Search Results (484)

Background: Fascicular turnover flap (FTF) is a donor-sparing option for segmental facial nerve repair. This study compared autologous nerve grafting with proximally based and distally based FTF in a rat facial nerve model. Methods: Adult male Wistar rats were randomized to autograft, proximal FTF, or distal FTF (n = 8 per group). A single additional animal with an untreated defect served as a qualitative histological reference. The prespecified primary endpoint was whisker motion amplitude at week 8; the secondary endpoints were central section histomorphometry (nerve tissue area, µm²) and variability metrics (IQR, SD, and coefficient of variation) as measures of reproducibility. Non-parametric tests (Kruskal–Wallis; Mann–Whitney U) were used; pairwise functional comparisons were Holm-corrected; and effect sizes were expressed as Cliff’s δ. Results: At week 8, the overall functional comparison was significant (Kruskal–Wallis p = 0.047), but no pairwise contrast remained significant after Holm correction. Functional recovery was highest in the autograft group, followed by proximal FTF and distal FTF. Both FTF groups showed lower inter-animal variability than autograft for the week-8 functional endpoint, with the distal FTF showing the lowest dispersion. Central section nerve area comparisons did not reach global significance; effect sizes and descriptive statistics favored autograft, and a single unadjusted pairwise contrast (autograft > proximal FTF) should be interpreted cautiously. Conclusions: Both FTF configurations achieved measurable functional and structural regeneration while avoiding an additional free donor nerve graft. Within an 8-week window, autograft remained the benchmark. Between FTF variants, distal FTF produced more stable functional outcomes, but this did not translate into superior functional recovery. Confirmation in larger, balanced cohorts with longer follow-up and vascular/neural labeling is warranted. Full article

Background/Objectives: Objective, non-invasive biomarkers are needed to track anterior cruciate ligament (ACL) graft maturation and support individualized return-to-sport decisions. This study evaluated a single-session multiparametric quantitative MRI (qMRI) protocol for longitudinal assessment of ACL graft microstructural evolution and its association with patient-reported outcomes. Methods: Twenty-eight patients undergoing primary ACL reconstruction with hamstring autografts underwent multiparametric qMRI (T1, T2*, R2*, and PD mapping) at 1, 3, 6, and 12 months. The contralateral native ACL served as a within-subject control. IKDC, Lysholm, and VAS scores were recorded at each visit. Linear mixed-effects models were used to test longitudinal changes. Correlations of baseline-normalized changes between adjacent visits were used to evaluate imaging–clinical associations. Results: All qMRI parameters changed significantly over time (all p < 0.001). At 1 month, T1, PD, and T2* were lower and R2* higher than the contralateral native ACL (all p < 0.001). Thereafter, T1, PD, and T2* increased and R2* decreased, with most metrics approaching contralateral values by 3–6 months (all p < 0.05), and changes entered a plateau after 6 months (all p > 0.05). IKDC, Lysholm, and VAS improved over time (all p < 0.001), mainly before 6 months. Greater early T2* increases and R2* decreases (1–3 months) were associated with less pain relief and smaller Lysholm improvement (p < 0.05); no significant associations were observed from 6–12 months. Conclusions: Single-session multiparametric qMRI sensitively captures ACL graft maturation and highlights 3–6 months as a critical remodeling window, providing objective biomarkers to complement clinical assessment for individualized rehabilitation monitoring and return-to-sport timing. Full article

