Search Results (113)

Cartilage is an important yet vulnerable tissue with limited self-healing capacity, where damage often progresses to joint degeneration, which eventually leads to severe osteoarthritis (OA). Current tissue engineering strategies focus on biocompatible scaffolds for cartilage regeneration, particularly amnion (or amniotic membrane), emerging as a promising biomaterial due to its wide availability, low immunogenicity, and naturally derived microenvironment that is advantageous for cartilage regeneration. This systematic review aims to evaluate the existing evidence on the efficacy of amnion as a tissue scaffolding material for cartilage regeneration in both preclinical and clinical studies. Using terms such as “cartilage damage”, “cartilage injuries”, “amnion” and “amniotic membrane”, 19 relevant studies were identified across three major databases (PubMed, Scopus and Web of Science) until 25 December 2025. All preclinical and clinical studies that utilized amnion for cartilage repair or as cartilage tissue engineering scaffolding materials were included. Evidence quality was assessed using the OHAT and MINORS risk of bias tool. This study is prospectively registered in the PROSPERO database under the ID 1178444. The findings consistently indicate that amniotic scaffolds, regardless of processing methods or cell seeding, yield favorable outcomes without adverse effects across different species. In vitro analysis revealed that treatment groups with amnion show better cell attachment, viability, and proliferation, and higher content of cartilage-related markers expressed by the seeded cells, either chondrocyte, bone marrow-derived mesenchymal stem cells (MSCs), adipose tissue-derived MSCs, placenta-derived MSCs, umbilical cord-derived MSCs, amniotic MSCs or amniotic epithelial cells. In in vivo and ex vivo studies, amnion-treated groups demonstrated improved quality of the treated cartilage, with better integration, as indicated by higher histological scores and the presence of type II collagen (COL-II). There was an inconsistency in the reporting of cartilage defect dimensions in the in vivo models across the different studies. Nevertheless, the outcome measurements were consistently reported with histological analysis, with or without International Cartilage Repair Society (ICRS) scoring and immunohistochemistry (IHC) analysis, across the studies. Clinically, most subjects show improvement in the Knee Injury and Osteoarthritis Outcome Score (KOOS) Sports and Recreation score and KOOS Quality of Life score, as well as reduced Visual Analogue Scale (VAS) average and maximum pain scores. In conclusion, preclinical and clinical studies support amnion as an ideal scaffold material for cartilage tissue engineering and regeneration. Future research should focus on optimizing and standardizing amnion scaffold preparation at a production scale to facilitate the translation of these positive outcomes into clinical applications. This study is funded by the Ministry of Higher Education Malaysia via Prototype Research Grant Scheme (PRGS/1/2021/SKK01/UM/02/1) and UM International Collaboration Grant—2023 SATU Joint Research Scheme Program: ST007-2024. Full article

Background: Osteotomy around the knee (OAK) is a joint-preserving surgery for knee osteoarthritis, yet some patients experience suboptimal outcomes. Preoperative identification of high-risk patients remains challenging. This study aimed to develop a machine learning model to predict clinical outcomes after OAK using preoperative gait acceleration data from inertial measurement units (IMUs). Methods: This multicenter prospective study enrolled patients undergoing OAK. Preoperative gait was recorded using synchronized IMUs placed on the lumbar spine and tibia. Lumbar and tibial signals were used for gait-cycle segmentation, while wavelet-based time–frequency features were extracted from tibial acceleration only. Outcomes were defined by achievement of the minimal clinically important difference in ≥3 KOOS subscales at 2-year follow-up (Good vs. Poor). Continuous wavelet transform features (5–20 Hz) were summarized as mean and standard deviation across six stance subphases. A Random Undersampling Boost classifier was trained and evaluated using nested leave-one-subject-out cross-validation. A sensitivity analysis using logistic regression confirmed that the IMU-based prediction score was independently associated with outcome after adjustment for baseline KOOS (p = 0.047). Results: Of 67 enrolled patients, 37 were classified as Good and 30 as Poor outcome. For machine learning analysis, 1173 tibial acceleration gait-cycle waveforms were usable. The model achieved an AUC of 0.744 (95% CI, 0.610–0.860) using a median of 15 features (range, 5–25) with sensitivity of 0.69 and specificity of 0.72. The most informative predictors were the mean magnitude in the 5–8 Hz band during loading response (0–17%) and variability in the 5–8 Hz band during late stance (67–83%). No significant differences in baseline demographics or radiographic parameters were found between outcome groups. Conclusions: Preoperative IMU-derived gait acceleration features showed moderate-to-good discrimination between outcome groups and may support preoperative risk stratification and individualized perioperative management. Full article

