Search Results (399)

Introduction: Patellofemoral osteoarthritis (PFOA) remains a therapeutic challenge with few effective non-surgical options. Objective: The aim of this study was to evaluate the feasibility, safety, and preliminary outcomes of ultrasound (US)-guided tibial endplate aspiration and intra-articular injection of bone marrow concentrate (BMC) in patients with isolated PFOA. Methods: In this retrospective case series, seven consecutive patients with symptomatic PFOA unresponsive to conservative therapy were treated with US-guided tibial endplate aspiration followed by intra-articular BMC injection. Clinical outcomes were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 12 months. MRI with T2 mapping was performed to evaluate cartilage structure. BMC composition was analyzed, including colony-forming unit fibroblast (CFU-F) assays. Results: The procedures were feasible in all cases, and no adverse events occurred. WOMAC scores improved significantly from 21.7 ± 17.3 at baseline to 9.0 ± 9.3 at 12 months (p = 0.030). MRI showed a mean relative increase of 25.4% ± 43.5% in healthy cartilage volume, though this was not statistically significant (p = 0.49). Correlation analyses revealed no consistent association between clinical response and cellular composition, including estimated MSC dose. Conclusions: This small retrospective series suggests that US-guided tibial endplate aspiration and intra-articular BMC injection are safe, technically feasible, and may provide clinical benefit in isolated PFOA. Larger controlled studies are needed to confirm these preliminary findings. Full article

Thirty dogs were equally assigned to a platelet-rich plasma group (PRPG), a photobiomodulation group (PBMTG), or a combined therapies group (PRP + PBMTG). Response to treatment was evaluated with weight-bearing distribution and different owner-reported outcome measures. Evaluations were conducted at 0, +8, +15, +30, +60, +90, +120, +150, and +180 days after the initial treatment. After the first 180 days, a crossover was performed, and a second 180-day follow-up was conducted. A second cross-over was performed, with a final 180-day follow-up. Nineteen males and eleven females were included, with a mean age of 9.4 ± 2.7 years and a body weight of 26.6 ± 3.8 kg. Six hips were classified as mild, eighteen as moderate, and six as severe. All treatments were able to produce clinically significant improvements in different evaluation modalities, with varied degrees of magnitude and duration. At the last follow-up, the combination of PRP and PBMT had a greater effect, showing a significant difference compared to the isolated treatments, with a moderate to large effect size. Kaplan–Meier estimators showed that PRP + PBMTG had more extended periods with better results. PRP and PBMT could improve objective outcomes and client-reported outcome measures in dogs with OA. Their combined use leads to greater, longer-lasting, clinically significant improvements. Full article

Background and Objectives: The anesthetic nerve block test is a surgical technique that can assist in the differential diagnosis of forefoot pain. The MTP joint, enclosed by its capsule, may act as a sealed cavity with predictable contrast dispersion, whereas the IM space, lacking clear boundaries and containing bursae and the plantar digital nerve, favors diffuse spread. Due to the high rate of false positives in suspected cases of Morton’s neuroma with the anesthetic block current procedure in the intermetatarsal space, the aim of this study was to propose an alternative to the current procedure. Material and Methods: Six fresh cadaveric feet were used. Under ultrasound guidance, the 2nd–4th MTP joints received stepwise intra-articular injections of radiopaque contrast. The third common digital nerve was injected within the third intermetatarsal space. Standard radiographs were obtained to assess distribution and proximal spread. Results: A volume of 0.3 mL was sufficient to fully reach the intra-articular cavity and potentially induce effective localized anesthesia. When the third common digital plantar nerve was injected in an anatomically healthy region, the contrast medium showed a proximal diffusion pattern extending up to the mid-diaphyseal level of the third and fourth metatarsal bones. On radiographs, the intra-articular infiltration lines appear sharply demarcated, supporting the interpretation of the metatarsophalangeal joint as a sealed compartment. Conclusions: Low intra-articular anesthetic volumes may yield targeted effects, while Morton’s neuroma injections spread proximally, risking loss of diagnostic specificity; this technique may improve decision-making accuracy and reduce failures. Full article

