Dataset on patient education and digital information quality in knee cartilage restoration with matrix-induced autologous chondrocyte implantation (MACI)

Treatment options and outcomes for paediatric knee cartilage lesions: a systematic review.

One of the predominant clinical challenges faced by orthopedic practitioners and researchers is the regeneration of articular cartilage. Articular cartilage lesions and/or defects, as well as degeneration, are the primary causes of knee cartilage impairment. Tissue-engineered articular cartilage constructs are being developed to restore articular cartilage. Recent developments in the design of biomaterials have enabled the creation of many promising biomaterials for articular cartilage restoration. The purpose of this review is to provide researchers in the field of tissue engineering with a general overview of the approaches being used to examine articular cartilage and the evaluation methods being used to assess tissue-engineered constructs in animal models. Most tissue-engineered cartilage constructs tested in animal models are evaluated at leastmacroscopically and histologically. Furthermore, ICRS gross morphology scoring, immunohistochemistry, biochemicalassays, biomechanicaltesting, gene expression analysis, and imagingtechniques have been used to evaluate the regeneration potential of tissue-engineered constructs. This review also presents a comprehensive summary of the animal models used in the evaluation of tissue-engineered constructs for cartilage regeneration.

Kartogenin-encapsulated self-healing injectable hydrogel based on hyaluronic acid and chitosan derivative for use as viscosupplementation in knee osteoarthritis.

To analyze meniscus allograft failure rates, timing, and mechanisms to characterize risk factors and identify modifiable variables that could be addressed to optimize outcomes after meniscus allograft transplantation (MAT). Using prospectively collected registry data, patients who underwent primary fresh MAT at a single institution between 2016 and 2023 with a minimum follow-up of 2 years were analyzed. Initial treatment failure was defined as re-operation, including partial or complete allograft removal, revision MAT, or conversion to unicompartmental or total knee arthroplasty. Treatment failure mechanisms included joint disease progression, meniscus tearing, meniscus extrusion, graft shrinkage, malunion/nonunion, and fixation failure. Treatment failure and nonfailure cohorts were compared, as well as failure mechanism subcohorts, based on patient sex, age, body mass index, laterality, nicotine use, concomitant procedures, graft preservation method, MAT technique, and adherence. A total of 61 patients with a mean age of 33 years (range, 15-62 years) and mean follow-up of 47.2 months (range, 24-88 months) were included. Thirteen patients underwent medial MAT and 44 patients underwent lateral MAT. Seven patients (11.5%) were found to have initial treatment failure at a mean of 18.1 months versus 54 patients (88.5%) who had functional graft survival. All failures involved medial MAT. Patients were more likely to experience treatment failure if they used nicotine (odds ratio [OR], 19.5) or had concomitant OCAT (OR, 8.8). The most common mechanism of failure was the progression of degenerative joint disease (n = 5, 71.4%), followed by meniscus tears (n = 2, 28.6%). Four failures underwent revision MAT, while three underwent TKAs. Two of the patients who underwent revision MAT remained as nonfailures at >2 years after revision surgery, resulting in a 91.8% overall MAT functional survival. Fresh MAT resulted in a high (92%) short- to mid-term functional survival rate, with nicotine use and concomitant cartilage restoration procedure(s) being significant risk factors for treatment failure; joint disease progression and meniscus allograft tears were the primary mechanisms of failure. Level III, cross-sectional analysis of prospectively collected registry data.

