell therapy”/exp)	Human, English, Year: 2014–2024	Used EMTREE terms with explosion (/exp)
Google Scholar	13 June 2024	allintitle: “tendon regeneration” AND (“platelet-rich plasma” OR “stem cells” OR “MSC” OR “PRP” OR “regenerative therapy”)	Custom date range: 2014–2024	Screened the first 200 results by relevance
ClinicalTrials.gov	14 June 2024	Condition or disease: “Tendon injury” OR “Tendinopathy” Other terms: “Stem cells”, “Platelet-rich plasma”, “Regenerative medicine”	Studies posted from 2014 to 2024, Completed/Recruiting	Used for identifying unpublished or ongoing trials

Appendix 3: Risk of bias 2 (RoB 2.0) summary table.
Study	Randomization Process	Deviations from Intended Interventions	Missing Outcome Data	Measurement of Outcome	Selection of Reported Result	Overall Risk of Bias
Zhang and Wang (2010) (In vitro)	Not Applicable—In vitro	Low—Intervention consistently applied	Low—Controlled lab conditions	Low—Standard cell measures	Low—Full results reported	Low
Chiou et al. (2015) (Animal)	Some concerns—Randomization not reported	Low—Defined protocols followed	Low—All animals accounted for	Low—Histology methods standard	Some concerns—Not clear if outcomes prespecified	Some concerns
Chiou et al. (2015) (Animal)	Some concerns—Same as above	Low	Low	Low	Some concerns	Some concerns
Zhou et al. (2015) (In vitro)	Not Applicable—In vitro	Low	Low	Low	Low	Low
Guevara-Alvarez et al. (2014) (Animal)	Some concerns—No mention of allocation concealment	Low	Low	Low	Some concerns—Reporting bias possible	Some concerns

Appendix 4: Newcastle-ottawa scale (cohort studies).
Study	Selection (0–4)	Comparability (0–2)	Outcome (0–3)	Total Score (Out of 9)	Risk of Bias
Beerts et al. (2017) (Equine Cohort)	3—Well-defined sample, baseline comparable	1—No mention of confounding control	2—Long-term outcome assessed, no blinding	6/9	Moderate
Beerts et al. (2017) (Repeat Entry)	Same as above	Same	Same	6/9	Moderate

Appendix 5: ROBINS-I: risk of bias in nonrandomized studies of interventions (Applied to reviews/intervention studies that are not RCTs).
Study	Bias Due to Confounding	Bias in Selection	Bias in Classification	Bias Due to Deviations	Bias Due to Missing Data	Bias in Measurement	Bias in Reporting	Overall Risk
Gentile and Garcovich (2020)	Serious—No control group	Moderate	Low	Low	Low	Moderate	Moderate	Serious
Pas et al. (2017)	Low—Systematic methods used	Low	Low	Low	Low	Low	Low	Low
Kim et al. (2019)	Serious—Lacks control	Moderate	Low	Low	Low	Moderate	Moderate	Serious
Taylor et al. (2011)	Low	Low	Low	Low	Low	Low	Low	Low
van den Boom et al. (2020)	Low	Low	Low	Low	Low	Low	Moderate	Low–Moderate
Migliorini et al. (2020)	Serious	Moderate	Low	Low	Low	Moderate	Moderate	Serious
Citro et al. (2023)	Moderate	Moderate	Low	Low	Low	Moderate	Moderate	Moderate
Reddy et al. (2018)	Serious—Mixed data types	Serious	Low	Low	Low	High	High	Serious–Critical
Wang et al. (2016)	Moderate	Moderate	Low	Low	Low	Low	Moderate	Moderate
Andia et al. (2018)	Moderate	Moderate	Low	Low	Low	Moderate	Moderate	Moderate
LaPrade et al. (2016) (Review)	Moderate	Moderate	Low	Low	Low	Low	Moderate	Moderate
Ajibade et al. (2014)	Serious	Moderate	Low	Low	Low	Moderate

