Basic science investigations on the biochemical pathways after a musculoskeletal injury have suggested that vitamin C, also known as ascorbic acid, may enhance collagen synthesis and soft tissue healing. 7, 20, 34 Poorly developed extracellular matrices derived from collagen can lead to inadequate tissue structures and biomechanical strength, which can result in unsatisfactory outcomes and an increased risk for reinjuries. The healing of musculoskeletal tissues, such as bone, tendons, and ligaments, is dependent on the capacity of collagen synthesis and cross-linking.
No animal or human studies reported any adverse effects of vitamin C supplementation. Vitamin C supplementation was shown to decrease oxidative stress parameters by neutralizing reactive oxygen species through redox modulation in animal models. Of the clinical studies evaluating fracture healing, 1 study reported no significant differences in the rate of fracture healing at 50 days or functional outcomes at 1 year. The 1 preclinical study after anterior cruciate ligament (ACL) reconstruction reported significant short-term (1-6 weeks) improvements in ACL graft incorporation in the vitamin C group compared with control groups however, there was no long-term (42 weeks) difference. The 2 preclinical studies evaluating tendon healing reported significant increases in type I collagen fibers and scar tissue formation with vitamin C compared with control groups. Of the preclinical studies evaluating fracture healing, 2 studies reported significantly accelerated bone healing in the vitamin C supplementation group compared with control groups. After applying the inclusion and exclusion criteria, 10 articles were included in the final analysis.