To determine whether chondroplasty for isolated medial patellar facet lesions produces similar clinical outcomes compared to patients without patellofemoral cartilage lesions in the setting of medial patellofemoral ligament (MPFL) reconstruction for patellar instability. We retrospectively identified patients who underwent MPFL reconstruction with or without tibial tubercle osteotomy (TTO) from 2015 to 2020 with minimum 2-year follow-up. Operative reports detailed patellofemoral articular surfaces and Outerbridge grade. Exclusion criteria were: prior knee surgery, multiple lesions, concomitant cartilage repair, trochleoplasty, or meniscus repair. Patients with isolated medial facet lesions (case) were propensity matched to patients without patellofemoral cartilage injury (control) by age, sex, BMI, and concomitant TTO. Clinical outcomes were evaluated using the Kujala score, Tegner activity scale, and the Visual Analog Score (VAS) for pain. Of 79 eligible patients, 59 (74.7%) completed all surveys, and 40 patients (8 M and 32 F) were matched 1:1 with mean 4.1-year (range: 2.1-8.5) follow-up, including 20 patients with medial facet lesions (5 grade II, 6 grade III, and 9 grade IV). There were no significant differences between groups with respect to Kujala score (85.2 vs 84.6, p=0.906), Tegner (5.7±2.6 vs 4.9±3.0, p=0.924), or VAS pain score (12.4±20.1 vs 16.5±23.9, p=0.718). Chondral lesion size at the index procedure was not significantly correlated with pain (R=-0.06, p=0.816) or Kujala score (R=-0.67, p=0.779). Chondroplasty for isolated medial patellar facet lesions led to similar clinical outcomes to patients with intact patellofemoral articular cartilage at a minimum of 2years following MPFL reconstruction. These findings support conservative management of isolated medial facet lesions without need for cartilage restoration procedures. Retrospective comparative cohort study.

Abstract It is now understood that oxidative stress, characterized by an excess of reactive oxygen species (ROS) within growth plate injury sites, can impede cartilage repair through various mechanisms. Morinda officinalis (MO), a traditional Chinese herbal medicine, possesses potent antioxidant properties. Furthermore, extracellular vesicles (EVs) derived from plants exhibit comparable physical and chemical characteristics to their parent plants, along with favorable tissue permeability and biocompatibility. Herein, it develops a ROS‐sensitive hydrogel by self‐crosslinking two natural extracellular matrix (ECM)‐derived components: polyvinyl alcohol (PVA) and chondroitin sulfate grafted with phenylboric acid (CSBA). The hydrogel is subsequently combined with MO‐derived EVs (MO‐EVs) to eliminate excess ROS from the damaged microenvironment and release MO‐EVs as needed to facilitate growth plate damage healing. In vitro studies revealed that a CSBA‐PVA hydrogel containing MO‐EVs facilitated the restoration of chondrocyte mitochondrial function by activating the NRF2‐HO‐1/NQO1 pathway, thereby enhancing endogenous antioxidant capacity. Furthermore, in vivo results reveal that implantation of CSBA‐PVA hydrogel loaded with MO‐EVs significantly inhibited bone bridge development and facilitated cartilage restoration within the growth plate. CSBA‐PVA@MO‐EVs therapy brings huge prospects as a therapeutic approach, offering novel insights and therapeutic strategies for treating growth plate injuries.

Digital light processing 3D bioprinting of collagen-based gradient osteochondral scaffold for cartilage-bone regeneration.