Background/Objectives: Knee osteoarthritis (KOA) is associated with pain, functional decline, and altered biomechanics. The Step-Up and Down-Forwards (StUD-F) task provides an ecologically relevant assessment of challenging movements. This study investigated neuromuscular activation and lower-limb kinematics of leading and trailing-limbs during the StUD-F in individuals with KOA. Methods: Forty participants with KOA (65.3 ± 7.68 years; 21M/19F; BMI 28.9 ± 4.52 kg/m²) completed a 25 cm box StUD-F task. Surface electromyograph recorded bilateral activation of the vastus medialis (VM), vastus lateralis (VL), bicep femoris (BF), and semitendinosus (ST). Triplanar hip, knee, and ankle joint angles were estimated using inertial measurement units. StUD-F events (initial stance; step contact; ascent completion; descent preparation; step-down touchdown; and descent completion) were identified using custom algorithms. Pain was assessed using visual analogue scales and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Limb differences were analysed for leading or trailing roles using paired samples t-tests or non-parametric equivalents; waveforms were visually inspected. Results: Distinct neuromuscular and kinematic asymmetries were observed when affected and contralateral limbs were compared within each role (leading/trailing). During step-up, the affected leading limb demonstrated higher quadriceps activation at initial stance (VM: p = 0.035; VL: p = 0.027) and reduced trailing-limb activation at step contact (VM: p = 0.015; VL: p = 0.018), with sagittal-plane ankle differences (p = 0.004). During step-down, when the affected limb initiated ascent, trailing limb activation was higher at descent completion (VL: p < 0.001; VM: p = 0.003; BF: p = 0.009), with coronal-plane hip deviations (p < 0.001). When the contralateral limb-initiated ascent, trailing-limb muscles activation differences (VM: p < 0.001; VL: p = 0.015; BF: p = 0.007) and ankle/coronal-plane asymmetries (p ≤ 0.049) persisted. Conclusions: The StUD-F task elicits altered strategies in KOA, including elevated quadriceps–hamstring co-activation and altered sagittal/coronal alignment, and habitual limb choice across ascent and descent. These adaptations may enhance stability and joint protection but could increase medial compartment loading. The findings support rehabilitation focused on dynamic control, alignment, and shock absorption. Full article

