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Mesenchymal stem cell (MSC)-based therapies may aid in the repair of articular cartilage defects. The purpose of this study was to investigate the effects of intraarticular injection of allogeneic MSCs in an in vivo anterior cruciate ligament transection (ACLT) model of osteoarthritis in rabbits. Allogeneic bone marrow-derived MSCs were isolated and cultured under hypoxia (1% O2). After 8 weeks following ACLT, MSCs suspended in hyaluronic acid (HA) were injected into the knees, and the contralateral knees were injected with HA alone. Additional controls consisted of a sham operation group as well as an untreated osteoarthritis group. The tissues were analyzed by macroscopic examination as well as histologic and immunohistochemical methods at 6 and 12 weeks post-transplantation. At 6 and 12 weeks, the joint surface showed less cartilage loss and surface abrasion after MSC injection as compared to the tissues receiving HA injection alone. Significantly better histological scores and cartilage content were observed with the MSC transplantation. Furthermore, engraftment of allogenic MSCs were evident in surface cartilage. Thus, injection of the allogeneic MSCs reduced the progression of osteoarthritis in vivo.

Purpose The purpose of this study was to clinically validate the Hill–Sachs interval to glenoid track width ratio (H/G ratio) compared with the instability severity index (ISI) score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair. Methods A retrospective evaluation was performed using data from patients with anteroinferior shoulder instability who underwent arthroscopic Bankart repair with a follow-up period of at least 24 months. A receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for the H/G ratio and the ISI score to predict an increased risk of recurrent instability. The area under the ROC curve (AUC) of the two methods and the sensitivity and specificity of their optimal cut-off values were compared. Results A total of 222 patients were included, among whom 31 (14.0%) experienced recurrent instability during the follow-up period. The optimal cut-off values for predicting an increased risk of recurrent instability were an H/G ratio of ≥ 0.7 and ISI score of ≥ 4. There were no significant differences between the AUC of the two methods (H/G ratio AUC = 0.821, standard error = 0.035 and ISI score AUC = 0.792, standard error = 0.04; n.s.) nor between the sensitivity and specificity of the optimal cut-off values (n.s. and n.s., respectively). Conclusions The H/G ratio is comparable to the ISI score for predicting an increased risk of recurrent instability after arthroscopic Bankart repair. Surgeons are recommended to consider other strategies to treat anterior shoulder instability if H/G ratio is ≥ 0.7. Level of evidence III.

Purpose Native Shoulder Septic Arthritis (NSSA) is uncommon, even among immunocompromised populations. Despite its rarity, clinical management remains complex, and elderly patients with multiple comorbidities may face mortality rates up to 30%. Methods We retrospectively reviewed patients under the age of 70 who were diagnosed with NSSA and received surgical treatment at a single tertiary care center between January 2009 and January 2020. Patients underwent either arthroscopic-assisted or open debridement during their hospital stay. We evaluated postoperative complications, microbiological culture results, duration of hospitalization, in-hospital mortality, 30-day readmission rate, and mid-term outcomes (minimum 5-year follow-up), including shoulder imaging and functional scores. Results A total of 20 patients (mean age: 57.8 years) were included. Arthroscopic debridement was performed in 14 cases (70%), while 6 patients (30%) underwent open debridement. Bacterial cultures yielded no growth in 11 cases (55%). Mean American Shoulder and Elbow Surgeons (ASES) scores at follow-up were: pain subscore 35.9 (SD 6.6; range 17–45), function subscore 36.4 (SD 5.9; range 21–48), and total score 72.4 (SD 12.3; range 39–93). Two patients ultimately required shoulder arthroplasty. No in-hospital or follow-up mortality was observed. Conclusions Patients with diabetes mellitus exhibited a higher likelihood of undergoing repeated irrigation procedures during hospitalization. In middle-aged individuals with NSSA, favorable long-term functional outcomes were achievable through thorough surgical debridement and appropriate antibiotic treatment. Level of evidence IV Case series.

Background Osteoarthritis (OA) is the most prevalent musculoskeletal disease worldwide. Cell-based therapies have emerged as a promising approach for OA therapy. The therapeutic potential of mesenchymal stem cells (MSCs) has been demonstrated in a wide array of inflammatory diseases. A previous study demonstrated that the injection of the allogeneic MSCs cultured under hypoxia could reduce the progression of osteoarthritis in an anterior cruciate ligament transection (ACLT) model of OA in rabbits. The possible factors involved in the therapeutic effect of hypoxic MSCs in OA were further analyzed in the current study. Methods Using the ACLT model of OA, we investigated gene expression changes in the groups of control, OA, and OA treated by hyaluronic acid (OA + HA), and additionally injected with hypoxic MSCs (OA + HA + MSC) by PCR array. Results Increased expression of TGF-β in the group treated with hypoxic MSCs was observed. Significant higher transcript and protein expressions of TGF-β were also demonstrated in cartilage treated with hypoxic MSCs. We further generated TGF-β-knockout (KO) MSCs and observed notably reduced levels of TGF-β in cartilage treated with hypoxic TGF-β KO MSCs. Immunohistochemical analysis revealed that the group treated with TGF-β KO MSCs exhibited significantly decreased type II collagen (COL II) and increased type X collagen (COL X) as compared to that treated with MSCs without TGF-β-KO. Conclusions Collectively, we suggest hypoxic MSCs might exert therapeutic effects mediated by stimulating TGF-β and subsequently promote and inhibit the expressions of COL II and COL X respectively.