Background:Patellofemoral instability most commonly affects young patients and is often associated with concomitant chondral injury, the incidence of which increases with each dislocation event. The impact of these chondral injuries on the function and pain levels of patients who undergo isolated medial patellofemoral ligament (MPFL) reconstruction without bony realignment remains unclear.Purpose/Hypothesis:The purpose of this study was to compare patient-reported outcome measures (PROMs) between individuals who underwent isolated MPFL reconstruction with concomitant cartilage restoration versus those patients who did not require a concomitant cartilage procedure at the time of their MPFL reconstruction. It was hypothesized that cartilage injury that required intervention in patients with patellofemoral instability would be associated with worse preoperative PROMs compared with patients without chondral injury and that these differences would be mitigated by concomitant surgical intervention to address chondral damage performed in addition to their MPFL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with recurrent patellar instability were collected in an institutional registry beginning March 2014. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of their bony anatomic features. PROMs, episodes of recurrent instability, and return to sport (RTS) data were obtained at baseline and annually. Patients were retrospectively assigned to the cartilage intervention group if they underwent concomitant particulated juvenile cartilage allograft, osteochondral allograft, open reduction internal fixation, microfracture, or removal of loose body. Those without intervention or isolated chondroplasty comprised the comparison group. PROMs were assessed at baseline and at 2 and 5 years after surgical intervention.Results:A total of 138 patients underwent MPFL reconstruction without bony correction between March 2014 and December 2019. Two patients were excluded for concomitant anterior cruciate ligament reconstruction. A total of 22 patients underwent concomitant cartilage restoration, whereas 114 patients underwent chondroplasty or no concomitant cartilage intervention. In total, 50 patients were evaluated at ≥5 years, of whom 40 (80%) completed follow-up PROMs. A total of 119 patients were evaluated at ≥2 years, of whom 89 (75%) completed follow-up PROMs. All PROMs improved significantly over time except for the Pediatric Functional Activity Brief Scale (Pedi-FABS) (P = .095). Baseline PROMs were significantly lower for the concomitant cartilage injury group compared with the MPFL-only group for Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale (P = .0075), KOOS Pain Score (PS) (P = .0138), and Kujala score (P = .0481). However, at 2 years after surgery, no statistically significant difference in PROMs was found between the cartilage and no-cartilage intervention groups, a finding that was maintained at 5 years after surgery. Patients in the cartilage intervention group displayed a lower overall RTS than patients in the no-intervention group (64.29% vs 92.41%; P = .0103). The patients who achieved RTS had a shorter time to RTS after cartilage intervention compared with no intervention (7.55 vs 9.46 months; P = .0461).Conclusion:The treatment of cartilage lesions in addition to MPFL reconstruction for recurrent patellar instability was associated with similar improvement in PROMs compared with isolated MPFL reconstruction without cartilage intervention at 2 and 5 years after surgery, despite lower preoperative PROMs in the group requiring cartilage intervention. Patients who underwent cartilage intervention had lower overall RTS rates. Future work will seek to confirm the durability of these results with longer term follow-up.

Rheumatoid Arthritis (RA) and Osteoarthritis (OA) are among the most impactful musculoskeletal disorders causing articular cartilage degradation, ultimately leading to loss of the joint functionality. Matrix-assisted Autologous Chondrocytes Implantation (MACI) is one of the most promising reconstructive techniques to treat chondral defects (CDs). MACI relies on a matrix cellularized with autologous chondrocytes implanted directly onto cartilage defects. Despite MACI's effectiveness, post-surgery rehabilitation remains a challenge, as it fails to induce the optimal mechanobiology necessary for an effective cartilage regeneration. Additionally, there is a significant patient-to-patient variability and the local loads occurring during rehabilitation might consequently vary greatly. We propose a personalized approach focused on the delivery local pro-regenerative mechanobiological cues to dramatically improve the cartilage restoration after MACI.We developed an innovative scaffold to be used as matrix in MACI, capable to enhance the cartilage repair by delivering in situ controlled, and personalized, mechanical cues triggering pro-regenerative cellular responses to embedded human articular chondrocytes (hACs). The scaffold relies on an electrospun matrix made of aligned fibers composed of PVDF-TrFE, a piezoelectric polymer, enriched with ferromagnetic Fe3O4 nanoparticles capable to confer magnetic properties to the scaffold. MNPs were simultaneously dispersed in the polymeric solution, and microfibers were collected onto a high-speed rotating collector to obtain an aligned micropattern, capable to give mechanical anisotropy to the scaffold. After cellularization with hACs, we subjected the scaffold to daily magnetic stimulation up to 14 days.The scaffold was highly responsive to external magnetic stimuli. In addition, hACs produced a type II collagen-rich extracellular matrix when cultured within the scaffolds subjected to magnetic stimulation. Remarkably, we observed an increase of cell viability, and of type II/type X collagen ratio.Our scaffold was able to provide pro-regenerative cues to hACs after mechanical cyclic deformations induced by repeated magnetic stimulations. Such an approach paves the way to an effective, and definitive therapeutic procedure for the treatment of chondral defects.