Poly(lactic-co-glycolic acid) (PLGA) sustained-release systems for intra-articular (IA) delivery aim to extend joint residence time and reduce the reinjection frequency of conventional IA therapies. This review synthesizes current understanding of PLGA degradation, the acidic microenvironment inside degrading microspheres, and release behavior in joints, and surveys clinical experience with extended-release corticosteroid depots alongside emerging platforms for nonsteroidal and biologic agents. To situate PLGA within the broader IA field, we briefly summarize selected non-PLGA sustained-release approaches—such as multivesicular liposomes, hyaluronic acid conjugates, and hybrid matrices—to contextualize comparative performance and safety. For proteins and peptides, central barriers include acidification inside degrading microspheres, aggregation during fabrication and storage, and incomplete or delayed release, as illustrated by glucagon-like peptide-1 analog formulations. Mitigation strategies span pH buffering, excipient-based stabilization, and gentler manufacturing that improve encapsulation efficiency and preserve bioactivity. Translation hinges on manufacturing scale-up and quality systems that maintain critical particle attributes and enable informative in vitro–in vivo interpretation. Clinically, prolonged symptom relief after single dosing has been demonstrated for corticosteroid depots (e.g., ~50% pain reduction over 12 weeks with a single PLGA–triamcinolone injection), whereas repeat-dose safety and indication expansion beyond the knee remain active needs best addressed through multicenter trials incorporating imaging and patient-reported outcomes. Consistent real-world performance will depend on controlling batch-to-batch variability and implementing pharmacovigilance approaches suited to long dosing intervals, enabling broader clinical adoption. Full article

Background and Objectives: This study aimed to evaluate whether delayed intra-articular application of injectable platelet-rich fibrin (i-PRF) improves clinical and radiologic outcomes compared to nanofracture alone. Materials and Methods: A total of 76 patients with ICRS Grade III–IV femoral condyle or trochlear cartilage defects larger than 2 cm² were enrolled in this prospective controlled study. Patients were allocated into two groups: Group 1 (n = 40) underwent nanofracture followed by delayed intra-articular i-PRF injection at three weeks postoperatively, while Group 2 (n = 36) underwent nanofracture alone. Preoperative MRI was evaluated using the AMADEUS grading system. Clinical outcomes—including WOMAC and IKDC scores—were assessed at baseline and at 6, 12, and 24 months postoperatively. MOCART 2.0 scoring was used to evaluate cartilage repair at ≥12 months follow-up. Results: Both groups demonstrated significant functional improvement according to the IKDC and WOMAC scores. However, Group 1 showed a significantly greater improvement in WOMAC total score at final follow-up (Group 1: 20.1 ± 4.3 vs. control: 23.2 ± 3.4; p = 0.0008). No statistically significant differences were found between groups in IKDC score (p = 0.238), Tegner score (p = 0.776), or time to return to daily activities (p = 0.401). Baseline demographic, radiological, and intraoperative variables were comparable between groups (p > 0.05 for all). Radiologic outcomes based on the mean MOCART 2.0 scores were 57.1 and 50, respectively, in group 1 and group 2 (p = 0.0316). These results showed significantly improved results in group 1 according to the MRI evaluation. Conclusions: In patients with large chondral defects (>2 cm²), delayed intra-articular i-PRF injection following nanofracture may improve mid-term functional and radiological outcomes, particularly in pain and symptom relief. This regenerative strategy enhances cartilage repair potential during the early healing phase without adding surgical complexity. Full article

Viscosupplementation with intra-articular hyaluronic acid (HA) is a key therapeutic option for osteoarthritis (OA), yet the field is hampered by clinical controversies and an outdated classification of available products. This comprehensive review critically analyzes the current landscape, moving from a mechanical to a biological paradigm of HA’s mechanism of action. We argue that the traditional HA product classification based solely on molecular weight is insufficient, as it conflates chemically distinct products. Therefore, we propose a new, two-tiered classification framework: the primary distinction is based on chemical structure, separating linear (non-modified) HA from cross-linked (chemically modified) HA. Linear HA is then sub-classified by molecular weight (Low, Intermediate, and High), while cross-linked HA is defined as a separate category of hydrogels with a ultra-high effective molecular weight. Within this clearer framework, we analyze the central controversy between formulations, highlighting the pivotal emergence of high-concentration, high-molecular-weight (>2 million Dalton) linear HA. These formulations not only challenge the durability rationale for cross-linking by providing year-long efficacy but also possess a superior biological profile for chondroprotection, preserving chondrocyte viability and function. Furthermore, we explore the expanding frontier of combination therapies, where linear HA serves as the ideal physiological scaffold for agents like corticosteroids, PRP and other injectable orthobiologics such as bone marrow aspirate and stromal vascular fraction. Full article

