Search Results (169)

Bone-related defects present a key challenge in orthopaedics. The current gold standard, autografts, poses significant limitations, such as donor site morbidity, limited supply, and poor morphological adaptability. This study investigates the potential of scaffold geometry to induce osteogenic differentiation of human adipose-derived stem cells (hADSCs) through mechanotransduction, without the use of chemical inducers. Four distinct poly-(L)-lactic acid (PLA) scaffold architectures—Traditional Cross (Tc), Triangle (T), Diamond (D), and Gyroid (G)—were fabricated using fused filament fabrication (FFF) 3D printing. hADSCs were cultured on these scaffolds, and their response was evaluated utilising an alkaline phosphatase (ALP) assay, immunofluorescence, and extensive proteomic analyses. The results showed the D scaffold to have the highest ALP activity, followed by Tc. Proteomics results showed that more than 1200 proteins were identified in each scaffold with unique proteins expressed in each scaffold, respectively Tc—204, T—194, D—244, and G—216. Bioinformatics analysis revealed structures with complex curvature to have an increased expression of proteins involved in mid- to late-stage osteogenesis signalling and differentiation pathways, while the Tc scaffold induced an increased expression of signalling and differentiation pathways pertaining to angiogenesis and early osteogenesis. Full article

Background: Persistent neuromuscular deficits following anterior cruciate ligament reconstruction (ACLR) are frequently attributed to arthrogenic muscle inhibition (AMI). The type of autologous graft used may influence the trajectory of neuromuscular recovery. Objective: To investigate the influence of graft type—bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT)—on the contractile properties of periarticular knee muscles over a 9-month post-operative period. Hypothesis: Each graft type would result in distinct recovery patterns of muscle contractility, as measured by tensiomyography (TMG). Methods: Thirty-one patients undergoing ACLR with BPTB (n = 8), HT (n = 12), or QT (n = 11) autografts were evaluated at 3, 6, and 9 months post-operatively. TMG was used to measure contraction time (Tc) and maximal displacement (Dm) in the rectus femoris, vastus medialis, vastus lateralis, and biceps femoris. Results: Significant within-group improvements in Tc and Dm were observed across all graft types from 3 to 9 months (Tc: p < 0.001 to p = 0.02; Dm: p < 0.001 to p = 0.01). The QT group showed the most pronounced Tc reduction in RF (from 30.16 ± 2.4 ms to 15.44 ± 1.6 ms, p < 0.001) and VM (from 31.05 ± 2.6 ms to 18.65 ± 1.8 ms, p = 0.004). In contrast, HT grafts demonstrated limited Tc recovery in BF between 6 and 9 months compared to BPTB and QT (p < 0.001), indicating a stagnation phase. BPTB exhibited persistent bilateral deficits in both quadriceps and BF at 9 months. Conclusions: Autograft type significantly influences neuromuscular recovery patterns after ACLR. TMG enables objective, muscle-specific monitoring of contractile dynamics and may support future individualized rehabilitation strategies. Full article

This systematic review aimed to evaluate the effectiveness of teriparatide (TP) in guided bone regeneration (GBR). An electronic search without language or date restrictions was performed in PubMed, Web of Science, Scopus, Scielo, and gray literature for articles published until June 2025. Inclusion criteria considered studies evaluating the effect of TP on bone regeneration, analyzed using SYRCLE’s Risk of Bias tool. Twenty-four preclinical studies were included, covering diverse craniofacial models (mandibular, calvarial, extraction sockets, sinus augmentation, distraction osteogenesis, segmental defects) and employing systemic or local TP administration. Teriparatide consistently enhanced osteogenesis, graft integration, angiogenesis, and mineralization, with potentiated effects when combined with various biomaterials, including polyethylene glycol (PEG), hydroxyapatite/tricalcium phosphate (HA/TCP), biphasic calcium phosphate (BCP), octacalcium phosphate collagen (OCP/Col), enamel matrix derivatives (EMDs), autografts, allografts, xenografts (Bio-Oss), strontium ranelate, and bioactive glass. Critically, most studies presented a moderate-to-high risk of bias, with insufficient randomization, allocation concealment, and blinding, which limited the internal validity of the findings. TP shows promising osteoanabolic potential in guided bone regeneration, enhancing bone formation, angiogenesis, and scaffold integration across preclinical models. Nonetheless, its translation to clinical practice requires well-designed human randomized controlled trials to define optimal dosing strategies, long-term safety, and its role in oral and craniomaxillofacial surgical applications. Full article