Background/Objectives: The peroneus longus tendon (PLT) is increasingly used as an autograft for anterior cruciate ligament reconstruction (ACLR). However, during PLT harvest, the necessity of distal peroneus longus-to-peroneus brevis (PL-to-PB) tenodesis for the potential preservation of donor ankle function and medial longitudinal arch alignment remains unclear. This study compared ankle function, donor-site morbidity, complications, and weight-bearing radiographic foot alignment after PLT harvest with and without distal tenodesis. Methods: Between January 2020 and December 2024, 92 primary ACLR cases using an ipsilateral PLT autograft were retrospectively screened; 60 patients with available bilateral weight-bearing comparative foot radiographs were included and categorized into a tenodesis group (n = 30) or a non-tenodesis group (n = 30). Ankle outcomes included American Orthopedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot and Foot and Ankle Disability Index (FADI) scores, ankle range of motion (ROM), and donor-site complications. Radiographic alignment was assessed using Meary’s angle and calcaneal pitch angle on bilateral weight-bearing lateral foot radiographs, including side-to-side differences. Results: Follow-up duration was comparable between groups (18.5 ± 4.4 vs. 16.8 ± 3.4 months, p = 0.113). No patient demonstrated clinically relevant loss of ankle range of motion or strength at final follow-up. AOFAS (97.3 ± 4.9 vs. 95.0 ± 5.5, p = 0.078) and FADI (96.8 ± 5.2 vs. 95.3 ± 5.5, p = 0.091) scores were similarly high in the tenodesis and non-tenodesis groups, respectively. Sural nerve sensory disturbance occurred in 6/30 (20.0%) versus 5/30 (16.7%) patients (p = 0.739), and no harvest-site infection was observed. On weight-bearing radiographs, Meary’s angle and calcaneal pitch angle did not differ significantly between groups on the operated side (Meary: 7.99 ± 6.76 vs. 4.76 ± 6.32°, p = 0.061; calcaneal pitch: 23.19 ± 5.94 vs. 21.41 ± 4.64°, p = 0.201) or intact side (Meary: 7.05 ± 6.89 vs. 5.36 ± 6.11°, p = 0.320; calcaneal pitch: 23.33 ± 5.43 vs. 22.00 ± 4.48°, p = 0.305). Side-to-side differences were small and comparable (Δ Meary: 0.94 ± 3.97 vs. −0.60 ± 3.58°, p = 0.120; Δ calcaneal pitch: −0.14 ± 3.35 vs. −0.59 ± 3.29°, p = 0.603). Conclusions: Distal PL-to-PB tenodesis did not appear to provide measurable advantages in donor-ankle patient-reported outcomes or weight-bearing radiographic foot alignment compared with no tenodesis after PLT harvest for ACLR. Full article

Background and Objectives: Burn wounds are associated with delayed healing, infection, and pathological scarring. Effective repair requires tightly regulated immune and oxidative stress responses, including macrophage polarization. This study evaluated the association of the photosensitizer Rose Bengal, delivered in a hydrogel vehicle, with macrophage polarization and oxidative stress after burn injury. Materials and Methods: Three female red Duroc pigs underwent full-thickness contact burns followed by excision and autografting. Wounds received 20% Pluronic F-127 hydrogel containing 0.1% Rose Bengal sodium, hydrogel alone, or PBS (phosphate-buffered saline) on days 1, 7, and 14 post-burn. Biopsies from days 7 and 120 were analyzed by immunohistochemistry for pan-macrophage marker, CD206 (M2 macrophages), CD3E (T-cell infiltration), and 4-hydroxynonenal (4-HNE; oxidative stress marker). Mean fluorescence intensity was analyzed using two-way ANOVA with Tukey’s post hoc test (mean ± SD, p < 0.05). Results: At day 120, Rose Bengal treatment showed higher pan-macrophage expression (0.80 ± 0.07) compared with PBS (0.62 ± 0.10; p = 0.0034), whereas the difference versus hydrogel (0.68 ± 0.07; p = 0.0628) was not significant. CD206 expression was similarly higher in Rose Bengal-treated wounds (0.77 ± 0.06) compared with PBS (0.62 ± 0.05; p = 0.0277); hydrogel also differed from PBS (p = 0.0287), without a difference between hydrogel and Rose Bengal. For CD3E, a significant main effect of treatment was observed (F(2,12) = 8.346, p = 0.0054), with lower values in Rose Bengal versus PBS at day 120 (p = 0.0360). No differences in 4-HNE were detected. Conclusions: Rose Bengal–hydrogel treatment was associated with increased macrophage presence and enhanced M2 polarization without increased T-cell infiltration. Effects were significant versus PBS but not hydrogel, suggesting Rose Bengal may contribute to a pro-regenerative immune microenvironment without excessive adaptive activation. Full article