Background Intra-articular tranexamic acid (TXA) has been proven effective in reducing postoperative bleeding in anterior cruciate ligament reconstruction (ACLR). We aimed to evaluate the effect of intra-articular injection of TXA with different acting times after an ACLR procedure. Patients and methods Patients receiving ACLR and intra-articular injection of TXA between September 2023 and January 2024 were randomly divided into two groups, with drainage clamped for 4 h (TXA 4 h group) or 8 h (TXA 8 h group). Postoperative drainage output was the primary outcome. The secondary outcomes included the visual analog scale (VAS), grade of hemarthrosis, and International Knee Documentation Committee (IKDC) functional score. The data of another two groups of patients (TXA 2 h group and placebo group) were retrieved from a previous study as historical control groups for subsequent analysis. Results 121 patients were included. There were no significant differences in drainage output between TXA 4 h and TXA 8 h groups. On postoperative day 3, significantly decreased grades of hemarthrosis were noted in the TXA 8 h group ( P  = 0.030). There were no significant differences in the VAS at different postoperative time points or in the IKDC scores. Comparison with the placebo and TXA 2 h groups revealed significant reduction in postoperative drainage among the TXA 4 h and 8 h groups. The IKDC scores were significantly worse in the TXA 8 h group compared with the TXA 2 h ( P  < 0.001) and placebo ( P  = 0.009) groups. Conclusions A 4 h clamping time for intra-articular TXA administration after ACLR may be considered in current practice, as it effectively reduces drainage and pain without negatively impacting functional outcomes. Level of evidence Level III, cohort study.

Purpose This study aimed to assess the clinical and radiographic healing rates of the arthroscopic all-inside wrapping repair technique for lateral meniscus bucket-handle tears (LMBHTs). Methods This retrospective study examined patients diagnosed with LMBHTs who underwent all-inside wrapping repair with or without anterior cruciate reconstruction between 2012 and 2021. Patients with previous knee surgeries, multiligamentous knee injuries, or advanced osteoarthritis were excluded. Clinical follow-up was at least 2 years. Clinical healing was defined as no reoperation of LMBHTs following initial repair and the absence of symptoms related to the LMBHT during follow-up. Postoperative clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score. At 6 months postoperatively, the healing of the repaired meniscus was evaluated using Henning’s criteria through magnetic resonance imaging (MRI). Results Of the 34 patients included, two required re-operation for a re-tear of the BHT, resulting in a clinical healing rate of 94.1% (95% confidence interval [CI]: 82.9–99.2%) at a mean follow-up of 4.2 years. Among the remaining 32 patients, the mean postoperative IKDC score was 83.7 ± 8.2 (range, 70–95). MRI evaluations at 6 months postoperatively revealed complete healing in 64.7% (22/34; 95% CI: 47.9–79.5%), partial healing in 23.5% (8/34), and failure to heal in 12.5% (4/34, including the two re-tear cases). Subgroup analyses indicated no significant difference in the IKDC scores between patients with complete healing and those with partial healing on MRI (85.5 ± 7.9 vs. 82.3 ± 8.5; p  = 0.53). Future studies with larger cohorts and stratified analyses are needed to explore potential predictors of healing outcomes. Conclusions The all-inside wrapping repair technique demonstrated favorable outcomes in patients with lateral BHTs and can be used as a viable alternative.

Background Tunnel enlargement (TE) might jeopardize knee function and ligament stability after revision surgery of anterior cruciate ligament reconstruction. To date, only few studies concern TE following posterior cruciate ligament reconstruction (PCLR). This study aims to determine TE after isolated PCLR and its relationship with patient-reported outcomes. Methods Patients who received primary isolated PCLR were screened. Femoral and tibial tunnel size was measured using an anteroposterior and lateral view of radiographs at least 6 months after surgery. TE is considered significant if the width of the bone tunnel increases by 25% over the drilled size. Patient-reported outcomes were determined using the subjective International Knee Documentation Committee (IKDC) score and the Lysholm score. The association between patient baseline characteristics, patient-reported scores, and the severity of TE was investigated. Results Fifty-four patients were enrolled. TE was observed in 15 femoral tunnels and in 14 tibial tunnels. The average TE rate is 17.9% for femur and 7.9% for tibia. No correlation between the level of TE and patient-reported outcomes is noted. However, when patients are classified into TE and non-TE group on the basis of 25% of enlargement, those who exhibit femoral TE have a lower postoperative Lysholm score (81.1 ± 13.0 vs. 90.5 ± 12.3, P  = 0.031) and those with tibial TE have a lower postoperative IKDC score (76.0 ± 17.4 vs. 87.1 ± 12.1, P  = 0.031). Conclusions The overall incidence of femoral and tibial TE after isolated PCLR is low. However, femoral and tibial TE are correlated with worse patient-reported outcomes in terms of the lower postoperative Lysholm and IKDC scores.

