Next Article in Journal
Impact of Glycerol and Heating Rate on the Thermal Decomposition of PVA Films
Previous Article in Journal
Mesoscale Damage Evolution, Localization, and Failure in Solid Propellants Under Strain Rate and Temperature Effects
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Polymers
Volume 17
Issue 15
10.3390/polym17152094
polymers-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

Engineered Hydrogels for Musculoskeletal Regeneration: Advanced Synthesis Strategies and Therapeutic Efficacy in Preclinical Models

by
Gabriela Calin
1,2,†,
Mihnea Costescu
3,*,
Marcela Nour (Cârlig)
1,4,*,
Tudor Ciuhodaru
1,4,†,
Batîr-Marin Denisa
2,
Letitia Doina Duceac
1,4,
Cozmin Mihai
1,
Melania Florina Munteanu
5,
Svetlana Trifunschi
5,
Alexandru Oancea
6 and
Daniela Liliana Damir
7
1
Faculty of Medicine, “Apollonia” University of Iasi, 11 Pacurari Str., 700511 Iași, Romania
2
Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 47 Domneasca Str., 800008 Galati, Romania
3
Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, Dionisie Lupu Str. nr. 37, Sector 2, 020021 București, Romania
4
“Prof. Dr. Nicolae Oblu” Emergency Clinical Hospital, 2 Ateneului Street, 700309 Iași, Romania
5
Department of Pharmaceutical Sciences, “Vasile Goldiş” Western University of Arad, B-dul Revoluției 94–96, 310025 Arad, Romania
6
Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, “Vasile Goldiş” Western University of Arad, B-dul Revoluției 94–96, 310025 Arad, Romania
7
Department of Forensic Medicine, Medical Deontology and Bioethics, Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iași, 16 Universității Street, 700115 Iași, Romania
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Polymers 2025, 17(15), 2094; https://doi.org/10.3390/polym17152094 (registering DOI)
Submission received: 17 June 2025 / Revised: 22 July 2025 / Accepted: 29 July 2025 / Published: 30 July 2025
(This article belongs to the Section Polymer Applications)
Browse Figures
Versions Notes

Abstract

According to the World Health Organization, musculoskeletal injuries affect more than 1.71 billion people around the world. These injuries are a major public health issue and the leading cause of disability. There has been a recent interest in hydrogels as a potential biomaterial for musculoskeletal tissue regeneration. This is due to their high water content (70–99%), ECM-like structure, injectability, and controllable degradation rates. Recent preclinical studies indicate that they can enhance regeneration by modulating the release of bioactive compounds, growth factors, and stem cells. Composite hydrogels that combine natural and synthetic polymers, like chitosan and collagen, have compressive moduli that are advantageous for tendon–bone healing. Some of these hydrogels can even hold up to 0.8 MPa of tensile strength. In osteoarthritis models, functionalized systems such as microspheres responsive to matrix metalloproteinase-13 have demonstrated disease modulation and targeted drug delivery, while intelligent in situ hydrogels have exhibited a 43% increase in neovascularization and a 50% enhancement in myotube production. Hydrogel-based therapies have been shown to restore contractile force by as much as 80%, increase myofiber density by 65%, and boost ALP activity in bone defects by 2.1 times in volumetric muscle loss (VML) models. Adding TGF-β3 or MSCs to hydrogel systems improved GAG content by about 60%, collagen II expression by 35–50%, and O’Driscoll scores by 35–50% in cartilage regeneration.

1. Introduction

Musculoskeletal injuries are a major global health problem that affects people of all ages and activity levels. The World Health Organization (WHO) says that musculoskeletal conditions are the main cause of disability around the world, affecting about 1.71 billion people. Traumatic injuries to muscles and bones caused by accidents and surgery are some of the most common and serious, the numbers are just as high when it comes to sports and exercise [1,2,3,4,5,6].
Muscle strains, ligament sprains, and bone fractures make up most of the 8.6 million injuries that happen in the U.S. each year because of sports and other fun activities. These injuries can not only make it hard to move around, but they can also cause problems like fibrosis, slow healing, less range of motion, and long-term pain. Trauma-related bone fractures are a common reason for emergency room visits and hospital stays. Muscle injuries make up 10 to 55% of all sports-related injuries. Because diseases like osteoporosis increase the chance for older people to receive bone injuries, the need for effective treatment options is even greater. Despite progress in the management of musculoskeletal injuries, traditional treatment modalities such as medication, prostheses, and transplantation exhibit significant limitations. Pharmacological therapies, although effective in alleviating inflammation and pain, frequently neglect the fundamental structural and functional deficiencies. Prosthetic implants can partially restore mechanical function; nevertheless, they are constrained by material degradation, insufficient biological integration, and the incapacity to remodel or regenerate tissue. Tissue or organ transplantation is limited by donor availability, the risk of immunological rejection, and the longevity of graft survival. A comprehensive understanding of the intrinsic functions of musculoskeletal tissues is essential for formulating regeneration methods. The bone exhibits an inherent regeneration ability, mostly facilitated by osteoprogenitor cells and the richly vascularized composition of bone marrow. Conversely, cartilage, especially articular cartilage, is avascular and devoid of the cellular mechanisms necessary for spontaneous repair, rendering damage in these tissues extremely difficult to heal. Tendons demonstrate a restricted healing ability due to insufficient vascularization and a low rate of cellular turnover, frequently leading to fibrosis instead of genuine regeneration. Muscle tissue, however, is more adept at regeneration through satellite cell activation, and encounters healing constraints in cases of severe injuries or chronic diseases. These limitations highlight the necessity for biomimetic materials, such as hydrogels, that can facilitate and direct the regeneration of these specific tissues through customized biochemical and mechanical signals [7,8,9,10,11].
Current methods have problems with tissue and site morbidity, immune rejection, and not connecting well with host tissue. This means that we need better biomaterial-based solutions that can speed up healing, restore tissue structure and function, and lower the risk of long-term disability. Hydrogels have recently received a lot of attention as a possible biomaterial for regenerative medicine, especially for use in musculoskeletal applications [12,13,14,15,16].
Hydrogels are like the natural extracellular matrix (ECM) because they hold a lot of water. They can help cells grow, move, and change into different types of cells. These 3D networks of hydrophilic polymers keep their shape even when they are in a lot of water. Hydrogels have a lot of possible medical uses because they can break down, work with living things, and change their mechanical properties.
Each type has its own strengths and weaknesses when it comes to biocompatibility, mechanical strength, and functionalizability. These materials can be used in smart delivery systems that can adapt to the changing environment of damaged tissues. For example, they can include cells, growth factors, or medications and can respond to changes in pH, temperature, or enzyme activity (Figure 1). There are two main types of polymers: those that come from nature, like collagen, alginate, or chitosan, and those that come from man-made sources, like polyethylene glycol or polyvinyl alcohol. There are also composite polymers that combine the two [17,18,19,20].
Hydrogels have shown promise in promoting myogenesis during muscle regeneration by enhancing satellite cell activity and regulating the inflammatory microenvironment to encourage regenerative repair over fibrotic repair. Hydrogels play a role in bone regeneration that is similar to that of osteoinductive scaffolds. They help osteoprogenitor cells penetrate into the bone, form blood vessels, and deposit minerals. One significant advantage of utilizing hydrogels for the treatment of deep tissue or irregular injuries is their moldability and injectability, facilitating a less invasive administration [12,21,22,23,24].
The objective of this review is to consolidate the current literature on hydrogels for bone and muscle regeneration and to conduct a critical evaluation. We will talk about many different kinds of hydrogels, including what they are made of, how they work, and how they help heal tissues.
This review seeks to encapsulate the current status of hydrogel research in musculoskeletal regeneration, point out the therapeutic advantages of these materials, and delineate the challenges and prospective avenues for their clinical application through a comprehensive analysis of the existing literature.

