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More than 70 million adults in the United States are impacted by osteoarthritis (OA). Symptomatic articular cartilage loss that progresses to debilitating OA is being diagnosed more frequently and earlier in life, such that a growing number of active patients are faced with life-altering health care decisions at increasingly younger ages. Joint replacement surgeries, in the form of various artificial arthroplasties, are reliable operations, especially for older (≥65 years), more sedentary patients with end-stage OA, but have major limitations for younger, more active patients. For younger adults and those who wish to remain highly active, artificial arthroplasties are associated with significantly higher levels of pain, complications, morbidity, dysfunction, and likelihood of revision. Unfortunately, non-surgical management strategies and surgical treatment options other than joint replacement are often not indicated and have not proven to be consistently successful for this large and growing population of patients. As such, these patients are often relegated to postpone surgery, take medications including opioids, profoundly alter their lifestyle, and live with pain and disability until artificial arthroplasty is more likely to meet their functional demands without high risk for early revision. As such, our research team set out to develop, test, and validate biologic joint restoration strategies that could provide consistently successful options for young and active patients with joint disorders who were not considered ideal candidates for artificial arthroplasty. In pursuit of this goal, we implemented a targeted bedside-to-bench-to-bedside translational approach to hypothesis-driven studies designed to address this major unmet need in orthopaedics by identifying and overcoming key clinical limitations and obstacles faced by health care teams and patients in realizing optimal outcomes after biologic joint restoration. The objective of this article is to condense more than two decades of rigorous patient-centered research aimed at optimizing osteochondral and meniscus allograft transplantation toward more consistently successful management of complex joint problems in young and active patients., Competing Interests: Authors report the following disclosures: C.B. has no conflicts to report. C.R.C. reports the following:Arthrex, Inc: IP royalties; Paid consultant Paid presenter or speaker; Research support; Collagen Matrix Inc: IP royalties; Paid consultant; Paid presenter or speaker; Research support; Musculoskeletal Transplant Foundation: IP royalties; Paid consultant; Paid presenter or speaker; Research support. C.C. has no conflicts to report. B.D.C. reports the following:AO Trauma North America: Board or committee member; Arthrex, Inc: Other financial or material support; Curvafix: Paid consultant; Paid presenter or speaker; DePuy, A Johnson & Johnson Company: Paid presenter or speaker; Fragility Fracture Network--USA: Board or committee member; Globus Medical: IP royalties; International Geriatric Fracture Society: Board or committee member; Journal of Hip Preservation: Editorial or governing board; Journal of Orthopaedic Trauma: Editorial or governing board; KCI: Paid consultant; Paid presenter or speaker; Orthopaedic Trauma Association: Board or committee member; Osteocentric: Unpaid consultant; RomTech: Stock or stock Options; SLACK Incorporated: Editorial or governing board; Synthes: Paid consultant; Research support; Urgo Medical: Unpaid consultant. S.D.F. reports the following:AO North America: Other Professional Activities; Stryker Corporation: Other Professional Activities. C.H. reports the following:Allosource (license): IP royalties; Journal of Orthopaedic Research: Editorial or governing board; Publishing royalties, financial or material support; Musculoskeletal Transplant Foundation: Research support; Orthopedic Research & Reviews: Editorial or governing board. *J.L.C. reports the following:AANA: Research support; AO Trauma: Research support; Advanced Research Projects Agency for Health: Research support; Arthrex, Inc: IP royalties; Paid consultant; Research support; Boehringer Ingelheim: Paid consultant; Collagen Matrix Inc: Paid consultant; Research support; GE Healthcare: Research support; Journal of Knee Surgery: Editorial or governing board; Midwest Transplant Network: Board or committee member; Musculoskeletal Transplant Foundation/MTF Biologics: Board or committee member; IP royalties; Research support; National Institutes of Health (NIAMS & NICHD): Research support; OREF: Research support; PCORI: Research support; Thieme: Publishing royalties, financial or material support; Trupanion: Paid consultant; U.S. Department of Defense: Research support. K.K. has no conflicts to report. M.J.S. reports the following:American Shoulder and Elbow Surgeons: Board or committee member; Current Orthopedic Practice: Editorial or governing board; DePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker; Ignite Orthopedics: IP royalties; Stock or stock Options. C.N. reports the following:AAOS: Board or committee member; American Orthopaedic Society for Sports Medicine: Board or committee member; AO Foundation: Other financial or material support; Arthrex, Inc: Paid presenter or speaker; Arthroscopy: Editorial or governing board; Publishing royalties, financial or material support; Arthroscopy Association of North America: Board or committee member; Guidepoint Consulting: Paid consultant; Vericel, Inc.: Paid presenter or speaker. L.R. has no conflicts to report. K.R. reports the following:National Institutes of Health: Other Professional Activities; Advanced Research Projects Agency for Health: Other Professional Activities. K.S. reports the following:AAOS: Board or committee member; AO North America: Board or committee member Arthrex, Inc: Paid presenter or speaker; Research support; CarboFix: Stock or stock Options; Johnson & Johnson: Paid consultant; Paid presenter or speaker; ODi: IP royalties; Orthopaedic Trauma Association: Board or committee member. J.P.S. reports the following:Arthrex, Inc: Paid consultant; Research support, DePuy, A Johnson & Johnson Company: Paid consultant; Journal of Knee Surgery: Editorial or governing board; National Institutes of Health (NIAMS & NICHD): Research support; Orthopedic Designs North America: Paid consultant; Smith & Nephew: Paid consultant; Thieme: Publishing royalties, financial or material support; U.S. Department of Defense: Research support. A.M.S. reports the following:IP royalties from the Musculoskeletal Transplant Foundation. R.S. has no conflicts to report. *Note: Authors James L. Cook and Cristi R. Cook are husband and wife., (Thieme. All rights reserved.)

Synovial lipomatosis is an uncommon, intra-articular, fat-containing, proliferative lesion with unknown etiology that is rarely reported in dogs. A retrospective study spanning 13 years was conducted to search for cases of canine synovial lipomatosis. Among 188 synovial biopsies of major diarthrodial joints (ie, shoulder, elbow, carpus, hip, stifle, and tarsus) from 186 dogs, 4 cases (2.1%) of synovial lipomatosis were identified. One case occurred in a stifle with chronic lateral patellar luxation. The other 3 cases had microscopic evidence of synovitis (eg, synovial hyperplasia, lymphoplasmacytic infiltrates, hemosiderin-laden macrophages, myxomatous changes, fibrosis, and increased vascularity) but lacked a clinical history of arthritis. Immunohistochemistry for HMGA2 was negative, suggesting canine synovial lipomatosis is a non-neoplastic proliferative lesion, yet the cause remains unknown., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.