Regenerative techniques are a rapidly expanding frontier in the interventional treatment of musculoskeletal disorders, involving endogenous mechanisms and bioactive molecules to repair tissue and modulate inflammation. Despite extensive basic research, the evidence supporting clinical use is highly heterogeneous and limited by variability in cell sources, preparation protocols and patient selection, high risk of bias, small sample sizes, and short follow-up periods. This article presents a critical overview regarding viscosupplementation, prolotherapy, platelet-rich plasma, collagen, stem cell and bone marrow aspirate concentrate therapy for osteoarthritis, chronic low back pain, tendinopathies, ligament, muscle, meniscal, and bone lesions.

Interventional radiology (IR) procedures are becoming increasingly relevant in the management of musculoskeletal disorders due to their high precision and low invasiveness. However, specific considerations need to be made when applied to children and adolescents, especially in terms of anesthetic care and radioprotection. The aim of this article is to provide a description of the main IR procedures available for the treatment of benign and malignant bone tumors, septic arthritis, and rheumatic diseases in the pediatric population (including radiofrequency ablation, high-intensity focused ultrasound, intralesional injection of sclerosing agents or steroids, biopsies, and embolization), summarizing available evidence and outlining distinctive aspects.

Metabolic bone disease is characterized by impaired bone strength, density, or mineralization, increasingly observed in athletes due to complex nutritional, hormonal, and mechanical factors. The underlying pathophysiology includes dysregulated bone turnover driven by hormonal imbalances, inflammatory cytokines, and microdamage accumulation.Although weight-bearing activity generally promotes bone health, excessive training, inadequate recovery, and nutritional deficiencies, such as low calcium and vitamin D, disrupt bone remodeling, leading to decreased bone mineral density and heightened fracture risk. Female athletes with menstrual irregularities, disordered eating, and energy deficits are particularly susceptible to osteoporosis and osteopenia, components of the female athlete triad; hormonal disturbances like hypogonadism also affect males.Imaging techniques such as magnetic resonance imaging and dual-energy X-ray absorptiometry facilitate early detection of microdamage and bone loss, guiding timely interventions. Prevention strategies are nutritional optimization, balanced training, hormonal regulation, and routine bone mineral density screening. An integrated approach of early diagnosis, lifestyle modifications, and education is vital for maintaining skeletal health and preventing long-term complications in athletes.

Computed tomography (CT)-guided musculoskeletal interventions (MSK-CTg-IR) are integral to modern interventional radiology, offering precise anatomic visualization, reproducibility, and accuracy for complex osseous and deep soft tissue procedures. These include biopsies, spinal pain interventions, vertebral augmentation, cementoplasty, osteosynthesis, and thermal ablation. Outcomes rely not only on imaging but also on lesion characteristics, workflow, radiation optimization, technical strategy, and patient interaction. Many practical insights remain underreported. This expert framework bridges theory and real-world practice, emphasizing planning, technical nuances, anatomic challenges, and troubleshooting. Success depends on anticipating procedural difficulties and adapting techniques dynamically to ensure safety, efficacy, and optimal patient outcomes.

Spinal lesions in athletes can be classified into overuse and acute injuries. Overuse injuries can be found after repetitive spinal load during sport activity; acute trauma injuries of the spine are common in contact sports. We present an overview of the wide spectrum of spinal injuries related to sport activity and review their imaging findings. Concerning overuse injuries, we focus on degenerative spine disease, spondylolysis, pedicle fractures, apophyseal ring injuries, Schmorl's nodes, and Scheuermann's disease. Acute spinal injuries are relatively frequently reported in athletes and may be the reason for severe morbidity. Similar to the general population, the type of acute spine fracture in athletes depends on the specific trauma mechanism.

This article provides a practical overview of technical strategies for ultrasound-guided musculoskeletal interventions, focusing on optimization of procedural safety, accuracy, and reproducibility. Key aspects include probe selection, parameter management, operator and patient positioning, planning of needle trajectory, and techniques for improving needle visualization. Other adjunctive approaches such as hydrodissection and Doppler imaging are also discussed, together with common technical pitfalls and strategies to avoid them. Emphasis is placed on the integration of technical proficiency, ergonomic setup, and dynamic anatomic understanding to improve outcomes in musculoskeletal interventional ultrasound.