2. Materials and Methods

This review utilized a systematic literature analysis to examine hydrogels utilized in musculoskeletal tissue regeneration, focusing specifically on preclinical (in vivo) studies. Peer-reviewed articles published from 2020 to 2024 were obtained from sources such as PubMed, Scopus, and Web of Science, utilizing keywords such “muscle regeneration hydrogel,” “bone scaffold,” “injectable hydrogel,” “osteogenesis,” and “smart biomaterials.”
Studies were selected according to specific criteria: the utilization of in vivo animal models pertinent to musculoskeletal repair, the presentation of quantitative biological or functional outcomes, and the inclusion of functional additives such as MSCs (mesenchymal stem cells), growth factors, or bioactive nanoparticles. Exclusion criteria included studies confined to in vitro analysis, those devoid of quantifiable therapeutic effects, or those concentrating on non-musculoskeletal targets.
Data extraction concentrated on hydrogel composition, crosslinking methodologies, mechanical characteristics, gelation kinetics, degradation patterns, and regeneration results. Summary tables were used to perform comparative synthesis, which showed performance patterns and found viable material methods in distinct biological situations.

3. Novel Design for Functionalized Composite Hydrogels

Natural polymers like collagen and chitosan offer inherent bioactivity, promoting cell adhesion and proliferation. However, their mechanical strength is often limited. Synthetic polymers such as PEG (polyethylene glycol) and PVA (polyvinyl alcohol) provide tunable mechanical properties and degradation rates but lack bioactivity [25,26,27,28,29,30] (Figure 2).
Recent advancements have focused on composite hydrogels that combine the advantages of both (Table 1). For instance, Xu et al. (2022) [31] developed a stratified-structural hydrogel incorporating magnesium-ion-modified black phosphorus nanosheets, enhancing neurovascularized bone regeneration. This composite demonstrated a compressive modulus of approximately 150 kPa and supported significant bone tissue formation in vivo.
The crosslinking methods used to make hydrogels have a big effect on how stable and useful they are. Physical crosslinking, which includes ionic interactions or hydrogen bonding, makes hydrogels that can change back and forth and respond to stimuli, but it may make them less strong. Chemical crosslinking, which uses covalent bonds, makes things stronger and more stable. Enzymatic crosslinking is specific and happens at low temperatures [38,39,40,41].
Zhou et al. (2024) [32] developed a hydrogel microsphere system responsive to hypoxia and matrix metalloproteinase-13 (MMP-13), which mitigated the progression of osteoarthritis in vivo. The hydrogel had a compressive modulus of about 60 kPa and broke down when exposed to MMP-13, which made sure that the medicine was delivered to the right place.
It is especially important to improve the bioactivity of hydrogels for tissue regeneration to work. Adding bioactive molecules, nanoparticles, or cells can greatly improve the results of treatment. Chen et al. (2021) [33] created an injectable self-healing hydrogel that released Mg2+ and curcumin, which worked together to speed up the healing of tendons to bones. The hydrogel had a tensile strength of 800 kPa and allowed for a sustained release over 21 days, which improved the histological scores and biomechanical properties in a rat model.
Wu et al. (2024) [42] created smart, responsive in situ hydrogel systems for engineering bone tissue. These hydrogels react to the inflammatory microenvironment by releasing therapeutic agents as needed. They also had a compressive modulus of 120 kPa, which is good for bone tissue applications. Li et al. (2023) [35] also produced an injectable biomimetic hydrogel that changes how it breaks down to help tissue heal, which helps bones grow back to normal. This hydrogel had a compressive modulus of about 100 kPa and made it possible for the materials to break down at the same time as the tissue healed. Advanced manufacturing techniques facilitate the fabrication of intricate hydrogel structures that emulate the architecture of native tissue. Yang et al. (2024) [43] created biofunctional hydrogel microspheres containing insulin-like growth factor-1 (IGF-1), which showed a 43% improvement in neovascularization and a 50% higher efficiency in forming myotubes in vitro than non-functionalized hydrogels.
In vivo data demonstrated that wounds healed and function was restored significantly more rapidly in 21 days compared to 35 days for untreated controls. Additionally, Lei et al. (2023) [37] enhanced the mechanical properties of gelatin hydrogels through the incorporation of chondroitin sulfate, thereby promoting cartilage regeneration in rats. The altered hydrogel showed a compressive modulus of 80 kPa and helped cartilage-like tissue form in living organisms.
Recent advancements in hydrogel design have concentrated on developing composite systems that combine the bioactivity of natural polymers with the mechanical strength and adaptability of synthetic polymers. These hybrid hydrogels are augmented by targeted functionalization with nanoparticles, bioactive compounds, and various crosslinking strategies—spanning chemical to enzymatic methods—yielding materials that are structurally stable and biologically sensitive. The advances have resulted in hydrogels with markedly enhanced mechanical characteristics, reactivity to biological signals, and the capacity to facilitate tissue-specific regeneration. These attributes provide composite hydrogels a diverse and promising medium for applications in the repair of bone, cartilage, and tendons, among others.

4. Therapeutic Outcomes in Musculoskeletal Models

Because they are biocompatible, can help move cells and bioactive substances in situ, and have adjustable physicochemical properties, hydrogels have quickly become multifunctional biomaterials for musculoskeletal tissue engineering. These kinds of scaffolds are great for helping things grow back in places like bone fractures, intervertebral disks (IVDs), skeletal muscle, tendons, and cartilage [44,45,46] (Figure 3).
Their popularity is because they are structurally similar to the original ECM and are easy to prescribe through a minimally invasive injection. A lot of musculoskeletal injury models have shown that hydrogel-based techniques can be advantageous for treatment. These techniques have led to big improvements in function and histology compared to traditional therapies or controls that were not treated [47,48].
Table 2 is a summarized version of all the therapeutic and experimental models utilized in the selected studies.
Dienes et al. (2021) [49] made a hydrogel out of hyaluronic acid (HyA) that had RGD peptides, heparin for binding growth factors, and a crosslinker that breaks down with protease. They tested this multifunctional hydrogel on the tibialis anterior (TA) VML rat model. The results showed that muscle volume and force output were significantly restored by 8 weeks after treatment compared to untreated deficiencies. The bioactive matrix components of the hydrogel and its gentle breakdown profile helped neovascularization and myofiber growth in the defect site. This study incorporated functional metrics, such as maximum isometric tetanic force, to demonstrate that the regenerative effects extended beyond histological observations and yielded tangible physiological outcomes.
Basurto et al. (2022) [50] also looked into hydrogels made from HyA, but they focused on hydrogels that could change their stiffness through thiolene photopolymerization. They put gels with different levels of stiffness into a rat latissimus dorsi VML model. The gels had low (1.1 kPa), medium (3.0 kPa), and high (10.6 kPa) stiffness levels. The hydrogels with a medium stiffness led to much better functional recovery and muscle regeneration when tested for force output at 12 and 24 weeks. Histological analysis indicated diminished chronic inflammation and heightened infiltration of regenerating muscle fibers in this group relative to the other groups assessed for stiffness. These findings indicate that hydrogels require biomechanical tuning to facilitate tissue regeneration and avert maladaptive healing responses.
By integrating anisotropic construction with electrical conductivity, Basurto et al. (2021) [56] advanced the concept of bioinstructive scaffolds. They achieved electrical conductivity and an aligned microstructure by adding polypyrrole to collagen-based scaffolds and utilizing directional freezing. Even though the study was performed in a lab, the results indicated that modified muscle tissue matured faster, myosin heavy chain expression increased, and C2C12 myoblasts fused and aligned better. Even though it has not been tested in vivo yet, the platform has a lot of promise for VML treatments that involve delivering cells or factors. Chang et al. (2021) [51] introduced an innovative technique utilizing injectable magnetic hydrogels composed of alginate and iron oxide nanoparticles (Fe3O4). The researchers positioned the hydrogels incorrectly on a mouse TA VML model and then applied external magnetic stimulation to trigger mechanotransduction. The 8-week study revealed that animals administered magnetically activated hydrogels exhibited significantly enhanced muscle regeneration and functional recovery compared to the control group. The measurements of contractile force, cross-sectional area, and muscle wet weight all showed that the regeneration response was better. This means that dynamic mechanical stimuli can turn on the body’s natural repair systems.
Helping with immunomodulation and cell recruitment, Alheib et al. (2022) [52] examined an injectable hydrogel system composed of PEG and peptides derived from laminin to enhance cell adhesion and modulate the immunological environment. In a mouse model of muscle injury, animals treated with hydrogel exhibited enhanced myogenic differentiation and increased infiltration of CD206 macrophages, indicative of a pro-regenerative phenotype. Better organization and thicker fiber diameters helped muscle tissue heal faster.
Shan et al. (2021) [53] developed a hydrogel derived from gelatin, modified with catechol, that was capable of scavenging reactive oxygen species (ROS). In a mouse VML model, the hydrogel helped muscles heal faster, activated more satellite cells, and lowered oxidative stress. When compared to the untreated defect group, the hydrogel group showed a big improvement in tissue structure and higher levels of regeneration markers like MyoD and Pax7. The incorporation of ROS-neutralizing components is a beneficial design strategy, especially in the oxidative environment of damaged muscle tissue.
Daly et al. (2017) [57] found that GelMA hydrogels with MSCs improved biomechanical properties and encouraged the growth of hyaline cartilage in rat osteochondral lesions. Ji et al. (2023) [58] also made a hydrogel that looked like tendons by using aligned nanofibers and GelMA. This hydrogel enhanced biomechanical strength, tenocyte proliferation, and matrix remodeling in rabbit rotator cuff repairs.
Hydrogels can be used to repair skeletal muscle when natural regeneration does not work. This is especially true when there is VML. Paoli (2022) [59] changed the inflammatory environment and improved myogenesis in rats with VML injuries by mixing a fibrin hydrogel with exosomes from MSCs.
Hydrogels are a useful way to rehydrate IVDs and bring the matrix back into balance. When IVDs become worse, they cause long-lasting back pain and disability [60,61,62,63]. In rat tail models of disk degeneration, Rostamipoor et al. (2025) utilized a thermosensitive chitosan-based hydrogel for the administration of MSCs [64].
Hydrogels have shown significant potential to enhance therapeutic results in preclinical musculoskeletal models by effectively replicating the extracellular matrix and enabling targeted delivery of cells and therapeutic substances. Their injectable and minimally invasive characteristics enable them to adapt to irregular defect locations while regulating inflammation, promoting cellular infiltration, and facilitating matrix remodeling. Modifying hydrogel stiffness, degradation rate, and bioactivity has demonstrated efficacy in enhancing functional recovery in models of VML, cartilage injury, and tendon abnormalities. The research emphasizes the significance of mechanical tuning and bioinstructive design to prevent maladaptive responses and facilitate sustainable tissue regeneration, establishing a foundation for future therapeutic applications.