Background:Management of chondral injury can be difficult due to the avascularity of articular cartilage and the limited ability to proliferate and promote repair. Untreated lesions can lead to early development of arthritis and the need for joint replacement. For intermediate-sized lesions, osteochondral autograft transfer and autologous cell-based cartilage treatment have been accepted as the most effective treatment options.Purpose:To investigate the rates of complications within 2 years of initial surgery in patients who undergo primary autologous cell-based cartilage treatment and osteochondral autograft.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective cohort study was performed on July 17, 2024, using a commercially available insurance claims database to investigate 2-year orthopaedic complication rates in 1298 patients after primary osteochondral autograft and autologous cell-based cartilage treatment for chondral injuries of the knee. Patient cohorts were propensity score matched with a caliper set to 0.2 at a ratio of 1 to 1 on the following variables: age, sex, diabetes, and tobacco use. Rates of surgical complications were compared using multivariable logistic regression, adjusted for age, sex, diabetes, obesity, and tobacco use. Odds ratios (ORs) with corresponding 95% CIs were calculated for each comparison.Results:A total of 1298 patients were included in this retrospective analysis. Patients who underwent autologous cell-based cartilage treatment were significantly more likely to need revision cartilage restoration surgery compared with those who underwent osteochondral autograft treatment (11.1% vs 7.4%; OR, 1.58 [95% CI, 1.08-2.34]). There was no significant difference in the rate of progression to osteoarthritis (11.4% vs 10.6%; OR, 1.15; [95% CI, 0.80-1.65]) or subsequent knee arthroplasty (0.5% vs 1.1%; OR, 0.54 [95% CI, 0.11-2.06]) within 2 years of initial procedure between the treatment cohorts.Conclusion:This study highlights the increased risk of revision for patients who underwent autologous cell-based cartilage treatment compared with those who underwent osteochondral autograft treatment. However, no significant difference was identified in progression to osteoarthritis or subsequent knee arthroplasty within 2 years after the initial procedure. Further studies that evaluate long-term outcomes and the progression of symptoms are needed.

