How Regenerative Medicine Works for Athletes and When It’s Indicated

Dr. De Girolamo explains: “The most frequently affected areas are the joints of the lower and upper limbs, particularly the knee, ankle, and shoulder, but also the hip and elbow, depending on the sport practiced.”

The most common sports injuries and conditions in soccer

For example, sports that involve changes of direction or explosive movements, such as soccer, may lead to meniscal and ligament injuries.

The most common sports injuries and conditions in basketball

Injuries in basketball are very frequent, including patellar tendinopathies related to jumping.

The most common sports injuries and conditions in tennis and padel

In tennis or padel, which involve repetitive and asymmetric movements, players are often exposed to inflammatory or degenerative conditions, such as the so-called tennis elbow.

The most common sports injuries and conditions in skiing

Among the sports with the highest risk of injuries is also skiing: “In this case, the most frequent injuries involve the knee,” explains the doctor, “because the ankle, locked inside the ski boot, cannot absorb movements. Fractures or dislocations of the upper limbs due to high-speed falls are also common.”

Conditions involving the spine

The spine can also suffer from incorrect or excessive training, especially at the lumbosacral level where most postural load is concentrated.

The knee: why is it the most stressed joint in sports?

Among the most complex and stressed joints in the human body, the knee plays a crucial role in most athletic movements, both at the amateur and competitive level, making it essential yet equally vulnerable. In sports, the knee is often affected by:

• ligament and meniscal injuries;
• tendinopathies;
• early forms of osteoarthritis linked to functional overload.

“These are conditions that, even when not severe, can compromise performance and the quality of life of those who practice sports regularly,” continues Dr. De Girolamo.

Regenerative medicine can be useful in both trauma and overload-related conditions.

Regenerative medicine treatments for acute injuries

“In acute injuries, regenerative techniques are often used as support to surgery, for example in:

• anterior cruciate ligament reconstruction;
• meniscal repairs.

In these cases, the surgeon may use a biological preparation, such as PRP, to stimulate and accelerate healing processes.”

Regenerative medicine treatments for overuse

“In overuse conditions, regenerative medicine can instead be used without surgery through a typically infiltrative conservative approach to:

• promote recovery;
• reduce pain and inflammation.”

In the musculoskeletal field, regenerative treatments are based on the use of so-called orthobiologics, meaning derivatives from the patient’s own blood or tissues. The most commonly used are PRP and mesenchymal cells.

What PRP is and what it does

Among blood-derived products, the most common is PRP (Platelet-Rich Plasma), obtained through a simple blood draw and centrifugation that separates and concentrates the platelet fraction, rich in growth factors. These molecules:

• promote reparative processes;
• also have an important anti-inflammatory effect.

What mesenchymal cells are and what they are used for

The other major category consists of cell-based products, particularly mesenchymal stem cells (MSCs). These are cells already present in all our tissues and become active whenever tissues are affected by damage or inflammation.

They can be prepared from a small sample of tissues such as adipose tissue or bone marrow. They are used directly at the site of the problem, for example in:

• a joint;
• an injured tendon.

Both are minimally invasive procedures performed in an outpatient setting that make use of the body’s natural regenerative capacity. The protocols vary depending on the type of product:

Cell-based treatments:

• involve a single administration;
• their benefits may appear within 2 to 3 months and last for more than 2 years.

PRP treatment:

• is performed in cycles of 2–3 injections spaced about 2 weeks apart;
• patients report significant improvements after about 1 month, and on average the benefits last up to 12–18 months.

“However, these are not definitive solutions,” emphasizes the doctor, “because aging and degenerative processes continue. In some cases, repeating the cycle after some time is perfectly normal and does not represent a therapeutic failure, but rather a physiological need for maintenance.

It is important to underline that regenerative medicine is not a preventive therapy: there is no scientific evidence proving its effectiveness in such cases. Instead, it is an approach indicated for those who:

• have an early or moderate joint, tendon or muscle condition;
• wish to recover function and reduce pain through a conservative approach, avoiding or delaying more invasive and complex procedures.”

Not all patients, however, respond in the same way: “We know that about 25% of patients do not respond significantly to treatment,” notes Dr. De Girolamo. “These differences may depend on:

• genetic factors;
• characteristics of the treated tissue;
• associated conditions;
• quality of the blood or fat sample.

Understanding these mechanisms better will help us further personalize treatments and achieve better results.”

In the sports field, the prevention of musculoskeletal damage is not limited to biomechanical or training-related aspects.

“A well-vascularized tissue, with a balanced cellular metabolism and a microenvironment free of chronic inflammation,” explains Dr. De Girolamo, “is less likely to develop overload-related lesions and responds better to regenerative treatments.

In fact, inflammatory status and body composition directly influence how cells respond to both mechanical and biological stimuli, and therefore represent crucial factors for both prevention and personalized care.”

Within IRCCS Ospedale Galeazzi – Sant’Ambrogio, RE.GA.IN is a reference point for the development of innovative therapies in the field of orthobiology.

“The goal,” concludes Dr. De Girolamo, “is to transform research into safe, effective, and accessible clinical solutions, to help more and more people restore joint function and return to their sports and daily lives in the most natural way possible.”