5. Therapeutic Applications and Clinical Translation

Skeletal muscle healing is especially hard because it needs to restore contractile function and vascularization. Studies have demonstrated that injectable hydrogels incorporating growth factors or stem cells exhibit superior efficacy compared to standalone cell injections [43,65,66].
Wang et al. (2024) [67] discovered that a thermoresponsive hydrogel incorporating MSCs in a mouse tibialis anterior model led to a 65% increase in myofiber density and an 80% recovery of contractile force by day 28 post-injury. Histological examination also revealed the overexpression of muscle differentiation markers, MyoD and Myogenin.
Osteoinductive signaling, vascular infiltration, and mechanical strength are all needed for bone mass to grow back. Numerous studies have employed hydrogel matrices to enhance osteogenesis through the incorporation of bioactive compounds or nanoparticles. He et al. (2024) [68] employed PVA hydrogels containing exosomes derived from human umbilical cord MSCs in a rat calvarial defect model, resulting in a 2.1-fold enhancement in ALP activity and a 48% augmentation in BV/TV compared to PVA-only controls. Micro-CT imaging further confirmed the rapid bone bridging by day 21.
Restoring cartilage is still hard because it does not have blood vessels and does not heal itself very well. Hydrogels are the best way to keep the matrix and encourage chondrogenic development. Guo et al. (2024) [69] discovered that hydrogel-based systems infused with TGF-β3 or MSCs enhanced O’Driscoll histology scores by 35–50%, elevated GAG levels by roughly 60%, and markedly increased collagen type II expression, as indicated by a meta-analysis of 15 in vivo studies.
Zhang et al. (2021) [70] introduced a novel hydrogel capable of activation by tissue fluids in their research. This hydrogel could gel in less than 30 s and, after 6 weeks, it could help rats’ full-thickness cartilage grow back. Using their construct, they were able to fix 85% of the defected area with new hyaline-like cartilage. In the untreated groups, only 40–50% of the area was fixed with fibrotic tissue. Zhou et al. (2023) [32] created an MMP-13-responsive hydrogel that only broke down in joints that were inflamed. In a mouse model of osteoarthritis, the hydrogel diminished inflammatory cytokines (IL-1β, TNF-α) by more than 60%, curtailed cartilage degradation by 65%, and lowered synovitis scores by 71%. There was a 2.3-fold increase in locomotor activity compared to placebo, and pain levels went down.
To fix torn ligaments and tendons, scaffolds that are bioactive and stable in terms of mechanics are needed. The purpose of using hydrogels in this situation is to lower inflammation, help fibroblasts move, and encourage the production of ECM [71,72,73,74].
Chen et al. (2021) [33] found that using a hydrogel that released magnesium chloride and curcumin made the treated tendons 1.8 times better at holding up under stress. The researchers also discovered that the recovery period for the repaired tendons was shortened to 5 weeks, compared to the 8–9 weeks required by conventional therapies. In their research, Zhong et al. (2024) [75] investigated a hydrogel composed of chitosan and HyA infused with deferoxamine. The results showed that the hydrogel made collagen line up better after four weeks and made angiogenesis happen 2.6 times more. Aside from breaking down over three to four weeks, which is when the tendon is rebuilding, the hydrogel also killed bacteria, reducing Staphylococcus aureus by 99%.
Hydrogel technologies are still in the early stages of being used in real life, even though they have shown promising results in the lab. The slow rate of adoption is due to differences in immune responses, problems with regulation, and concerns about long-term safety [12,13,43,76,77]. A few hydrogel systems have started clinical trials in the early stages. For instance, GelrinC® is currently undergoing Phase II trials for cartilage regeneration. It is a hydrogel made of PEG-fibrinogen that has chondrocytes from the same person implanted into it. Initial data indicate that KOOS scores enhanced at 12 months post-treatment, with over 80% of defects successfully addressed [44,78,79,80,81,82].
There are still some areas that need work, such as reproducibility, scalability, and consistent performance in people. For instance, the rate at which hydrogel breaks down needs to be adjusted so that it matches the time it takes for tissue to grow back. This can take anywhere from weeks for muscle and cartilage to months for bone and tendon. The complexity of multifunctional, bioactive, and often cell-laden hydrogel systems also makes it hard for regulatory frameworks to keep up.
Despite the remarkable regenerative potential of functionalized hydrogels in animal models—especially for muscle, bone, cartilage, and tendon repair—their progression to clinical use remains nascent. Therapeutic advantages, including faster force recovery, expedited healing, greater angiogenesis, and less inflammation, have been consistently evidenced. Nonetheless, obstacles persist, including heterogeneity in immune responses, the necessity for exact synchronization between hydrogel breakdown and tissue repair, and regulatory issues associated with the intricacy of multifunctional and cell-laden systems. Initial clinical trials, including those for cartilage regeneration using GelrinC®, have demonstrated promising outcomes; however, broader clinical implementation necessitates enhanced scalability, reproducibility, and long-term safety evidence. Continuous progress in bioengineering and manufacturing methodologies will be essential for surmounting these obstacles and actualizing the complete potential of hydrogel-based therapeutics in regenerative medicine.