Objectives:Traumatic lateral patellar dislocation is frequently associated with cartilage lesions, particularly of the patella and lateral femoral condyle (LFC). Multiple treatment options to address these chondral lesions including debridement, microfracture, cartilage restoration with allo- or autograft, and osteotomies can be utilized at the index patellar stabilization surgery, or in a staged fashion. However, these additional procedures are not without increased morbidity and long-term benefit has not been well elucidated. In patients with traumatic chondral lesions associated with patellofemoral instability (PFI), meniscal coverage of the lesion and intervention to eliminate further patellar instability may be all that is required for a successful outcome. Thus rendering the increased time, morbidity, and cost of chondral procedures unjustified in this setting. The purpose of this study was to assess outcomes of patients with LFC chondral lesions after traumatic patellar dislocations and whether meniscus coverage of the lesion on magnetic resonance imaging (MRI) has an impact on patient outcomes.Methods:A retrospective chart review was performed to compare outcomes for patients with LFC lesions following acute patellar dislocation treated surgically at a single institution. MRI, operative reports, and intraoperative imaging were reviewed to assess for LFC lesions. Size of the LFC lesion and evaluation of meniscus coverage was measured in the coronal plane on T2 MRI sequences (Figure 1). Patient charts were reviewed to follow postoperative rehabilitation and clinical course. Patient reported outcome measures (PROMs) were obtained using the International Knee Documentation Committee (IKDC) score, Lysholm Knee score, Visual Analog Scale (VAS), and Tegner Activity score.Results:A total of 228 patients underwent surgical stabilization for patellar instability from 2001 to 2022, 81 of which had an LFC lesion identified on MRI and confirmed intraoperatively. Seven of these patients underwent a concomitant cartilage restoration procedure (3 internal fixation of osteochondral fragment, 2 microfracture, 1 osteochondral allograft, and 1 MACI) and they were excluded from the study leaving 74 patients. In assessing meniscus coverage of the chondral lesion, 10 of these lesions had no meniscus coverage, 8 had 1-50% coverage, and 56 had 51-100% coverage. The average size of the chondral lesion was 7.1 ± 2.9 mm and the majority were in the anterior one-third of the LFC. Average follow up from the index surgery was 7.6 years (range, 2.2-15.2 years). During this time frame, 12 patients had subsequent knee surgeries, none of which were to address the LFC lesion (Table 2). Postoperatively, nearly all patients reported improvement in their pain with an average VAS pain decrease of 3.7 points. There were no significant differences in PROMs in patients with meniscus coverage versus those without (Table 2). At the time of final follow-up, four patients had radiographic evidence of knee osteoarthritis (OA) within the lateral compartment, and one underwent a total knee arthroplasty (TKA). The patient that underwent a TKA had no meniscal coverage of their chondral lesion at the time of their index procedure.Conclusions:Cartilage lesions secondary to traumatic lateral patellar dislocation are common; however, appropriate management of these lesions remains unclear. The present findings suggest that not surgically addressing chondral lesions in patients with overlying meniscus coverage can allow for high functional outcomes and minimal pain after patellar stabilization procedures. Although only four patients progressed to radiographic evidence of OA, long term data will be valuable to understand whether overlying meniscus coverage is also protective against the development of OA and progression to TKA.

Objectives:Focal cartilage lesions or osteochondral defects, most commonly observed in the knee, are also found in the hip, elbow, and ankle. Osteochondral autograft transplantation (OAT) and osteochondral allograft transplantation (OCA) are two viable surgical tissue transfer options, that often rely on press-fit graft fixation for cartilage restoration. Symptomatic lesions can occur on the peripheral aspects of a joint surface where there is loss of bone containment and as a result, graft stability could be compromised. This study attempts to understand properties of uncontained osteochondral lesions and identify factors affecting stability of an osteochondral graft.Biomechanical study and analysis of skeletal reconstruction for cartilage restoration