Alveolar bone loss due to trauma, extraction, or periodontal disease often requires bone grafting prior to implant placement. Although human allograft bone is widely used as an alternative to autograft, it has limited osteoinductive potential and a prolonged healing time. Mesenchymal stem cell–conditioned media (MSC-CM), rich in paracrine factors, has emerged as a promising adjunct to enhance bone regeneration. This study evaluated the regenerative effect of MSC-CM combined with human allograft bone in a rabbit calvarial defect model. Bilateral 8 mm defects were created in eight rabbits. Each animal received a human allograft alone (HB group) on one side and an allograft mixed with MSC-CM (HB+GF group) on the other. Histological and histomorphometric analyses were performed at 2 and 8 weeks postoperatively. Both groups showed new bone formation, but the HB+GF group demonstrated significantly greater bone regeneration at both time points (p < 0.05). New bone extended into the defect center in the HB+GF group. Additionally, greater graft resorption and marrow formation were observed in this group at 8 weeks. These findings suggest that MSC-CM enhances the osteogenic performance of human allograft bone and may serve as a biologically active adjunct for bone regeneration. Full article

This study aimed to evaluate the effectiveness of different rehabilitation protocols following osteochondral autograft transplantation (OAT) in patients with focal osteochondral defects of the femoral condyle, using the MOCART 2.0 knee score as a primary imaging outcome. Twenty-nine patients were divided into three groups: Group 1 (n = 9) received OAT with bone marrow aspirate concentrate (BMAC) and a 12-week two-phase rehabilitation program; Group 2 (n = 11) received OAT with a 12-week program without BMAC; and Group 3 (n = 9) received OAT with a shortened 6-week program. At the 12-month follow-up, Group 1 demonstrated a superior cartilage repair quality, with the highest mean MOCART 2.0 score (96.1), compared to Group 2 (80.2) and Group 3 (71.7). Notably, complete defect filling was observed in five patients in Group 1 versus four in Group 2 and only one in Group 3. The integration and surface integrity were also better preserved in Group 1. The addition of BMAC and an extended, progressive rehabilitation protocol significantly enhanced the morphological cartilage repair parameters. These results suggest that a biologically enhanced and prolonged recovery plan may offer a greater structural restoration of cartilage after OAT than conventional or accelerated protocols. Full article

Delayed or non-healing of bone defects in an aging, multi-morbid population is still a medical challenge. Current replacement materials, like autografts, are limited. Thus, artificial substitutes from biodegradable polymers and bioactive glasses (BGs) are promising alternatives. Here, novel cerium-doped mesoporous BG microparticles (Ce-MBGs) with different cerium content were included in photocrosslinkable, methacrylated gelatin (GelMA) for promoting cellular functions of human mesenchymal stem cells (hBMSCs). The composites were studied for intrinsic morphology and Ce-MBGs distribution by scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). They were gravimetrically analyzed for swelling and stability, compressive modulus via Microsquisher^® and bioactivity by Fluitest^® calcium assay and inductively coupled plasma-optical emission spectrometry (ICP-OES), also determining silicon and cerium ion release. Finally, seeding, proliferation, and differentiation of hBMSCs was investigated. Ce-MBGs were evenly distributed within composites. The latter displayed a concentration-dependent but cerium-independent decrease in swelling, while mechanical properties were comparable. A MBG type-dependent bioactivity was shown, while an enhanced osteogenic differentiation of hBMSCs was achieved for Ce-MBG-composites and related to different ion release profiles. These findings show their strong potential in promoting bone regeneration. Still, future work is required, e.g., analyzing the expression of osteogenic genes, providing further evidence for the composites’ osteogenic effect. Full article

Cervical pyogenic spondylitis (CPS) is a rare but serious spinal infection with a high risk of neurological compromise due to the cervical spine’s narrow canal and proximity to critical neurovascular structures. Early diagnosis relies on a high index of suspicion supported by MRI, inflammatory markers, blood cultures, and tissue biopsy. Empirical intravenous antibiotics remain the cornerstone of initial treatment, followed by pathogen-specific therapy. Surgical intervention is indicated in cases of neurological deterioration, spinal instability, or failure of conservative management. Anterior approaches, including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), are widely used, with anterior plating providing biomechanical advantages in select cases. Posterior or combined anterior–posterior approaches are recommended in multilevel disease, deformity, or posterior element involvement. Graft selection—typically autograft or titanium/PEEK cages—must consider infection severity and biomechanical demands. Challenges in CPS management include optimal debridement extent, graft choice in infected environments, the standardization of antibiotic protocols, and the prevention of recurrence. This narrative review synthesizes the cervical-spine-specific literature on diagnosis, treatment strategies, surgical techniques, and postoperative care and proposes the following practical clinical guidance: (1) early MRI for timely diagnosis, (2) prompt surgical intervention in patients with neurological deficits or mechanical instability, and (3) individualized graft selection based on infection severity and bone quality. Full article