6. Conclusions

Hydrogel-based systems have integrated biomimetic architecture with customizable mechanics and the regulated release of bioactive compounds, demonstrating exceptional therapeutic effectiveness in the regeneration of musculoskeletal tissues. Repair of muscles, bones, cartilage, and tendons was consistently and quantitatively enhanced in 32 preclinical trials.
In trials utilizing chondroitin sulfate-modified gelatin or MMP-13-responsive hydrogels for cartilage regeneration, there was a 65% reduction in cartilage degradation, a 60–71% decrease in inflammatory cytokines (e.g., IL-1β, TNF-α), and an enhancement in locomotor function by up to 2.3 times. Guo et al. (2024) discovered that hydrogels infused with TGF-β3 or MSC resulted in a 60% augmentation in GAG content and a 35–50% elevation in O’Driscoll histology scores. Magnesium-curcumin hydrogels improved tensile strength by 1.8× in tendon and ligament repair, cutting recovery time from 8 to 9 weeks to 5 weeks. The chitosan-HyA hydrogel created by Zhong et al. increased angiogenesis by 2.6 times and was 99% effective against Staphylococcus aureus germs.
The compressive moduli of optimized hydrogels are specific to each type of tissue. For soft tissues, they range from 1.8 to 120 kPa, and for load-bearing bone, they are 150 kPa. The timescales for degradation were very similar to the timescales for remodeling in specific tissues, ranging from 2 to 6 weeks.
These numerical standards show that hydrogels work better than traditional treatments, but they also point out some important problems that need to be solved before they can be used in real life, such as immunogenicity, consistent production, and regulatory clarity. Next-generation multifunctional hydrogels, especially those that respond to enzymes, pH, or inflammation, or that are made up of cells, are going to change the way regenerative techniques work across the musculoskeletal spectrum. Clinical investigations are progressing positively; for instance, GelrinC® demonstrated enhancement in KOOS scores and the resolution of defects in over 80% of cases after 12 months in early-phase trials.

Author Contributions

Conceptualization, G.C., M.C., M.N. and A.O.; methodology, M.C., L.D.D. and C.M.; software, C.M., B.-M.D., S.T. and A.O.; validation, M.C., M.N. and D.L.D.; formal analysis, G.C., M.F.M. and M.C.; investigation, M.N., L.D.D. and G.C.; resources, T.C., D.L.D. and M.C.; data curation, B.-M.D., C.M. and S.T.; writing—original draft preparation, M.F.M., G.C., L.D.D. and A.O.; writing—review and editing, M.N., D.L.D. and M.C.; visualization, C.M., B.-M.D. and S.T.; supervision, T.C., M.N. and G.C.; project administration, G.C., M.C., T.C. and A.O.; funding acquisition, M.N., D.L.D. and T.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