Background and Objectives: While particulated costal hyaline cartilage allograft (PCHCA) combined with microdrilling demonstrates superior cartilage regeneration compared to microdrilling alone in high tibial osteotomy (HTO), the impact on early clinical recovery remains uncertain. The aim of this study is to compare early clinical outcomes (within 6 months) between microdrilling alone versus combined particulated costal hyaline cartilage allograft (PCHCA) with microdrilling in medial open-wedge high tibial osteotomy (MOWHTO) for medial compartment osteoarthritis, and to investigate age-related differences in treatment response. Materials and Methods: This prospective, dual-center, randomized controlled trial with blinded outcome assessment enrolled 64 patients (33 treatment and 31 control) undergoing MOWHTO with medial femoral condyle cartilage defects (ICRS III-IV, ≥200 mm²). The treatment group received PCHCA implantation combined with microdrilling, while the control group received microdrilling alone. Patients and outcome assessors were blinded to group allocation. Primary outcomes were KOOS-Pain and VAS scores at 12 and 24 weeks. Age-stratified analysis compared patients ≤ 60 years (n = 44) versus > 60 years (n = 20) Results: The treatment group showed significantly superior KOOS-Pain scores at 12 weeks (70.6 vs. 61.6, p = 0.014) and 24 weeks (82.9 vs. 71.5, p = 0.011), with corresponding VAS improvements (p = 0.010 and p = 0.004). Age-stratified analysis revealed patients ≤ 60 years achieved comparable outcomes regardless of treatment (p = 0.574), while patients > 60 years demonstrated significantly superior outcomes with PCHCA (KOOS-Pain improvement: 24.7 vs. 17.9 points, p = 0.012). BMI ≥ 26 kg/m² significantly predicted reduced odds of achieving MCID for both pain (OR 0.88, p = 0.028) and ADL (OR 0.80, p = 0.003). Conclusions: PCHCA combined with microdrilling provides superior early pain relief compared to microdrilling alone in MOWHTO, with effects most pronounced in patients > 60 years. Age-stratified treatment selection and BMI optimization should be considered to maximize outcomes. Full article

Background: Total knee arthroplasty (TKA) effectively relieves pain in end-stage osteoarthritis, yet a proportion of patients remain dissatisfied despite advances in surgical technique. Medial-congruent (MC) bearings are designed to recreate native medial-pivot kinematics, which depend on appropriate medial compartment soft tissue tension. Robotic-assisted TKA (RA-TKA) has been shown to improve the accuracy and soft tissue balance. However, evidence of its additional benefits in MC TKA remains limited. Methods: We retrospectively identified consecutive primary TKAs with the same MC bearing performed between April 2022 and June 2024 at a tertiary center. After performing 1:1 propensity score matching to reduce baseline imbalance, 36 patients who received RA-TKA and 36 who underwent manual TKA (M-TKA) were included. Primary outcomes were evaluated with the 12-month Oxford Knee Score (OKS) and KOOS-JR. Secondary outcomes included radiographic alignment parameters, outlier rates, operative time, liner thickness, and hospital stay. Results: Baseline characteristics and liner thickness were comparable, and operative time was longer in the RA-TKA group than in the M-TKA group. Both RA-TKA and M-TKA produced significant 12-month improvements in OKS and KOOS-JR with no difference in mean scores. RA-TKA had fewer posterior tibial slope outliers (mean slope 4.3° ± 1.8 vs. 5.9° ± 3.1; outlier rate 16.7% vs. 41.7%; p = 0.02), whereas coronal alignment parameters did not differ between groups. Conclusions: RA-TKA with MC bearing provides functional outcomes comparable to M-TKA and may decrease sagittal alignment variability; long-term follow-up studies are needed to determine whether this potential benefit translates into sustained functional gains or improved implant survivorship. Full article

Background: Patient-reported outcome measures (PROMs) provide important insights into recovery after anterior cruciate ligament reconstruction (ACLR). Previous research suggests that males and females recover differently after ACLR, with females reporting greater pain, slower functional gains, and lower psychological readiness at later stages of rehabilitation. However, it is unknown if patient-reported outcomes differ by sex early after ACLR. To address this gap, we conducted a cross-sectional analysis comparing patient-reported outcome measures between sexes three months after ACLR. We hypothesized that females would report worse PROMs compared to males. Methods: This cross-sectional analysis used data from a prospectively maintained ACL reconstruction cohort. Fifty-six individuals (female: 23 and male: 33) with primary, unilateral ACLR completed PROMs three months after surgery. These PROMs included the Knee Injury and Osteoarthritis Outcome Score (KOOS; Symptoms, Pain, Activities of Daily Living, Sport and Recreation, Quality of Life), International Knee Documentation Committee (IKDC) subjective score, Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS), Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI), and the Tampa Scale of Kinesiophobia (TSK). All outcomes were expressed on a 0 to 100 percent scale, with higher scores indicating better outcomes, except for TSK, where lower scores indicated better outcomes. Normality was assessed within sex, using the Shapiro–Wilk test. Two-tailed independent-samples t-tests with Welch correction were used for approximately normal variables; otherwise, Mann–Whitney U tests were utilized (α = 0.05). Several outcomes had limited statistical power to detect MCID-sized differences, and findings for these measures should be interpreted cautiously. Results: No significant differences between sexes were found for any of the PROMs. Males trended towards having better KOOS Sport and Recreation and IKDC, but these were not statistically significant, and the effect sizes were small-to-moderate. Conclusions: No statistically significant sex-based differences were detected in PROMs at approximately 3 months after ACLR, indicating that any sex-related divergences between these measures may not occur until later in recovery. Full article

