Compounds with a graded row

Ordered by rung, strongest first. The rung rates the study design; the chip beside it says what the study measured. Both are needed.

1. Collagen Peptides

   human RCT Direct outcome Not approved for this condition

   Who was studied

   adults with chronic mid-portion Achilles tendinopathy, 13 men and 7 women, mean age 44 (SD 8), n=20, 6 months (3 months per phase, crossover)

   Double-blind placebo-controlled crossover trial: 2.5 g specific collagen peptides twice daily alongside a bi-daily eccentric calf-strengthening and return-to-running programme. VISA-A improved 12.6 points on the peptide phase against 5.3 on placebo, above the 6.5-point minimal clinically important difference; contrast-enhanced ultrasound microvascularity fell similarly in both phases. The authors describe it as a pilot: n=20, no separate parallel control, and no other tendon or ligament injury has been tested this way.

   Source PubMed Central 2 primary sources read for this row

2. BPC-157

   animal in vivo Direct outcome Not approved for this condition

   Who was studied

   male albino Wistar rats, 12 weeks old, 6 per group per timepoint, quadriceps myotendinous junction detachment, assessed to 42 days

   Rats, not humans. After surgical detachment of the quadriceps tendon from the muscle, BPC 157 (10 ug/kg or 10 ng/kg intraperitoneally, or in drinking water) improved walking and motor functional indices, joint angles, muscle extensibility on tensiometry and collagen fibre organisation against saline controls; the wider rat literature covers transected Achilles tendon and transected muscle with the same design. The only registered human study of BPC-157 is a phase 1 pharmacokinetic and safety trial in healthy volunteers (NCT02637284, status unknown since 2016) with no injury endpoint, so no human healing-time, imaging or return-to-activity result exists on file.

   Source PubMed Central 3 primary sources read for this row

3. GHK-Cu

   animal in vivo Direct outcome Not approved for this condition

   Who was studied

   rats after unilateral anterior cruciate ligament reconstruction, n=72 randomised across saline, 0.3 mg/mL and 3 mg/mL, followed to 12 weeks

   Rats, not humans. Weekly intra-articular GHK-Cu injections for 4 weeks from week 2 gave a smaller side-to-side difference in knee laxity at 6 weeks, and higher graft complex stiffness at 0.3 mg/mL, but the effect did not persist after treatment stopped. Route was intra-articular injection into a surgical knee, which is not the topical skin use GHK-Cu is otherwise studied for, and no human ligament or tendon study is on file.

   Source PubMed 1 primary source read for this row

4. Thymosin Beta-4

   animal in vivo Direct outcome Not approved for this condition

   Who was studied

   rats with sharply transected medial collateral ligament, 4 weeks; strain and n not reported in the abstract obtained

   Rats, not humans, and full-length thymosin beta-4 rather than the TB-500 fragment: 1 ug of Tb4 in 100 uL fibrin sealant placed in the ligament gap. Healing tissue showed larger collagen fibril diameters on electron microscopy and better biomechanical properties than control at 4 weeks. Thymosin beta-4 is named among growth factors on the WADA prohibited list, so a competing athlete reading this is looking at a banned substance; the human trials that exist are in venous stasis ulcers and ocular surface disease, not musculoskeletal injury.

   Source PubMed 2 primary sources read for this row

Checked, and nothing recorded

2 compounds were checked against soft tissue injury and produced no gradeable row.

• Cartilage Peptides — checked, no row on file
• TB-500 — checked, no row on file

A compound is here because someone looked and the sources did not support a row — not because nobody looked. Under the rubric, uncertainty resolves to no row, and a row resting on a vendor page or a clinic blog is worse than no row at all.