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BACKGROUND: Talus cartilage injury is a common motor system disease. This type of injury will affect the patient’s daily life and work ability, and may worsen the condition if left untreated. Surgical treatment is commonly used, but the selection of surgical methods and the evaluation of medium- and long-term follow-up results have always been difficult clinical problems. OBJECTIVE: To explore the influence of T1ρ technique on the range of quantitative evaluation of talus osteochondral injury on the choice of surgical method and the results of medium- and long-term follow-up. METHODS: A total of 154 patients with osteochondral injury of talus admitted to The Second Hospital of Tangshan from January 2019 to August 2022 were retrospectively selected as the study subjects. The lesion site of talus was examined by MRI before operation, and the T1ρ and T2 values of different types were compared. Different surgical methods were selected according to the different T1ρ values. Group A (n=73) was treated with microfracture surgery with T1ρ < 45 ms; group B (n=81) was treated with autogenous bone and cartilage transplantation with T1ρ ≥ 45 ms. The general clinical characteristics and curative effects of patients under different surgical methods were compared; the important factors of postoperative recurrence were analyzed by multivariate Logistic regression, and the relationship between T1ρ value and postoperative recurrence was analyzed by restricted cubic spline graph, y=1-1/(1+e-z) regression equation to build a prediction model. The stability of the model was verified by cross-checking method. RESULTS AND CONCLUSION: (1) Classification of talus osteochondral injury in 154 patients (type I: 36 cases; type II: 37 cases; type III: 40 cases; type IV: 41 cases), T1ρ and T2 values of the four groups were statistically significant (P < 0.05); pairwise comparison was also statistically significant (all P < 0.05). (2) After treatment of 154 patients, 7 cases (4.6%) had local swelling, 3 cases (2.0%) had pain aggravation, and 5 cases (3.3%) had wound infection. There were 2 cases (1.3%) with poor cartilage healing. (3) After treatment, there were statistically significant differences between groups A and B in terms of American Orthopaedic Foot & Ankle Society score, visual analog scale score, plantar flexor motion range, dorsoextension motion range, subchondral bone marrow edema volume, interleukin-6, interleukin-8, C-reactive protein, procalcitonin, platelet-derived growth factor, transforming growth factor-β1, and efficacy (P < 0.05). The total effective rate of group B (90%) was higher than that of group A (85%) (P < 0.05). (4) Age (OR=1.589, 95%CI: 0.305-1.252, P=0.036), interleukin-6 (OR=1.737, 95%CI: 0.974-5.254, P=0.049), interleukin-8 (OR=1.385, 95%CI: 1.066-4.355, P=0.034), C-reactive protein (OR=1.957, 95%CI: 1.323-2.178, P=0.035), transforming growth factor-β1 (OR=1.459, 95%CI: 0.897-2.455, P=0.038), T1-ρ (OR=1.687, 95%CI: 0.854-3.321, P=0.026), T2 (OR=1.843, 95%CI: 0.657- 2.454, P=0.036), complications (OR=1.719, 95%CI: 0.654-3.464, P=0.019), and classification of osteochondral injury of talus (OR=3.789, 95%CI: 1.023-5.897, P=0.028) were independent risk factors for postoperative recurrence. Microfracture surgery (OR=0.751, 95%CI: 0.321-1.264, P=0.012) and autogenous bone and cartilage grafting (OR=0.649, 95%CI: 0.246-1.356, P=0.023) were independent protective factors for recurrence after medium- and long-term follow-up. (5) When T1ρ value ≤35 ms, the risk of postoperative recurrence decreased rapidly, and when T1ρ value > 35 ms, the risk of postoperative recurrence increased rapidly. (6) Further stepwise regression analysis showed that these nine risk factors were most closely associated with postoperative recurrence, and the formula for postoperative recurrence was obtained. The probability of postoperative recurrence was calculated using the regression equation. When P=0.75, the maximum value of Jorden index was 77.728, indicating that the model has a better prediction effect. (7) It is indicated that the quantitative evaluation of T1ρ before operation can effectively guide the selection of surgical methods, improve the success rate of surgery and the quality of life of patients. [ABSTRACT FROM AUTHOR]

Objective: Knee osteoarthritis is the most common osteoarthritis and imposes a significant burden on patients' lives. Several treatment methods can promote cartilage repair to varying extents, but there are limited studies on the combined application of different treatments. The purpose of this study is to evaluate the clinical efficacy of microfracture combined with fibrinogen and platelet-rich plasma (PRP) under arthroscopic in treating knee osteoarthritis, so as to provide a basis for clinical treatment decisions. Method: A total of 113 patients with knee osteoarthritis who received orthopedic treatment from January 2021 to June 2022 were selected. They were divided into two groups according to whether they received fibrinogen and PRP treatment in addition to microfracture treatment. The two groups were analyzed to compare the differences in knee joint function and quality of life at different points. Results: The study compared changes in knee joint function scores and quality of life between the two groups after treatment and found that the quality of life of patients in the combined treatment group was significantly better than that of patients who received microfracture only (at 12-month follow-up, EuroQol-VAS scores were 64.32 ± 5.63 for the microfracture group (MFx) and 75.65 ± 8.57 for the fibrinogen combined with platelet-rich plasma-assisted microfracture group (FPRPA MFx); P = 0.015; at 24-month follow-up, EuroQol-VAS scores were 66.47 ± 5.18 for the MFx group and 79.40 ± 7.43 for the FPRPA MFx group, P = 0.022). There was also a strong correlation between patients' quality of life and knee joint function score index (IKDC score correlation coefficient r=-0.375, Lysholm score correlation coefficient r = 0.497, MOCART score correlation coefficient r = 0.579, VAS score correlation coefficient r = 0.242, T2 value correlation coefficient r=-0.293, P < 0.001). Age-stratified analysis of the patients in the microfracture combined with fibrinogen platelet-rich plasma treatment group showed that the effect of the combined treatment was more pronounced in elderly patients. Conclusions: The results of the study showed that compared with microfracture alone, microfracture combined with fibrinogen platelet-rich plasma therapy can further improve patients' knee joint-related function and their quality of life after treatment. The improvement was more obvious in elderly patients. [ABSTRACT FROM AUTHOR]

A radiographic gold standard to distinguish osteoporotic vertebral fractures (VFs) from nonosteoporotic VFs does not exist. Radiographic fracture-shaped vertebral deformity (FSVD) is common among young populations with normal bone strength. FSVD in an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely associated with compromised bone strength. For more severe grade deformities or when a vertebra is collapsed, experienced readers can make an osteoporotic VF diagnosis with a high degree of certainty. In milder cases, radiographic osteoporotic VF is often diagnosed based on a high probability rather than an absolute diagnosis. For older women, three nonadjacent minimal grade OLVFs (< 20% height loss), one minimal grade OLVF and one mild OLVF (≥ 20∼25% height loss), or one OLVF with ≥ 25% height loss meets the diagnosis of osteoporosis. For older men, a single OLVF with ≥ 33 to 40% height loss is insufficient to suggest the patient has osteoporosis. [ABSTRACT FROM AUTHOR]