Prophylactic measures and treatment strategies of implant-related bone and joint infections frequently involve the local delivery of high doses of antimicrobial drugs into the affected bone tissue or articular space in addition to the use of systemic antibiotics. Antibiotic-loaded biomaterials, such as Polymethyl Methacrylate (PMMA) cement, calcium sulfate, calcium phosphate, bioglass, and others, have proven to be clinically effective. However, they suffer from important limitations regarding elution and freedom of choice of admixable antimicrobial drugs. In order to overcome these shortcomings, the techniques of direct intraosseous or intra-articular injection/infusion of antibiotics via needles/cannulas or catheters are gaining popularity. Their attractiveness is based on the potential to achieve extremely high drug concentrations in situ, which can be maintained for as long as the catheters are left in place without increased risks of systemic toxicity. Although these methods are still in an experimental stage, reports on their clinical outcomes look promising. This articles summarizes the knowledge of when, how, and in which clinical settings the different modes and philosophies of local antibiotic delivery work best, with the aim to provide surgeons and infectious disease physicians guidance in clinical practice. This will help to optimize the use for the sake of the patients. Full article

Background/Objectives: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal conditions affecting the temporomandibular joints and masticatory muscles. In recent years, autogenous injections have been investigated as minimally invasive therapeutic options to alleviate pain and improve function. However, the clinical effectiveness of such therapies across different TMD phenotypes remains uncertain. Methods: Electronic searches were performed in MEDLINE, Embase, and Web of Science for articles published between January 2015 and May 2025. Studies involving intra-articular or intra-muscular autogenous injections in TMD patients were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Thirteen studies met the inclusion criteria. Six were randomized controlled trials (RCTs) and seven were non-randomized clinical studies. Ten studies evaluated intra-articular conditions such as disc displacement or Temporomandibular Joint (TMJ) osteoarthritis, while three focused on myofascial pain. Platelet-Rich Plasma (PRP) was the most frequently investigated agent. Most studies reported statistically significant reductions in pain and improvements in mandibular mobility following autogenous injections, with PRP generally outperforming comparators such as hyaluronic acid, corticosteroids, or saline. No serious adverse events were reported. Conclusions: All PRP and Platelet-Rich Fibrin (PRF) injection protocols reviewed were effective in reducing pain and improving mobility in patients with TMD. However, differences in protocols and follow-up times prevented a meta-analysis from being conducted. More standardized RCTs are needed to determine clear clinical guidelines. Full article

Background: Knee osteoarthritis (OA) is a leading cause of disability, with limited therapies that modify both symptoms and structural degeneration. Autologous microfragmented adipose tissue (MFAT) has emerged as a promising regenerative option, especially in phenotypically distinct OA subgroups. This randomized controlled trial evaluated the clinical and structural efficacy of intra-articular MFAT versus hyaluronic acid (HA) in patients with early to moderate inflammatory phenotype knee OA. Methods: Fifty-three patients were randomized in a 2:1 ratio to receive either MFAT (n = 35) or HA (n = 18). Patients were followed-up for six months post-injection and evaluated using patient-reported outcome measures (KOOS, WOMAC, VAS) and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC). A responder analysis defined structural response as ≥10% increase in dGEMRIC in ≥3 of 7 predefined cartilage regions. Results: Both MFAT and HA led to statistically significant improvements in clinical scores and cartilage glycosaminoglycan content. MFAT showed greater mean improvements across most clinical and dGEMRIC measures, although without reaching statistical significance, except for KOOS Symptoms (MFAT: +25.0 vs. HA: +12.7, p = 0.008). Responder-level analysis revealed that all patients who demonstrated structural response also experienced clinically meaningful pain improvement (KOOS Pain ≥ 10), while no patient showed structural benefit without parallel symptomatic relief. Conclusions: MFAT led to greater improvement in symptoms related to joint stiffness, swelling, and crepitus compared to HA, reflecting its potential benefit in targeting the inflammatory features of knee OA. Importantly, HA also led to significant clinical and structural improvements, supporting its continued role as a standard-of-care comparator in knee OA management. Furthermore, the correlation between dGEMRIC and clinical response suggests its utility as a predictive biomarker of treatment success. Full article