Older men suffer from hip FFx (fragility fracture) at femoral neck T-score approximately 0.6 higher than older women, thus we proposed a new category of low BMD status, osteofrailia, for older Caucasian men with femoral neck T-score ≤ −2.0 (T-score ≤ −2.1 for older East Asian men) who have an increased risk of hip FFx. Around the age of 78 years, mean LS (lumbar spine) QCT BMD is around 68 mg/mL and 100 mg/mL for East Asian men and Caucasian men, respectively. For East Asian men, LS QCT BMD <68 mg/mL offers a sensitivity of 77

Background and Aims Studies on age-related changes in body composition often included ethnically different subjects, or few men or women with limited age range. Methods and Results We retrospectively studied 1860 (1304 female, 556 male) free-living subjects, 20-to-98 years-old, including 324 with type 2 diabetes (T2DM). We measured absolute and total body mass(TBM)-adjusted fat mass (FM), lean mass (LM), appendicular lean mass (ALM), bone mineral content (BMC), TBM, skeletal muscle index (SMI) by DXA. From a subset of 20-50 years-old non-obese subjects, we defined sex-specific cutoffs for high-FM (mean +2SD), and low-LM, -ALM, -BMC, -SMI (mean -2SD), to investigate their impact on mortality.Women had higher FM, and lower absolute and TBM-adjusted LM, ALM, BMC. and SMI than men. Absolute and TBM-adjusted FM positively correlated with age, whereas all the other parameters decreased with age, with negative correlations being steeper in men. The regressions of TBM-adjusted values differed between subjects with or without T2DM. T2DM negatively interacted with the correlations of FM and FM/TBM with age, and positively with that between LM/TBM and age.TBM-adjusted parameters shifting from the reference distribution influenced mortality, with the respective HR being: 1.65 (95%CI:1.31-2.07; p<0.0001) for FM/TBM; 1.58 (95%CI:1.25-2.00; p<0.0001) for LM/TBM; 1.53 (95%CI:1.23-1.90; p=0.00012) for BMC/TBM; 1.05 (95%CI:0.83-1.34; p=0.68) for ALM/TBM; 1.77 (95%CI:1.37-2.28; p<0.0001) for SMI; 1.66 (95%CI:1.30-2.11; p<0.0001) for low-ALM+low-BMC; 1.47 (95%CI:1.12-1.93; p=0.0056) for high-FM+low-ALM; 1.51 (95%CI:1.18-1.94; p=0.0009) for high-FM+low-BMC. Conclusion Age-related body composition changes differ between sexes. Several individual or clustered parameters shifting from the distribution of younger subjects affect mortality.

Bone health remains an underestimated component of athlete care and long-term performance. Many athletes, particularly those involved in endurance or weight-sensitive sports, exhibit reduced bone mineral density or impaired bone microarchitecture due to energy deficiency, hormonal imbalance, or chronic stress. These often underdiagnosed conditions increase the risk of stress fractures, ultimately threatening career longevity. Conventional assessment techniques, such as dual-energy X-ray absorptiometry and quantitative computed tomography, provide valuable diagnostic information but are limited by radiation exposure, high costs, poor accessibility, and low feasibility for routine use in athletic populations.Radiofrequency echographic multi-spectrometry is an ultrasound-based radiation-free technique that estimates bone mineral density and bone quality through the analysis of raw radiofrequency signals. This review examines the role of radiofrequency echographic multi-spectrometry as a supportive diagnostic tool in sports medicine for the prevention, monitoring, and management of bone fragility and stress-related injuries in athletes. We also highlight future directions for research and clinical integration.