Bone marrow stimulation (BMS), a procedure involving the creation of multiple channels in the greater tuberosity, is often performed alongside arthroscopic rotator cuff repair (ARCR). This study evaluated the effect of BMS on clinical and structural outcomes following ARCR. This study involved 204 patients with small, medium, and large full-thickness rotator cuff tears. In all, 103 patients who underwent BMS and ARCR made up the BMS group, while the 101 patients who only had ARCR made up the control group with randomization. Clinical and functional outcomes were assessed before and at 3 months, 6 months, 1 year, and 2 years after surgery, using parameters such as range of motion, functional scores (American Shoulder and Elbow Surgeons and Constant score), and clinical scores (Visual Analogue Scale). Tendon integrity was also examined postoperatively via ultrasound at 6 months and 2 years. There were no significant differences between the two groups concerning range of motion, functional scores (American Shoulder and Elbow Surgeons score and Constant score), and clinical score (Visual Analogue Scale) during the 2-year postsurgery period (all P >.05). Similarly, the rotator cuff retear rate, as assessed using ultrasonographic tendon integrity checks over 2 years postsurgery, did not significantly vary between the groups (all P >.05). There were no significant disparities in functional scores and clinical outcomes between the BMS and control groups. Further, no significant differences were observed in tendon integrity postsurgery. Therefore, the inclusion or exclusion of BMS is not anticipated to influence the postoperative outcome in ARCR for patients with small, medium, or large rotator cuff tears. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the effects of microfracture (MF) versus intra-articular hyaluronic acid (HA) + oral glucosamine and chondroitin sulfate (GC) in addition to MF in patients with osteoarthritic knees who underwent medial open wedge high tibial osteotomy (MOWHTO) after an average follow-up of five years. Methods: The study was designed retrospectively and included patients who underwent MOWHTO due to gonarthrosis, the MF method performed on these patients, and HA + GC treatments applied in addition to MF. Three groups consisting of 79 patients were formed: only HTO (Group 1), HTO + MF (Group 2), and HTO + MF + HA + GC (Group 3). The groups were compared using knee injury and osteoarthritis outcome score (KOOS), visual analog scale (VAS) for pain, and range of motion (ROM). The associations between the degree of correction and function and pain were evaluated. Additionally, the KOOS subparameters were compared between the groups. Results: There were significant improvements in the postoperative KOOS and VAS scores in all three groups (p < 0.05). However, the ROM did not improve in Group 1. There was no significant difference in the postoperative KOOS, VAS, or ROM values ​​between Groups 2 and 3, but these values ​​were significantly better in Groups 2 and 3 than in Group 1 (p < 0.05). When the degree of correction increased, there were no significant positive changes in the postoperative KOOS or VAS score in Group 1, unlike in the other two groups (p < 0.05). In corrections of ≥ 10°, while there was no significant difference in the postoperative KOOS or VAS score ​​between Groups 2 and 3, these parameters significantly improved in these two groups compared to Group 1 (p < 0.05). Among the KOOS subparameters, pain and activities of daily living scores ​​were greater in Groups 2 and 3 than in Group 1 (p < 0.05). Conclusions: In MOWHTO, MF is a sufficient treatment method that improves the patient's clinical condition without requiring additional treatments such as HA and GC. Level of evidence: III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Treating cartilage damage is challenging as its ability for self-regeneration is limited. Left untreated, it can progress to osteoarthritis (OA), a joint disorder characterized by the deterioration of articular cartilage and other joint tissues. Surgical options, such as microfracture and cell/tissue transplantation, have shown promise as techniques to harness the body's endogenous regenerative capabilities to promote cartilage repair. Nonetheless, these techniques have been scrutinized due to reported inconsistencies in long-term outcomes and the tendency for the defects to regenerate as fibrocartilage instead of the smooth hyaline cartilage native to joint surfaces. Orthobiologics are medical therapies that utilize biologically derived substances to augment musculoskeletal healing. These treatments are rising in popularity because of their potential to enhance surgical standards of care. More recent developments in orthobiologics have focused on the role of exosomes in articular cartilage repair. Exosomes are nano-sized extracellular vesicles containing cargo such as proteins, lipids, and nucleic acids, and are known to facilitate intercellular communication, though their regenerative potential still needs to be fully understood. This review aims to demonstrate the advancements in cartilage regeneration, highlight surgical and biological treatment options, and discuss the recent strides in understanding the precise mechanisms of action involved. [ABSTRACT FROM AUTHOR]

Purpose: Bone marrow stimulation is a common treatment for full‐thickness cartilage defects in the hip joint. However, common procedures may result in poor fibrous repair tissue and changes to the subchondral anatomy. This study investigated the clinical outcome of a cohort of International Cartilage Repair Society (ICRS) grades 3 and 4 cartilage defects treated with bone marrow stimulation compared to those who received simple debridement/chondroplasty. Methods: In this retrospective registry study, 236 patients with uni‐focal acetabular chondral lesions of the hip up to 400 mm² (mean 177.4 ± 113.4 mm²) and of ICRS grade ≥3 with follow‐up of at least 12 months (mean 33.2 ± 15.3 months) were included. Eighty‐one patients underwent bone marrow stimulation (microfracture: n = 44, abrasion: n = 37) besides treatment of the underlying pathology, 155 patients underwent defect debridement/chondroplasty. The patient‐reported outcome was measured using the International Hip Outcome Tool 33 (iHOT33) score and the Visual Analogue Scale (VAS) for pain. Results: iHOT33 and VAS both improved highly statistically significantly (p < 0.001) in the debridement group after 6, 12, 24, 36 and 60 months compared to the preoperative scores, whereas iHOT33 and VAS after microfracture or abrasion did not show statistically significant changes over time. Twenty‐four and sixty months postsurgery the debridement group revealed significant higher scores in the iHOT33 compared to the bone marrow stimulation groups. Conclusion: Patients with chondral lesions of the hip ≤400 mm2 sustainably benefit from arthroscopic debridement under preservation of the subchondral bone plate in terms of functional outcome and pain in contrast to patients treated with bone marrow stimulation. These findings discourage the currently recommended use of microfracture in the hip joint. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