Background/Objectives: Knee osteoarthritis (OA) is a major cause of pain and functional disability worldwide, leading to a growing interest in more durable and less invasive therapies. Micro-fragmented adipose tissue (MFAT) injections have emerged as a promising frontier in regenerative therapies using mesenchymal stem cells (MSCs). This study assessed the safety and effectiveness of MFAT injections for symptomatic knee OA while investigating the duration of treatment effects. Methods: This longitudinal study screened patients with symptomatic Kellgren-Lawrence (KL) grade II-IV knee OA who received single-dose MFAT injections. Outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales at baseline, 3, 6, and 12 months. A linear mixed effects model was performed to explore how age, BMI, sex, and OA severity influence outcomes. Results: Among 39 evaluable patients, mean baseline KOOS was 46.5 (SD 18.1). KOOS scores improved significantly across all subscales, peaking at six months and remaining higher than baseline at 12 months. Improvements exceeded clinically meaningful thresholds, including KL grades IV. Female patients reported significantly worse overall outcomes than male patients (p < 0.05). Minor self-limiting synovitis was reported in 18% of cases, and no severe adverse events were observed. Conclusions: MFAT infiltration may represent a safe, minimally invasive option to improve symptoms and delay surgery in patients with knee OA, including those with advanced disease. These findings highlight the potential role of MFAT as part of the treatment algorithm for knee OA, although strategies to sustain long-term benefits and confirmatory trials are needed. Full article

Patellofemoral osteoarthritis (OA) and chondromalacia patellae (CMP) are common and disabling conditions that significantly affect physical performance and quality of life. Despite the great deal of scientific research on the subject, there is limited evidence regarding the outcome of nonoperative interventional procedures. Platelet-rich plasma (PRP) has demonstrated positive results for tibiofemoral knee osteoarthritis, but its role in anterior knee pain (AKP) remains unclear. The aim of this study was to review the evidence on the efficacy (clinical and radiological) and safety of PRP in patients suffering from patellofemoral OA, CMP, and AKP. Medline/Pubmed, Web of Science, and Scopus databases were systematically searched up to June 2025 to identify all the available relevant studies. Five studies, including 146 patients, fulfilled the eligibility criteria and were included in the systematic review. Although there was a statistically significant improvement in clinical setting, radiologic evidence of cartilage regeneration was limited and uncertain. Specifically, the pooled analysis revealed an improvement of the Visual Analogue Scale from 6.7 to 2.1 (p < 0.001), the Western Ontario and McMaster Universities Osteoarthritis Index score from 24 to 10.3 (p < 0.001), the Oxford score from 35.1 to 37.4 (p < 0.001), the Kujala score from 71 to 83 (p < 0.001), and the Tegner/Lysholm score from 65.3 to 86.5 (p < 0.001). Well-designed and appropriately powered randomized trials with imaging endpoints are needed to validate the efficacy of PRP administration in PFA, CMP, and AKP and refine patient selection criteria. Full article

Objective: Platelet-rich plasma (PRP) therapy has become a popular treatment for knee osteoarthritis. We aimed to determine the outcomes of knee osteoarthritis patients following PRP therapy using magnetic resonance imaging (MRI) findings and patient-reported outcome measures (PROMs). Design: In this retrospective observational cohort study, we enrolled 161 patients (221 knees) with varus knee osteoarthritis who received multiple PRP injections at our hospital from June 2017 to June 2019. Patients underwent whole-body MRI before and 6 months after treatment. Whole-organ MRI score (WORMS) cartilage integrity and synovial fluid volume were assessed for the medial femorotibial (MFTJ), lateral femorotibial (LFTJ), and patellofemoral joints (PFJ). Pain visual analog scale and Knee Injury and Osteoarthritis Outcome scores were used as PROMs. In addition, a historical control group of 30 patients with medial knee osteoarthritis who did not receive intra-articular injections was evaluated by MRI over the same period for comparison. Results: After 6 months of PRP therapy, the mean WORMS cartilage score of the LFTJ and PFJ and the total WORMS cartilage score for all three joints improved significantly, and synovial fluid volume reduced significantly. Moreover, a reduction in synovial fluid volume correlated with improvements in several KOOS subscales but not with VAS, which may explain the lack of association with responder status. These results suggest that synovial fluid reduction reflects functional improvement but is not a direct surrogate for pain relief. In addition, the change score of WORMS PFJ cartilage correlated positively with clinical outcomes in responders. By contrast, in the control group, no compartment demonstrated improvement in WORMS cartilage scores, and several compartments showed a trend toward deterioration. Conclusions: In this retrospective observational study, PRP therapy was associated with improvements in WORMS cartilage integrity scores and reductions in synovial fluid volume, with partial correlations to patient-reported outcomes. The inclusion of a historical control group strengthens the interpretation of these findings, although definitive conclusions cannot be drawn. Further randomized controlled trials are needed to confirm these preliminary observations. Full article

