Early results of an orthoplastic multidisciplinary approach to diabetic foot ulcer soft tissue reconstruction.

Objective: Diabetic foot ulcer (DFU) is a common complication in patients with diabetes. With current treatment, only two-thirds of patients heal, with a median duration of 3-6 months. Hard-to-heal DFUs are a major source of morbidity and mortality.

Addressing the Peri-Wound Intact Skin of Hard-To-Heal Diabetic Foot Ulcers With Topical Red Deer Conditioned Media (PTT-6) Skin Conditioner: A Case Series on Clinical Efficacy.

Background And Aim: The healing of diabetic foot ulcers (DFUs) can be hindered by the susceptibility of the surrounding intact skin to pro-inflammatory proteases. A conditioned media, known as PTT-6, derived from mesenchymal stem cells found in the lining of red deer umbilical cords, has been formulated to protect the intact peri-wound skin of DFUs. The aim is to evaluate the clinical effectiveness of PTT-6 in managing peri-wound intact skin in hard-to-heal DFUs.

Single-Stage Arthroscopic Cartilage Repair With Chondrectomy and Implantation of a Templated Membrane Collagen Scaffold With Bone Marrow Aspirate Concentrate Augmentation (AMIC Plus).

Single-staged cartilage repair techniques have shown great clinical efficacy in the treatment of articular cartilage defects of the knee, particularly when using bilayered acellular scaffolds augmented with bone marrow aspirate concentrate. We describe an all-arthroscopic approach to the single-staged cartilage repair procedure using a porcine-derived collagen I/III bilayered scaffold that is templated arthroscopically and augmented with bone marrow aspirate concentrate, in the treatment of critically sized articular defects of the knee.

Small extracellular vesicles from mesenchymal stromal cells: the next therapeutic paradigm for musculoskeletal disorders.

Musculoskeletal disorders are one of the biggest contributors to morbidity and place an enormous burden on the health care system in an aging population. Owing to their immunomodulatory and regenerative properties, mesenchymal stromal/stem cells (MSCs) have demonstrated therapeutic efficacy for treatment of a wide variety of conditions, including musculoskeletal disorders. Although MSCs were originally thought to differentiate and replace injured/diseased tissues, it is now accepted that MSCs mediate tissue repair through secretion of trophic factors, particularly extracellular vesicles (EVs).

Biomaterials for meniscus and cartilage in knee surgery: state of the art.

Meniscus and cartilage injuries of the knee joint lead to cartilage degeneration and osteoarthritis (OA). The research on biomaterials and artificial implants as substitutes in reconstruction and regeneration has become a main international focus in order to solve clinical problems such as irreparable meniscus injury, postmeniscectomy syndrome, osteochondral lesions and generalised chronic OA. In this review, we provide a summary of biomaterials currently used in clinical practice as well as state-of-the-art tissue engineering strategies and technologies that are developed for articular cartilage and meniscus repair and regeneration.

Does the Choice of Acellular Scaffold and Augmentation With Bone Marrow Aspirate Concentrate Affect Short-term Outcomes in Cartilage Repair? A Systematic Review and Meta-analysis.

Background: Matrix-induced chondrogenesis (MIC) is a promising treatment option for critical-size cartilage lesions of the knee; however, there exists substantial heterogeneity in the choice of acellular scaffold matrix for MIC cartilage repairs.

Hypothesis: The choice of acellular matrix will not affect patient outcomes after MIC cartilage repair procedures, and the addition of concentrated bone marrow aspirate (cBMA) will improve short-term patient outcomes regardless of matrix choice.

Study Design: Meta-analysis; Level of evidence, 4.

Mesenchymal Stem Cell Exosomes Promote Growth Plate Repair and Reduce Limb-Length Discrepancy in Young Rats.

Background: The objective of this study was to examine the therapeutic effects of human mesenchymal stromal/stem cell (MSC) exosomes in a rat model of growth plate injury.

Methods: A growth plate defect was surgically created on the distal part of the right femur of 40 female Sprague-Dawley rats. A single intra-articular injection of 100 µg of MSC exosomes in 100 µL of phosphate-buffered saline solution (PBS), or an equivalent volume of PBS alone, was administered to the right knee immediately after surgery.

Mesenchymal Stem Cell Exosomes Promote Functional Osteochondral Repair in a Clinically Relevant Porcine Model.

Background: Previous studies have reported the efficacy of human mesenchymal stem cell (MSC) exosomes for the repair of osteochondral defects in rats and rabbits. However, the safety and efficacy of MSC exosomes remain to be validated in a clinically relevant large animal model.

Purpose: To validate the safety and efficacy of human MSC exosomes for osteochondral repair in a clinically relevant micropig model.

Securing Transplanted Meniscal Allografts Using Bone Plugs Results in Lower Risks of Graft Failure and Reoperations: A Meta-analysis.

Background: Meniscal allograft transplant (MAT) is an important treatment option for young patients with deficient menisci; however, there is a lack of consensus on the optimal method of allograft fixation.

Hypothesis: The various methods of MAT fixation have measurable and significant differences in outcomes.

Study Design: Meta-analysis; Level of evidence, 4.