While microfracture has been shown to be an effective treatment for chondral lesions in the knee, evidence to support its use for chondral defects in the shoulder is limited to short-term outcomes studies. The purpose of this study is to determine if microfracture provides pain relief and improved shoulder function in patients with isolated focal chondral defects of the humeral head at a minimum 5-year follow-up. Patients who underwent microfracture procedure for isolated focal chondral defects of the humeral head with a minimum follow-up of 5 years between 02/2006 and 08/2016 were included. At minimum 5-year follow-up, pre- and postoperative patient-reported outcome (PRO) measures were collected, including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Short Form–12 (SF-12) Physical Component Summary (PCS), Visual Analog Scale (VAS) for pain, and patient satisfaction level (1 = unsatisfied, 10 = very satisfied). Demographic, injury, and surgical data were retrospectively reviewed. Surgical failure was defined as revision surgery for humeral chondral defects or conversion to arthroplasty. Kaplan–Meier analysis was performed to determine survivorship at 5 years. A total of 17 patients met inclusion/exclusion criteria. There were 15 men and 2 women with an average age of 51 years (range 36-69) and an average follow-up of 9.4 years (range 5.0-15.8). The median ASES score improved from 62 (range: 22-88) preoperatively to 90 (range: 50-100) postoperatively (P =.011). Median satisfaction was 8 out of 10 (range: 2-10). There was no correlation between patient age or defect size and PROs. Postoperatively, patients reported significant improvements in recreational and sporting activity as well as the ability to sleep on the affected shoulder (P ≤.05). Three patients failed and required revision surgery. The Kaplan–Meier analysis determined an overall survivorship rate of 80% at 5 years. The presented study illustrates significant improvements for PROs, improved ability to perform recreational and sporting activities, and a survival rate of 80% at a mean of 9.4 years after microfracture for focal chondral humeral head defects. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to compare the early clinical and functional outcomes of two surgical interventions, microfracture and mosaicoplasty, in the treatment of medial talus osteochondral lesions (OCLs). Materials and Methods: This retrospective study included patients treated in the Department of Orthopaedics and Traumatology, Faculty of Medicine, Düzce University from January 2016 to January 2022. Patients were divided into two groups as those who underwent arthroscopic microfracture (Group 1, n=20) and those who underwent mosaicoplasty (Group 2, n=17). Preoperative and postoperative follow-up data were evaluated with visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores at baseline, 6 months and 12 months. Results: The mean age was 37.9±12.5 years in the microfracture group and 38±12.46 years in the mosaicoplasty group (p=0.981). Both groups showed significant improvement in VAS scores from baseline to the 6th and 12th months, and pain reduction was more significant in the mosaicoplasty group (p<0.001). AOFAS scores improved significantly in both groups and the mosaicoplasty group had better functional results at 12 months (p=0.069). Conclusions: Microfracture and mosaicoplasty are effective in the treatment of medial talus OCLs to reduce pain and improve clinical status in the early period. [ABSTRACT FROM AUTHOR]

Abstract Objective Knee osteoarthritis is the most common osteoarthritis and imposes a significant burden on patients’ lives. Several treatment methods can promote cartilage repair to varying extents, but there are limited studies on the combined application of different treatments. The purpose of this study is to evaluate the clinical efficacy of microfracture combined with fibrinogen and platelet-rich plasma (PRP) under arthroscopic in treating knee osteoarthritis, so as to provide a basis for clinical treatment decisions. Method A total of 113 patients with knee osteoarthritis who received orthopedic treatment from January 2021 to June 2022 were selected. They were divided into two groups according to whether they received fibrinogen and PRP treatment in addition to microfracture treatment. The two groups were analyzed to compare the differences in knee joint function and quality of life at different points. Results The study compared changes in knee joint function scores and quality of life between the two groups after treatment and found that the quality of life of patients in the combined treatment group was significantly better than that of patients who received microfracture only (at 12-month follow-up, EuroQol-VAS scores were 64.32 ± 5.63 for the microfracture group (MFx) and 75.65 ± 8.57 for the fibrinogen combined with platelet-rich plasma-assisted microfracture group (FPRPA MFx); P = 0.015; at 24-month follow-up, EuroQol-VAS scores were 66.47 ± 5.18 for the MFx group and 79.40 ± 7.43 for the FPRPA MFx group, P = 0.022). There was also a strong correlation between patients’ quality of life and knee joint function score index (IKDC score correlation coefficient r=-0.375, Lysholm score correlation coefficient r = 0.497, MOCART score correlation coefficient r = 0.579, VAS score correlation coefficient r = 0.242, T2 value correlation coefficient r=-0.293, P

Abstract Background This study aimed to compare the effects of microfracture (MF) versus intra-articular hyaluronic acid (HA) + oral glucosamine and chondroitin sulfate (GC) in addition to MF in patients with osteoarthritic knees who underwent medial open wedge high tibial osteotomy (MOWHTO) after an average follow-up of five years. Methods The study was designed retrospectively and included patients who underwent MOWHTO due to gonarthrosis, the MF method performed on these patients, and HA + GC treatments applied in addition to MF. Three groups consisting of 79 patients were formed: only HTO (Group 1), HTO + MF (Group 2), and HTO + MF + HA + GC (Group 3). The groups were compared using knee injury and osteoarthritis outcome score (KOOS), visual analog scale (VAS) for pain, and range of motion (ROM). The associations between the degree of correction and function and pain were evaluated. Additionally, the KOOS subparameters were compared between the groups. Results There were significant improvements in the postoperative KOOS and VAS scores in all three groups (p

Articular cartilage repair and regeneration is still a significant challenge despite years of research. Although microfracture techniques are commonly used in clinical practice, the newborn cartilage is usually fibrocartilage rather than hyaline cartilage, which is mainly attributed to the inadequate microenvironment for effectively recruiting, anchoring, and inducing bone marrow mesenchymal stem cells (BMSCs) to differentiate into hyaline cartilage. This paper introduces a novel cartilage acellular matrix (CACM) microgel assembly with excellent microporosity, injectability, tissue adhesion, BMSCs recruitment and chondrogenic differentiation capabilities to improve the microfracture-based articular cartilage regeneration. Specifically, the sustained release of simvastatin (SIM) from the SIM@CACM microgel assembly efficiently recruits BMSCs in the early stage of cartilage regeneration, while the abundant interconnected micropores and high specific area assure the quick adhesion, proliferation and infiltration of BMSCs. Additionally, the active factors within the CACM matrix, appropriate mechanical properties of the microgel assembly, and excellent tissue adhesion provide a conductive environment for the continuous chondrogenic differentiation of BMSCs into hyaline cartilage. Owing to the synergistic effect of the above-mentioned factors, good articular cartilage repair and regeneration is achieved.

At many quarries for the extraction of building stone there is a problem of increased output of fines after all stages of crushing and grinding, which leads to a decrease in the economic performance of mining enterprises. The fine fraction is formed by the crushing / grinding of prefractured rock mass. Reducing the intensity and size of the prefracture zones will lead to a solution to the problem at hand. To determine the effect of explosive detonation properties on the degree of structural weakening of a rock mass, studies were conducted to measure the detonation velocity, stresses generated by a blast in the rock mass, as well as laboratory studies of microfracturing by X-ray computer microtomography. The size of the prefracture zones increases from 33 to 77 charge radii with increasing the detonation velocity from 2 to 5.2 km/s. The dependence of the number of microdefects (microfractures) generated by a blast on the velocity of explosive detonation takes the form of an exponent for the near zone and is linear for the distances far from the blast. According to the data of the experiments conducted at short distances (10R), the density of induced microfracturing N is within ≈5 thousand pcs/cm3, and with increasing the detonation velocity it increases to ≈13.8 thousand pcs/cm3. At medium (40R) and long (70R) distances, N increases from ≈750 to ≈2,400 pcs/cm3 and from 0 to ≈200 pcs/cm3, respectively. Using explosives with a reduced detonation velocity allows reducing the “surplus” impact on a rock mass and thus reducing the intensity of prefracture in the zone of controlled crushing during a blast. The study allowed obtaining quantitative parameters of the intensity and size of the prefracture zones, which compose the supplement to findings of historical studies on qualitative determination of prefracture.