Background: Knee osteoarthritis (KOA) is a progressive joint disorder that leads to pain, functional limitations, and reduced quality of life. While physical therapy (PT) and resistance exercise are effective in managing KOA, creatine supplementation (CS) may provide additional benefits. Aims/Objectives: To determine the additive effects of creatine supplementation alongside physical therapy (PT) and resistance exercise training in individuals with KOA. Methods: A parallel-design, double-blind, randomized controlled trial was conducted on 40 patients with KOA (≤grade III on Kellgren classification), aged 40–70 years. Participants were randomly allocated to either a placebo control group, which received placebo supplementation (maltodextrin) along with PT, including heat therapy, electrotherapy, manual therapy, and resistance exercises, for four weeks, or an experimental group, which received CS instead of maltodextrin in addition to the same treatment. Outcome measures included the visual analog scale (VAS), fall risk, Knee Injury and Osteoarthritis Outcome Score (KOOS), isometric muscle strength (IMS), five-repetition sit-to-stand test (5xSST), knee range of motion (ROM), and body composition analysis. Results: No significant differences were observed between the two groups at baseline. After four weeks of treatment, a significant interaction effect (treatment group x time) was observed for VAS (p = 0.001), fall risk score (p < 0.001), KOOS overall score (p < 0.001), IMS (p < 0.001), and body composition parameters (p < 0.05) in favor of the CS group. However, no significant interaction effect was observed for knee ROM and KOOS QOL subscale. Conclusions: CS, when combined with PT and resistance exercise, may provide additional benefits in terms of pain, function, muscle strength, and body composition parameters in individuals with KOA. However, no supplementary benefits of CS are observed in terms of quality of life and ROM. Full article

Objectives: Arthroscopic meniscal surgery (AMS) is one of the most common orthopedic procedures worldwide, and its prevalence has been steadily increasing. In this study, we aimed to compare the short-term clinical outcomes (STCOs) and patient-reported outcome measures (PROMs) with anxiety and satisfaction in Mongolian patients. Methods: A prospective cohort study involved 103 patients who underwent arthroscopic knee surgery at The National Trauma Orthopedic Research Center and Grandmed Hospital in Mongolia between 2020 and 2023. STCO and PROM were calculated for the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores, the visual analog scale was assessed for pain (VAS), and Knee Range of Motion (ROM), Measures of Anxiety State-Trait Anxiety Inventory (STAI), and The Surgical Satisfaction Questionnaire (SSQ-8) were also used. Results: Out of 103 patients (69 for partial meniscectomy and 34 for meniscal repair), KOOSs improved significantly from pre-operative to post-operative levels. The Koos subscores for pain were 57.93 ± 12.58 pre-operatively and 80.93 ± 5.70 post-operatively; Koos subscores for Symptoms (KOOS Sx) were 54.13 ± 12.73, 80.27 ± 6.22; Koos subscores for Activities of Daily Living (KOOS ADL) were 61.28 ± 13.19, 79.61 ± 4.91; Koos subscores for Sports/Recreation (KOOS SR) were 42.28 ± 13.21, 72.04 ± 6.88; and Koos subscores for Quality of Life (KOOS QOL) were 45.08 ± 12.46, 77.85 ± 7.96. On the other hand, the pre-operative and post-operative results of the STAI were not significant (46.03 ± 8.2 vs. 39.59 ± 7.13, p = 0.781). Conclusions: In the present study, we elucidated patient- and injury-specific factors that may guide personalized surgical decision-making in Mongolian patients. Our findings suggest that AMS is a viable option for alleviating pain and enhancing function in the short term for patients with meniscal tears. The high PROMs and satisfaction scores reflect good-to-excellent results, and meniscal repair was associated with better outcome scores. While pre-operative anxiety levels were high, they decreased after surgery, although they did not entirely disappear. Full article