Purpose: To develop and evaluate cross-sequence transfer learning for automatic femoral cartilage segmentation, testing bidirectional transfer between dual-echo steady-state (DESS) and sagittal proton density-weighted 3D fast spin-echo (Cube) sequences. Materials and Methods: We optimized a modified 2D U-Net on 507 DESS images from the Osteoarthritis Initiative (OAI). We then established same-sequence baselines using subject-level cross-validation on a subset of 44 OAI DESS images and 44 Cube images acquired at the Istituto Ortopedico Rizzoli, Bologna, Italy. Each subset included 22 non-lesioned and 22 lesioned subjects. Finally, we performed transfer learning across sequences by fine-tuning the pretrained models on the target sequence with increasing training set sizes to study convergence, while keeping validation and test sets fixed. Segmentations were evaluated using Dice similarity coefficient (DSC) and average surface distance (ASD). Lesion effects were assessed with two-sided Mann-Whitney U tests with Bonferroni correction. Results: Same-sequence training yielded higher accuracy on DESS than Cube (DSC, 0.900 vs 0.830; P < .001). Cube-to-DESS transfer matched DESS performance (DSC, 0.903 ± 0.032 vs 0.900 ± 0.027), reaching a performance plateau at 9 training subjects. DESS-to-Cube yielded a lower combined DSC (0.802 ± 0.049 vs 0.830 ± 0.042), reaching a plateau at 24 training subjects. Lesions did not affect DESS (P ≥ .39) but reduced Cube accuracy (DSC, 0.805 vs 0.856; P < .001). Conclusion: Transfer learning across sequences can substantially reduce target-sequence annotation requirements for femoral cartilage segmentation, but performance is direction- and sequence-dependent, and the effects of lesions on segmentation may vary across MRI sequences.

Abstract:Interest is growing about the opportunistic use of imaging data. We conducted a scoping review to provide an overview and define perspectives and gaps in knowledge for the opportunistic extraction of measurements of skeletal muscle and fat quantity or quality from spinal examinations. A comprehensive search on PubMed was performed with key terms such as "sarcopenia," "obesity," "fat," and "muscle," focusing on spine computed tomography and magnetic resonance imaging. Only articles published in the previous 5 years were included. We identified 29 studies, most of which were classified as level of evidence 3/4 and had significant limitations. The clinical settings were diverse, including spine surgery, osteoporosis, degenerative spine disease, and low back pain. This work highlights that an opportunistic assessment of paravertebral muscles by computed tomography/magnetic resonance imaging is feasible, although more evidence is needed to clarify the relationship between specific pathologic conditions and muscle loss/degeneration (aside from aging and disuse) before clinical implementation.

Ewing sarcoma (EWS), the second most common pediatric bone tumor, presents with a markedly heterogeneous clinical spectrum and optimal risk stratification is therefore crucial for improving treatment outcomes. The RNA-binding protein IGF2BP3 is a critical oncogenic driver of EWS malignancy. This study evaluates the clinical utility of circulating IGF2BP3 as a biomarker to predict treatment response and risk of disease progression in patients with EWS. Plasma samples from 60 patients with EWS diagnosed and treated at the IRCCS Rizzoli Orthopedic Institute (Bologna, Italy) were collected at diagnosis before treatment initiation and/or after induction chemotherapy. For 51 of these patients, blood was collected at diagnosis, prior to any treatments. For 25 patients, blood samples were available at diagnosis and before surgical intervention, allowing longitudinal analysis in the same patient. For 9 patients, blood was collected only after preoperative chemotherapy, before surgical intervention. Circulating IGF2BP3 levels were quantified using a highly specific and sensitive ELISA assay. Plasma samples from healthy donors served as controls. IGF2BP3 plasma levels were correlated with IGF2BP3 tumor tissue expression, established clinical risk factors, and cumulative incidence of relapse using univariable and multivariable analyses. Plasma IGF2BP3 levels were significantly elevated in patients with EWS compared with healthy controls, with a subset of patients (22/51, 43.2%) exhibiting clinically relevant concentrations. Circulating IGF2BP3 levels reflected tumor expression of the molecule and provided additional prognostic information beyond standard clinicopathologic features. The prognostic impact of circulating IGF2BP3 was primarily observed in patients with localized disease, in whom elevated levels were identified as a significant adverse prognostic factor for disease-specific survival (hazard ratio, 10.63; 95% CI, 1.27-88.62; P = 0.029). Longitudinal monitoring demonstrated that persistence of IGF2BP3 in plasma after induction chemotherapy was a strong predictor of poor clinical outcomes. Circulating IGF2BP3 represents a valuable biomarker for early risk stratification in EWS, particularly in patients with localized disease. Although this is single-marker assay, the expression of the molecule may impact on the fate of many mRNAs. We present an accurate, simple, cost-effective and easy clinical applicable tool to support risk-adapted therapeutic interventions. The limited number of employed patients warrants the need of larger cohorts for validation.