Abstract Dam stability is one of the most important issues in hydraulic engineering. Microfractures and damage commonly occur during impoundment, which might lead to serious dam problems. In this study, based on the engineering background of the Sanhekou hydropower station, microseismic monitoring and numerical simulation were employed to systematically investigate the microfracture and damage characteristics of the dam body. First, the microseismic monitoring system was established to capture the microfractures inside the dam. The results indicated that the rise in water level elevation has a significant effect on the microfracture and damage characteristics of the dam body, especially during the early stage of impoundment. This can be reflected by the variation in the derived source parameters, i.e., the b value, daily energy release, daily apparent stress and daily apparent volume. In addition, the failure mode of the microfractures could be determined by using the E S /E P value of microseismic events and the moment tensor inversion method. The cracking orientation of the failure surfaces could also be determined by the moment tensor inversion method. Subsequently, numerical simulation was conducted where the initial damage of the dam was considered by integrating the microseismic monitoring data. The simulation results suggested that dam deformation under impoundment considering microseismic feedback agrees well with the real field measured results. The stress level of the dam toe was larger than that of the dam heel, and both the dam toe and dam heel were under compression before impoundment. However, with increasing water level elevation, the stress status of the dam heel area changes from compression to tension. The findings in this study will provide a better understanding of the damage and failure mechanism of dams during impoundment, which might be helpful for the design and support of dams in hydropower stations.

Since the role of the menisci in knee stability, proprioception, and homeostasis has been well established, significant efforts have been made to repair meniscal tears, resulting in excellent clinical outcomes and a reduction in the progression of knee osteoarthritis (OA). However, varying failure rates have been reported, raising questions regarding the healing potential in cases of complex injuries, poorly vascularized and degenerated areas, and generally in the presence of unfavorable biological characteristics. Therefore, over the last few decades, different strategies have been described to increase the chances of meniscal healing. Biological augmentation of meniscal repair through various techniques represents a safe and effective strategy with proven clinical benefits. This approach could reduce the failure rate and expand the indications for meniscal repair. In the present study, we thoroughly reviewed the available evidence on meniscal repair surgery and summarized the main techniques that can be employed to enhance the biological healing potential of a meniscal lesion. Our aim was to provide an overview of the state of the art on meniscal repair and suggest the best techniques to reduce their failure rate. [ABSTRACT FROM AUTHOR]

Purpose: To compare the clinical efficacy and complication rates between the medial midline and anterolateral portals in ankle arthroscopy for treating medial osteochondral lesions of the talus (OLTs). Methods: We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients. Results: There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0 years, and the mean follow-up duration was 18.7 ± 6.4 months. The clinical outcomes improved significantly in both groups (*P < 0.05), but there was no significant difference between the two groups (P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups (P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group. Conclusion: The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs. [ABSTRACT FROM AUTHOR]

Purpose: Autologous matrix-induced chondrogenesis (AMIC®) and microfracture are established treatments for focal chondral defects in the knee, but there are little clinical data concerning these procedures over the long term. This study evaluates the outcomes of AMIC® compared to microfracture over 10-year follow-up. Methods: Forty-seven patients were randomized and treated either with MFx (n = 13), sutured AMIC® (n = 17) or glued AMIC® (n = 17) in a prospective, randomized, controlled multicentre trial. The Modified Cincinnati Knee Score, a visual analogue scale for pain and MOCART score were used to assess outcomes over 10 years post-operatively. Results: All treatment arms improved in the first 2 years, but a progressive and significant deterioration in scores was observed in the MFx group, while both AMIC® groups remained stable. MOCART scores were comparable between groups. Conclusion: The AMIC® procedure results in improved patient outcomes in comparison with microfracture up to 10 years following surgery for the repair of focal chondral defects in the knee. ClinicalTrials.gov Identifier: NCT02993510 [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children. Methods: This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months. Results: The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up (P <.01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm2 in area (P =.02) and from 283.2 to 185.6 mm3 in volume (P =.05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively (P =.05). Conclusion: All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes. Level of Evidence: Level IV, retrospective case-control study. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY In our study, it was aimed to evaluate the efficacy of microfracture and retrograde subchondral drilling on clinical outcomes in patients who underwent ankle arthroscopy due to osteochondral lesion of medial talus. MATERIAL AND M ETHODS Twenty eight patients with osteochondral lesion of talus less than 1.5 cm2 treated with ankle arthroscopy were evaluated retrospectively. Microfracture was performed in 16 patients and retrograde subchondral drilling was performed in 12 patients that there was no loss of integrity in the cartilage layer or cartilage layer is partially preserved during ankle arthroscopy. Postoperative evaluations of the patients were done with Foot and Ankle Ability Measure (FAAM) and results of both group were compared statistically. RESULTS The mean activities of daily living scale was 93.4±3.2 and sportive activity scale was 90.1±5.7 in the retrograde drilling group. In the micro-fracture group, mean activities of daily living scale was 93.8±4.1 and mean sportive activity scale was 88.9±9.5. No significant difference was found as a result of statistical comparisons of both groups results. DISCUSSION It has been determined that the size and preservation of the integrity of talar osteochondral lesions are important factors on clinical results. Results of arthroscopic debridement, microfracture and drilization are not good in lesions larger than 1.5 cm² and lesions with impaired integrity. In our study, depending on the general literature, osteochondral lesions in talus were less than 1.5 cm² in patients who underwent arthroscopic micro fracture and retrograde drilling. CONCLUSIONS Both microfracture and retrograde subchondral drilling are effective treatment methods with good clinical results for talar osteochondral lesions less than 1,5cm². Retrograde subchondral drilling can be an alternative treatment method with the reliability of clinical results in patients with no loss of the integrity of the cartilage layer or cartilage layer is partially preserved. [ABSTRACT FROM AUTHOR]

Chondral defects in the athlete's hip are a relatively common occurrence, often presenting with debilitating pain and activity limitation. Preoperative identification of cartilage defects is challenging and there are many different modalities for treatment. Nonsurgical interventions, including activity modification, physical therapy, and injections, play a vital role, especially in less severe cases and as adjuncts to surgical intervention. Treating surgeons must be familiar with the cartilage restoration procedures available, including debridement, microfracture, and various implantation and transplantation options. Safe and effective management of cartilage defects is imperative to an athlete's return to sport. It is also imperative that surgeons are aware of all these various treatment options to determine what modality is best for their patients. This review serves to outline these options, cover the published literature, and provide general guidelines for surgeons when they encounter chondral defects in the office and the operating room. [ABSTRACT FROM AUTHOR]

Regenerative cartilage procedures have become increasingly more important in the reconstructive treatment of acute and chronic chondral and osteochondral lesions in the knee joint. Depending on the size and depth of the defect standard methods with high evidence and potential methods with rather low evidence have been established. Long-term results determine the success and failure of the applied procedures and are being discussed in this CME article. [ABSTRACT FROM AUTHOR]

Osteochondral lesions of the talus (OLTs) are a common cause of post-traumatic ankle pain and disability. Atelocollagen-induced chondrogenesis (ACIC) aims to encourage the development of hyaline cartilage, which is biomechanically superior to fibrocartilage. This single-center, retrospective database study assessed patients who underwent arthroscopic microfracture with or without atelocollagen scaffold augmentation for OLT. Between 2010 and 2019, 87 patients underwent microfracture only and 31 patients underwent ACIC. Propensity score matching was used to match the ACIC group in a 1:2 ratio to a corresponding microfracture-only group using logistic regression. American Orthopaedic Foot & Ankle Society (AOFAS) scores, 100-mm Visual Analog Scale (VAS), Short Form-36 (SF-36), and satisfaction were assessed at preoperative, 3-, 6-, and 12-month intervals. There were no differences in baseline characteristics between groups after matching (P >.05). Both groups had similar improvements to VAS, AOFAS, and SF-36 scores up to 12 months (P >.05). Both groups had significant 1-year improvements to physical functioning, physical limitations in usual role activities, pain, and social functioning domains, but the ACIC group additionally had significant improvements to general health, vitality, and mental health. Patients in the ACIC group were also more satisfied than the microfracture group at all time points. Patients with OLTs who underwent ACIC reported superior satisfaction and improvements to quality of life, although clinical outcomes were similar to those who underwent microfracture alone at 1 year. Level of Evidence: Level III: Cohort study [ABSTRACT FROM AUTHOR]

