Hyperbaric oxygen therapy (HBOT) as an adjuvant to surgical treatment of musculoskeletal injuries: a scoping review

DOI: 10.70885/hmsj.2026.07.003

Abstract

Background: Hyperbaric oxygen therapy (HBOT) increases tissue oxygen tension and may modulate inflammation, angiogenesis, and collagen remodeling - mechanisms relevant to postoperative healing. Its use in musculoskeletal and sports settings has expanded, but perioperative evidence remains unclear.Hypothesis/Purpose: To map and characterize the clinical and preclinical evidence on HBOT as an adjunct after musculoskeletal surgery (indications, protocols, comparators, outcomes, and gaps). We hypothesized that adjuvant HBOT would improve healing and, when assessed clinically, outcomes and failure rates.Methods: PubMed/MEDLINE, Embase, and the Cochrane Library were searched from inception to the final search date (protocol registered on OSF; r2np7). We included primary clinical studies and animal surgical/repair models evaluating HBOT (supra-atmospheric oxygen) in musculoskeletal/orthopaedic operative contexts. Data were charted for study design, indication/model, HBOT regimen, comparators, and outcome domains. Risk-of-bias appraisal and meta-analysis were not performed.Results: Fifteen primary studies were included: 7 clinical studies and 8 preclinical/animal experiments. Clinical studies largely addressed acute wound/trauma or perioperative recovery contexts (eg, grafts/flaps, crush injury, necrotizing fasciitis, complex open elbow injuries, and total knee arthroplasty) with substantial variability in HBOT dosing and outcomes. Preclinical studies most consistently evaluated tendon–bone interface healing (ACL reconstruction and rotator cuff repair) and generally reported improved interface maturation and/or biomechanical properties with HBOT versus controls. Protocols were highly heterogeneous (approximately 1.4–2.5 ATA; 60–120 minutes; 2 sessions to multiweek regimens), limiting cross-study comparability and clinical inference.Conclusion: Evidence for perioperative HBOT in musculoskeletal surgery is limited and heterogeneous. Preclinical studies show the most consistent signal for improved tendon–bone healing, while clinical orthopaedic data are insufficient to support routine postoperative use. Indication-specific, adequately powered randomized trials with standardized HBOT regimens and clinically meaningful endpoints are needed.Clinical Relevance: HBOT may be a promising adjunct for biologically challenging sports procedures requiring tendon–bone integration (eg, ACL reconstruction, rotator cuff repair), but clinical effectiveness remains unproven.Study Design: Scoping reviewLevel of evidence: Level VKeywords: Hyperbaric oxygen therapy; Tendon–bone interface; Anterior cruciate ligament reconstruction; Rotator cuff repair; Scoping review.https://doi.org/10.70885/hmsj.2026.07.003

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