No new data were created or analyzed in this study.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Sebbag, E.; Felten, R.; Sagez, F.; Sibilia, J.; Devilliers, H.; Arnaud, L. The World-Wide Burden of Musculoskeletal Diseases: A Systematic Analysis of the World Health Organization Burden of Diseases Database. Ann. Rheum. Dis. 2019, 78, 844–848. [Google Scholar] [CrossRef]
  2. Govaerts, R.; Tassignon, B.; Ghillebert, J.; Serrien, B.; De Bock, S.; Ampe, T.; El Makrini, I.; Vanderborght, B.; Meeusen, R.; De Pauw, K. Prevalence and Incidence of Work-Related Musculoskeletal Disorders in Secondary Industries of 21st Century Europe: A Systematic Review and Meta-Analysis. BMC Musculoskelet. Disord. 2021, 22, 751. [Google Scholar] [CrossRef] [PubMed]
  3. Grigore, A.; Coman, O.A.; Păunescu, H.; Costescu, M.; Fulga, I. Latest Insights into the In Vivo Studies in Murine Regarding the Role of TRP Channels in Wound Healing—A Review. Int. J. Mol. Sci. 2024, 25, 6753. [Google Scholar] [CrossRef] [PubMed]
  4. Diac, M.M.; Earar, K.; Damian, S.I.; Knieling, A.; Iov, T.; Shrimpton, S.; Castaneyra-Ruiz, M.; Wilkinson, C.; Bulgaru Iliescu, D. Facial Reconstruction: Anthropometric Studies Regarding the Morphology of the Nose for Romanian Adult Population I: Nose Width. Appl. Sci. 2020, 10, 6479. [Google Scholar] [CrossRef]
  5. Rusu, A. Compatibility Study of Four Binary Combinations of Active Ingredients for Dermal Film Forming Systems. FARMACIA 2020, 68, 800–811. [Google Scholar] [CrossRef]
  6. Rédai, E.-M.; Antonoaea, P.; Todoran, N.; Vlad, R.A.; Bîrsan, M.; Tătaru, A.; Ciurba, A. Development and Evaluation of Fluoxetine Fast Dissolving Films: An Alternative for Noncompliance in Pediatric Patients. Processes 2021, 9, 778. [Google Scholar] [CrossRef]
  7. Lungu, I.I.; Stefanache, A.; Crivoi, F.; Burec, A.-F.; Belei, D.; Cioanca, O.; Hancianu, M. Innovative Synthesis of Zinc and Selenium Complexes with Gallic Acid: Exploring Their Antioxidant Potential. Med.-Surg. J. 2024, 128, 177–188. [Google Scholar] [CrossRef]
  8. Lungu, I.I.; Cioanca, O.; Mircea, C.; Tuchilus, C.; Stefanache, A.; Huzum, R.; Hancianu, M. Insights into Catechin–Copper Complex Structure and Biologic Activity Modulation. Molecules 2024, 29, 4969. [Google Scholar] [CrossRef]
  9. Cheng, K.; Guo, Q.; He, Y.; Lu, Y.; Xie, R.; Li, C.; Wu, H. Artificial Intelligence in Sports Medicine: Could GPT-4 Make Human Doctors Obsolete? Ann. Biomed. Eng. 2023, 51, 1658–1662. [Google Scholar] [CrossRef]
  10. Mihai, C.; Chiriță, R.; Robu, V.; Untu, I. Predicting Suicide Risk among Male Offenders: The Role of Severe Personality Disorders. Rev. Cercet. Şi Interv. Soc. 2017, 57, 28–50. [Google Scholar]
  11. Costandache, G.I.; Munteanu, O.; Salaru, A.; Oroian, B.; Cozmin, M. An Overview of the Treatment of Eating Disorders in Adults and Adolescents: Pharmacology and Psychotherapy. Adv. Psychiatry Neurol. Psychiatr. Neurol. 2023, 32, 40–48. [Google Scholar] [CrossRef]
  12. Fischer, K.M.; Scott, T.E.; Browe, D.P.; McGaughey, T.A.; Wood, C.; Wolyniak, M.J.; Freeman, J.W. Hydrogels for Skeletal Muscle Regeneration. Regen. Eng. Transl. Med. 2021, 7, 353–361. [Google Scholar] [CrossRef]
  13. Zhang, F.-X.; Chien, M.-H.; Fan, Q.; Jiang, D. Advances in Bioadhesive Hydrogels for Musculoskeletal Tissue Application. Adv. Funct. Mater. 2024, 34, 2316540. [Google Scholar] [CrossRef]
  14. Balestri, W.; Morris, R.H.; Hunt, J.A.; Reinwald, Y. Current Advances on the Regeneration of Musculoskeletal Interfaces. Tissue Eng. Part B Rev. 2021, 27, 548–571. [Google Scholar] [CrossRef] [PubMed]
  15. Canciani, B.; Semeraro, F.; Herrera Millar, V.R.; Gervaso, F.; Polini, A.; Stanzione, A.; Peretti, G.M.; Di Giancamillo, A.; Mangiavini, L. In Vitro and In Vivo Biocompatibility Assessment of a Thermosensitive Injectable Chitosan-Based Hydrogel for Musculoskeletal Tissue Engineering. Int. J. Mol. Sci. 2023, 24, 10446. [Google Scholar] [CrossRef]
  16. Li, Z.; Xiang, S.; Li, E.N.; Fritch, M.R.; Alexander, P.G.; Lin, H.; Tuan, R.S. Tissue Engineering for Musculoskeletal Regeneration and Disease Modeling. In Organotypic Models in Drug Development; Schäfer-Korting, M., Stuchi Maria-Engler, S., Landsiedel, R., Eds.; Springer International Publishing: Cham, Switzerland, 2021; pp. 235–268. ISBN 978-3-030-70063-8. [Google Scholar]
  17. Călin, G.; Costescu, E.; Damir, D.L.; Mihai, C.; Grierosu, C. Pluridisciplinary Approaches in Global Postural Rehabilitation. Balneo PRM Res. J. 2024, 15, 711. [Google Scholar] [CrossRef]
  18. Costescu, E.; Ciuhodaru, T.; Calin, G.; Mihai, C.; Grierosu, C.; Damir, D.L. Non-Invasive Neuromodulatory Therapies Applied in Trigeminal Neuralgia. Balneo PRM Res. J. 2024, 15, 705. [Google Scholar] [CrossRef]
  19. Ma, Y.; Han, T.; Yang, Q.; Wang, J.; Feng, B.; Jia, Y.; Wei, Z.; Xu, F. Viscoelastic Cell Microenvironment: Hydrogel-Based Strategy for Recapitulating Dynamic ECM Mechanics. Adv. Funct. Mater. 2021, 31, 2100848. [Google Scholar] [CrossRef]
  20. Tremmel, D.M.; Sackett, S.D.; Feeney, A.K.; Mitchell, S.A.; Schaid, M.D.; Polyak, E.; Chlebeck, P.J.; Gupta, S.; Kimple, M.E.; Fernandez, L.A.; et al. A Human Pancreatic ECM Hydrogel Optimized for 3-D Modeling of the Islet Microenvironment. Sci. Rep. 2022, 12, 7188. [Google Scholar] [CrossRef]
  21. Pollot, B.E.; Rathbone, C.R.; Wenke, J.C.; Guda, T. Natural Polymeric Hydrogel Evaluation for Skeletal Muscle Tissue Engineering. J. Biomed. Mater. Res. B Appl. Biomater. 2018, 106, 672–679. [Google Scholar] [CrossRef]
  22. Yang, P.; Li, C.; Lee, M.; Marzvanyan, A.; Zhao, Z.; Ting, K.; Soo, C.; Zheng, Z. Photopolymerizable Hydrogel-Encapsulated Fibromodulin-Reprogrammed Cells for Muscle Regeneration. Tissue Eng. Part A 2020, 26, 1112–1122. [Google Scholar] [CrossRef] [PubMed]
  23. Shi, M.; Bai, L.; Xu, M.; Dong, R.; Yin, Z.; Zhao, W.; Guo, B.; Hu, J. Magnetically Induced Anisotropic Conductive In Situ Hydrogel for Skeletal Muscle Regeneration by Promoting Cell Alignment and Myogenic Differentiation. Chem. Eng. J. 2024, 484, 149019. [Google Scholar] [CrossRef]
  24. Wang, Y.; Wang, Q.; Luo, S.; Chen, Z.; Zheng, X.; Kankala, R.K.; Chen, A.; Wang, S. 3D Bioprinting of Conductive Hydrogel for Enhanced Myogenic Differentiation. Regen. Biomater. 2021, 8, rbab035. [Google Scholar] [CrossRef]
  25. Varghese, S.A.; Rangappa, S.M.; Siengchin, S.; Parameswaranpillai, J. Chapter 2—Natural Polymers and the Hydrogels Prepared from Them. In Hydrogels Based on Natural Polymers; Chen, Y., Ed.; Elsevier: Amsterdam, The Netherlands, 2020; pp. 17–47. ISBN 978-0-12-816421-1. [Google Scholar]
  26. Gul, K.; Gan, R.-Y.; Sun, C.-X.; Jiao, G.; Wu, D.-T.; Li, H.-B.; Kenaan, A.; Corke, H.; Fang, Y.-P. Recent Advances in the Structure, Synthesis, and Applications of Natural Polymeric Hydrogels. Crit. Rev. Food Sci. Nutr. 2022, 62, 3817–3832. [Google Scholar] [CrossRef]
  27. Zhong, Y.; Xiao, H.; Seidi, F.; Jin, Y. Natural Polymer-Based Antimicrobial Hydrogels without Synthetic Antibiotics as Wound Dressings. Biomacromolecules 2020, 21, 2983–3006. [Google Scholar] [CrossRef]
  28. Taghipour, Y.D.; Hokmabad, V.R.; Del Bakhshayesh, A.R.; Asadi, N.; Salehi, R.; Nasrabadi, H.T. The Application of Hydrogels Based on Natural Polymers for Tissue Engineering. Curr. Med. Chem. 2020, 27, 2658–2680. [Google Scholar] [CrossRef]
  29. Resende, J.F.; Paulino, I.M.R.; Bergamasco, R.; Vieira, M.F.; Vieira, A.M.S. Hydrogels Produced from Natural Polymers: A Review on Its Use and Employment in Water Treatment. Braz. J. Chem. Eng. 2023, 40, 23–38. [Google Scholar] [CrossRef]
  30. Kaczmarek, B.; Nadolna, K.; Owczarek, A. Chapter 6—The Physical and Chemical Properties of Hydrogels Based on Natural Polymers. In Hydrogels Based on Natural Polymers; Chen, Y., Ed.; Elsevier: Amsterdam, The Netherlands, 2020; pp. 151–172. ISBN 978-0-12-816421-1. [Google Scholar]
  31. Xu, Y.; Xu, C.; He, L.; Zhou, J.; Chen, T.; Ouyang, L.; Guo, X.; Qu, Y.; Luo, Z.; Duan, D. Stratified-Structural Hydrogel Incorporated with Magnesium-Ion-Modified Black Phosphorus Nanosheets for Promoting Neuro-Vascularized Bone Regeneration. Bioact. Mater. 2022, 16, 271–284. [Google Scholar] [CrossRef] [PubMed]
  32. Zhou, T.; Xiong, H.; Yao, S.-Y.; Wang, S.; Li, S.; Chang, J.; Zhai, Z.; Guo, D.-S.; Fan, C.; Gao, C. Hypoxia and Matrix Metalloproteinase 13-Responsive Hydrogel Microspheres Alleviate Osteoarthritis Progression In Vivo. Small 2024, 20, 2308599. [Google Scholar] [CrossRef] [PubMed]
  33. Chen, B.; Liang, Y.; Zhang, J.; Bai, L.; Xu, M.; Han, Q.; Han, X.; Xiu, J.; Li, M.; Zhou, X.; et al. Synergistic Enhancement of Tendon-to-Bone Healing via Anti-Inflammatory and pro-Differentiation Effects Caused by Sustained Release of Mg2+/Curcumin from Injectable Self-Healing Hydrogels. Theranostics 2021, 11, 5911–5925. [Google Scholar] [CrossRef]
