Small Wonders: How Nanotechnology Is Redefining Shoulder and Elbow Surgery

Nanotechnology has been increasingly incorporated into shoulder and elbow surgery, from bioinductive collagen scaffolds for rotator cuff repair to nanostructured implant surfaces for arthroplasty and nanoparticle-functionalized sutures for elbow tendon repair. This review evaluates the current evidence base for these applications and clarifies which technologies are supported by clinical data versus preclinical/mechanistic evidence alone.

A narrative review was conducted using PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and Scopus (January 2005-September 2026), supplemented by manual screening of society guidelines. Of 1842 records identified, 77 articles and 6 guideline documents were considered in the initial evidence synthesis, with 54 references ultimately retained in the published review. Because of heterogeneity in study design (randomized trials, cohorts, and preclinical models), findings were synthesized narratively.

In rotator cuff repair, bioinductive collagen (REGENETEN) and acellular dermal matrix augmentation have the most mature clinical evidence, with randomized and cohort data showing reduced retear rates, whereas the collagen-PLLA biocomposite (BioBrace) remains largely preclinical. In shoulder and elbow arthroplasty, nanostructured and nanotextured titanium surfaces have preclinical and early clinical support for enhanced osseointegration, while antimicrobial silver and titanium dioxide nanocoatings and metal-phenolic network coatings remain supported chiefly by in vitro and animal data, with cytotoxicity and photocatalytic limitations still unresolved. In elbow surgery specifically, nanoparticle- and gene-functionalized sutures have shown benefit in flexor tendon models with anatomically agnostic translational potential, but direct elbow-specific clinical data are lacking, and applications to the ulnar collateral ligament, cartilage, and total elbow arthroplasty bearings remain at the preclinical or expert-opinion stage.

Nanotechnology is clinically established only for a small number of shoulder and elbow applications, principally bioinductive collagen augmentation of rotator cuff repair; most other applications, including antimicrobial nanocoatings and elbow-specific nanoparticle delivery systems, remain mechanistically promising but clinically unproven. Progress toward clinical translation will depend on adequately powered trials that separate device-specific effects from the heterogeneous preclinical literature currently supporting the field.