BACKGROUND:There is a paucity of literature evaluating (1) changes in lateral compartment tibiofemoral contact mechanics and lateral meniscal function and (2) the effect of varying repair constructs in treating partial-thickness (type 3) lateral meniscal oblique radial tears (LMORTs). HYPOTHESIS:(1) Type 3 LMORTs would significantly alter lateral compartment contact mechanics and meniscal function when compared with the intact state, and (2) tibia-based suture anchor repair would more effectively restore these metrics to native levels when compared with capsular-based side-to-side repair or debridement. STUDY DESIGN:Controlled laboratory study. METHODS:Eight nonpaired fresh-frozen human cadaveric knees were utilized for this study. Each specimen was tested across 5 states in the following order: intact lateral meniscus, LMORT type 3 (partial thickness) tear created 12 mm lateral to the root attachment, tibia-based suture anchor fixation, capsular-based side-to-side repair, and debridement. For each state, 4 knee flexion angles were tested in random order: 0°, 30°, 60°, and 90° with 500 N of axial load. The following were recorded for each state: contact area, mean contact pressure, peak contact pressure of the lateral compartment, lateral meniscal extrusion, and 3-dimensional lateral meniscal anterior root forces (via use of a novel 3-axis sensor). Differences in means of outcomes were compared by 2-way repeated measures analysis of variance. RESULTS:Type 3 LMORTs were associated with significantly increased contact pressures and extrusion at all flexion angles and decreased contact area at high knee flexion angles as compared with the intact state. The tear state was also associated with significantly decreased forces experienced at the lateral meniscal anterior root attachment versus the intact state. Tibia-based suture anchor and capsular-based side-to-side repair restored contact mechanics, extrusion, and anterior root forces to the intact state, with no significant difference between the repair conditions. Debridement was associated with worse or no better outcomes than tear state alone. CONCLUSION:In a cadaveric model, type 3 LMORTs significantly alter tibiofemoral joint mechanics and lateral meniscal force transmission, and repair of these tears restores the native state, regardless of repair construct. Clinically, this study provides biomechanical support for the repair of type 3 LMORTs at the time of anterior cruciate ligament reconstruction. CLINICAL RELEVANCE:This study provides data regarding the effects of type 3 LMORTs and LMORT repair on tibiofemoral contact mechanics and meniscal function. The results of our study provide additional biomechanical justification for LMORT repair at the time of anterior cruciate ligament reconstruction.
Background: Interbody spinal fusion is a common surgical treatment for degenerative, traumatic, and deformity-related spinal pathologies. Despite advances in cage geometry and fixation strategies that improve alignment and early stability, reliable fusion remains limited by the mechanical and biological constraints of conventional interbody implant materials. Traditional titanium and polymer-based cages often fail to optimally balance load sharing, osteointegration, and biological activity within the mechanically demanding interbody environment. This narrative review examines the development and translational potential of 3D-printed interbody fusion devices, with emphasis on how additive manufacturing enables the integration of mechanical performance with biologically active scaffold design. Methods: A thorough literature review was performed to evaluate the evolution, design principles, material properties, and translational outcomes of three-dimensional (3D)-printed interbody fusion devices. Results: Additive manufacturing enables precise control over implant architecture, allowing for the fabrication of porous, lattice-based cages with tunable stiffness, optimized load sharing, and enhanced bone–implant integration. Preclinical and early clinical studies suggest that 3D-printed porous titanium cages may reduce subsidence, promote osteointegration, and improve fusion-related outcomes compared with conventional designs. Emerging evidence indicates that scaffold porosity, surface microtopography, and bioactive coatings influence macrophage polarization, angiogenesis, and osteogenic signaling. Polymeric and composite constructs, particularly hybrid designs incorporating surface functionalization, represent promising adjuncts, though clinical evidence remains limited. Conclusions: Three-dimensional printing represents a paradigm shift in interbody fusion device design. Continued translational research and longer-term clinical follow-up are required to validate efficacy and guide widespread clinical adoption.