This article summarizes practical and evidence-based strategies for ultrasound-guided musculoskeletal interventions, highlighting technical aspects that influence procedural precision, safety, and therapeutic effectiveness. Topics covered include patient selection, informed consent, aseptic preparation, equipment setup, needle visualization, and technical considerations for different anatomic regions, including small joints, spine, sacroiliac joint, and calcific tendinopathy. The article also addresses common procedural pitfalls, complication management, and the role of rehabilitation after intervention. Particular attention is given to the integration of anatomic expertise, real-time sonographic guidance, and standardized procedural techniques to enhance reproducibility and minimize complications in everyday musculoskeletal interventional practice.

Background:Innovation in focused ultrasound (FUS) has led to new applications for treating musculoskeletal pathologies, including oncologic, infectious, and degenerative diseases. Focused ultrasound-mediated drug delivery is particularly interesting in fields in which high selectivity and localized action are needed to avoid unwanted side effects or therapy failure, for example with antineoplastic and antimicrobial drugs. Method:For this paper, a literature search of the PubMed database was performed using the keywords "focused ultrasound" and "musculoskeletal applications". Conclusion:This review article presents an overview of the currently available technologies for focused ultrasound-mediated drug delivery and their possible musculoskeletal applications, along with a discussion of recent promising preclinical and clinical results. Key Points:· Focused ultrasound is able to deliver drugs in a very selective way.. · Focused ultrasound-mediated hyperthermia may be promising for treating bone infections.. · Focused ultrasound-mediated drug delivery may also be an elegant method for treating bone cancer and arthritis.. Citation Format:· Sassi R, Gazzotti S, Aparisi Gómez MP et al. Focused ultrasound-mediated drug delivery systems: a technological overview, possible musculoskeletal applications, and future directions. Rofo 2025; DOI 10.1055/a-2760-5392.

Abstract:Inflammatory conditions of the anterior chest wall are clinically relevant but remain underrecognized and inconsistently assessed in imaging protocols. The anterior chest wall may be affected by systemic and localized diseases, such as spondyloarthritis, chronic nonbacterial osteitis, rheumatoid arthritis, crystal arthropathies, and osteoarthritis. In spondyloarthritis, anterior chest wall involvement is common yet frequently subclinical. Magnetic resonance imaging enables early detection of enthesitis, synovitis, and osteitis, as well as structural lesions, such as erosions, fatty metaplasia, sclerosis, ankylosis, and hyperostosis. Rheumatoid arthritis typically presents with synovitis, inflammatory cysts, and erosions. Pediatric chronic nonbacterial osteitis manifests as multifocal bone inflammation, often involving the clavicle, requiring whole-body imaging. Adult chronic nonbacterial osteitis includes variants such as sternocostoclavicular hyperostosis and Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis syndrome. Abstract:Members of the Arthritis Subcommittee of the European Society of Musculoskeletal Radiology prepared this article. It presents updated information on imaging the anterior chest wall in rheumatic conditions with emphasis on systematic assessment. Guidance is provided on optimal imaging sequences, reporting terminology, and differential diagnoses. Ultrasound is the first-line examination. Magnetic resonance imaging is the modality of choice for detecting active inflammation in bone and soft tissue; computed tomography remains preferred for detailed bone and crystal disease evaluation. Recognizing anterior chest wall inflammation can improve diagnostic accuracy and guide early treatment.

