Chondroitin sulfate in osteoarthritis treatment: a twenty-year bibliometric analysis and comprehensive review.

This study employs bibliometric methods to systematically analyze the research trajectory and frontier trends in the application of chondroitin sulfate (CS) for the treatment of osteoarthritis (OA) from 2005 to 2025. Through a visual analysis of 2004 relevant articles from the Web of Science core collection, the field is revealed to have evolved through three distinct stages: from early pharmacological treatment and fundamental research, to the integration of tissue engineering and biomaterials, culminating in the current focus on intelligent therapeutic strategies centered on precision drug delivery systems. The findings indicate a global research landscape characterized by a "dual-core dominance of China and the United States." While China leads in publication output, its academic influence, as measured by citation metrics, lags behind that of European and American countries. Keyword analysis identifies "inflammation" and "drug delivery systems" as recent research hotspots, with targeted delivery systems based on biomaterials such as hydrogels and nanoparticles emerging as the technological frontier. The study also highlights persistent challenges in the clinical translation of CS, including issues related to delivery efficiency, material properties, large-scale manufacturing, and interdisciplinary collaboration. Looking forward, by integrating smart responsive materials, multimodal synergistic therapies, and strengthening international cooperation, CS-based strategies show promise in shifting the OA treatment paradigm from symptomatic relief to structural repair. By bridging macro-level literature analysis with micro-level materials chemistry insights, this work provides a comprehensive framework that integrates quantitative research mapping with mechanistic understanding of CS-based biomaterial design. This dual perspective aims to inform not only research planning and translational pathways, but also the rational design of CS derivatives with tailored physicochemical properties for specific OA therapeutic applications.