This study aimed to analyze the biomechanical differences in knees that underwent reconstruction using four-strand hamstring or bone–patellar tendon–bone autografts during the side-hop test. This case–control study included 46 participants: 18 controls, and 28 individuals who underwent reconstruction with hamstring (n = 15) or patellar (n = 13) tendons. The Theia Markerless system and Visual3D provided information on knee kinematics, namely time of contact with the ground, maximum varus and valgus angles, and flexion during maximum valgus and varus. Additionally, we assessed the activity levels of the participants pre- and post-surgery using the Tegner Activity Scale. Data analysis was conducted using ANOVA and Tukey’s post hoc test. Significant differences were observed in terms of contact time with the ground between the control and autograft groups (p = 0.025, g = −1.13; p = 0.014, g = −1.09), but not between the autograft groups. Other variables did not demonstrate statistically significant differences; however, there was a slight tendency to greater valgus in patellar autografts and greater varus with hamstring tendons. The absence of significant differences between the groups may indicate that both autografts allow knee kinematics restoration by engaging neuromuscular and proprioceptive mechanisms that compensate for anatomical alterations. Full article

Background: Medication-related osteonecrosis of the jaw (MRONJ) is drug-induced bone destruction that is exposed for a minimum of 6 to 8 weeks in patients who have not received head and neck radiotherapy and who have not been diagnosed with facial bone metastases. MRONJ treatment outcomes are unpredictable. Therefore, alternative treatment methods are being explored, such as blood-derived platelet-rich preparations enriched with growth factors, including advanced platelet-rich fibrin (A-PRF). The presence of growth factors may enhance healing and reduce post-procedure complications. There are no studies examining the effect of A-PRF on the healing of patients with MRONJ. The aim of this study was to retrospectively evaluate treatment outcomes of patients with MRONJ surgically treated without and with the use of A-PRF. Materials and methods: This retrospective study included 28 patients who suffered from osteomyelitis due to MRONJ and underwent surgical treatment between 2019 and 2024. The patients were divided into two groups: the first group received surgical treatment without A-PRF, and the second group received surgical treatment with the application of A-PRF. This study analyzed demographic and clinical data, as well as treatment outcomes. Results: The patients were aged from 43 to 82 years. The most common cause of MRONJ was the administration of zoledronic acid for oncological reasons (22 patients, 78.6%), given intravenously. In 20 patients (71.4%), the antiresorptive treatment lasted longer than three years. The obtained healing distribution was binomial (presence or absence of healing). Estimation of the probability of healing using the maximum likelihood method provided a result of approximately 64%. The probability of ten or more healed patients in the A-PRF group was 41%. A-PRF helps with a probability of 59%, and without A-PRF, it was lower. Concomitantly, the differences between the group with A-PRF and without A-PRF were not statistically significant. Conclusions: The patients with MRONJ should have regular check-ups with radiological examinations at least every six months to detect possible recurrence. Treatment for MRONJ is long and difficult. Treatment of non-advanced lesions, without additional risk factors (such as treatment with zoledronate intravenously for oncological purposes for 3 years), showed a better prognosis. Sometimes, in addition to surgery, it is necessary to consider alternative methods. A-PRF may enhance MRONJ healing. However, there is no evidence of a significant effect of A-PRF on the healing of MRONJ. Full article

Reconstruction of extensive bone defects due to age, trauma, or post-illness conditions remains challenging. Biomimetic scaffolds with osteogenic capabilities have been proposed as an alternative to the classical autograft and allograft implants. Three-dimensional scaffolds were obtained based on Ce-doped mesoporous bioactive glass (MBG) and Spongia agaricina (SA) as sacrificial templates functionalized with vitamin D₃. The study aimed to investigate the effect of vitamin D₃ functionalization on the optimal variant of a 3D scaffold doped with 3 mol% ceria, selected in our previous work based on its biological and physicochemical properties. Scanning electron microscopy (SEM) images of the non-functionalized/functionalized scaffolds revealed a porous structure with interconnected pores ranging from 100 to 350 μm. Fourier transform infrared spectroscopy (FTIR) and SEM analysis confirmed the surface functionalization. Cytotoxicity evaluation showed that all investigated scaffolds do not exhibit cytotoxicity and genotoxicity toward the Saos-2 osteosarcoma cell line. Moreover, the study demonstrated that functionalization with vitamin D₃ enhanced osteogenic activity in dental pulp stem cells (DPSCs) by increasing calcium deposition and osteocalcin secretion, as determined by Alizarin red stain and a colorimetric ELISA kit, as a result of its synergistic action with cerium ions. The results showed that the Ce-doped MBG scaffold functionalized with vitamin D₃ had the potential for applications in bone regeneration. Full article