Reconstruction of craniomaxillofacial (CMF) bony defects requires individualized strategies based on defect characteristics and graft bed biology, with traditional approaches relying on autogenous non-vascularized bone grafts or vascularized free flaps that, while reliable, are associated with donor-site morbidity and operative complexity. Biologically driven reconstructive strategies, including tissue engineering, cellular bone matrix allografts (CBMs), and growth factor adjuncts, have emerged as alternatives or complements to autograft-based reconstruction. This review introduces and details these new innovations with emphasis on the current literature, thus empowering surgeons to enhance their clinical armamentarium. Full article

Background/Objectives: With increasing survival rates following oncologic mastectomies, loss of breast sensation can negatively impact a patient’s quality of life. Methods: PubMed, Embase, and Web of Science were searched in April 2025 for studies reporting sensory outcomes after neurotized breast reconstruction. Eligible studies included patients undergoing autologous or implant-based reconstruction with any neurotization technique. Forty studies were included, and outcomes involved objective sensory testing (e.g., Semmes-Weinstein monofilaments, pressure-specified sensory devices, and thermal thresholds) and patient-reported quality of life (e.g., BREAST-Q). Results: Neurotization consistently accelerated and improved recovery of tactile, thermal, and protective sensation compared with non-neurotized controls, particularly in DIEP and TRAM flaps. Direct coaptation was most frequently employed, while nerve allografts, conduits, and autologous grafts offered effective alternatives when direct repair was not feasible. Implant-based reconstructions using allografts also demonstrated significant improvements in the nipple–areola complex and breast skin sensation. Across studies, earlier and more uniform sensory return was reported, with improved sensation often associated with high patient satisfaction and quality of life. Conclusions: The preponderance of observational evidence suggests that nerve coaptation, whether by direct suture, conduit, allograft, or autograft, represents a promising adjunct to breast reconstruction in both autologous and implant-based reconstruction. However, many studies were retrospective in design, had small sample sizes, and lacked randomization. Full article

Anterior cruciate ligament (ACL) injuries frequently lead to persistent gait asymmetries, posing challenges for early rehabilitation and functional status. Comprehensive monitoring of pelvic gait symmetry during rehabilitation remains underexplored. This study evaluated post-operative functional status using an integrated monitoring approach combining pelvic-mounted inertial measurement unit (IMU) sensors with standardized clinical assessments in 32 individuals (9 women, 23 men; aged 19–64) following ACL reconstruction with patellar tendon autografts. IMU recordings captured pelvic oscillations in the sagittal, frontal, and transverse planes during standardized 10 m walking tests, providing objective digital biomarkers of gait symmetry. Clinical assessments included knee range of motion, thigh circumference, swelling, and pain using a modified 0–20 visual analogue scale (VAS). Across the early rehabilitation period, VAS scores decreased from 13.6 to 3.0, knee swelling from 2.88 cm to 1.09 cm, knee extension deficit from −9.38° to −2.03°, and knee flexion improved from 61.56° to 98.75°. Thigh hypotrophy increased from 1.13 cm to 2.53 cm. Pelvic oscillations improved in all planes (sagittal: 36.2 to 49.2; frontal: 71.9 to 92.2; transverse: 73.4 to 90.9), reflecting progressive restoration of gait control as patients transitioned from crutch-assisted to independent walking. The integration of wearable sensor data with clinical metrics enabled sensitive tracking of pelvic gait symmetry and functional status, demonstrating the utility of technology-supported monitoring to support individualized clinical assessment and early-phase monitoring following ACL reconstruction. Full article