Treatment for musculoskeletal fibromatosis remains challenging. Surgical excision for fibromatosis is the standard therapy but recurrence remains high. Corticosteroids, an anti-fibrogenic compound, have been used to treat early stage palmar fibromatosis, but the mechanism is unknown. We investigated the inhibitory mechanism effect of corticosteroids in the murine model of fibromatosis nodule as well as in cultured FSCs. Quantitative reverse transcription/polymerase chain reaction (PCR) analysis and immunofluorescence (IF) staining for markers of myofibroblasts (α-smooth muscle actin and type III collagen) were used to examine the effect of dexamethasone on myofibroblasic differentiation of FSCs both in vitro and in vivo. Transforming growth factor-β1 (TGF-β1) signaling and its downstream targets were examined using western blot analysis. TGF-β1 expression in FSCs before and after dexamethasone treatment was compared. In addition, inhibition of TGF-β1 expression was examined using RNA interference (RNAi) on FSCs, both in vitro and in vivo. Treating FSCs with dexamethasone inhibited FSCs' myofibroblastic differentiation in vitro. Treating FSCs with dexamethasone before or after implantation further inhibited formation of fibromatosis nodules. Dexamethasone suppressed expression of TGF-β1 and pSmad2/3 by FSCs in vitro. TGF-β1 knockdown FSCs showed reducing myofibroblastic differentiation both in vitro and in vivo. Finally, addition of TGF-β1 abolished dexamethasone-mediated inhibition of myofibroblastic differentiation. Dexamethasone inhibits the myofibroblastic differentiated potential of FSCs both in vitro and in vivo through inhibition of TGF-β1 expression in FSCs. TGF-β1 plays a key role in myofibroblastic differentiation.

Adipose-derived mesenchymal stem cells (ADSCs), which tended to neurogenically differentiate spontaneously after achieving high confluence, were observed. Human ADSCs reaching 80% confluence were cultured in DMEM without an inducing factor for 24 h and then maintained in DMEM plus 1% FBS medium for 7 days. The neurogenic, adipogenic, and osteogenic genes of the factor-induced and confluence-initiated differentiation of the ADSCs and bone marrow-derived mesenchymal stem cells (BMSCs) at passages 3 to 5 were determined and compared using RT-qPCR, and the neurogenic differentiation was confirmed using immunofluorescent staining. In vitro tests revealed that the RNA and protein expression of neuronal markers, including class III β-tubulin (TUBB3), microtubule-associated protein 2 (MAP2), neurofilament medium polypeptide (NEFM), neurofilament heavy polypeptide (NEFH), and neurofilament light polypeptide (NEFL), had been enhanced in the confluence-initiated differentiation of the ADSCs. In addition, the expressions of neurotrophins, such as the nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and glial cell-derived neurotrophic factor (GDNF), were also elevated in the confluence-initiated differentiation of the ADSCs. However, the confluent ADSCs did not show a tendency toward spontaneous adipogenic and osteogenic differentiation. Moreover, compared with the confluent ADSCs, the tendency of spontaneous neurogenic, adipogenic, and osteogenic differentiation of the confluent human bone marrow mesenchymal stem cells (BMSCs) was not observed. The results indicated that ADSCs had the potential to spontaneously differentiate into neuron-like cells during the confluent culture period; however, this tendency was not observed in BMSCs.

Purpose The use of hamstring tendon autografts for anterior cruciate ligament (ACL) surgery has become more and more common. The purposes of this study were to determine whether anthropomorphic measurement correlated with tendon sizes in Chinese patient group and whether tendon sizes in Chinese and Caucasian patient groups differed. Methods From 2008 to 2009, 100 patients that received double-bundle ACL reconstruction with autologous hamstring tendons were prospectively enrolled. The original lengths and triple-folded graft diameters of the individual semitendinosus (ST) and gracilis (Gr) tendons were recorded and correlated with the anthropometric data (height, weight, body mass index, gender, thigh length, shank length, leg length and bilateral thigh circumference) of the patients. Later, using height for predictions, the original heights of patients were added to the equations previously used for regression models to compare the tendon lengths in different ethnic groups. Results After stepwise multiple linear regression analysis, the height and leg lengths showed greatest correlation with the lengths of both tendons. The lengths of both the semitendinosus and gracilis tendons in Caucasian patients were significantly longer than in the Chinese patients. Conclusions The results of this study showed that anthropomorphic measurements (height and leg length) correlated with tendon lengths. In addition, Caucasians had significantly longer hamstring tendons than the Chinese patients. Level of evidence Prospective cohort study (prevalence), Level I.