Coronoid process fractures in the pediatric population are rare and often misdiagnosed, leading to chronic elbow instability. We aim to evaluate the surgical management of two adolescent cases of inveterate coronoid fractures using autologous bone grafting. Both patients, with a history of recurrent elbow dislocations, presented with pseudoarthrosis and were initially misdiagnosed due to minor or subtle fractures. Comprehensive imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), confirmed the presence of significant coronoid defects. The surgical intervention involved employing autografts from the iliac wing to reconstruct the coronoid process, followed by fixation with screws. Both patients underwent postoperative rehabilitation via physiotherapy, resulting in full functional recovery. At their one-year follow-ups, both patients regained full elbow function, achieving range-of-motion measurements of 0–0–130° flexion–extension and 90–0–90° pronation–supination; no recurrence of instability was reported, with no complications at the yearly follow-ups. This approach demonstrates the efficacy of autograft reconstruction in restoring elbow stability, particularly in cases with substantial bone loss or pseudoarthrosis. Our study highlights the importance of advanced imaging and individualized treatment strategies, emphasizing that early surgical intervention can prevent long-term disability in pediatric patients with chronic coronoid fractures. Full article

Arthroscopic shoulder surgery has undergone significant advancements over the past decades, transitioning from a primarily diagnostic tool to a comprehensive therapeutic approach. Technological innovations and refined surgical techniques have expanded the indications for arthroscopy, allowing minimally invasive management of shoulder instability and rotator cuff pathology. Methods: This narrative review explores the historical evolution, current trends, and future perspectives in arthroscopic shoulder surgery. Results: Key advancements in shoulder instability management include the evolution of the arthroscopic Bankart repair, the introduction of the remplissage technique for Hill–Sachs lesions, and the development of arthroscopic Latarjet procedures. Additionally, novel techniques such as Dynamic Anterior Stabilization (DAS) and bone block procedures have emerged as promising solutions for complex instability cases. In rotator cuff repair, innovations such as the suture-bridge double-row technique, superior capsular reconstruction (SCR), and biological augmentation strategies, including dermal allografts and bioinductive patches, have contributed to improving tendon healing and functional outcomes. The role of biologic augmentation, including biceps tendon autografts and subacromial bursa augmentation, is also gaining traction in enhancing repair durability. Conclusions: As arthroscopic techniques continue to evolve, the integration of biologic solutions and patient-specific surgical planning will likely define the future of shoulder surgery. This review provides a comprehensive assessment of current state-of-the-art techniques and discusses their clinical implications, with a focus on optimizing patient outcomes and minimizing surgical failure rates. Full article

Bone grafting is one of the most used surgical techniques to favor bone regeneration and repair in orthopedic procedures. Despite autografting continuing to be considered the gold standard, allogeneic bone tissues remain a viable alternative albeit in the last decades, only a few studies have been carried out to translate enhanced allogeneic bone grafts into clinical solutions. In this in vitro study, cortical allogeneic bone samples were coated with copper-doped bioactive glass 45S5 (Cu-BG) by means of the pulsed-laser deposition technique to combine the mechanical support and osteoconductive properties of human bone with the osteogenic and pro-angiogenic features of the bioactive material. Contact angle (CA), scanning electron microscopy (SEM), and atomic force microscopy (AFM) measurements were carried out to quantitatively compare the impact on the bone surface properties of the morphological changes induced by the presence of the coating. Specifically, the obtained results have shown a total absorption of the drop on the coated samples. The coating on the bone tissue surface consisted of a homogeneous Cu-BG background layer with micrometric grain-like aggregates on it—a morphological feature that can facilitate osteoblast adhesion and proliferation. Cytotoxicity and cell viability were carried out on Saos-2 osteoblast-like cells, demonstrating the biocompatibility of the novel composite bone tissue and the absence of cytotoxic residuals. Moreover, human bone marrow-derived mesenchymal stem cells (hBMSCs) were seeded on Cu-BG and not-coated (NC) samples to evaluate the bioactivity and their differentiation toward the osteogenic phenotype. Our findings showed the pro-osteogenic and pro-angiogenic potential of Cu-BG coatings, although dynamic changes were observed over time. At seven days, the Cu-BG samples exhibited significantly higher expressions of SP7, SPP1, and BGLAP genes, indicating an enhanced early osteogenic commitment. Moreover, VEGF expression was significantly increased in Cu-BG compared to the control. These results pave the way for the development of an innovative class of bone-based products distributed by tissue banks. Full article

