Regenerative Therapies inTendinopathies and PartialRotator Cuff Tears

Abstract

Rotator cuff tendinopathies and partial‑thickness tears are common causes of shoulder pain, particularly in adults over 40, with a significant impact on quality of life and work capacity. While conservative treatment remains the first‑line approach, a substantial proportion of patients experience suboptimal outcomes. In recent years, regenerative therapies have emerged as promising alternatives or adjuncts to traditional treatment, aiming to promote tendon healing, reduce pain, and delay or avoid surgical intervention. This review critically evaluates the current evidence on regenerative interventions, including corticosteroid injections, hyaluronic acid, prolotherapy, platelet‑rich plasma (PRP), and cell‑based therapies such as bone marrow aspirate (BMA) and adipose‑derived mesenchymal stem cells (AD‑MSCs). Among these, leukocyte‑poor PRP (LP‑PRP) demonstrates the most consistent results in pain relief and functional improvement, with sustained effects observed for up to 12 months. Prolotherapy and hyaluronic acid, particularly in high‑molecular‑weight formulations, also show favorable short‑term results. Conversely, corticosteroids provide only transient analgesia and may negatively affect tendon healing if administered postoperatively. Cell‑based therapies have shown encouraging preliminary findings, including structural tendon improvement and reduction in lesion size. However, current studies are limited by methodological heterogeneity, small sample sizes, and short follow‑up periods, precluding definitive conclusions. This article emphasizes the need for individualized treatment selection based on patient profile, clinical severity, and access to therapy. Although some regenerative strategies are becoming more accessible, many remain experimental and should be restricted to research protocols until further high‑quality evidence becomes available. Therapeutic decisions should involve shared decision‑making, clearly addressing benefits, limitations, costs, and safety profiles of each modality.