Introduction: Articular cartilage injuries of the knee are a complex and challenging clinical pathology. Objectives: The purpose of this study was to establish consensus statements via a Delphi process on bone marrow stimulation (BMS) for knee cartilage injuries. Methods: A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Fourteen questions were generated on BMS, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement. Results: Of the 14 total questions and consensus statements on BMS developed from 3 rounds of voting, 0 achieved unanimous consensus, 3 achieved strong consensus, 4 achieved consensus, and 7 did not achieve consensus. Conclusions: The statements that achieved strong consensus related to lesion site preparation, ability to differentiate healthy/damaged cartilage, and distance between BMS holes. The statements that did not achieve consensus were primarily related to the indications for BMS, as well as the instrumentation and whether orthobiologics/scaffolds should be utilized.

Abstract Purpose This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO). Materials and methods The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and Google Scholar, covering articles published until August 31, 2023. Results Sixteen studies (1277 patients) revealed that HTO, with or without concurrent cartilage procedures, leads to cartilage regeneration based on the International Cartilage Repair Society (ICRS) grade during second-look arthroscopy. No concurrent procedure showed improvement in ICRS grade (mean difference: − 0.80 to − 0.49). Microfracture (mean difference: − 0.75 to − 0.22), bone marrow aspirate concentrate (BMAC) (mean difference: − 1.37 to − 0.67), and human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) (mean difference: − 2.46 to − 1.81) procedures also demonstrated positive outcomes. Clinical outcome assessments for each cartilage procedure were also improved during postoperative follow-up, and no specific complications were reported. Conclusions HTO with or without concurrent cartilage procedures promotes cartilage regeneration observed during second-look arthroscopy, with improved clinical outcomes. Future randomized controlled trials on the same topic, along with subsequent meta-analyses, are necessary for conclusive findings.

Abstract The Pabdeh Formation represents organic matter enrichment in some oil fields, which can be considered a source rock. This study is based on the Rock–Eval, Iatroscan, and electron microscopy imaging results before and after heating the samples. We discovered this immature shale that undergoes burial and diagenesis, in which organic matter is converted into hydrocarbons. Primary migration is the process that transports hydrocarbons in the source rock. We investigated this phenomenon by developing a model that simulates hydrocarbon generation and fluid pressure during kerogen-to-hydrocarbon conversion. Microfractures initially formed at the tip/edge of kerogen and were filled with hydrocarbons, but as catagenesis progressed, the pressure caused by the volume increase of kerogen decreased due to hydrocarbon release. The transformation of solid kerogen into low-density bitumen/oil increased the pressure, leading to the development of damage zones in the source rock. The Pabdeh Formation’s small porethroats hindered effective expulsion, causing an increase in pore fluid pressure inside the initial microfractures. The stress accumulated due to hydrocarbon production, reaching the rock’s fracture strength, further contributed to damage zone development. During the expansion process, microfractures preferentially grew in low-strength pathways such as lithology changes, laminae boundaries, and pre-existing microfractures. When the porous pressure created by each kerogen overlapped, individual microfractures interconnected, forming a network of microfractures within the source rock. This research sheds light on the complex interplay between temperature, hydrocarbon generation, and the development of expulsion fractures in the Pabdeh Formation, providing valuable insights for understanding and optimizing hydrocarbon extraction in similar geological settings.

Water plugging by grouting in rock microfracture is a technical challenge in deep underground engineering. In this paper, a novel grouting test system was developed, which can simulate microfracture grouting tests under triaxial stress conditions. A specimen preparation method that can monitor the seepage and diffusion of microfine cement slurry in microfracture was also proposed. Microfracture grouting model tests were conducted on sandstone-like specimens to investigate the effects of confining pressure, roughness, and microfracture aperture on the seepage and diffusion characteristics of sandstone-like specimens. The test results show that microfine cement slurry can effectively seal the microfracture. However, when the microfracture aperture is small or the roughness is large, the slurry is easy to gather and deposit at the inlet, resulting in the phenomenon of ''seepage filtration'', which makes it difficult for the slurry to be injected into the microfracture. The pressure at the measuring point gradually decreases along the seepage and diffusion direction of the slurry, and the decreasing trend increases with the increase of microfracture roughness. The nonlinear relationship between the slurry volume flow rate and the hydraulic gradient can be described by Forchheimer's law. Moreover, both coefficients a and b in Forchheimer's equation show a gradual increase with increasing microfracture roughness. This study can provide a meaningful reference for the development of rock microfracture grouting technology in deep engineering.

Background: Marrow stimulation is a common reparative approach to treat injuries to cartilage and other soft tissues (e.g., rotator cuff). It involves the recruitment of bone marrow elements and mesenchymal stem cells (MSCs) into the defect, theoretically initiating a regenerative process. However, the resulting repair tissue is often weak and susceptible to deterioration with time. The populations of cells at the marrow stimulation site (beyond MSCs), and their contribution to inflammation, vascularity, and fibrosis, may play a role in quality of the repair tissue. Summary: In this review, we accomplish three goals: (1) systematically review clinical trials on the augmentation of marrow stimulation and evaluate their assumptions on the biological elements recruited; (2) detail the cellular populations in bone marrow and their impact on healing; and (3) highlight emerging technologies and approaches that could better guide these specific cell populations towards enhanced cartilage or soft tissue formation. Key Messages: We found that most clinical trials do not account for cell heterogeneity, nor do they specify the regenerative element recruited, and those that do typically utilize descriptions such as “clots,” “elements,” and “blood.” Furthermore, our review of bone marrow cell populations demonstrates a dramatically heterogenous cell population, including hematopoietic cells, immune cells, fibroblasts, macrophages, and only a small population of MSCs. Finally, the field has developed numerous innovative techniques to enhance the chondrogenic potential (and reduce the anti-regenerative impacts) of these various cell types. We hope this review will guide approaches that account for cellular heterogeneity and improve marrow stimulation techniques to treat chondral defects. [ABSTRACT FROM AUTHOR]

Background: Whether arthroscopic microfracture is effective in treating cystic osteochondral lesions of the talus (OLTs) remains controversial. In this study, outcome parameters in patients with small and shallow subchondral cysts are compared to patients without cysts with the hypothesis that equivalent outcomes may be found after primary microfracture treatment. Methods: From 2018 to 2021, all 50 OLTs treated with arthroscopic microfracture in the authors' hospital were retrospectively reviewed for eligibility. Single unilateral symptomatic lesions were included and divided into the cyst and noncyst groups, whereas kissing lesions and arthritic lesions were excluded. Numeric rating scale (NRS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, Tegner activity level scores, Foot and Ankle Ability Measure (FAAM) scores, and magnetic resonance (MR) imaging results were used to describe outcomes. Results: A total of 35 patients were included, 16 in the cyst group and 19 in the noncyst group. The patient characteristics were similar between the 2 groups (P >.05). In the cyst group the average cysts depth was 5.0 ± 1.3 mm. After a mean follow-up duration of 36.2 ± 10.2 months, no significant differences were found between the 2 groups in NRS, AOFAS, FAAM, or Tegner score improvement (P >.05). Three patients (19%) in the cyst group had no NRS score improvement. Conclusion: OLTs with small and shallow subchondral cysts can be treated with arthroscopic microfracture and achieve similar outcomes as noncystic lesions. A few cystic lesions may not respond to microfracture treatment. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO). Materials and methods: The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and Google Scholar, covering articles published until August 31, 2023. Results: Sixteen studies (1277 patients) revealed that HTO, with or without concurrent cartilage procedures, leads to cartilage regeneration based on the International Cartilage Repair Society (ICRS) grade during second-look arthroscopy. No concurrent procedure showed improvement in ICRS grade (mean difference: − 0.80 to − 0.49). Microfracture (mean difference: − 0.75 to − 0.22), bone marrow aspirate concentrate (BMAC) (mean difference: − 1.37 to − 0.67), and human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) (mean difference: − 2.46 to − 1.81) procedures also demonstrated positive outcomes. Clinical outcome assessments for each cartilage procedure were also improved during postoperative follow-up, and no specific complications were reported. Conclusions: HTO with or without concurrent cartilage procedures promotes cartilage regeneration observed during second-look arthroscopy, with improved clinical outcomes. Future randomized controlled trials on the same topic, along with subsequent meta-analyses, are necessary for conclusive findings. [ABSTRACT FROM AUTHOR]

The Pabdeh Formation represents organic matter enrichment in some oil fields, which can be considered a source rock. This study is based on the Rock–Eval, Iatroscan, and electron microscopy imaging results before and after heating the samples. We discovered this immature shale that undergoes burial and diagenesis, in which organic matter is converted into hydrocarbons. Primary migration is the process that transports hydrocarbons in the source rock. We investigated this phenomenon by developing a model that simulates hydrocarbon generation and fluid pressure during kerogen-to-hydrocarbon conversion. Microfractures initially formed at the tip/edge of kerogen and were filled with hydrocarbons, but as catagenesis progressed, the pressure caused by the volume increase of kerogen decreased due to hydrocarbon release. The transformation of solid kerogen into low-density bitumen/oil increased the pressure, leading to the development of damage zones in the source rock. The Pabdeh Formation's small porethroats hindered effective expulsion, causing an increase in pore fluid pressure inside the initial microfractures. The stress accumulated due to hydrocarbon production, reaching the rock's fracture strength, further contributed to damage zone development. During the expansion process, microfractures preferentially grew in low-strength pathways such as lithology changes, laminae boundaries, and pre-existing microfractures. When the porous pressure created by each kerogen overlapped, individual microfractures interconnected, forming a network of microfractures within the source rock. This research sheds light on the complex interplay between temperature, hydrocarbon generation, and the development of expulsion fractures in the Pabdeh Formation, providing valuable insights for understanding and optimizing hydrocarbon extraction in similar geological settings. [ABSTRACT FROM AUTHOR]

Chinese medicine believes that the "kidney essence of the marrow" in the bone formation, maintain its function is very important, kidney qi deficiency is marrow reduction bone dry, bone mass reduction, osteoporosis. Knee osteoarthritis is also based on kidney essence deficiency. In recent years, modern medical research believes that osteoporosis and knee osteoarthritis are strongly related from the aspects of epidemiology, clinical symptoms and pathogenesis, and the two are often co-occurring or concomitant. Therefore, it is recommended to manage osteoporosis and knee osteoarthritis according to the co-disease mode. Based on the understanding of the correlation between osteoporosis and knee osteoarthritis in modern medical research, this paper takes the sign of “microfracture” of knee subchondral bone as the starting point to deeply explore the connection and modern connotation between “flastie” and “Bi” in the category of bone diseases in Chinese medicine. The core pathogenesis of the combined disease was summarized as “marrow reduction and bone depletion”. Clinical diagnosis should focus on the principle of “marrow reducing bone dry”, hold the whole concept, and actively take the same treatment or combined treatment of different diseases. In order to provide a new perspective of Chinese medicine for the management and prevention of the comorbidity of senile osteoporosis and knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Osteochondral lesion of the talus (OLT) is a localized cartilage and subchondral bone injury of the talus trochlea. OLT is caused by trauma and other reasons, including osteochondritis dissecans of the talus (OCD) and talus osteochondral tangential fracture. OLT can develop from being asymptomatic to subchondral bone cysts accompanied by deep ankle pain. OLT tends to occur on the medial and lateral sides of the talar vault. OLT seriously affects the patients' life and work and may even lead to disability. Herein, we reviewed advances in the treatment of OLT and the strengths and weaknesses of various treatments. Different treatment methods, including conservative treatments and surgical treatments, can be adopted according to the different subtypes or clinical symptoms of OLT. Conservative treatments mostly relieve symptoms in the short term and only slow down the disease. In recent years, it has been discovered that platelet-rich plasma injection, microfracture, periosteal bone grafting, talar cartilage transplantation, allograft bone transplantation, reverse drilling under robotic navigation, and other methods can achieve considerable benefits when each of these treatment methods is applied. Furthermore, microfracture combined with platelet-rich plasma injections, microfracture combined with cartilage transplantation, and various other treatment methods combined with anterior talofibular ligament repair have all led to good treatment outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Cartilage lesions and osteoarthritis are very prevalent and imply a significant clinical and economic burden. Objectives: To review treatments for cartilage lesions in a time life sequence and its particularities. Methods: We performed a broad PUBMED database review with a sensitive systematized strategy without restriction to article date or type. Results: This review brings us to the aspects of chondral and osteochondral lesions throughout the different age groups of patients. Focusing mainly on surgical treatment, we present here the most widely used techniques. To facilitate discussion, patients have been divided into 3 groups: children and adolescents with open physes, adults until the fifth decade, and adult patients over the fifth decade. For open physes patients, their capacity for healing is of important consideration in both conservative and operative management. In those with closed physes, most patients are treated surgically. While marrow stimulation is the most common cartilage treatment procedure, there is a growing use of other techniques such as osteochondral autograft transplantation and osteochondral allograft transplantation. Patients over 50 years old commonly present with more severe chondral lesions, which influences the treatment decision-making process. Conclusion: When attempting to optimize cartilage restoration in these 3 groups, it is important to weigh the physiologic age, the extent of the cartilage lesion, and the stage of the degenerative and osteoarthritic processes.

Background: Advancements have been made in the realm of cartilage-regenerative techniques in the past decades. However, their comparative advantage has not yet been fully studied. Objectives: To comparatively analyze the functional, radiological and histological outcomes, and complications of various procedures available for the treatment of cartilage defects. Data sources: PubMed, Embase, Web of Science, Cochrane, and Scopus. Study eligibility criteria, participants, and interventions: Randomized controlled trials reporting functional, radiological, histological outcomes, or complications of various methods were utilized in the management of cartilage defects. Patients with cartilage defects. Treatment methods include microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft/autograft transplantation (OAT), mosaicplasty, or acellular implants. Study appraisal and synthesis methods: Cochrane’s Confidence in Network meta-analysis approach. Network meta-analysis was conducted in Stata. Random effects model was used for forest plots. Results: Three thousand one hundred ninety-three patients from 54 randomized controlled trials were included in the analysis. The mean age of included patients was 37.9 (±9.46) years. MFX-I was used as a constant comparator. Among the restorative methods, OAT-II offered significantly better functional outcome at 5 years (weighted mean difference [WMD] = 16.00, 95% confidence interval [CI] [11.66, 20.34], P

The field data of shale fracturing demonstrate that the flowback performance of fracturing fluid is different from that of conventional reservoirs, where the flowback rate of shale fracturing fluid is lower than that of conventional reservoirs. At the early stage of flowback, there is no single-phase flow of the liquid phase in shale, but rather a gas-water two-phase flow, such that the single-phase flow model for tight oil and gas reservoirs is not applicable. In this study, pores and microfractures are extracted based on the experimental results of computed tomography (CT) scanning, and a spatial model of microfractures is established. Then, the influence of rough microfracture surfaces on the flow is corrected using the modified cubic law, which was modified by introducing the average deviation of the microfracture height as a roughness factor to consider the influence of microfracture surface roughness. The flow in the fracture network is simulated using the modified cubic law and the lattice Boltzmann method (LBM). The results obtained demonstrate that most of the fracturing fluid is retained in the shale microfractures, which explains the low fracturing fluid flowback rate in shale hydraulic fracturing.

Background: The utilization of decellularized extracellular matrix has gained considerable attention across numerous areas in regenerative research. Of particular interest is the human articular cartilage-derived extracellular matrix (hACECM), which presents as a promising facilitator for cartilage regeneration. Concurrently, the microfracture (MF) ​technique, a well-established marrow stimulation method, has proven efficacious in the repair of cartilage defects. However, as of the current literature review, no investigations have explored the potential of a combined application of hACECM and the microfracture technique in the repair of cartilage defects within a sheep model. Hypothesis: The combination of hACECM scaffold and microfracture will result in improved repair of full-thickness femoral condyle articular cartilage defects compared to the use of either technique alone. Study design: Controlled laboratory study. Methods: Full-thickness femoral condyle articular cartilage defect (diameter, 7.0 ​mm; debrided down to the subchondral bone plate) were created in the weight-bearing area of the femoral medial and lateral condyles (n ​= ​24). All of defected sheep were randomly divided into four groups: control, microfracture, hACECM scaffold, and hACECM scaffold ​+ ​microfracture. After 3, 6 and 12 months, the chondral repair was assessed for standardized (semi-) quantitative macroscopic, imaging, histological, immunohistochemical, mechanics, and biochemical analyses in each group. Result: At 3, 6 and 12 months after implantation, the gross view and pathological staining of regenerative tissues were better in the hACECM scaffold and hACECM scaffold ​+ ​microfracture groups than in the microfracture and control groups; Micro-CT result showed that the parameters about the calcified layer of cartilage and subchondral bone were better in the hACECM scaffold and hACECM scaffold ​+ ​microfracture groups than the others, and excessive subchondral bone proliferation in the microfracture group. The results demonstrate that human cartilage extracellular matrix scaffold alone is an efficient, safe and simple way to repair cartilage defects. Conclusion: hACECM scaffolds combined with/without microfracture facilitate chondral defect repair. The translational potential of this article: Preclinical large animal models represent an important adjunct and surrogate for studies on articular cartilage repair, while the sheep stifle joint reflects many key features of the human knee and are therefore optimal experimental model for future clinical application in human. In this study, we developed a human articular cartilage-derived extracellular matrix scaffold and to verify the viability of its use in sheep animal models. Clinical studies are warranted to further quantify the effects of hACECM scaffolds in similar settings.

Considering the action mechanisms of overpressure on physical changes in skeletal grains of deep reservoir rocks and the differences in physical changes of skeletal grains under overpressure and hydrostatic pressure, the sandstone of the Jurassic Toutunhe Formation in the southern margin of Junggar Basin was taken as an example for physical modeling experiment to analyze the action mechanisms of overpressure on the physical properties of deep reservoirs. (1) In the simulated ultra-deep layer with a burial depth of 6000–8000 m, the mechanical compaction under overpressure reduces the remaining primary pores by about a half that under hydrostatic pressure. Overpressure can effectively suppress the mechanical compaction to allow the preservation of intergranular primary pores. (2) The linear contact length ratio under overpressure is always smaller than the linear contact length ratio under hydrostatic pressure at the same depth. In deep reservoirs, the difference between the mechanical compaction degree under overpressure and hydrostatic pressure shows a decreasing trend, the effect of abnormally high pressure to resist the increase of effective stress is weakened, and the degree of mechanical compaction is gradually close to that under hydrostatic pressure. (3) The microfractures in skeletal grains of deep reservoirs under overpressure are thin and long, while the microfractures in skeletal grains of deep reservoirs under hydrostatic pressure are short and wide. This difference is attributed to the probable presence of tension fractures in the rocks containing abnormally high pressure fluid. (4) The microfractures in skeletal grains under overpressure were mainly formed later than that under hydrostatic pressure, and the development degree and length of microfractures both extend deeper. (5) The development stages of microfractures under overpressure are mainly controlled by the development stages of abnormally high pressure and the magnitude of effective stress acting on the skeletal grains. Moreover, the development stages of microfractures in skeletal grains are more than those under hydrostatic pressure in deep reservoir. The multi-stage abnormally high pressure plays an important role in improving the physical properties of deep reservoirs.

Treating cartilage damage is challenging as its ability for self-regeneration is limited. Left untreated, it can progress to osteoarthritis (OA), a joint disorder characterized by the deterioration of articular cartilage and other joint tissues. Surgical options, such as microfracture and cell/tissue transplantation, have shown promise as techniques to harness the body’s endogenous regenerative capabilities to promote cartilage repair. Nonetheless, these techniques have been scrutinized due to reported inconsistencies in long-term outcomes and the tendency for the defects to regenerate as fibrocartilage instead of the smooth hyaline cartilage native to joint surfaces. Orthobiologics are medical therapies that utilize biologically derived substances to augment musculoskeletal healing. These treatments are rising in popularity because of their potential to enhance surgical standards of care. More recent developments in orthobiologics have focused on the role of exosomes in articular cartilage repair. Exosomes are nano-sized extracellular vesicles containing cargo such as proteins, lipids, and nucleic acids, and are known to facilitate intercellular communication, though their regenerative potential still needs to be fully understood. This review aims to demonstrate the advancements in cartilage regeneration, highlight surgical and biological treatment options, and discuss the recent strides in understanding the precise mechanisms of action involved.

Fatigue fractures in materials are the main cause of approximately 80% of all material failures, and it is believed that such failures can be predicted and mathematically calculated in a reliable manner. It is possible to establish prediction modalities in cases of fatigue fractures according to three fundamental variables in fatigue, such as volume, number of fracture cycles, as well as applied stress, with the integration of Weibull constants (length characteristic). In this investigation, mechanical fatigue tests were carried out on specimens smaller than 4 mm2, made of different industrial materials. Their subsequent analysis was performed through precision computed tomography, in search for microfractures. The measurement of these microfractures, along with their metrics and classifications, was recorded. A convolutional neural network trained with deep learning was used to achieve the detection of microfractures in image processing. The detection of microfractures in images with resolutions of 480 × 854 or 960 × 960 pixels is the primary objective of this network, and its accuracy is above 95%. Images that have microfractures and those without are classified using the network. Subsequently, by means of image processing, the microfracture is isolated. Finally, the images containing this feature are interpreted using image processing to obtain their area, perimeter, characteristic length, circularity, orientation, and microfracture-type metrics. All values are obtained in pixels and converted to metric units (μm) through a conversion factor based on image resolution. The growth of microfractures will be used to define trends in the development of fatigue fractures through the studies presented. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus (OCLT) are common injuries that can be difficult to treat. To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage implantation with or without calcaneal autograft have not been compared. Methods: Thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single surgeon. Calcaneal bone graft use was determined by lesion size > 150 mm2 and/or deeper than 5 mm. Patients were evaluated using physical examination, patient interviews, and PROMs. Results: When comparing patients in regards to calcaneal bone graft implantation, no difference in age, BMI, pre-operative PROMs, or follow-up was noted, however, calcaneal bone graft patients did have a significantly larger lesion size (188.5 ± 50.9 vs. 118.7 ± 29.4 mm2 respectively; p value = 0.027). VAS and FAAM ADL scores during final follow-up improvement did not significantly differ between cohorts. The FAAM Sports score improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.032). The AOFAS score improvement did not differ between cohorts (p value = 0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting. Conclusion: While patients followed over the course of ~ 8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT®) with/without autogenous calcaneal bone graft had positive post-operative PROMs, patients without calcaneal bone graft had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear. Level of Evidence: III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Les lésions ostéochondrales du talus restent aujourd'hui un défi diagnostique et thérapeutique pour le praticien. Cet article permet la mise à jour des connaissances et traite de l'étiologie, de la présentation clinique, des modalités diagnostiques et thérapeutiques les plus récentes ainsi que des résultats escomptés chez les patients sportifs et non sportifs. Un algorithme décisionnel simple et reproductible est proposé. Osteochondral lesions of the talus remain a diagnostic and therapeutic challenge for practitioners today. This monograph provides an update on the current state of knowledge and discusses the aetiology, clinical presentation, most recent diagnostic and therapeutic modalities and expected results in sports and non-sports patients. A simple, reproducible decision-making algorithm is proposed. [ABSTRACT FROM AUTHOR]

To systematically evaluate the efficacy of arthroscopic microfracture surgery combined with platelet-rich plasma (PRP) injection in treating osteochondral lesions of talus (OLT). A computer-based search of the PubMed, EMbase, Cochrane Library was developed. The search time was dated in December 2022. Randomized controlled trials and prospective case control studies comparing the treatment of OLT with microfracture surgery combined with PRP injection and microfracture surgery alone were included. The quality of the literatures were evaluated. Meta analysis was completed using the data of postoperative pain and function scores of the ankle joint reported in the literature. Five randomized controlled trials with a total of 198 patients were included. Compared with microfracture surgery alone, meta-analysis showed that the postoperative visual analogue scale (VAS) score for ankle pain was significantly lower (P < 0.001), and the American Orthopaedic Foot and Ankle Society score (AOFAS) was significantly better (P < 0.001) in the group of microfracture surgery combined with PRP injection. The change of VAS and AOFAS was also significantly better in the group of microfracture surgery combined with PRP injection (P < 0.001). Arthroscopic microfracture surgery combined with PRP injection in treating OLT can significantly reduce pain and improve ankle function. More long-term follow-up, high-quality studies are needed. II [ABSTRACT FROM AUTHOR]

Background: The most used treatment modality for chondral lesions of the patella, particularly when the lesion is <2 cm2, is microdrilling. However, reduced working space and mobility of the patella make this procedure technically difficult. To bypass this technical difficulty, we describe a simple technique of "Push and park" for microdrilling of the chondral lesions of the patella. Materials and Methods: Patients operated on by this technique in 2021 were followed for 1 year. Patients operated for magnetic resonance imaging-proven International Cartilage Repair Society grade III and IV patellofemoral chondral lesions (PFCLs) that are localized and <2 cm2 with or without other concomitant knee pathologies were included. The functional outcomes were evaluated using the Tegner Lysholm score and Kujala score. Results: Twenty-one patients were included in the study. Of these, 7 cases had isolated PFCL, 8 cases had associated medial meniscal posterior horn root tears, and the remaining 6 cases had anterior cruciate ligament injuries. The mean follow-up period was 14 (±2) months. The average age was 41 (±7) years. We had 12 female and 9 male patients. The Tegner Lysholm and Kujala scores improved significantly in all the patients at 1-year postsurgery (P = 0.035 and P = 0.026, respectively). Conclusion: We have described a simple and reproducible technique for microdrilling of difficult-to-access patellar lesions. When used appropriately, the technique can be a cost-effective method of managing the chondral lesions of the patella. [ABSTRACT FROM AUTHOR]

There is ongoing controversy regarding the effect of bone channeling in arthroscopic rotator cuff repair. Since the most recent systematic reviews in 2019, several large high-level trials have been completed. This study assessed all available level I randomized controlled trials (RCTs) that compared arthroscopic rotator cuff repair with and without bone marrow channeling. A systematic search of the Ovid MEDLINE, Embase, and Cochrane Library databases was conducted through mid January 2023. Two reviewers performed screening of studies meeting the eligibility criteria: English-language RCTs in patients aged ≥18 years comparing arthroscopic rotator cuff repair of full-thickness tears with and without bone marrow channeling (channeling group and control group, respectively). Functional scores, pain, healing rates, and reoperations were reviewed using pooled analysis where appropriate. The methodologic quality of included studies was assessed using the Cochrane risk-of-bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 6 randomized studies (N = 593) met the inclusion criteria. Pooled analysis of all 6 studies showed no significant mean difference in function (1.32; 95% confidence interval [CI], −0.63 to 3.26), as measured by the Constant-Murley score. Retear rates were also not statistically different between groups (risk ratio, 0.99; 95% CI, 0.57 to 1.71), with pooled retear rates of 19.6% (48 of 245) with channeling and 19.8% (51 of 257) without. The other outcomes of interest were only available for analysis in a subset of studies. There were no standardized mean differences in pain (0.09; 95% CI, −0.18 to 0.36), and there were similar reoperation rates (risk ratio, 1.19; 95% CI, 0.43 to 3.34) in the channeling and control groups. For the included studies, the overall quality of evidence by outcome was judged to be moderate (function, pain, and reoperations) or low (retear rates), mainly owing to risk of bias (all outcomes) and inconsistency (retear rates). The results of this study refute the findings of prior systematic reviews that showed that channeling reduces the retear rate when combined with arthroscopic rotator cuff repair. This meta-analysis of level I evidence, including recent larger RCTs, demonstrates that bone marrow stimulation in the setting of primary arthroscopic rotator cuff repair has no significant effect on functional outcomes, healing, pain, or reoperation rates. [ABSTRACT FROM AUTHOR]