Background/Objectives: Knee osteoarthritis (KOA) is a common pathology characterized by impaired joint cartilage. Mesenchymal stromal cell (MSC)-based treatments, such as stromal vascular fraction (SVF), are increasingly being used for their potential cartilage-generating capabilities; however, there is still insufficient evidence to confirm their effectiveness. The aim of the study was to assess the efficacy of SVF treatment in KOA in terms of pain relief. Methods: An experimental clinical trial was performed. We included adults with symptomatic KOA who attended Celular Clinic (Andorra). A laboratory-manufactured and standardized SVF product (Celstem^®) was applied to selected patients. Clinical, functional, and radiological assessments using the visual analog scale, KOOS (Knee Injury and Osteoarthritis Outcome Score), SF-36 scale, and MOCART classification (Magnetic Resonance Observation of Cartilage Repair Tissue) were performed. Variables were compared before treatment and at one, six, and twelve months after treatment. Adverse effects were reported. Results: In total, 184 patients were included in the clinical trial, 78 of whom were finally analyzed. There were statistically significant differences in both resting and activity-related pain and in all KOOS subscales after SVF treatment (p < 0.001). The quality of life also showed significant changes (p = 0.021). No significant changes were observed in MOCART values. However, a positive association was found between MOCART and cell yield. Few adverse effects were reported. Conclusions: Our nonrandomized uncontrolled clinical trial showed that SVF treatment has promise to reduce pain in patients with KOA. Improvements in functionality and quality of life were also observed. Future randomized controlled trials regarding SVF versus placebo therapies will further clarify this potential. Full article

Background: While topical NSAID patches are effective in non-surgical knee conditions, their efficacy following total knee arthroplasty (TKA) remains understudied. The intention behind this study was the comparison of pain and functional score between esflurbiprofen and placebo patches for postoperative pain control after TKA. Methods: A triple-blinded randomized controlled trial was conducted among patients aged 55–80 years with primary knee osteoarthritis. Patients who had an allergy to study medications, had chronic kidney disease, had diabetes, used steroids, were unsuitable for spinal and subsartorial block, or were unwilling to participate were excluded. All eligible participants were randomized and assigned to either esflurbiprofen 40 mg transdermal patch or placebo patch starting from postoperative day 3 to 16 blindly and followed up for 3 months. Outcome assessment was a visual analog scale (VAS), morphine use, minimum daily VAS, time to minimum VAS, knee osteoarthritis outcome score, joint replacement (KOOS, JR), knee circumference, flexion angle, and adverse events. Results: Seventy patients underwent primary TKA (n = 35 each group). The average age and body mass index were 67.5 ± 13.7 years and 26.8 ± 4.5 kg/m². There was no statistically significant difference in baseline characteristics between the two groups. When compared with the placebo group, the esflurbiprofen group presented statistically significantly diminished VAS scores after day 7 and morphine use at day 3 (p < 0.001), as well as subsequently enhanced KOOS scores at 6 weeks and 3 months (p < 0.001). No statistically significant difference between groups was found in terms of knee circumference, flexion angle, or time to minimum VAS (p > 0.05 for all). One patient in the esflurbiprofen group (2.86%) reported a mild skin reaction. Conclusions: Esflurbiprofen patches significantly reduce postoperative pain and improve short-term function after TKA without major complications. Full article

