Growth Plate Injuries: Advances and Future Directions in Regenerative Medicine

Growth plate injuries account for up to 30% of pediatric fractures, with a substantial number leading to complications such as bony bar formation that can impair longitudinal growth, resulting in limb length discrepancies, angular deformities, or premature growth arrest. Conventional treatments focus on surgical resection of the bone bridge and interpositional grafting, but these approaches often fail to restore the native architecture or biological function of the physis, and recurrence is common. Recent advances in regenerative medicine offer promising alternatives that move beyond mechanical barriers toward biologically active repair. This review examines the biology and pathophysiology of the growth plate, emphasizing the cellular and molecular mechanisms involved in pathological repair, including inflammation, fibrogenesis, osteogenesis, and remodeling. It highlights the roles of mesenchymal stem cells (MSCs), signaling pathways, and immune responses in regulating both normal and aberrant healing. Emerging strategies such as cell-based therapies, tissue engineering scaffolds, gene therapies, growth factor delivery, and exosome-based therapies are discussed for their potential to promote cartilage regeneration and prevent bone bridge formation. The review also addresses key translational challenges and future directions for advancing personalized regenerative therapies in orthopedic and pediatric practice. A comprehensive understanding of current and emerging regenerative strategies, along with the underlying healing mechanisms, is essential to guide the development of targeted therapies that restore growth plate function, minimize complications, and improve long-term outcomes in pediatric patients.