procedures should include properties of the joint, characteristics of host cartilage, bone, and donor tissue, graft and lesion sizes, and the nature of graft fixation. Current orthopaedic literature is without study of press-fit osteochondral transplant in sites with a loss of native bone containment. We thus hypothesized that stability of a graft would be affected by decreasing levels of bone containment at its recipient site; and that the peak tensile force to failure, defined as pull out or loosening of a press-fit osteochondral allograft plug, would decrease significantly at a specific threshold of containment.Our analysis aimed to identify the optimal levels of lesion containment, and which characteristics determine stability of standard press-fit graft. This information may be useful to surgeons in decision making during OAT and OCA procedures, and determining when supplemental graft fixation or alternative treatments should be considered for these challenging defects.Methods:This study utilized 14 cadaveric distal femurs, and 5 osteochondral allograft plugs obtained from each specimen - 70 total allografts. Dual-energy X-ray absorptiometry (DEXA) scans were performed on each intact distal femur to determine subchondral bone mineral density (BMD) of five regions of interest (ROI), including the entire distal femur, medial condyle, lateral condyle, posterior condyles, trochlea, and individual plugs.Using a single-use osteochondral autograft transplant system, osteochondral grafts were extracted from the medial or lateral trochlea as a cylindrical plug, to a size of 10 mm diameter by 10 mm depth. Five recipient sites were prepared on the medial and lateral femoral condyle and randomly assigned to simulate five different levels of bone containment: 100%, 90%, 80%, 70% and 60% contained (0% bone loss to 40% bone loss). The measured circumference for resection from each site was templated in 10% intervals, with the cartilage, cortical and cancellous bone removed from its wall in a peripherally directed fashion. The grafts were fixed to a suture passed through a central drill hole and a 2mm x 2mm steel plate at its base, in preparation for pull out testing. Using a standard surgical press-fit technique, the grafts were inserted coaxially into each recipient site and gently tamped to a level flush with the surrounding cartilage surface anatomy.Tensile testing was performed using the MTS 858 Bionix testing system. A load perpendicular to the articular surface was applied at a rate of 0.20 mm/second, and force-displacement curves were generated to determine the tensile pull-out force (Newtons), required to remove or loosen the graft from its implanted site. Comparisons between anatomic and biomechanical data were made utilizing One-Way Analysis of Variance and post-hoc analysis via Tukey’s method to test for group comparisons. Significance level was set at alpha < 0.05.Results:The mean tensile force to failure of each graft, was higher at increased levels of lesion containment, and a significant difference was seen across all five levels of containment, 100-60% contained (P<.05).Post-hoc analysis revealed significant differences between the mean forces at both 60 and 70% containment, when compared to 100% containment. No such difference was found between 80 or 90% containment, when compared to 100%, indicating a statistically significant threshold of 80% containment.There were no significant differences in the dimensional characteristics or BMDs of corresponding ROIs across specimens. BMD of osteochondral grafts and recipient sites from the trochlea, medial and lateral femoral condyles, was similar.Conclusions:Our findings indicate that greater containment of a graft within its recipient site positively influences graft stability after transplantation, and suggests a critical threshold of 80% bone containment or greater for improved stability of a 10mm x 10mm press-fit osteochondral allograft.This provides insight into containment level influencing the biomechanical stability of osteochondral grafts and the existence of a containment threshold for optimal graft stability. Likewise, may be valuable to surgeons when considering press-fit fixation during osteochondral grafting procedures. Future biomechanical research could extend these findings, and further in-vivo studies may validate the identified containment threshold, and its impact on graft failure versus successful incorporation. Ultimately, helping to develop techniques ensuring successful outcomes for patients undergoing OCA or OAT for articular cartilage restoration.

