Part of the Franklyn Health series on innovation in the musculoskeletal space

Written by Rob Bedford

 

Sports medicine has always been a field shaped by innovation. The injuries it treats are common, the patients are often young and active. The demand for faster and more complete recovery has driven a century of change in how we diagnose and repair the musculoskeletal system. The global sports medicine market is projected to reach around USD 11.9 billion by 2034, a figure that reflects sustained clinical and commercial appetite for better solutions. [8]  

This is the second article in our series on innovation across the musculoskeletal space, following the overview of orthopaedic device innovation. It looks first at where the major advances in sports medicine came from, then at where the field is heading and what that means for the companies developing the next generation of devices, biologics and software.

The Arthroscopic Revolution 

Modern sports medicine rests on a single foundational technology, the arthroscope. Endoscopic examination of the knee was attempted in Japan from the 1930s under Kenji Takagi, and it was his student Masaki Watanabe who made arthroscopy practical. Watanabe developed the first genuinely usable arthroscopic instruments and is widely regarded as the father of modern arthroscopy.[1] 

Arthroscopy became an established diagnostic tool through the 1970s and, once paired with video monitoring, a leading treatment tool through the 1980s. From the knee it extended to the shoulder, ankle, elbow, wrist and eventually the hip. The effect was profound. Procedures that once required open surgery and prolonged recovery could be performed through small incisions, and by the 1990s most were carried out as day cases.[1] Every soft tissue technique that follows in this article depends on that platform. 

 

 

The ACL Pendulum 

Few stories illustrate the non-linear nature of surgical innovation better than the anterior cruciate ligament. Open primary repair of the torn ACL was popularised in the early twentieth century and produced encouraging short-term results. Longer follow-up proved disappointing, and a series of randomised trials in the late 1980s and early 1990s favoured reconstruction over repair. By the 1990s open primary repair had been almost completely abandoned.[2,3] 

Reconstruction with an intra-articular autograft, typically bone-patellar tendon-bone or hamstring tendon, became and remains the gold standard for active patients. The path there included several dead ends. Synthetic ligaments such as the Kennedy LAD, Leeds-Keio and carbon fibre grafts were trialled through the 1970s and largely abandoned by the 1980s because of their complications.[2] 

The pendulum has since begun to swing back. Better imaging now allows surgeons to identify the tear patterns most suitable for preservation and augmentation techniques such as internal bracing and dynamic intraligamentary stabilisation have revived interest in repairing the native ligament.[3] Bridge-enhanced ACL restoration, which uses a resorbable implant to support the body’s own healing, has reported non-inferiority to reconstruction at two years with higher return-to-sport rates at six months in early studies.[9] The lesson for innovators is invaluable: a technique abandoned in one era can return in another once the surrounding technology catches up. 

From Resection to Preservation 

A parallel shift has played out in how surgeons treat the meniscus and the articular cartilage. For much of the twentieth century the standard response to a torn meniscus was to remove it. Fairbank’s classic 1948 description of the degenerative changes that follow meniscectomy provided the early evidence that the meniscus was worth preserving.[6] Practice moved from total meniscectomy to partial meniscectomy, then to repair, and most recently toward scaffold-based regeneration and replacement.[7] 

Cartilage repair followed a similar arc from removal toward regeneration. Marrow-stimulation techniques such as microfracture offered a simple way to recruit the body’s own repair cells. The field changed again in 1994 when Brittberg and colleagues reported autologous chondrocyte implantation, the first cell-based cartilage treatment, in the New England Journal of Medicine.[4] Subsequent generations brought matrix-induced implantation and osteochondral grafting, each refining the same ambition of restoring durable cartilage rather than simply debriding the defect.[5] 

 

The Biologics Turn 

The 2000s brought a biological dimension to sports medicine. Platelet-rich plasma and mesenchymal stem cell preparations offered a way to influence the healing environment directly. The concept is compelling and clinical interest is high. The evidence base has been slower to mature, held back by heterogeneous preparation protocols, inconsistent dosing and underpowered trials.[10] This tension between biological promise and evidential rigour is the defining challenge of the area and it carries directly into where the field is now heading. 

 

Where Innovation Is Headed 

Several threads run through the current wave of sports medicine innovation. Each builds on the history above and each raises a distinct evidence and regulatory question. 