Acute skeletal muscle injury and age-related degeneration represent a challenge in orthopaedic surgery, sports medicine and the care of the aging population. Skeletal muscle functions as a regenerative and endocrine organ that directly influences bone integrity, joint health and surgical outcomes through mechanical loading, myokine secretion and bidirectional muscle–bone–joint crosstalk. Disruption of this integrated system following injury, immobilization, metabolic disease, corticosteroid exposure or aging contributes to impaired regeneration, fibrosis, delayed recovery and inferior outcomes after orthopaedic intervention. Understanding the fundamental mechanisms of muscle repair, including satellite cell activation, angiogenesis, inflammatory modulation and mitochondrial function is critical to enhance evidence-based resistance exercise and nutritional optimization as adjuncts to muscle recovery. This review synthesizes the orthopaedic-relevant basic science and emerging clinical evidence related to orthobiologic and cell-based strategies aimed at improving skeletal muscle recovery and preservation. This review further examines the current state of orthobiologic and regenerative approaches, including platelet-rich plasma, autologous cell-based injectable therapies, extracellular vesicles, and selected metabolic and pharmacologic adjuncts, exploring the translational promise and limitations of available clinical data. While multiple biologic strategies demonstrate compelling preclinical support and favorable safety profiles, clinical evidence demonstrating consistent improvements in functional muscle recovery remains limited and heterogeneous. For the practicing orthopaedic surgeon, orthobiologic and cell-based therapies should presently be considered adjuncts to—not substitutes for—structured rehabilitation, progressive loading and nutritional optimization. Future investigation should prioritize standardized biologic characterization, combination and timing-based regenerative strategies, and rigorously designed clinical trials focused on objective, functionally meaningful muscle recovery.
BACKGROUND:Stable osteochondritis dissecans (OCD) lesions are primarily treated nonoperatively. Nonoperative treatment includes several recommendations, including the use of an unloader brace. However, little is known about the clinical effectiveness of unloader bracing and its influence on OCD healing, return to sports, and patient-reported outcomes (PROs). The purpose of this investigation was to evaluate the impact of unloader bracing on patients with stable medial femoral condyle (MFC) OCD lesions treated nonoperatively. PURPOSE:To investigate the influence of valgus unloader bracing on the success of treating stable MFC OCD with nonoperative treatment strategies. STUDY DESIGN:Cohort study; Level of evidence, 2. METHODS:The authors used a prospective cohort of patients receiving nonoperative care for stable MFC knee OCD lesions. The primary variable of interest was the efficacy of bracing. The primary outcomes were transition from nonoperative care to surgical intervention, return-to-play (RTP) clearance, and PROs. Bivariate testing was used to determine if there were differences between groups. Chi-square testing was used to determine if there were differences in rates of transition to surgery by group. The timing of the transition by each group was assessed using a Wilcoxon rank-sum test, given the nonparametric nature of the data. Kaplan-Meier survival analysis was used to calculate time at risk, incidence rate, and survival times for each group. RESULTS:A total of 185 knees (bracing group: 123 [66.5%] knees; no-bracing group: 62 [33.5%] knees) were analyzed. Overall, 142 (76.8%) knees were successfully treated nonoperatively. Transition to surgery occurred in 43 (23.2%) knees. There were no differences in transition to surgery by groups, with no differences seen by group. Of the knees that did not transition to surgical care, 65 (71.4%) in the bracing group and 38 (74.5%) in the no-bracing group received RTP clearance (P = .693). PRO scores were similar between the 2 groups at the time of RTP clearance. CONCLUSION:The inclusion of an unloader brace in the nonoperative treatment for stable MFC OCD lesions did not decrease the likelihood of patients undergoing surgical intervention or improve their PRO scores at the time of RTP clearance. REGISTRATION:NCT02771496 (ClinicalTrials.gov identifier).
Background Management of moderate-to-large (1-2.9 cm 2 ) osteochondral lesions of the talus (OLT) remains challenging due to the transition from reparative to replacement surgical strategies and the absence of high-level comparative evidence guiding treatment selection. Methods An international panel of experts participated in a modified Delphi consensus process during the International Congress on Cartilage Repair of the Ankle (ICCRA) meetings held in 2017 and 2025. Survey rounds and structured discussions were used to generate and refine consensus statements. Consensus strength was categorized as consensus (51%-74%), strong consensus (75%-99%), or unanimous (100%), and levels of evidence were graded according to established criteria. Results Consensus statements were developed for autologous osteochondral transplantation (AOT), osteochondral allograft transplantation (OCA), scaffold-based cartilage restoration techniques, and emerging extracellular matrix and juvenile cartilage allograft strategies. Autologous osteochondral transplantation was supported as a primary treatment option for cystic, uncontained, and revision lesions, with emphasis on graft continuity and appropriate depth. Osteochondral allograft transplantation was recommended for larger or uncontained lesions and in cases where autograft is contraindicated, with preference for fresh, size-matched grafts used within 28 days. Scaffold-based techniques were identified as viable alternatives in select primary and revision settings, although not superior to AOT for larger lesions. Extracellular matrix cartilage allograft (ECMA) and particulate juvenile cartilage allograft transplantation (PJCAT) potentially enhance cartilage restoration. Conclusion The ICCRA consensus provides a structured, evidence-informed framework for the surgical management of moderate-to-large OLT. Although multiple treatment strategies demonstrate clinical utility, the current literature remains heterogeneous with limited high-level evidence. Further prospective and comparative studies are warranted to better define optimal indications and long-term outcomes for each approach. Level of Evidence: V, Expert consensus