Negative Pressure Wound Therapy With Instillation and Dwell Time Modifications for Lower Limb Wounds With the Waterfall Technique: A Case Series.

Background: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an integrated system that combines conventional NPWT with an irrigation feature. Wound size and location of diabetic foot wounds may make NPWTi-d utilization difficult, commonly resulting in leakages and blockages.

Objective: This study evaluates the effectiveness of a novel waterfall technique, a modification of the usual bridging used during NPWTi-d application, to facilitate the channeling of instillation fluid into diabetic foot wounds with small entry points.

Negative Pressure Wound Therapy With Instillation and Dwell Time Used to Treat a Deep Foot Abscess With a Small Plantar Surface Incision.

Introduction: Deep soft tissue wounds have a significant volume of dead space that often delays healing. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) used as an irrigation channel to manage deep cavity wounds with a tunneled opening has yet to be described to the authors' knowledge.

Case Report: The patient presented with pain and swelling of the left foot along with fever, elevated inflammatory markers, and signs of infection.

Intra-articular Injections of Mesenchymal Stem Cells Without Adjuvant Therapies for Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Background: While many reviews have been performed to attempt to provide conclusive evidence regarding the outcomes of mesenchymal stem cells (MSCs) in osteoarthritis treatment, the evidence for MSC treatment in osteoarthritis remains contentious, as these reviews have been limited by the heterogeneous evidence available.

Purpose: To pool the results of treatment using intra-articular injections of MSCs without any adjuvant therapies for osteoarthritis.

Study Design: Systematic review and meta-analysis.

Intra-Articular Injections of Mesenchymal Stem Cell Exosomes and Hyaluronic Acid Improve Structural and Mechanical Properties of Repaired Cartilage in a Rabbit Model.

Purpose: To compare the efficacy of mesenchymal stem cell (MSC) exosomes with hyaluronic acid (HA) against HA alone for functional cartilage regeneration in a rabbit osteochondral defect model.

Methods: Critical-size osteochondral defects (4.5-mm diameter and 1.

Mesenchymal Stem Cell Exosomes for Cartilage Regeneration: A Systematic Review of Preclinical Studies.

Clinical and animal studies have demonstrated efficacy of mesenchymal stem/stromal cells (MSCs) in cartilage repair. Although MSCs were originally predicated to mediate tissue repair through cellular differentiation and cell replacement, it is now recognized that MSCs exert most of their paracrine effects on tissue repair through the release of extracellular vesicles (EVs). In particular, 50-200 nm small EVs that also include exosomes carry a rich cargo of lipids, nucleic acids, and proteins, and have been reported to be therapeutically efficacious in various disease indications, including osteochondral injuries and osteoarthritis (OA).

Equivalent 10-Year Outcomes After Implantation of Autologous Bone Marrow-Derived Mesenchymal Stem Cells Versus Autologous Chondrocyte Implantation for Chondral Defects of the Knee.

Background: The use of bone marrow-derived mesenchymal stem cells (BMSCs) in cartilage repair procedures circumvents some of the limitations of autologous chondrocyte implantation (ACI), but long-term outcomes for this newer procedure are lacking. The authors previously reported comparable outcomes for the 2 procedures at 2-year follow-up.

Purpose/hypothesis: The purpose was to compare the long-term clinical outcomes of ACI versus BMSCs.

Correlations between ultrasonographic and subsequent radiographic findings of developmental dysplasia of the hips.

Purpose: The study aimed to investigate the utility of ultrasonographic findings in predicting the subsequent radiographic parameters of developmental dysplasia of the hips.

Methods: In this 12-year retrospective cohort study, all new-born infants with a positive clinical examination or risk factors were included. They were scheduled for hip ultrasonography in the first 3 months, and subsequent radiographs at 1 year of life.

Chemoprophylaxis in addition to mechanical prophylaxis after total knee arthroplasty surgery does not reduce the incidence of venous thromboembolism.

Background: Venous thromboembolism (VTE) of the lower limbs is an important complication post total knee arthroplasty (TKA). Current guidelines recommend routine chemical prophylaxis to all patients undergoing this procedure but this is rarely done in Asia as it is believed that Asians have a lower risk of VTE. However, recent evidence suggests otherwise.

The Outcomes of Isolated Lateral Release in Patellofemoral Instability: A Systematic Review and Meta-Analysis.

There have been conflicting reports regarding the outcomes of lateral release when used in the management of patellofemoral instability. This systematic review and meta-analysis therefore aims to evaluate the outcomes of isolated lateral release in the management of patellofemoral instability. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

The earliest timing of ultrasound in screening for developmental dysplasia of the hips.

Purpose: The current study aimed to evaluate the results of ultrasound screening for developmental dysplasia of the hips (DDH) done at various weeks of life, to determine the earliest time that ultrasound screening can be performed reliably.

Methods: In this 17-year cohort study, all neonates who underwent ultrasound screening prior to the 12th week of life with subsequent follow-up radiography done at 1 year of life were included. The ultrasound images were evaluated according to the Graf classification, Harcke's dynamic ultrasound screening method, and Terjesen's femoral head coverage method.