Construction of organoids using bioprinting technology: a frontier exploration of cartilage repair.

Defective lymphangiogenesis and iron removal after hemarthrosis in factor VIII-deficient mice are rectified with therapeutic factor VIII administration-implications for joint health.

Objectives:Sagittal plane malalignment is increasingly recognized as a risk factor for patellofemoral (PF) cartilage wear. While lateral cartilage lesions may be unloaded with anteromedializing tibial tubercle osteotomies (TTOs), central and medial lesions may be better addressed with pure anteriorization TTOs (aTTOs), particularly when patients have normal patellar height and coronal plane alignment (i.e., normal tibial-tubercle trochlear groove distance). Traditional aTTO techniques were associated with unacceptable complication rates, however, and there is need for aTTO techniques that may be performed more safely. The purpose of this study was to assess the relative safety and efficacy of a contemporary aTTO technique for isolated PF chondral wear.Methods:Consecutive patients undergoing a modern aTTO technique for isolated PF chondral wear by a single surgeon from 2016-2024 with minimum 6-month follow-up were evaluated. In brief, this previously published technique consists of an anterior-posterior cut ~5° off the vertical line, a lateral-medial cut parallel to the posterior tibial cortex, straight anteriorization of the osteotomy shingle by 10-15 mm proximally with an anterior periosteal hinge distally, and fixation by two 4.5 mm lag screws. No proximal bone block is required. Patient demographic and surgical data were collected. The primary outcome was overall complication rate, including wound complications, non-union, and fracture, among others. Secondary outcomes included range-of-motion (ROM) at six- and twelve-weeks, and patient-reported outcome measures (PROMs) at two-years (among the 28 patients with minimum two-year follow-up). Removal of hardware (ROH) is offered to all patients in our practice and not considered a complication. Comparisons were made with Student t-tests.Results:There were 48 patients with an average follow-up of 3.2 years (range 6 months-8.1 years). The mean (standard deviation) age was 28.9 (6.7) years and 58.3% of patients were women. Thirty-one (64.6%) patients underwent concomitant cartilage restoration procedures (15 [48.4%] isolated patellar, 9 [29.0%] isolated trochlear, and 7 [22.6%] to both), while 17 (35.4%) patients underwent aTTO alone. Additional patient and lesion details are presented in Table 1. The mean anteriorization amount with aTTO was 10.9 (2.3) mm. The overall complication rate was 4.2% (2 patients). This consisted of one (2.1%) manipulation under anesthesia for arthrofibrosis at 2.5 months postoperatively and one (2.1%) episode of superficial cellulitis managed with oral antibiotics alone. There were no episodes of wound dehiscence or deep surgical site infection (0%), non-union (0%), or fracture (0%). Average knee ROM was 0°-122° at 6-weeks and 0°-128° at 12-weeks postoperative. Fifteen (31.3%) patients underwent elective ROH. Among the 28 patients with minimum two-year follow-up, there were significant improvements in International Knee Documentation Committee scores from a mean 42.2 (14.0) preoperatively to 83.3 (15.7) at two-year follow-up (p<0.001). Similarly, visual analog pain scores significantly improved from a mean 4.4 (2.3) preoperatively to 1.5 (0.7) at two-year follow up (p<0.001).Conclusions:Anteriorizing TTO can be performed safely for isolated PF chondral lesions with low complication rates and significant improvements in PROMs. In contrast to historical results, in this cohort of 48 patients undergoing contemporary aTTO, there we no deep wound infections, fractures, or non-unions, and the overall complication rate (4.2%) was comparable or superior to other modern TTO types (e.g., anteromedializing, distalizing, etc.) as reported in the literature. Furthermore, patients experienced substantial improvement in PROMs from baseline to two-year follow-up. Moving forward, aTTO may be a safe and effective option in properly indicated patients with PF overload.

Early-stage knee osteoarthritis (knee OA) lacks effective regenerative therapies. This study aimed to compare the cartilage regenerative effects, clinical efficacy, and safety of intra-articular injections of autologous adipose-derived mesenchymal stem cells (ADSCs) versus hyaluronic acid (HA). Forty-eight patients with early knee OA were enrolled in a prospective open-blinded multi-center study at Suranaree University of Technology Hospital and Phramongkutklao Hospital. Participants were randomized into either the ADSC or HA group. Primary outcomes included MRI-based cartilage lesion volume, synovial thickness via ultrasound, and WOMAC scores over 6 months. MRI results revealed significant and progressive cartilage regeneration in the ADSC group. In particular, medial femoral cartilage lesion volume decreased by 50.06 mm3, whereas the HA group showed an increase of 36.44 mm3. Synovial thickness also declined significantly in the ADSC group at 3 and 6 months. Both groups demonstrated reduced symptoms, but the ADSC group achieved superior and sustained improvements in WOMAC pain, stiffness, and function scores throughout the 6-month follow-up. The clinical benefits were consistent and more pronounced compared with HA. No serious adverse events occurred. In conclusion, intra-articular ADSC injections show superior cartilage restoration on MRI and better clinical outcomes than HA injection, making them a promising treatment for early-stage knee OA.

Abstract Femoral osteotomy is an effective surgical intervention for correcting torsional deformities that contribute to hip instability and femoroacetabular impingement. However, traditional osteotomy techniques require extensive soft tissue dissection, disrupt the femoral canal, and complicate future total hip arthroplasty. Additionally, traditional approaches frequently involve multiple incisions when combined with other procedures, prolonging recovery and increasing morbidity. The direct anterior approach (DAA) offers a minimally invasive alternative that preserves the femoral anatomy while enabling simultaneous intra-articular interventions. This technique provides access to the femoral neck for varisation, valgisation, and rotational osteotomies while preserving critical vascular structures. Moreover, the DAA facilitates concurrent hip arthroscopy, periacetabular osteotomy, and cartilage restoration procedures. We describe the DAA for femoral neck osteotomy to correct torsional deformities and discuss its potential benefits in optimizing surgical outcomes.