Background/Objectives: Severe knee osteoarthritis (KOA) is a degenerative disease that significantly affects quality of life (QoL). Although intra-articular (IA) injections of plasma rich in growth factors (PRGF) have proven effective, the subchondral bone plays a crucial role in pathogenesis. The objective of this study was to evaluate the efficacy of intraosseous (IO) PRGF infiltrations in comparison with a saline placebo, followed by the conventional standard treatment of three IA PRGF injections, in enhancing clinical outcomes in patients suffering from severe KOA. Methods: A prospective, randomized, double-blind, multicenter clinical trial was conducted. Eighty-six patients with Kellgren–Lawrence grade III-IV KOA were randomly assigned to two groups: one received an IO infiltration of PRGF and the other received an IO saline solution. Both groups subsequently received three IA PRGF injections. Clinical outcomes were assessed using the KOOS and WOMAC scales at baseline and at 3, 6, and 12 months. Results: Both groups showed a statistically significant improvement in all KOOS and WOMAC subscales at all follow-up points compared to their baseline values. However, the group that received the IO PRGF infiltration demonstrated significantly greater improvements in nearly all domains of the KOOS and WOMAC scales (pain, symptoms, function, and quality of life) at 3, 6, and 12 months compared to the saline group (p < 0.05). No serious adverse events were recorded. Conclusions: The combination of intraosseous and intra-articular PRGF infiltrations is a superior therapeutic strategy to the combination of intraosseous saline solution and intra-articular PRGF for treating severe KOA. These findings suggest that treating the subchondral bone directly with PRGF has a significant and clinically relevant therapeutic effect, resulting in greater pain reduction and functional improvement at one-year follow-up. Full article

Background: Exergame applications were introduced recently for orthopedic rehabilitation. This study aimed to evaluate the effectiveness of a 6-week home-based quadriceps exercise with mobile exergaming for treatment of primary knee osteoarthritis (KOA). Methods: A prospective randomized controlled trial was conducted in 56 primary KOA patients. All patients were allocated into two groups (n = 28 each group). Intervention group received the 6-week mobile exergaming program using a smartphone exercise game with a wearable wireless motion sensor. Control group received a standard 6-week exercise program. Outcomes were active knee arc of motion, quadriceps muscle power, visual analog scale score, timed “Up and Go” (TUG) test, and Knee Injury and Osteoarthritis Outcome Score (KOOS) at a 6-week follow-up. Results: At 6-week post-exercise, the intervention group significantly improved quadriceps power, arc of motion, VAS score at rest and on motion, TUG test, and KOOS-symptom domain compared to the control group (p < 0.05 all). No device- or exercise-related complications were found. Conclusions: Mobile exergaming with visual feedback control using a wearable wireless sensor significantly improves KOA outcomes compared to standard home-based exercise as early as 6 weeks post-application. Full article