Intra-articular injections form a substantial element of the temporomandibular joint disorder (TMD) therapy. Given the role played by IL-1β in pathology, the use of autologous conditioned serum (ACS) is well-founded. Despite years of effective use in different locations, data regarding the intra-articular administration of ACS in TMD is scarce, and the strategy itself is not routinely applied. This study aims to provide preliminary evidence on the therapeutic efficacy of administering intra-articular ACS in treating TMD. Patients with TMD who received intra-articular ACS were included. More invasive co-interventions, such as arthroscopy, were excluded. Final searches were conducted on 17 June 2025, using five databases (ACM, BASE, DOAJ, PubMed, and SciELO). Risk of bias was evaluated using the RoB 2 tool. The results were tabulated. Only one study met the inclusion criteria. When compared to dextrose prolotherapy in internal TMD, ACS therapy resulted in greater improvement in mouth opening, pain, and joint-sound reduction. The small sample size, head-to-head design, and limited blinding suggest a highly cautious interpretation of the findings. ACS is a promising, but still experimental, therapeutic strategy addressing critical mechanisms in TMD. However, the currently available data is insufficient to confirm the effectiveness and safety of such an approach, and further high-quality studies are needed. This study received no funding. PROSPERO registration number: CRD420251069310. Full article

Osteoarthritis (OA) is a major cause of equine lameness, with few effective disease-modifying treatments. This systematic review, conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluated the efficacy of platelet-rich plasma (PRP) for equine OA by analyzing 11 studies (6 clinical, 5 experimental) identified through Web of Science, Scopus, and PubMed (2000–2024). The screening process identified 252 records, of which 136 were duplicates and 105 were excluded based on predefined criteria. The analysis showed that intra-articular PRP injections are generally safe, with transient synovial inflammation occurring mainly when PRP was activated with bovine thrombin. Both leukocyte-rich (L-PRP) and leukocyte-poor (P-PRP) formulations exhibited comparable efficacy, though optimal platelet concentrations (423–658 × 10³/μL) and dosing regimens remain undefined. A PRISMA-based quality assessment highlighted substantial variability in study design, with clinical trials constrained by small sample sizes and high risk of bias. Experimental studies confirmed PRP’s biological activity but showed inconsistencies in preparation methods. The findings indicate that PRP activation is unnecessary and may even be pro-inflammatory, that multiple injections could improve outcomes, and that reporting of cellular composition is inconsistent across studies. The PRISMA framework identified critical evidence gaps, particularly regarding long-term efficacy and protocol standardization. These results emphasize the need for PRISMA-compliant randomized controlled trials featuring standardized PRP protocols, validated outcome measures, and extended follow-up periods to establish evidence-based guidelines for managing equine OA. Full article

Early-stage knee osteoarthritis (knee OA) lacks effective regenerative therapies. This study aimed to compare the cartilage regenerative effects, clinical efficacy, and safety of intra-articular injections of autologous adipose-derived mesenchymal stem cells (ADSCs) versus hyaluronic acid (HA). Forty-eight patients with early knee OA were enrolled in a prospective open-blinded multi-center study at Suranaree University of Technology Hospital and Phramongkutklao Hospital. Participants were randomized into either the ADSC or HA group. Primary outcomes included MRI-based cartilage lesion volume, synovial thickness via ultrasound, and WOMAC scores over 6 months. MRI results revealed significant and progressive cartilage regeneration in the ADSC group. In particular, medial femoral cartilage lesion volume decreased by 50.06 mm³, whereas the HA group showed an increase of 36.44 mm³. Synovial thickness also declined significantly in the ADSC group at 3 and 6 months. Both groups demonstrated reduced symptoms, but the ADSC group achieved superior and sustained improvements in WOMAC pain, stiffness, and function scores throughout the 6-month follow-up. The clinical benefits were consistent and more pronounced compared with HA. No serious adverse events occurred. In conclusion, intra-articular ADSC injections show superior cartilage restoration on MRI and better clinical outcomes than HA injection, making them a promising treatment for early-stage knee OA. Full article