Appendix 6: Study selection form
Section	Item	Details/Response
1. Study Identification	Author(s)
	Year
	Title
	Country
	Journal/Source
	DOI/Link
2. Study Characteristics	Study Design	◻ RCT ◻ Cohort ◻ Case-Control ◻ Other: ________
	Sample Size
	Population Type	◻ Human ◻ Animal ◻ In Vitro
	Age/Sex/Species
	Type of Tendon Injury
	Duration of Injury
	Chronicity	◻ Acute ◻ Chronic
3. Intervention	Intervention Type	◻ PRP ◻ MSCs ◻ Both
	Source of MSCs	◻ Autologous ◻ Allogeneic ◻ Not reported
	PRP Type	◻ Leukocyte-rich ◻ Leukocyte-poor ◻ Not stated
	Dose/Frequency
	Route of Administration	◻ Injection ◻ Surgical ◻ Scaffold-based
	Control Group	◻ Placebo ◻ Standard Care ◻ No control ◻ Other
4. Outcome Assessment	Outcomes Measured	◻ Functional ◻ Pain ◻ Histology ◻ Imaging
	Tools/Scales Used
	Follow-up Duration
	Outcome Timepoints
5. Results	Key Findings
	Statistical Significance Reported	◻ Yes ◻ No
	Adverse Effects	◻ Yes ◻ No ◻ Not reported
6. Quality Assessment	Risk-of-Bias Tool Used
	Risk-of-Bias Judgment	◻ Low ◻ Some Concerns ◻ High
	Blinding	◻ Participants ◻ Assessors ◻ Not reported
	Randomization	◻ Yes ◻ No ◻ Not reported
	Funding/Conflict of Interest
7. Inclusion Criteria Fit	Tendon injury focus	◻ Yes ◻ No
	Regenerative therapy used (PRP and/or MSCs)	◻ Yes ◻ No
	Outcome at patient or model level reported	◻ Yes ◻ No
Decision	Include in Review?	◻ Yes ◻ No ◻ Uncertain
	Reason for Exclusion (if applicable)

