Chinese Medical Journal Article Review application of hydrogel technologies in the treatment of musculoskeletal disorders

With rapid population aging and the increasing incidence of sports-related injuries, musculoskeletal disorders such as fractures, osteoarthritis, intervertebral disc degeneration, and tendon or muscle injuries are becoming a substantial burden on quality of life and work capacity. Conventional therapies still face important constraints, particularly in reconstructing complex tissue architecture, maintaining durable function under load-bearing conditions, improving local drug retention and deep tissue penetration, and achieving effective control of inflammatory microenvironments. These unmet clinical needs are accelerating the development of next-generation biomaterials that are injectable, conformable, and capable of carrying therapeutic payloads.  

The review made available online on June 15, 2026, in the Chinese Medical Journal notes that hydrogels are highly hydrated material platforms that can biomimic key features of the extracellular matrix (ECM), enabling a dual role in musculoskeletal tissue repair through structural support and biological regulation. Structurally, hydrogels can be injected and molded in situ to conform to irregular defects, and their strength and fatigue resistance can be enhanced through strategies such as double-network architectures, dynamic crosslinking, densification via ionic crosslinking, and reinforcement with fibers or nanoscale fillers. These advances improve their suitability for load-bearing or high-stress environments such as bone, cartilage, and intervertebral discs. Functionally, hydrogels can be engineered to carry drugs, cells, extracellular vesicles, or gene-editing tools, allowing prolonged local retention and spatiotemporally controlled release, thereby addressing limitations of conventional therapies, including inadequate deep-tissue penetration and rapidly diminishing efficacy. 

From a mechanistic perspective, hydrogels support regeneration by reshaping cell–matrix interactions and modulating the local immune milieu. In bone repair, hydrogel platforms can promote osteogenic signaling and facilitate new bone formation. In cartilage and osteoarthritis, they can combine mechanical buffering and lubrication with anti-inflammatory and anti-catabolic functions to slow matrix degradation and help maintain chondrocyte phenotype. In intervertebral disc degeneration, hydrogels primarily aim to restore space-filling capacity and hydration-dependent biomechanics, often complemented by anti-inflammatory, antioxidative, and pro-matrix synthesis cues to mitigate degeneration and pain. The review also highlights that clinical feasibility is strongly influenced by form factor. Injectable hydrogels are well suited to minimally invasive delivery in joints and discs; scaffold and patch designs are advantageous when structural guidance and interface integration are required, and adhesive hydrogel sealants are particularly promising for dural closure because they can adhere in wet environments, exhibit low swelling, and provide rapid sealing. 

Importantly, the review argues that the main barrier to translation is not the addition of more functions but the demonstration of long-term reliability. Many systems still lack rigorous evidence for fatigue resistance, wear-related risks, and sustained mechanical stability under repetitive loading. Increasing formulation complexity also creates practical challenges in batch consistency, sterilization, storage, scalable manufacturing, and regulatory readiness. Moving forward, translation will depend on robust comparative evidence aligned with clinical priorities, including pain relief, functional improvement, reoperation rates, and long-term safety. By clarifying these requirements, the review outlines a more actionable pathway for advancing hydrogel therapies from promising concepts to broadly adoptable clinical options. 

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Reference 
DOI: 10.1097/CM9.0000000000004158 

About Professor Yu Zhao from Peking Union Medical College Hospital, China 
Professor and Chief Physician in the Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences. His group focuses on spinal deformities, thoracic spinal canal stenosis, and postoperative complications, integrating genomics, biomechanics, human factors engineering, artificial intelligence, and biomaterials to advance translational research.  He has published more than 190 papers in leading international journals such as Bioactive Materials, Nano Today, Engineering, Journal of Orthopaedic Translation, and JBJS (American Volume). He holds over 30 granted patents, including Chinese invention and utility model patents, and has registered six software copyrights. 

Funding information 
This study was supported by the National Natural Science Foundation of China (Nos. 825B2077 and 82272464) and the Fundamental Research Funds for the Central Universities (Nos. 2025-PUMCH-H-012, 2025-PUMCH-A-105, 3332024113, and 3332024011).