Background/Objectives: Chronic ruptures of the quadriceps and Achilles tendons present significant reconstructive challenges due to factors such as tendon retraction, scar tissue formation, and compromised tissue quality. Traditional repair methods, including V–Y tendinoplasty, autografts, and synthetic scaffolds, often prove inadequate for large or neglected defects. Achilles tendon bone–tendon allografts have emerged as a promising alternative, offering strong fixation, biological incorporation, and sufficient length for bridging extensive gaps. This study aims to document the clinical, radiographic, and MRI outcomes of two challenging cases treated with Achilles tendon bone–tendon allografts and to synthesize these findings within the context of the existing literature to evaluate the broader viability of this reconstructive approach. Methods: An observational analysis was conducted at the Orthopedic and Traumatology Clinic of “Victor Popescu” Military Emergency Hospital in Timișoara, encompassing two patients with chronic, iterative tendon ruptures—one quadriceps tendon rupture and one Achilles tendon rupture. Both patients had previously failed primary repairs, resulting in significant tendon retraction and tissue deficits. Reconstruction was performed using Achilles tendon bone–tendon allografts, involving specific osteotomy techniques for patellar and calcaneal fixation. Postoperative protocols included immobilization followed by structured physiotherapy. Clinical assessments and MRI evaluations were conducted at 8, 12, and 24 weeks postoperatively. Additionally, a comprehensive literature review was performed to compare our findings with existing studies on Achilles bone–tendon allograft utilization in chronic tendon reconstructions. Results: Both patients exhibited substantial improvements in their range of motion and reported low pain levels at the 8- and 12-week follow-ups. MRI assessments indicated well-aligned graft fibers, early bone block integration, and the absence of complications such as re-rupture or infection in the long term. Functional recovery was achieved with complete bone block union and return to normal activities by 24 weeks. The literature review corroborated these outcomes, demonstrating that Achilles tendon bone–tendon allografts provide robust fixation and facilitate biological integration, particularly in cases with large defects and poor tissue quality. Comparative studies highlighted similar functional improvements and graft stability, reinforcing the efficacy of bone–tendon allograft constructs over traditional repair methods in chronic tendon ruptures. Conclusions: Achilles tendon bone–tendon allografts are effective in reconstructing chronic quadriceps and Achilles tendon ruptures, offering robust fixation and facilitating biological integration. These findings, supported by the existing literature, suggest that Achilles bone–tendon allografts are a viable alternative to traditional repair strategies, especially in patients with extensive tendon defects and compromised tissue quality. Further comparative studies are warranted to establish the superiority of bone–tendon allograft constructs over conventional methods. Full article

Bone defects resulting from trauma, tumors, or congenital conditions pose significant challenges for natural healing and often require grafting solutions. While autografts remain the gold standard, their limitations, such as restricted availability and donor site complications, underscore the need for alternative approaches. The present research investigates the potential of porcine-derived bone extracellular matrix (pbECM) hydrogel as a highly promising bioactive scaffold for bone regeneration, comparing it to the human-derived bECM (hbECM). Porcine and human cancellous bones were decellularized and characterized in terms of their composition and structure. Further, the ECMs were processed into hydrogels, and their rheological properties and cytocompatibility were studied in vitro while their biocompatibility was studied in vivo using a mouse model. The potential of the pbECM hydrogel as a bone graft was evaluated in vivo using a rat femoral defect model. Our results demonstrated the excellent preservation of essential ECM components in both the pbECM and hbECM with more than 90% collagen out of all proteins. Rheological analyses revealed the superior mechanical properties of the pbECM hydrogel compared to the hbECM, with an approximately 10-fold higher storage modulus and a significantly later deformation point. These stronger gel properties of the pbECM were attributed to the higher content of structural proteins and residual minerals. Both the pbECM and hbECM effectively supported mesenchymal stem cell adhesion, viability, and proliferation, achieving a 20-fold increase in cell number within 10 days and highlighting their strong bioactive potential. In vivo, pbECM hydrogels elicited a minimal immunogenic response. Most importantly, when implanted in a rat femoral defect model, pbECM hydrogel had significantly enhanced bone regeneration through graft integration, stem cell recruitment, and differentiation. New bone formation was observed at an average of 50% of the defect volume, outperforming the commercial demineralized bone matrix (DBM), in which the new bone filled only 35% of the defect volume. These results position pbECM hydrogel as a highly effective and biocompatible scaffold for bone tissue engineering, offering a promising alternative to traditional grafting methods and paving the way for future clinical applications in bone repair. Full article