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Quality assessment and risk of bias In line with PRISMA guidelines, the assessment of methodological quality was conducted to evaluate the strength of evidence, recognising that methodological limitations may introduce bias

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It also increases growth hormone receptor (GHR) expression in fibroblasts, augmenting the anabolic healing response, thus improving tendon structure and biomechanical function, even in conditions impaired by corticosteroids or limited vascular supply [15, 53]