Regenerative Approaches in Orthopedics

Abstract

Regenerative orthopaedics seeks to restore damaged musculoskeletal tissues to their native structure and function rather than replacing them with prosthetic hardware, yet clinical adoption of regenerative strategies varies markedly across tissue types and therapeutic modalities. We evaluated 224 regenerative orthopaedic programmes conducted across clinical and research centres in Spain, Switzerland, and France between 2014 and 2024, spanning five modality categories: platelet-rich plasma injections, bone morphogenetic protein augmentation, mesenchymal stem cell therapies, scaffold-based bone regeneration, and growth-factor-loaded hydrogel systems. A Regenerative Orthopaedics Translational Index (ROTI) was constructed from five sub-scores -- functional outcome improvement, tissue quality on imaging and histology, durability of repair beyond 24 months, adverse event profile, and evidence quality level -- with weights from regression against sustained clinical adoption. ROTI correlated with adoption at r = +0.83 and discriminated adopted from non-adopted programmes with an AUC of 0.878. Platelet-rich plasma programmes scored highest (mean ROTI 0.818), while growth-factor hydrogels trailed at 0.592. Only 33.5 percent of programmes exceeded the 0.75 ROTI threshold. Functional outcome improvement carried the largest regression weight (beta = +0.278), followed by evidence quality level (beta = +0.228).