To establish evidence-based consensus statements on imaging of scaphoid fractures. Nineteen hand surgeons formulated a preliminary list of eleven questions on imaging of scaphoid fractures. Based on this preliminary list, radiologists crafted statements considering literature and their clinical experience, then refined them through an iterative Delphi process to revise the questions and statements. A maximum of three Delphi rounds was scheduled until group consensus was achieved for an individual statement, whichever arose first. Twenty-eight radiologists drafted the statements and acted as Delphi panellists. Panellists rated their level of agreement with each statement on an 11-point numeric rating scale, the score ‘0’ indicated complete disagreement and the score ‘10’ indicated complete agreement, respectively. Group consensus was specified as a score of ‘8’ or higher for ≥ 23/28 panellists. Eight of eleven questions and statements achieved group consensus in the first Delphi round. The remaining three questions and statements achieved group consensus in the second Delphi round, indicating more controversial topics. It was agreed that radiographs are the initial imaging technique of choice for suspected scaphoid fractures. MRI or CT are advocated for suspected radiographically occult scaphoid fractures. CT is the method of choice for assessment of osseous consolidation. Contrast-enhanced MRI is the preferred imaging modality for assessing vascularisation of scaphoid nonunion. CT is the most valuable technique in the postoperative evaluation of scaphoid fractures. Delphi-based consensus statements suggest imaging pathways to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures. Question How can an international and interdisciplinary team of hand surgeons and musculoskeletal radiologists develop practical consensus statements on imaging of scaphoid fractures? Findings All eleven statements achieved group consensus among experts using the Delphi technique for consensus-building. Imaging pathways were suggested to diagnose and assess scaphoid fractures. Clinical relevance statement International, interdisciplinary and evidence-based consensus statements on imaging of scaphoid fractures were achieved using the Delphi technique. The focus of the statements was to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures.

Calcifications of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) of the knee are uncommon and potentially under-recognized entities. Only a limited number of cases have been published to date and their management is still not adequately standardized. Conservative options are typically proposed first, but refractory cases may require interventional/surgical procedures. We report the cases of two elderly women presenting with progressive knee pain and functional limitation, in whom calcifications of the LCL and MCL were diagnosed based on ultrasound, plain radiographs, and magnetic resonance imaging. After failure of medical therapy, both patients were managed with ultrasound-guided percutaneous fragmentation and lavage using a double needle approach similar to the one employed for rotator cuff calcific tendinopathy, leading to rapid and complete relief of symptoms. Although further evidence is required, this treatment could represent a promising and minimally invasive alternative in the management of these infrequent conditions.

Rare bone and mineral conditions (RBMCs) are diverse disorders involving skeletal fragility, altered bone metabolism, and multisystemic complications. Improved pediatric care has increased survival, creating a growing population of adolescents and young adults requiring specialized support. Yet, transition from pediatric to adult services remains fragmented and underdeveloped across RBMCs. This review aimed to map existing literature on transition care for young people with RBMCs and to identify priorities, barriers, and gaps to guide future research and practice. Within the ERN BOND framework, a scoping review was conducted following PRISMA-ScR guidelines. MEDLINE, EMBASE, and SCOPUS were searched (July–August 2025) for studies addressing transition from pediatric to adult care in RBMCs. All study designs were eligible. Screening and data extraction were performed by multiple reviewers using Covidence, and findings were summarized descriptively. Of 1706 records identified, 34 met inclusion criteria. Most studies originated from Europe and North America and focused on osteogenesis imperfecta or X-linked hypophosphatemia. Expert opinion and consensus papers dominated the evidence base, while empirical research remained limited. Across RBMCs, transition processes were consistently described as suboptimal, with poor coordination, limited adult multidisciplinary expertise, unclear pathways, and inadequate patient preparation. Patients, parents, and healthcare professionals highlighted priorities such as continuity of care, structured planning, patient empowerment, psychosocial support, and improved communication between pediatric and adult teams. Barriers included scarcity of adult specialists, organizational fragmentation, and insufficient training. Recommendations emphasized early planning, readiness assessment, multidisciplinary collaboration, and support for self-management. Evidence on transition care in RBMCs is sparse, largely expert-driven, and concentrated in a few conditions. Nonetheless, consistent themes underscore the need for structured, coordinated, and patient-centered transition pathways. Strengthening adult expertise, ensuring continuity of care, and enhancing psychosocial support are essential to improve outcomes. Further longitudinal and implementation research is urgently needed to inform evidence-based transitional care models for RBMCs.