Regenerative repair reaches maturity. The move from resection to preservation is now extending into active regeneration. Resorbable scaffolds, bio-augmented repair constructs and more standardised biologic preparations are converging on the goal of healing native tissue. The constraint here is no longer conceptual; it is the need for adequately powered trials and standardised protocols that can turn promising mechanisms into reimbursable, regulator-ready products.[5,10] 

Wearables and predictive monitoring. Load monitoring and wearable sensing have moved from elite sport into mainstream injury prevention. Smart clothing and continuous biomechanical tracking aim to predict injury risk before it materialises.[11] Where these systems make diagnostic or predictive claims they may fall within the definition of software as a medical device (SaMD), which brings a requirement to validate the specific claim the product makes with evidence tied directly to that claim. 

Artificial intelligence in diagnosis and return to sport. AI is being applied to musculoskeletal imaging analysis, intraoperative decision support and return-to-sport readiness.[12] As with all clinical AI, regulatory treatment as software as a medical device requires prospective validation of the specific diagnostic or predictive claim, transparency in how the model reaches its output and post-market monitoring that accounts for model updates. The companies that succeed here will be those that build a clinical evidence strategy around the claim itself from the outset. 

 

The Common Thread 

Across a century of sports medicine innovation one pattern repeats. The science tends to run ahead of the evidence. Arthroscopy had to prove itself against academic scepticism. Biologics with real mechanistic promise are still waiting on definitive trials. Wearable and AI tools need prospective validation of the claims they make. In each case the rate-limiting step has been clinical evidence and regulatory strategy. The underlying ideas arrived early; proving them took a little longer. 

For companies developing the next generation of sports medicine products, the implication is striking. Clinical evidence strategy, regulatory planning and study design belong on the critical path from the very beginning. They are the work that turns a promising technology into an adopted standard of care. 

At Franklyn Health we work at this intersection every day. Our team brings direct experience from some of the world’s leading orthopaedic and sports medicine companies, and we apply that depth across study design, regulatory strategy, clinical evaluation and post-market planning. Whether you are developing a biologic, a device, a digital tool or a combination of the three, we would be glad to talk. 

This is the second article in our three-part series on innovation across the musculoskeletal space. It follows our overview of orthopaedic device innovation. Read the opening article here. The final piece examines reconstruction of the skeleton across joint replacement, trauma and spine. 

 

References 

  1. Renstrom P. An interview on his personal perspective of the changes and developments in the sports medicine field over the last 40 years. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. Covers Watanabe and the development of modern arthroscopy from the 1960s.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653685/ 
  2. Lind M et al. Evolution of anterior cruciate ligament reconstruction and graft choice: a review. Annals of Joint. 2022.https://aoj.amegroups.org/article/view/7951/html 
  3. Anterior cruciate ligament repair, past,present and future. Journal of Experimental Orthopaedics. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002325/ 
  4. BrittbergM, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. New England Journal of Medicine. 1994;331(14):889-895. 
  5. Dewan AK et al. Evolution of Autologous Chondrocyte Repair and Comparison to Other Cartilage Repair Techniques. BioMed Research International. 2014.https://www.hindawi.com/journals/bmri/2014/272481/ 
  6. Fairbank TJ. Knee joint changes after meniscectomy. Journal of Bone and Joint Surgery (Br). 1948;30B(4):664-670.
  7. Wang et al. Collagen-Based Scaffolds for Meniscal Repair and Regeneration. Journal of Tissue Engineering and Regenerative Medicine. 2025.https://onlinelibrary.wiley.com/doi/10.1155/term/3446671 
  8. Towards Healthcare. Sports Medicine Market Size Captures USD 11.90 Bn by 2034. November 2025.https://www.towardshealthcare.com/insights/sports-medicine-market-size 
  9. RetzkyJS, Gomoll AH, Strickland SM et al. Indications, Techniques, and Outcomes of Bridge-Enhanced ACL Restoration (BEAR). Current Reviews in Musculoskeletal Medicine. 2025;18(4):140-148. https://pmc.ncbi.nlm.nih.gov/articles/PMC11965036/ 
  10. Koshy D, Koshy DI, Ooi E. Biologic Therapies in the Management of Sports-Related Tendon and Ligament Injuries: A Narrative Review. Cureus. 2025;17(5):e84556.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103820/ 
  11. Journal of Sports and Rehabilitation Sciences. Wearable technology in sports medicine: Innovations, challenges, and prospects. 2026.https://www.jsportrs.com/article_226692.html 
  12. O’Malley E et al. Artificial Intelligence and its Current Role in Clinical Outcome Prediction, Musculoskeletal Imaging, and Economic and Ethical Considerations withinOrthopedics and Sports Medicine. Current Reviews in Musculoskeletal Medicine. 2026;19(1):33. https://pmc.ncbi.nlm.nih.gov/articles/PMC13076830/ 

 

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