This manuscript consolidates 25 years of interdisciplinary research and clinical advancement in optimizing patient outcomes following osteochondral allograft (OCA) transplantation. In this manuscript, we detail the results of over 1500 OCA procedures and 115 research publications, integrating hypothesis-driven basic science and translational research with clinical outcomes data. The study highlights groundbreaking advancements, including: Innovations in fresh OCA preservation techniques that extend graft viability; Minimization of immunogenic, thermal, and impaction effects to enhance graft integration and durability; Cutting-edge methods for donor-recipient topographic matching, supported by 3D modeling; Evolution of the surgical technique, including the development of orthobiologic approaches to optimize outcomes; Evaluating long-term clinical outcomes and the effect of concomitant procedures; Decision-support algorithms that improve patient selection and surgical planning using machine learning tools. This manuscript illustrates the evolution of OCA transplantation into a reproducible, globally adopted technique for cartilage restoration. By merging basic science, translational insights, and clinical expertise, we redefine and improve the standards of graft handling, surgical technique, and clinical outcomes. The resulting data-driven guidelines and decision-support tools set a foundation for advancing the field, improving accessibility and patient selection, and enhancing patient outcomes worldwide.

BackgroundThe spontaneous healing of the osteochondral defects leads to the formation of fibrous or fibrocartilage tissue that lack normal cartilage characteristics. Therefore, there are different methods were approved for the functional treatment of osteochondral defects including, microfracture osteochondral mosaicoplasty, autologous chondrocyte implantation, platelets-rich plasma (PRP), bone marrow-derived mononuclear cells (BM-MNCs), Mesenchymal stem cells (MSCs) and platelets-rich fibrin (PRF). The present study evaluate the regeneration of osteochondoral defects in rabbits using PRF and BM-MNCs through immunohistochemical (IHC) and gene expression of collagen type II and aggrecan in the regenerated tissue at 3, 6 and 12 weeks postoperative.MethodsA total of 48 adult male New Zealand white rabbits, aged 5–6 months and weighed 3.5 to 4.0 kg, were used in this study and divided into four experimental groups, where all animals received an osteochondral defect of a 4 mm diameter and 5 mm depth was made in the trochlear groove of the left stifle joints. The defects were left for spontaneous repair in group A. They were filled either with 1 cm3 of PRF in group B, 6000k of BM-MNCs in group C or a combination of 0.8 cm3 of PRF and BM-MNCs in group D.ResultsGross observation of the defect, based on the degree of defect repair, the integration to border zone and the appearance of the defect area, was significantly higher in group D than other experimental groups (P ≤ 0.05). Microscopical evaluation including surface architecture, tissue morphology, cell distribution and safranin O staining of the matrix was significantly higher in group D than other groups (P ≤ 0.05). IHC staining showed a high concentration of collagen type II in groups B and D respectively; a moderate to high amount in groups and a moderate amount in group A (2.0 ± 0.5). The relative gene expression showed a significant increase of collagen type II and aggrecan in group D compared to other groups at all-time points.ConclusionsThe current study’s findings show that when PRF and BMNCs are combined, osteochondral lesions mend more quickly, and the regenerated tissue has stronger collagen type II and proteoglycan deposition than when either substance is utilized alone. To gather proof of the positive benefits of the combination of PRF and BMNCs, more research on clinically afflicted cases is required. Also, Autologous PRF is capable of stimulating BMSC growth and has good biocompatibility and can aid in the restoration of cartilage and subchondral bone.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-025-08952-x.