Large bone defects resulting from trauma, tumor resection, infection, or degenerative diseases pose a major clinical challenge in orthopedic surgery and regenerative medicine. Despite advances in biomaterials and surgical techniques, successful outcomes are often compromised by poor vascularization, limited osteoinduction, and donor-site morbidity associated with autografts or allografts. However, conventional delivery systems suffer from burst release, rapid clearance, off-target effects, and supraphysiologic dosing, which can lead to undesirable complications such as ectopic ossification and inflammation, with some reports raising concerns about the long-term tumorigenic risk. Heparin, a naturally highly sulfated glycosaminoglycan structurally related to heparan sulfate, has emerged as a particularly attractive candidate for affinity-based biomaterial systems. It naturally binds over 300 growth factors, including bone morphogenetic proteins. By protecting these proteins from enzymatic degradation, enhancing their bioavailability, and mediating receptor clustering, heparin provides both biochemical stability and biofunctional modulation. This review provides a comprehensive overview of heparin-based delivery strategies in bone tissue engineering. We begin by describing the biological functions of heparin in modulating growth factor activity. We then discuss in detail the different heparin-based biomaterials designed to sustain the release of growth factors for bone tissue engineering, including the heparin–polycation coacervate system; heparin-based supramolecules; and heparin-based hydrogels, nanoparticles, and microspheres for sustained release of bone morphogenic proteins and other growth factors for bone tissue engineering. Finally, we assess the clinical and translational relevance of heparin-based systems, identify key challenges, and outline future perspectives, highlighting the potential of these biomaterials for providing safer and more effective therapies for bone regeneration. Full article

Background: The management of bone defects in pediatric oncology represents a major challenge in orthopedics, as it requires preserving both joint function and skeletal growth. Traditional reconstructive approaches, such as autografts and allografts, are limited by availability, complications, and incomplete biological integration. In this context, xeno-hybrid bone substitutes have emerged as a promising alternative. The aim of this study was to evaluate the safety and effectiveness of SmartBone^® ORTHO in the reconstruction of post-oncological bone defects in children. Methods: Twelve pediatric patients treated at the Centro Traumatologico Ortopedico (CTO) and OIRM Hospital, AOU Città della Salute e della Scienza of Turin (Italy), between 2016 and 2019 were retrospectively analyzed. Lesions included simple and aneurysmal bone cysts, non-ossifying fibroma, chondroblastoma, and other benign conditions. All patients underwent curettage followed by defect filling with SmartBone^® ORTHO. Results: At clinical and radiological follow-up, nine patients (75%) showed stable graft integration and complete functional recovery. Three patients (25%) developed local recurrence, which was managed with revision surgery and re-implantation of SmartBone^®, with all achieving stable outcomes. Radiographs demonstrated progressive increases in bone density and trabecular thickness, reaching values comparable to those of native bone within 6–12 months. Conclusions: SmartBone^® ORTHO proved to be a safe and effective biomaterial for pediatric post-oncological bone reconstruction, promoting rapid osteointegration and physiological bone remodeling without infection or intolerance. Full article

Medial meniscus posterior root tears (MMPRTs) with focal cartilage defects present a therapeutic challenge, even in neutral-to-mild varus knees. Although transtibial pullout repair is standard for MMPRTs without advanced osteoarthritis, coexisting cartilage lesions may compromise outcomes and prompt unicompartmental knee arthroplasty (UKA). Combining pullout repair with osteochondral autograft transplantation (OAT) may offer a joint-preserving alternative by restoring meniscal hoop stress and reconstructing focal osteochondral defects. However, supporting evidence is limited. We retrospectively analyzed 150 patients treated surgically for MMPRT between 2015 and 2019, divided into three groups: pullout repair with OAT (Group O, n = 6), pullout repair alone (Group P, n = 120), and UKA (Group U, n = 24), with OAT being applied only in carefully selected patients based on strict clinical and radiographic indications. Clinical outcomes were assessed preoperatively, at 1 year, and at final follow-up (mean, 4.2–5.8 years). The primary outcome was the final clinical score, and secondary outcomes were changes from baseline. All groups improved postoperatively. Group O showed marked improvement in Knee Injury and Osteoarthritis Outcome Score—Symptom and Visual Analogue Scale—Pain score, achieving outcomes comparable to Group U at final follow-up. Group P showed consistent improvement from baseline. Radiographically, mild osteoarthritis progression was observed in Group O. Given the small sample size in Group O and the retrospective design, the findings are exploratory and warrant confirmation in larger prospective studies. Full article