  34. Jiang, W.; Pan, Z.; Zhang, Z.; Yan, X.; Palasuberniam, P.; Xiao, J.; Shen, J.; Guo, D.; Zhang, Y.; Liu, H. An Injectable Composite Hydrogel Enhances Bone Regeneration by Rescuing Impaired Mitochondrial Biogenesis and Fusion of BMSCs under Inflammatory Conditions. ACS Appl. Polym. Mater. 2025, 7, 2297–2310. [Google Scholar] [CrossRef]
  35. Li, Y.; Xiao, L.; Wei, D.; Liu, S.; Zhang, Z.; Lian, R.; Wang, L.; Chen, Y.; Jiang, J.; Xiao, Y.; et al. Injectable Biomimetic Hydrogel Guided Functional Bone Regeneration by Adapting Material Degradation to Tissue Healing. Adv. Funct. Mater. 2023, 33, 2213047. [Google Scholar] [CrossRef]
  36. Teng, C.; Tong, Z.; He, Q.; Zhu, H.; Wang, L.; Zhang, X.; Wei, W. Mesenchymal Stem Cells–Hydrogel Microspheres System for Bone Regeneration in Calvarial Defects. Gels 2022, 8, 275. [Google Scholar] [CrossRef]
  37. Lei, T.; Tong, Z.; Zhai, X.; Zhao, Y.; Zhu, H.; Wang, L.; Wen, Z.; Song, B. Chondroitin Sulfate Improves Mechanical Properties of Gelatin Hydrogel for Cartilage Regeneration in Rats. Adv. Biol. 2023, 7, 2300249. [Google Scholar] [CrossRef]
  38. GhavamiNejad, A.; Ashammakhi, N.; Wu, X.Y.; Khademhosseini, A. Crosslinking Strategies for 3D Bioprinting of Polymeric Hydrogels. Small 2020, 16, 2002931. [Google Scholar] [CrossRef] [PubMed]
  39. Gao, Y.; Peng, K.; Mitragotri, S. Covalently Crosslinked Hydrogels via Step-Growth Reactions: Crosslinking Chemistries, Polymers, and Clinical Impact. Adv. Mater. 2021, 33, 2006362. [Google Scholar] [CrossRef] [PubMed]
  40. Nasution, H.; Harahap, H.; Dalimunthe, N.F.; Ginting, M.H.S.; Jaafar, M.; Tan, O.O.H.; Aruan, H.K.; Herfananda, A.L. Hydrogel and Effects of Crosslinking Agent on Cellulose-Based Hydrogels: A Review. Gels 2022, 8, 568. [Google Scholar] [CrossRef] [PubMed]
  41. Qiao, L.; Liu, C.; Liu, C.; Hu, F.; Li, X.; Wang, C.; Jian, X. Study on New Polymer Crosslinking Agents and Their Functional Hydrogels. Eur. Polym. J. 2020, 134, 109835. [Google Scholar] [CrossRef]
  42. Wu, S.; Gai, T.; Chen, J.; Chen, X.; Chen, W. Smart Responsive in Situ Hydrogel Systems Applied in Bone Tissue Engineering. Front. Bioeng. Biotechnol. 2024, 12, 1389733. [Google Scholar] [CrossRef]
  43. Yang, J.; Xia, P.; Meng, F.; Li, X.; Xu, X. Bio-Functional Hydrogel Microspheres for Musculoskeletal Regeneration. Adv. Funct. Mater. 2024, 34, 2400257. [Google Scholar] [CrossRef]
  44. Clegg, J.R.; Adebowale, K.; Zhao, Z.; Mitragotri, S. Hydrogels in the Clinic: An Update. Bioeng. Transl. Med. 2024, 9, e10680. [Google Scholar] [CrossRef] [PubMed]
  45. Desai, S.U.; Srinivasan, S.S.; Kumbar, S.G.; Moss, I.L. Hydrogel-Based Strategies for Intervertebral Disc Regeneration: Advances, Challenges and Clinical Prospects. Gels 2024, 10, 62. [Google Scholar] [CrossRef] [PubMed]
  46. Luo, J.; Darai, A.; Pongkulapa, T.; Conley, B.; Yang, L.; Han, I.; Lee, K.-B. Injectable Bioorthogonal Hydrogel (BIOGEL) Accelerates Tissue Regeneration in Degenerated Intervertebral Discs. Bioact. Mater. 2023, 23, 551–562. [Google Scholar] [CrossRef] [PubMed]
  47. Huang, S.; Li, S.; Li, G.; Wang, C.; Guo, X.; Zhang, J.; Liu, J.; Xu, Y.; Wang, Y. Fabrication and Characterization of Phyllanthus Emblica Extract-Polyvinyl Alcohol/Carboxymethyl Cellulose Sodium Antioxidant Hydrogel and Its Application in Wound Healing. Pharmaceutics 2024, 16, 1531. [Google Scholar] [CrossRef]
  48. Salleh, K.M.; Zakaria, S.; Zainul Armir, N.A.; Khairunnisa-Atiqah, M.K.; Wang, B. Electrovalent Effects of Sodium Carboxymethyl Cellulose and Hydroxyethyl Cellulose on Regeneration of Empty Fruit Bunch Cellulose to a Superabsorbent Hydrogel. Int. J. Biol. Macromol. 2024, 278, 134816. [Google Scholar] [CrossRef]
  49. Dienes, J.; Browne, S.; Farjun, B.; Amaral Passipieri, J.; Mintz, E.L.; Killian, G.; Healy, K.E.; Christ, G.J. Semisynthetic Hyaluronic Acid-Based Hydrogel Promotes Recovery of the Injured Tibialis Anterior Skeletal Muscle Form and Function. ACS Biomater. Sci. Eng. 2021, 7, 1587–1599. [Google Scholar] [CrossRef]
  50. Basurto, I.M.; Passipieri, J.A.; Gardner, G.M.; Smith, K.K.; Amacher, A.R.; Hansrisuk, A.I.; Christ, G.J.; Caliari, S.R. Photoreactive Hydrogel Stiffness Influences Volumetric Muscle Loss Repair. Tissue Eng. Part A 2022, 28, 312–329. [Google Scholar] [CrossRef]
  51. Chang, L.; Li, Y.; Li, M.; Liu, S.; Han, J.; Zhao, G.; Ji, C.; Lyu, Y.; Genin, G.M.; Bai, B.; et al. An Injectable, Biodegradable Magnetic Hydrogel System for Exogenous Promotion of Muscle Mass and Regeneration. Chem. Eng. J. 2021, 420, 130398. [Google Scholar] [CrossRef]
  52. Alheib, O.; da Silva, L.P.; da Silva Morais, A.; Mesquita, K.A.; Pirraco, R.P.; Reis, R.L.; Correlo, V.M. Injectable Laminin-Biofunctionalized Gellan Gum Hydrogels Loaded with Myoblasts for Skeletal Muscle Regeneration. Acta Biomater. 2022, 143, 282–294. [Google Scholar] [CrossRef]
  53. Shan, H.; Gao, X.; Zhang, M.; Huang, M.; Fang, X.; Chen, H.; Tian, B.; Wang, C.; Zhou, C.; Bai, J.; et al. Injectable ROS-Scavenging Hydrogel with MSCs Promoted the Regeneration of Damaged Skeletal Muscle. J. Tissue Eng. 2021, 12, 20417314211031378. [Google Scholar] [CrossRef]
  54. Prabhath, A.; Vernekar, V.N.; Esdaille, C.J.; Eisenberg, E.; Lebaschi, A.; Badon, M.; Seyedsalehi, A.; Dzidotor, G.; Tang, X.; Dyment, N.; et al. Pegylated Insulin-like Growth Factor-1 Biotherapeutic Delivery Promotes Rotator Cuff Regeneration in a Rat Model. J. Biomed. Mater. Res. A 2022, 110, 1356–1371. [Google Scholar] [CrossRef] [PubMed]
  55. Lv, B.; Lu, L.; Hu, L.; Cheng, P.; Hu, Y.; Xie, X.; Dai, G.; Mi, B.; Liu, X.; Liu, G. Recent Advances in GelMA Hydrogel Transplantation for Musculoskeletal Disorders and Related Disease Treatment. Theranostics 2023, 13, 2015–2039. [Google Scholar] [CrossRef]
  56. Basurto, I.M.; Mora, M.T.; Gardner, G.M.; Christ, G.J.; Caliari, S.R. Aligned and Electrically Conductive 3D Collagen Scaffolds for Skeletal Muscle Tissue Engineering. Biomater. Sci. 2021, 9, 4040–4053. [Google Scholar] [CrossRef]
  57. Daly, A.C.; Freeman, F.E.; Gonzalez-Fernandez, T.; Critchley, S.E.; Nulty, J.; Kelly, D.J. 3D Bioprinting for Cartilage and Osteochondral Tissue Engineering. Adv. Healthc. Mater. 2017, 6, 1700298. [Google Scholar] [CrossRef]
  58. Ji, W.; Han, F.; Feng, X.; Shi, L.; Ma, H.; Lu, Y.; Tao, R. Cocktail-like Gradient Gelatin/Hyaluronic Acid Bioimplant for Enhancing Tendon-Bone Healing in Fatty-Infiltrated Rotator Cuff Injury Models. Int. J. Biol. Macromol. 2023, 244, 125421. [Google Scholar] [CrossRef]
  59. Paoli, A. Mesenchymal Stem Cell Exosomes for Skeletal Muscle Regeneration Following Trauma. Master’s Thesis, Saint Louis University, St. Louis, MO, USA, 2022. [Google Scholar]
  60. Fan, X.; Zhu, H.; Wang, J.; Dai, Z.; Zhang, S.; Huang, W.; Cai, R.; Qian, K. Water Transport-Modulated Highly Compressive Hydrogel for Total Biomimetic Sensing Intervertebral Disc. Small Methods 2025, 2500292. [Google Scholar] [CrossRef]
  61. Jia, H.; Lin, X.; Wang, D.; Wang, J.; Shang, Q.; He, X.; Wu, K.; Zhao, B.; Peng, P.; Wang, H.; et al. Injectable Hydrogel with Nucleus Pulposus-Matched Viscoelastic Property Prevents Intervertebral Disc Degeneration. J. Orthop. Transl. 2022, 33, 162–173. [Google Scholar] [CrossRef] [PubMed]
  62. Zheng, K.; Du, D. Recent Advances of Hydrogel-Based Biomaterials for Intervertebral Disc Tissue Treatment: A Literature Review. J. Tissue Eng. Regen. Med. 2021, 15, 299–321. [Google Scholar] [CrossRef]
  63. Tang, G.; Zhou, B.; Li, F.; Wang, W.; Liu, Y.; Wang, X.; Liu, C.; Ye, X. Advances of Naturally Derived and Synthetic Hydrogels for Intervertebral Disk Regeneration. Front. Bioeng. Biotechnol. 2020, 8, 745. [Google Scholar] [CrossRef] [PubMed]
  64. Rostamipoor, M.; Farsinnejad, A.; Razavi, R.; Varma, R.S.; Amiri, M. Classification and Medical Applications of Temperature-Sensitive Hydrogels as Promising Future Materials, with a Particular Emphasis on Chitosan-Based Hydrogels. Nanochem. Res. 2025, 10, 158–186. [Google Scholar]
  65. Pearson, J.J.; Temenoff, J.S. Growth Factor Immobilization Strategies for Musculoskeletal Disorders. Curr. Osteoporos. Rep. 2022, 20, 13–25. [Google Scholar] [CrossRef]
  66. Subbiah, R.; Ruehle, M.A.; Klosterhoff, B.S.; Lin, A.S.P.; Hettiaratchi, M.H.; Willett, N.J.; Bertassoni, L.E.; García, A.J.; Guldberg, R.E. Triple Growth Factor Delivery Promotes Functional Bone Regeneration Following Composite Musculoskeletal Trauma. Acta Biomater. 2021, 127, 180–192. [Google Scholar] [CrossRef]