Background/Objectives: Focal cartilage defects of the knee are a common cause of pain and functional impairment. While several patient-reported outcome measures (PROMs) and objective scores have been developed to assess clinical knee status and functional impairment, the correlation between subjective PROMs and objective clinical findings after cartilage repair surgery remains unclear. A better understanding of this relationship could enhance the interpretation of registry data and improve clinical decision-making. Methods: This study analyzed 52 patients from the German Cartilage Registry (KnorpelRegister DGOU) who underwent cartilage repair surgery of the knee at a single orthopedic university center in Germany. All patients were re-evaluated in a standardized follow-up examination. PROMs from either the registry or the follow-up examination and objective findings, summarized using a modified objective International Cartilage Repair Society [ICRS] score, derived from the International Knee Documentation Committee (IKDC) 2000 knee examination form, were correlated using Spearman’s rank correlation coefficient. Results: Moderate and statistically significant negative correlations were observed between the objective ICRS score and Knee Injury and Osteoarthritis Outcome Score (KOOS) Symptoms (ρ = −0.420, p = 0.005), KOOS Quality of Life (QoL) (ρ = −0.377, p = 0.013), and the subjective IKDC score (ρ = −0.305, p = 0.028) The subjective IKDC score (IKDC–Subjective Knee Form) was also moderately and significantly correlated with the objective ICRS score (ρ = –0.305, p = 0.028). Other KOOS subscales (Pain, Activities of Daily Living (ADL), Sport) did not show statistically significant correlations with the objective ICRS score. Conclusions: PROMs provide valuable insights into patients’ perceived outcomes after cartilage repair surgery, but do not fully reflect objective functional recovery, underlining the importance of combining them with clinical assessments. Level of Evidence: III. Full article

Background: Arthrofibrosis requiring arthrolysis is a relevant complication after anterior cruciate ligament (ACL) reconstruction. It has been suggested that intercondylar notch impingement may contribute to this outcome. The aim of this study was to evaluate whether systematic notchplasty during primary ACL reconstruction with hamstring autografts reduces the rate of secondary arthrolysis. Methods: Two groups of patients undergoing primary ACL reconstruction were compared: 149 patients without notchplasty and 140 patients with notchplasty, each with a minimum follow-up of 2 years. The incidence of arthrolysis and other complications, functional outcome scores, and return-to-sport data were analyzed. Results: No significant difference was observed in the rate of arthrolysis: Seven patients (4.7%) were in the non-notchplasty group, with seven patients (5.0%) in the notchplasty group (p = n.s.). Functional outcomes were comparable between groups, with mean subjective IKDC of 86.5, KOOS of 87.5, and Lysholm of 90.9. Return-to-sport rates were similar, and over 90% of patients in both groups reported being satisfied or very satisfied with their outcome. Conclusions: Systematic notchplasty during primary ACL reconstruction with hamstring autografts did not reduce the rate of secondary arthrolysis in this underpowered cohort. Arthrofibrosis is multifactorial, and larger studies are needed to clarify whether notchplasty has an independent effect. Full article

Background: Osteoarthritis (OA) is a major global health issue, increasing with aging and obesity. Current therapies mainly address symptoms without modifying disease progression. Platelet-rich growth factor (PRGF) therapy has potential regenerative effects through high cytokines and growth factors, but the outcomes of these therapies remain heterogeneous. This study explores the relationship between patient nutritional status, PRGF characteristics, and clinical outcomes in knee OA treatment. Methods: Baseline anthropometric, metabolic, and nutritional assessments of 41 patients with knee OA who underwent PRGF treatment were conducted. Blood samples were analyzed for metabolic and inflammatory markers. PRGF composition was assessed by protein content and extracellular vesicle (EV) markers. KOOS and VAS pain scores were collected at 2, 6, and 12 months. Responders improved KOOS by ≥10 points. An elastic-net regularized logistic model allowed the identification of the predictors of treatment response. Results: KOOS and VAS scores improved significantly at all follow-ups. At 2 months, the PRGF of responder patients showed higher PRGF G-CSF levels; at 12 months, increased CD49e and HLA-ABC expression. Higher BMI correlated with increased IL-6, IL-1ra, and resistin in PRGF samples. Hypercholesterolemic patients displayed altered EV profiles, with elevated levels of CD8 but reduced CD49e, HLA-ABC, CD42a, and CD31. Multivariate analysis identified BMI, biceps fold, fat percentage, red blood cell, platelet, and neutrophil counts as predictors of early response. Conclusions: Metabolic and immunological factors influence PRGF composition and clinical efficacy in knee OA. Baseline body composition and hematological parameters as key predictors of response, highlighting the potential of personalized PRGF therapy. Full article