Background/Objectives: Nonunion after tibiotalocalcaneal (TTC) arthrodesis remains challenging, especially in revision settings where union rates are substantially lower than in primary procedures. Biological adjuncts are commonly used to enhance healing, yet most described methods employ fibular onlay struts and cancellous autograft. To our knowledge, intramedullary placement of a fibular autograft for ankle fusion has not previously been reported. This study presents a revision of TTC arthrodesis nonunion treated with this technique and summarizes existing evidence on revision ankle arthrodesis, fibular grafting, and bone marrow aspirate concentrate (BMAC). Methods: We report a revision TTC arthrodesis nonunion managed with a decorticated intramedullary fibular autograft spanning the tibiotalar canal, supplemented with cancellous iliac crest autograft and BMAC. A review of PubMed, Scopus, and Google Scholar (search date: 1 September 2025) was performed to identify studies addressing revision ankle fusion, fibular grafting techniques, and BMAC use in foot and ankle arthrodesis. Primary outcomes included union and complications, with CT-based assessment prioritized when available. Results: At 3 months, radiographs and CT demonstrated progressive osseous bridging consistent with fusion; the patient achieved pain-free weight-bearing without complications. Conclusions: Intramedullary fibular autograft in revision TTC arthrodesis is a novel biological-mechanical strategy that leverages endosteal contact and axial stability while augmenting osteogenesis with cancellous autograft and BMAC. The review supports the biological plausibility and safety of this approach and underscores the importance of CT-based assessment. Full article

Background: Chronic Achilles tendon ruptures present a major surgical challenge due to tendon retraction, degeneration, and large defects. Autologous hamstring tendon grafts have emerged as a reliable reconstructive option, yet their biomechanical consequences remain poorly understood. This study investigated whether Achilles tendon reconstruction with semitendinosus and gracilis autografts alters the plantar flexor moment arm and whether such changes affect muscle strength. Methods: A cohort of 25 patients (mean age: 44.5 years) underwent minimally invasive endoscopic reconstruction using hamstring autografts. This secondary salvage procedure was performed in patients with neglected ruptures or failed primary treatment. Five patients were excluded from the original intervention group due to inadequate radiographic quality. Radiographic measurements of the Achilles tendon moment arm and isometric plantar flexor strength assessments were performed at 12 and 24 months postoperatively. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and correlation analyses. Results: Results showed a significant shortening of the Achilles tendon moment arm after reconstruction compared with the preoperative imaging length (mean reduction: 6.6 mm; p < 0.0001). Despite this, plantar flexor strength in the operated limb improved significantly over time at 12 and 24 months (+388.6 N at 24 months; p = 0.0067) and did not correlate with the degree of moment arm shortening (p > 0.3). By 24 months, the operated limb demonstrated comparable or greater strength than the contralateral side, with nearly half of the patients achieving substantial clinically meaningful improvements. Conclusions: In conclusion, Achilles tendon reconstruction with hamstring autografts leads to consistent moment arm shortening, yet this does not impair long-term restoration of plantar flexor strength. A progressive rehabilitation program extending up to two years appears essential to optimize recovery and compensate for biomechanical alterations. Full article

Background and Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is widely performed to restore knee stability and facilitate return to activity. However, recovery of muscle strength, balance, functional performance, and patient-reported outcomes does not occur uniformly over time. The longitudinal recovery trajectory across various functional areas during the first year after ACLR remains insufficiently characterized. Materials and Methods: We included 107 patients who underwent isolated unilateral ACLR using a hamstring autograft. Isokinetic knee extensor and flexor strength, postural stability, Y-Balance Test (YBT) performance, and subjective knee function scores were assessed post-injury (approximately six weeks after ACL injury and prior to ACLR) and at 3, 6, and 12 months postoperatively. All patients followed a standardized postoperative rehabilitation protocol. Results: Knee extensor strength deficit worsened at 3 months and remained present at 12 months. In contrast, knee flexor strength deficit decreased progressively and reached near-symmetrical values by 12 months. Sway path length decreased significantly over time in both limbs. In the operated limb, improvements plateaued after 6 months, and limb symmetry indices approached symmetry by 12 months. YBT limb symmetry indices demonstrated a non-linear recovery pattern. Anterior, posterolateral, and composite scores decreased at 3 months, recovered to post-injury levels by 6 months, and showed significant improvement at 12 months. Posteromedial reach did not decline at 3 months and improved significantly only at 12 months. Subjective knee function scores (Lysholm and IKDC) did not differ significantly between post-injury and 3-month assessments, but improved significantly from 6 months onward. Tegner activity scores gradually increased and returned to pre-injury levels by 12 months. Conclusions: Recovery after ACLR is prolonged and non-synchronous. Quadricep strength remains incompletely restored at 12 months, whereas hamstring strength recovers more favorably. Balance, functional performance, and subjective outcomes improve mainly after 6 months. These findings support the need for prolonged rehabilitation and serial, multidimensional functional assessments beyond time-based criteria. Full article