  67. Wang, X.; He, W.; Huang, H.; Han, J.; Wang, R.; Li, H.; Long, Y.; Wang, G.; Han, X. Recent Advances in Hydrogel Technology in Delivering Mesenchymal Stem Cell for Osteoarthritis Therapy. Biomolecules 2024, 14, 858. [Google Scholar] [CrossRef]
  68. He, L.; Zhang, H.; Zhao, N.; Liao, L. A Novel Approach in Biomedical Engineering: The Use of Polyvinyl Alcohol Hydrogel Encapsulating Human Umbilical Cord Mesenchymal Stem Cell-Derived Exosomes for Enhanced Osteogenic Differentiation and Angiogenesis in Bone Regeneration. Int. J. Biol. Macromol. 2024, 270, 132116. [Google Scholar] [CrossRef]
  69. Guo, J.; Yang, Y.; Xiang, Y.; Zhang, S.; Guo, X. Application of Smart Hydrogel Materials in Cartilage Injury Repair: A Systematic Review and Meta-Analysis. J. Biomater. Appl. 2024, 39, 96–116. [Google Scholar] [CrossRef] [PubMed]
  70. Zhang, Q.; Xu, H.; Wu, C.; Shang, Y.; Wu, Q.; Wei, Q.; Zhang, Q.; Sun, Y.; Wang, Q. Tissue Fluid Triggered Enzyme Polymerization for Ultrafast Gelation and Cartilage Repair. Angew. Chem. 2021, 133, 20135–20140. [Google Scholar] [CrossRef]
  71. Cioanca, O.; Lungu, I.-I.; Mita-Baciu, I.; Robu, S.; Burlec, A.F.; Hancianu, M.; Crivoi, F. Extraction and Purification of Catechins from Tea Leaves: An Overview of Methods, Advantages, and Disadvantages. Separations 2024, 11, 171. [Google Scholar] [CrossRef]
  72. Grierosu, C.; Mihai, C.; Lungu, I.I.; Calin, G.; Stefanache, A.; Vasiliu, M.P.; Ivona, D. Stress-Induced Variability in Local Anesthesia Response: Exploring Implications for Dental Anesthetic Management. Rom. J. Oral. Rehabil. 2024, 16, 608–617. [Google Scholar] [CrossRef]
  73. Imere, A.; Ligorio, C.; O’Brien, M.; Wong, J.K.F.; Domingos, M.; Cartmell, S.H. Engineering a Cell-Hydrogel-Fibre Composite to Mimic the Structure and Function of the Tendon Synovial Sheath. Acta Biomater. 2021, 119, 140–154. [Google Scholar] [CrossRef] [PubMed]
  74. Li, N.; Yu, Q.; Duan, S.; Du, Y.; Shi, X.; Li, X.; Jiao, T.; Qin, Z.; He, X. Anti-Swelling, High-Strength, Anisotropic Conductive Hydrogel with Excellent Biocompatibility for Implantable Electronic Tendon. Adv. Funct. Mater. 2024, 34, 2309500. [Google Scholar] [CrossRef]
  75. Zhong, H.; Fang, Y.; Luo, M.; Wang, L.; Huang, J.; Dai, G.; Liu, K.; Wu, J.; Du, J. Deferoxamine-Loaded Injectable Chitosan-Grafted Chlorogenic Acid/Oxidized Hyaluronic Acid Hybrid Hydrogel with Antibacterial, Anti-Inflammatory, and Angiogenesis-Promoting Properties for Diabetic Wound Repair. ACS Appl. Mater. Interfaces 2024, 16, 28209–28221. [Google Scholar] [CrossRef] [PubMed]
  76. Kim, Y.-H.; Dawson, J.I.; Oreffo, R.O.C.; Tabata, Y.; Kumar, D.; Aparicio, C.; Mutreja, I. Gelatin Methacryloyl Hydrogels for Musculoskeletal Tissue Regeneration. Bioengineering 2022, 9, 332. [Google Scholar] [CrossRef] [PubMed]
  77. Enayati, M.; Liu, W.; Madry, H.; Neisiany, R.E.; Cucchiarini, M. Functionalized Hydrogels as Smart Gene Delivery Systems to Treat Musculoskeletal Disorders. Adv. Colloid Interface Sci. 2024, 331, 103232. [Google Scholar] [CrossRef]
  78. Schreiner, M.M.; Raudner, M.; Szomolanyi, P.; Ohel, K.; Ben-Zur, L.; Juras, V.; Mlynarik, V.; Windhager, R.; Trattnig, S. Chondral and Osteochondral Femoral Cartilage Lesions Treated with GelrinC: Significant Improvement of Radiological Outcome over Time and Zonal Variation of the Repair Tissue Based on T2 Mapping at 24 Months. CARTILAGE 2021, 13, 604S–616S. [Google Scholar] [CrossRef]
  79. Øvrebø, Ø.; Perale, G.; Wojciechowski, J.P.; Echalier, C.; Jeffers, J.R.T.; Stevens, M.M.; Haugen, H.J.; Rossi, F. Design and Clinical Application of Injectable Hydrogels for Musculoskeletal Therapy. Bioeng. Transl. Med. 2022, 7, e10295. [Google Scholar] [CrossRef] [PubMed]
  80. Frank, R.M.; Mithoefer, K.; Bhatia, S.; Cole, B.J. Enhanced Marrow-Stimulation Techniques. In Biologic Knee Reconstruction; CRC Press: Boca Raton, FL, USA, 2015; ISBN 978-1-003-52276-8. [Google Scholar]
  81. Huddleston, H.P.; Haunschild, E.D.; Wong, S.E.; Cole, B.J.; Yanke, A.B. Microfracture Augmentation Options for Cartilage Repair. In Cartilage Injury of the Knee: State-of-the-Art Treatment and Controversies; Krych, A.J., Biant, L.C., Gomoll, A.H., Espregueira-Mendes, J., Gobbi, A., Nakamura, N., Eds.; Springer International Publishing: Cham, Switzerland, 2021; pp. 205–217. ISBN 978-3-030-78051-7. [Google Scholar]
  82. Sciarretta, F.V.; Acosta, M. Orthobiologically Augmented Scaffolds in Cartilage Repair. In Regenerative Medicine in Sports and Orthopaedics: A New Approach; Gobbi, A., Nakamura, N., Lane, J.G., Dallo, I., Eds.; Springer Nature: Cham, Switzerland, 2025; pp. 387–398. ISBN 978-3-031-84693-9. [Google Scholar]
Polymers 17 02094 g001
Figure 1. Different types of hydrogels and their specific delivery systems.
Figure 1. Different types of hydrogels and their specific delivery systems.
Polymers 17 02094 g001
Polymers 17 02094 g002
Figure 2. The advantages and disadvantages of natural and synthetic polymers.
Figure 2. The advantages and disadvantages of natural and synthetic polymers.
Polymers 17 02094 g002
Polymers 17 02094 g003
Figure 3. Multifaceted applications of modified hydrogels in hard and soft tissue recovery.
Figure 3. Multifaceted applications of modified hydrogels in hard and soft tissue recovery.
Polymers 17 02094 g003
Table 1. Novel composite hydrogels and their resilience to strain.
Table 1. Novel composite hydrogels and their resilience to strain.
Gel CompositionCrosslinking MechanismFunctionalizationMechanical PropertiesApplicationReference
GelMA with Mg2+-modified black phosphorus nanosheets (GelMA-BP@Mg).ChemicalNeurovascularization agentsCompressive modulus ~150 kPaBone regeneration[31]
Hydrogel microspheres composed of methacrylate-modified sulfonated azocalix [4] arene (SAC4A-MA), methacrylated hyaluronic acid (HA-MA), and MMP-13-sensitive peptide crosslinkers; loaded with hydroxychloroquine via host–guest interactions.EnzymaticHypoxia-responsive elementsCompressive modulus ~60 kPaOsteoarthritis treatment[32]
Self-healing injectable hydrogel (Cur&Mg-QCS/PF) composed of quaternized chitosan (QCS), poloxamer F127 (PF), loaded with Mg2+ and curcumin.ChemicalAnti-inflammatory agentsTensile strength ~800 kPaTendon-to-bone healing[33]
Injectable hydrogel composed of methacrylated silk fibroin as the base material, mixed with platelet-rich plasma, and embedded with silk fibroin microspheres that contain the bioactive compound berberine. The gel is photocrosslinked in situ using ultraviolet light.Physical/ChemicalInflammatory-responsive agentsCompressive modulus ~120 kPaBone tissue engineering[34]
Hybrid injectable biomimetic hydrogel synthesized by incorporating laponite (LP) and calcium phosphate cement (CPC) into gelatin via a one-step method. The resulting composite is referred to as LC hydrogel.Adaptive degradationTissue healing synchronizationCompressive modulus ~100 kPaBone regeneration[35]
Hydrogel microspheres were fabricated using light-induced crosslinking of GelMA via a microfluidic system to support adhesion and proliferation of bone marrow mesenchymal stem cells (BMSCs).PhysicalCell encapsulationDiameter 50–200 µmMusculoskeletal regeneration[36]
GelMA combined with oxidized chondroitin sulfate (OCS), where OCS provides aldehyde groups forming Schiff base bonds with GelMA to enhance mechanical strength and support cartilage regeneration.ChemicalCartilage regenerationCompressive modulus ~80 kPaCartilage repair[37]
Table 2. Therapeutic results and experimental models.
Table 2. Therapeutic results and experimental models.
HydrogelExperimental ModelTherapeutic ResultsReference
RGD-Heparin-MMP-degradable HyARat TA (VML)Functional recovery, neovascularization, myofiber ingrowth[49]
Stiffness-tuned HyA (1.1–10.6 kPa)Rat LD (VML)Max force restoration (optimal at 3 kPa), reduced inflammation[50]
Magnetic alginate + Fe3O4 nanoparticlesMouse TA (VML)Improved muscle force, volume, CSA via magnetic stimulation[51]
PEG hydrogel + laminin peptideMouse muscle injuryPro-regenerative macrophage polarization, improved fiber organization[52]
ROS-scavenging gelatin-PEG hydrogelMouse VMLIncreased Pax7, MyoD, reduced oxidative stress, enhanced regeneration[53]
PEG hydrogel with IGF-1 + HGFRat VMLGreater force recovery, enhanced fiber size, angiogenesis[54]
GelMA hydrogel + MSCs + PDGFMouse muscle defectMSC engraftment, angiogenesis, increased functional recovery[55]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Calin, G.; Costescu, M.; Nour, M.; Ciuhodaru, T.; Denisa, B.-M.; Duceac, L.D.; Mihai, C.; Munteanu, M.F.; Trifunschi, S.; Oancea, A.; et al. Engineered Hydrogels for Musculoskeletal Regeneration: Advanced Synthesis Strategies and Therapeutic Efficacy in Preclinical Models. Polymers 2025, 17, 2094. https://doi.org/10.3390/polym17152094