Appendix 7: Table A1: Summary of characteristics of included studies
Study Reference	Year	Country	Design	Sample Size	Intervention	Target Tendon	Outcome Measures	Follow-up	Main Finding
Andia et al.	2018	Spain	Review	NR	PRP	Multiple	Functional, Pain	NR	PRP showed moderate benefit in chronic tendinopathies
Taylor et al.	2011	USA	Systematic Review	NR	PRP	Ligament and Tendon	Functional, Pain	NR	PRP useful in early-stage injuries; evidence inconclusive
Wang et al.	2016	China	Review	NR	PRP + TSPCs	Achilles	Histology	NR	PRP enhances stem-cell proliferation in vitro
van den Boom et al.	2020	Netherlands	Systematic Review	15 studies	MSCs	Rotator cuff, Achilles	Imaging, Pain	6–24 months	Mixed evidence; promising but inconsistent
Guevara-Alvarez et al.	2014	Germany	Preclinical	10 rats	PRP + MSCs	Patellar	Histology	4 weeks	Combined PRP + MSC improved ECM organization
Zhou et al.	2015	USA	In vitro	Cell culture	PRP (LR vs. LP)	Tendon stem cells	Cell proliferation, Inflammation	24–72 hours	LR-PRP induced a higher inflammatory response
Malanga et al.	2014	USA	Narrative Review	NR	PRP, Stem Cells	Multiple	Functional, Histology	NR	Supports regenerative therapies in musculoskeletal injuries
Migliorini et al.	2020	Italy	Review	NR	MSCs	Patellar	Imaging, Pain	6–12 months	MSCs improve tendon thickness and histology
Mautner et al.	2015	USA	Expert Opinion	NR	Stem Cells	Rotator cuff	Pain, Strength	NR	The application of stem cells is promising in tendinopathy
Beerts et al.	2017	Belgium	Cohort (horses)	20	PB-MSCs + PRP	Digital flexor	Lameness score	24 months	Clinical improvement was maintained over 2 years
LaPrade et al.	2016	USA	Review	NR	PRP, MSC	Achilles, Patellar	Pain, MRI	NR	Recommends biologics in chronic cases
Reddy et al.	2018	India	Narrative Review	NR	PRP, MSC	Multiple	Functional, Pain	NR	PRP is good for early cases; MS Cs are better in chronic
Chiou et al.	2015	USA	Animal Study	30	PRP + ADSCs	Achilles	Histology	4 weeks	PRP + ADSCs improved collagen alignment
Pas et al.	2017	UK	Systematic Review	12 studies	MSCs	Patellar, Achilles	Imaging, Pain	6–12 months	Insufficient evidence for stem-cell efficacy
Kim et al.	2019	South Korea	Review	NR	PRP, MSCs	Multiple	Histology, Biomechanics	NR	Biomaterials + biologics improve repair outcomes
Ajibade et al.	2014	USA	Review	NR	Stem Cells	Multiple	Pain, Function	NR	Supports stem-cell applications in sports injuries
Lui et al.	2015	Hong Kong	Review	NR	MSCs	Patellar	Histology	NR	Discusses challenges and direction for tendon regeneration
Augustin et al.	2024	South Korea	Review	NR	Stem Cells	Achilles	Function, Histology	NR	Innovations in stem-cell and tissue engineering reviewed
LaPrade et al.	2016	USA	Consensus Statement	NR	Biologics	Tendinopathy	Function	NR	Biologic use is recommended for chronic tendon issues
Beerts et al.	2017	Belgium	Cohort (Equine)	20	PB-MSCs + PRP	Tendon/Ligament	Pain, Gait	24 months	Improved long-term tendon repair in horses
Reddy et al.	2018	India	Review	NR	Stem Cells, PRP	Various	Histology, Pain	NR	Summarizes pros/cons of PRP vs MSCs
Sayegh et al.	2015	USA	Review	NR	Growth Factors	Tendon	Biomechanics	NR	Highlights repair strategies in tendon healing
Sánchez et al.	2012	Spain	Review	NR	PRP	Tendon	Pain	NR	Therapeutic potential of PRP reviewed
Chiou et al.	2015	USA	Animal Study	30	ADSC + PRP	Achilles	Histology	4 weeks	Improved tendon structure with hydrogel delivery
Lana et al.	2013	Brazil	Book Chapter	NR	PRP	Musculoskeletal	Function	NR	Comprehensive overview of PRP applications
Citro et al.	2023	UK	Review	NR	Biologics	Tendon	Histology	NR	Summary of biologics for healing enhancement
Pas et al.	2017	Netherlands	Systematic Review	12	MSCs	Tendon	Pain, Imaging	6–12 months	Limited evidence for MSC efficacy
Kim et al.	2019	South Korea	Review	NR	PRP, MSC	Various	Histology	NR	Biomaterials improve outcomes with biologics
Leong et al.	2020	USA	Review	NR	Biologics	Ligaments, Tendons	Healing, Histology	NR	Focus on the regeneration of soft tissues
Xu et al.	2023	China	Bibliometric Study	NR	PRP	Various	Publications/Trends	20 years	Visualized growth of PRP literature
Costa-Almeida et al.	2019	Portugal	Review	NR	MSCs	Tendon	Function, ECM	NR	MSC applications supported by preclinical evidence
Zhang and Wang	2010	USA	In vitro	NR	PRP	Stem Cells	Tenogenic Differentiation	72 hours	PRP stimulated tenocyte differentiation
Yu et al.	2023	China	Review	NR	Biomaterials	Tendon	Histology	NR	Scaffolds and nanomaterials assist tendon repair
Freedman et al.	2022	USA	Perspective	NR	Advanced Therapies	Tendon	Future trends	NR	Highlighted transformative regenerative approaches
Gentile and Garcovich	2020	Italy	Systematic Review	25	PRP	Various	Concentration, Outcomes	NR	Effect of PRP concentration on healing outcomes

Appendix 8: Effect direction table
Study	Design	Sample Size	Intervention	Target Tendon	Outcomes	Follow-up	Effect Direction	Notes
Andia et al. (2018)	Review	NR	PRP	Multiple	Functional, Pain	NR	­	Moderate benefit in chronic tendinopathies
Taylor et al. (2011)	Systematic Review	NR	PRP	Ligament and Tendon	Functional, Pain	NR	±	Evidence inconclusive
Wang et al. (2016)	Review	NR	PRP + TSPCs	Achilles	Histology	NR	­	PRP enhances stem-cell proliferation in vitro
van den Boom et al. (2020)	Systematic Review	15 studies	MSCs	Rotator cuff, Achilles	Imaging, Pain	6–24 months	±	Promising but inconsistent evidence
Guevara-Alvarez et al. (2014)	Preclinical	10 rats	PRP + MSCs	Patellar	Histology	4 weeks	­	Improved ECM organization
Zhou et al. (2015)	In vitro	Cell culture	PRP (LR vs. LP)	TSCs	Proliferation, Inflammation	24–72 hours	¯ (for LR-PRP)	LR-PRP increased inflammation
Malanga et al. (2014)	Narrative Review	NR	PRP, Stem Cells	Multiple	Functional, Histology	NR	­	Supports regenerative therapies
Migliorini et al. (2020)	Review	NR	MSCs	Patellar	Imaging, Pain	6–12 months	­	Improved tendon thickness and histology
Mautner et al. (2015)	Expert Opinion	NR	Stem Cells	Rotator cuff	Pain, Strength	NR	­	Promising application
Beerts et al. (2017)	Cohort (horses)	20	PB-MSCs + PRP	Digital flexor	Lameness score	24 months	­	Long-term clinical improvement
Beerts et al. (2017)	Cohort (equine)	20	PB-MSCs + PRP	Tendon/Ligament	Pain, Gait	24 months	­	Enhanced long-term tendon repair
LaPrade et al. (2016)	Review	NR	PRP, MSC	Achilles, Patellar	Pain, MRI	NR	­	Biologics recommended in chronic cases
Reddy et al. (2018)	Narrative Review	NR	PRP, MSC	Multiple	Functional, Pain	NR	­	MSCs better in chronic; PRP in early cases
Chiou et al. (2015)	Animal Study	30	PRP + ADSCs	Achilles	Histology	4 weeks	­	Improved collagen alignment
Pas et al. (2017)	Systematic Review	12 studies	MSCs	Patellar, Achilles	Imaging, Pain	6–12 months	±	Limited evidence
Kim et al. (2019)	Review	NR	PRP, MSCs	Multiple	Histology, Biomechanics	NR	­	Biologics + biomaterials help repair
Ajibade et al. (2014)	Review	NR	Stem Cells	Multiple	Pain, Function	NR	­	Stem cells helpful in sports injuries
Lui et al. (2015)	Review	NR	MSCs	Patellar	Histology	NR	±	Highlights limitations and direction
Augustin et al. (2024)	Review	NR	Stem Cells	Achilles	Function, Histology	NR	­	Innovative tissue engineering
LaPrade et al. (2016)	Consensus	NR	Biologics	Tendinopathy	Function	NR	­	Recommends use in chronic issues
Sayegh et al. (2015)	Review	NR	Growth Factors	Tendon	Biomechanics	NR	­	Repair strategies highlighted
Sánchez et al. (2012)	Review	NR	PRP	Tendon	Pain	NR	­	PRP therapeutic potential
Lana et al. (2013)	Book Chapter	NR	PRP	Musculoskeletal	Function	NR	­	Comprehensive on PRP
Citro et al. (2023)	Review	NR	Biologics	Tendon	Histology	NR	­	Healing enhancement noted
Leong et al. (2020)	Review	NR	Biologics	Ligaments, Tendons	Healing, Histology	NR	­	Regeneration focused
Xu et al. (2023)	Bibliometric	NR	PRP	Various	Publication Trends	20 years	­	Literature growth visualized
Costa-Almeida et al. (2019)	Review	NR	MSCs	Tendon	Function, ECM	NR	­	MSC use supported
Zhang and Wang (2010)	In vitro	NR	PRP	Stem Cells	Tenogenic Differentiation	72 hours	­	PRP stimulated tenocytes
Yu et al. (2023)	Review	NR	Biomaterials	Tendon	Histology	NR	­	Scaffolds aid healing
Freedman et al. (2022)	Perspective	NR	Advanced Therapies	Tendon	Future Trends	NR	­	Discusses transformative therapies
Gentile and Garcovich (2020)	Systematic Review	25	PRP	Various	Concentration, Outcomes	NR	­	PRP concentration impacts healing

Cite this article as:
Mahmood A. Advances in Regenerative Medicine for Tendon Injuries: Stem Cells vs. PRP Therapies. Premier Journal of Sports Science 2025;3:100013

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