Synthetic biomaterials used as bone graft extenders (BGE) in spinal fusion surgery can supplement but do not replace autologous bone. This pilot study evaluated a calcium sulfate/hydroxyapatite (CaS/HA) material as an antibiotic-eluting BGE and a carrier for bone morphogenetic protein-2 (BMP-2) in a rabbit posterolateral lumbar (L4–L5) spinal fusion model (PLF). Pre-set CaS/HA beads were loaded with tobramycin (TOB) and tested for in vitro antibiotic release and antibacterial activity against Staphylococcus aureus. For the in vivo PLF study, CaS/HA beads were used in two treatment strategies: (1) CaS/HA + TOB + autograft (left side) and (2) CaS/HA + BMP-2 (right side). Serum levels of TOB were quantified and spinal fusion was evaluated after 12 weeks. TOB exhibited a rapid initial release, followed by a decline below detectable levels after 6 h in vitro and 48 h in vivo. TOB-loaded CaS/HA beads demonstrated in vitro antibacterial activity for 19 days. In the PLF study, 5/6 and 6/6 specimens were fused radiologically in the TOB and BMP groups, respectively, and 100% using mechanical testing. Micro-CT analysis showed no significant difference in bone volume between the TOB and BMP-2 groups (364 ± 84 vs. 479 ± 95 mm³). Histology verified continuous bone bridging in both groups. Our in vitro findings indicate that locally added TOB could protect the CaS/HA material from bacterial colonization and did not adversely impact the CaS/HA material negatively to act as BGE. The addition of low-dose BMP-2 to the CaS/HA material proved effective in building bone without the need to harvest autologous bone. In summary, this pilot PLF study demonstrates that the tested CaS/HA material combined with BMP-2 could replace autologous bone harvesting in spinal fusion surgery. Addition of TOB could potentially protect the material from bacterial colonization during the early post-operative period but further studies in infection models are warranted. Full article

Campanacci grade III giant cell tumors of the distal radius frequently require en bloc resection to achieve adequate oncologic control. Reconstruction of the resulting defect remains challenging, particularly with respect to preservation of distal radioulnar joint stability and forearm rotation. Although proximal fibular autograft reconstruction is well established, ligamentous stabilization of the distal radioulnar joint is rarely incorporated in oncologic settings. This technical note describes an integrated reconstructive strategy combining proximal fibular autograft with distal oblique bundle reconstruction, illustrated by a representative clinical case. The technique involves segmental en bloc resection of the distal radius followed by reconstruction using an ipsilateral, nonvascularized proximal fibular autograft including the fibular head. Distal radioulnar joint stability is addressed through reconstruction of the distal oblique bundle using an autologous palmaris longus tendon graft. Surgical indications, operative steps, donor site stabilization, and perioperative management are detailed. Functional evolution was assessed using the Musculoskeletal Tumor Society scoring system and range-of-motion measurements. Histopathological examination confirmed negative oncologic margins. Early postoperative events included donor-site common peroneal nerve dysfunction and radiocarpal instability requiring temporary Kirschner wire stabilization. At nine months, the Musculoskeletal Tumor Society score reached 80%, with forearm rotation preserved at 68.8% pronation and 81.3% supination of normal values. Combined osseous and ligamentous reconstruction following distal radius resection is technically feasible and may allow preservation of distal forearm mechanics while maintaining oncologic principles. Broader validation will require application in larger clinical series and longer follow-up. Full article