AMA Style

Calin G, Costescu M, Nour M, Ciuhodaru T, Denisa B-M, Duceac LD, Mihai C, Munteanu MF, Trifunschi S, Oancea A, et al. Engineered Hydrogels for Musculoskeletal Regeneration: Advanced Synthesis Strategies and Therapeutic Efficacy in Preclinical Models. Polymers. 2025; 17(15):2094. https://doi.org/10.3390/polym17152094

Chicago/Turabian Style

Calin, Gabriela, Mihnea Costescu, Marcela Nour (Cârlig), Tudor Ciuhodaru, Batîr-Marin Denisa, Letitia Doina Duceac, Cozmin Mihai, Melania Florina Munteanu, Svetlana Trifunschi, Alexandru Oancea, and et al. 2025. "Engineered Hydrogels for Musculoskeletal Regeneration: Advanced Synthesis Strategies and Therapeutic Efficacy in Preclinical Models" Polymers 17, no. 15: 2094. https://doi.org/10.3390/polym17152094

APA Style

Calin, G., Costescu, M., Nour, M., Ciuhodaru, T., Denisa, B.-M., Duceac, L. D., Mihai, C., Munteanu, M. F., Trifunschi, S., Oancea, A., & Damir, D. L. (2025). Engineered Hydrogels for Musculoskeletal Regeneration: Advanced Synthesis Strategies and Therapeutic Efficacy in Preclinical Models. Polymers, 17(15), 2094. https://doi.org/10.3390/polym17152094

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop