Studies have shown that various types of spine surgery can be a contributing factor in bone loss, but the influence of lateral lumbar interbody fusion (LIF) on postoperative bone loss remains unclear.

The most common cancer in women worldwide, breast cancer most often metastasizes to the bone. Improved chemo- and radiotherapies and novel molecular therapies have prolonged survival in women with osseous metastatic breast cancer, but spinal metastases often cause cord compression that degrades their functional independence.

Decreasing wound healing complications is important for total joint arthroplasty. 2-Octyl cyanoacrylate with polymer mesh tape (2OPMT) is a skin closure system that works by combining a liquid adhesive with a polymer mesh to form a waterproof microbial barrier over surgical wounds. However, allergic contact dermatitis (ACD) has been a reported complication of 2OPMT use, with an incidence ranging from 0.5% to 2.5%.

Anterior cruciate ligament (ACL) tears are common and often devastating injuries among elite athletes. While interest in ACL preservation has highlighted the importance of ACL tear location to treatment decision-making, there is limited data on ACL tear location in elite athletes.

Piriformis syndrome (PS) is a sciatic nerve entrapment condition caused by compression by the piriformis muscle, often presenting with symptoms that mimic lumbar radiculopathy and gluteal and buttock pain. This narrative review explores its diagnostic challenges and highlights the role of advanced imaging techniques in improving diagnostic accuracy. Literature suggests that PS may account for 5% to 8% of low back pain cases, frequently manifesting as buttock pain exacerbated by sitting or hip motion. Traditional imaging often fails to detect PS due to nonspecific findings, but magnetic resonance neurography can reveal sciatic nerve inflammation. A multimodal approach combining clinical assessment with targeted imaging enhances diagnostic precision and guides effective management of PS.

In the treatment of osteoarthritis and soft tissue injury, early basic science and clinical data have been promising for the use of autologous blood formulations. This review article explores autologous conditioned serum, alpha-2-macroglobulin, and autologous protein solution, which function via overlapping but distinct mechanisms to reduce inflammation, counteract catabolism, and improve joint homeostasis. The ideal timing and quantity of dosing are largely unknown and may vary based on indication. Additional high-quality clinical trials are necessary to define the efficacy of these interventions on both long-term symptomatic improvement and mitigation of osteoarthritic disease progression.

Robotic assistance is becoming increasingly popular among surgeons performing total hip arthroplasty (THA). The impact of robotic assistance on the assessment of intraoperative stability and acetabular liner selection is not well described.

Total shoulder arthroplasty (TSA) is an effective treatment for advanced osteonecrosis (ON) of the humeral head, a condition involving vascular disruption and bone necrosis. However, systemic comorbidities in ON patients may impact postoperative outcomes.

Gaining operative proficiency requires adequate case volume during orthopedic residency training. Numerous surgical fields have demonstrated that male residents report higher case volume than female residents. In general surgery, racially/ethnically underrepresented in medicine residents report lower case volume than White residents.

Cervical disc arthroplasty (CDA) has gained widespread recognition as a motion-preserving alternative to anterior cervical discectomy and fusion for treating degenerative cervical disc disease. Over the past decade, the rate of CDA procedures has increased by a remarkable 654%. However, CDA complications can lead to a repeat procedure or can be converted to fusion.

This guest editorial gives an overview of the field of regenerative medicine and the special issue.

While much evidence exists on the epidemiology of and prevention strategies for anterior cruciate ligament (ACL) injuries, there is less information on patellar dislocations.

Regenerative therapies are being studied for use in several orthopedic conditions, but as these approaches gain in popularity, insurance coverage denials have become a critical issue for patients, physicians, hospitals, and payers.

The formation of a stable fibrin clot plays an important role in early tissue repair. Tranexamic acid (TXA), a potent fibrinolysis inhibitor, prevents fibrin clot dissolution.

Nano-sized extracellular vesicles enclosed by a lipid bilayer and secreted by various cell types including mesenchymal stem cells, exosomes act as natural transporters, carrying bioactive molecules such as proteins, lipids, and nucleic acids that mediate intercellular communication. Exosomes influence a range of cellular processes, including immune modulation, tissue repair, and disease progression. Compared to whole-cell therapies, exosomes provide anti-inflammatory, immunosuppressive, and regenerative effects with reduced risks linked to cellular components, such as infusion toxicity, immunogenicity, and tumorigenic phenomena. This article reviews isolation, modification, characterization, and storage techniques, challenges in clinical translation, and innovative engineering strategies to enhance targeting and efficacy. It also examines preliminary evidence suggesting that exosomes may have potential in managing degenerative disorders such as osteoarthritis, intervertebral disc degeneration, osteoporosis, osteonecrosis, and tendinopathy, as well as non-degenerative disorders such as sciatic nerve injury, fractures, and soft tissue trauma.

Adipose-derived cellular therapies, including stromal vascular fraction (SVF) and adipose-derived stem cells (ASCs), have demonstrated increasing therapeutic potential across regenerative medicine applications. This narrative review examines the current evidence supporting the use of SVF and ASCs in 2 primary clinical contexts: osteoarthritis (OA) and chronic wound healing. SVF, a heterogeneous cell population isolated from lipoaspirated fat via enzymatic or mechanical methods, and ASCs, a more homogeneous culture-expanded mesenchymal cell product, both exert regenerative effects through angiogenic, immunomodulatory, and reparative mechanisms. In OA, both cell types have been shown to significantly reduce pain and improve function, with some studies indicating cartilage regeneration on imaging. While ASCs may offer faster symptom relief due to higher purity and dosing, SVF remains a more accessible, minimally manipulated alternative with comparable long-term outcomes. In wound healing, adipose-derived therapies have been associated with accelerated closure of chronic ulcers through enhanced neovascularization, modulation of the inflammatory microenvironment, and promotion of granulation tissue and re-epithelialization. Across both indications, these therapies have shown a good safety profile, with minimal adverse events reported. The review also addresses regulatory distinctions, standardization challenges, and biologic variability, particularly in SVF preparations. Taken together, the evidence suggests the clinical utility of adipose-derived cellular therapies while highlighting the need for further standardization, long-term safety monitoring, and large-scale randomized trials to confirm efficacy and optimize clinical translation.

The possibility of modifying disease through regenerative medicine applications, particularly stem cell therapies, raises ethical and regulatory challenges in orthopedics. This review article provides historical context of stem cell research, ethical issues such as informed consent, therapeutic misconception, and equitable access, emphasizing the responsibilities of providers offering investigational treatments. It also examines the evolving role of the U.S. Food and Drug Administration (FDA) in regulating regenerative therapies through frameworks like the Regenerative Medicine Advanced Therapy (RMAT) designation, and more point-of-care enforcement discretion policies for therapies such as autologous micro-fragmented adipose tissue and bone marrow aspirate concentrate. The authors underscore the importance of innovative therapies to address unmet needs in musculoskeletal healthcare while acknowledging the need for more rigorous basic and clinical research. They call for a continuous refinement of regulatory and ethical standards as regenerative medicine advances.

Body protection compound-157 (BPC-157) is a naturally occurring gastric peptide that promotes mucosal integrity and homeostasis. Preclinical studies show its potential for promoting healing in musculoskeletal injuries such as fractures, tendon ruptures, ligament tears, and muscle injuries. Despite lacking US Food and Drug Administration approval and its use being banned in professional sports, it is increasingly used by clinicians and athletes. We sought to (1) provide a comprehensive synthesis of the BPC-157 literature from an orthopedic sports medicine perspective and (2) elucidate the mechanism of action, musculoskeletal effects, metabolism, and safety profile. We conducted a systematic review of English-language literature, published from database inception to June 3, 2024, from PubMed, Cochrane, and Embase. We searched PROSPERO to identify any current or unpublished reviews. Studies reporting BPC-157's mechanism, musculoskeletal outcomes, metabolism, and safety were included. Articles were screened in 3 phases by 2 reviewers. In cases of a disagreement between the 2 reviewers, blinding was removed, and eligibility was determined by group consensus, with a third author making the final decision. A total of 544 articles from 1993 to 2024 were identified. After duplicates were removed, 36 studies were included (35 preclinical studies, 1 clinical study). The studies suggest that BPC-157 enhances growth hormone receptor expression and several pathways involved in cell growth and angiogenesis, while reducing inflammatory cytokines. In preclinical models, BPC-157 improved functional, structural, and biomechanical outcomes in muscle, tendon, ligament, and bony injuries. In a retrospective study of musculoskeletal pain following intraarticular injection of BPC-157 for unspecified chronic knee pain, 7 of 12 patients reported relief for >6 months. BPC-157 is metabolized in the liver, with a half-life of less than 30 minutes, and is cleared by the kidneys. Preclinical safety studies showed no adverse effects across several organ systems. No clinical safety data were found. This systematic review of level IV and level V studies suggests that BPC-157 shows promise for promoting recovery from musculoskeletal injuries. Adverse effects are possible due to unregulated manufacturing, contamination, or unknown clinical safety. We recommend that clinicians counsel athletes to understand their organizations' rules to remain compliant with medication/supplement safety and testing standards.