Clin Sports Med
· 2026 Jan · PMID 41207754
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Distal femoral osteotomy (DFO) is commonly used to correct excessive valgus knee deformities. Valgus malalignment places increased loads on the lateral tibiofemoral joint, accelerating lateral compartment degeneration. T...Distal femoral osteotomy (DFO) is commonly used to correct excessive valgus knee deformities. Valgus malalignment places increased loads on the lateral tibiofemoral joint, accelerating lateral compartment degeneration. This article explores the benefits of DFO in correcting valgus deformities and addresses concomitant procedures for managing lateral compartment pathology, offering practical guidance for surgeons to optimize outcomes and restore knee function.
Lezak BA, Mercer NP, Lin CC
… +2 more, Rynecki ND, Strauss EJ
Clin Sports Med
· 2026 Jan · PMID 41207753
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High tibial osteotomy (HTO) is commonly used to correct excessive varus knee malalignment. Varus alignment places increased loads on the medial tibiofemoral joint, accelerating medical compartment degeneration. This arti...High tibial osteotomy (HTO) is commonly used to correct excessive varus knee malalignment. Varus alignment places increased loads on the medial tibiofemoral joint, accelerating medical compartment degeneration. This article explores the benefits of HTO in correcting varus deformities and addresses concomitant procedures for managing medial compartment pathology, offering practical guidance for surgeons to optimize outcomes and restore knee function.
Clin Sports Med
· 2026 Jan · PMID 41207752
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Osteotomies around the knee are an effective procedure that shifts the weight-bearing axis from the pathologic side to the uninvolved side to alleviate pain, unload cartilage transplantations, slow down the progression o...Osteotomies around the knee are an effective procedure that shifts the weight-bearing axis from the pathologic side to the uninvolved side to alleviate pain, unload cartilage transplantations, slow down the progression of arthritis, and protect ligament reconstructions. The advancement in plates from nonlocking to locking have increased the stability of constructs to allow for early mobilization and maintained corrections. Further developments with patient-specific instrumentation have made these techniques more reproducible and accurate. Bone grafting and biologics remain a topic of debate but likely a helpful adjuvant in the context of larger corrections or joint preservation surgeries.
Clin Sports Med
· 2026 Jan · PMID 41207751
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Tibial tubercle osteotomy (TTO) is a commonly performed procedure to address patellar instability and/or patellofemoral cartilage pathology. Complication rates are reported at varied incidences in the literature, most co...Tibial tubercle osteotomy (TTO) is a commonly performed procedure to address patellar instability and/or patellofemoral cartilage pathology. Complication rates are reported at varied incidences in the literature, most commonly symptomatic hardware requiring removal. This article will review current data on complications after TTO and propose prevention and management strategies when faced.
Bertha N, Stokes DJ, Gonzalez-Lomas G
… +1 more, Frank RM
Clin Sports Med
· 2026 Jan · PMID 41207750
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Deciding the appropriate procedure for an active patient with medial compartment knee osteoarthritis can be challenging, and both medial opening wedge high tibial osteotomy (HTO) and medial unicompartmental knee arthropl...Deciding the appropriate procedure for an active patient with medial compartment knee osteoarthritis can be challenging, and both medial opening wedge high tibial osteotomy (HTO) and medial unicompartmental knee arthroplasty have great long-term outcomes. However, the literature suggests that HTO may be most appropriate in patients who want to maintain a very active lifestyle, specifically continuing high-impact activities. Unicompartmental knee arthroplasty may be more appropriate for patients who are seeking pain relief and are more accepting of only participating in lower impact activities.
Clin Sports Med
· 2026 Jan · PMID 41207749
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Tibial tuberosity osteotomy (TTO) is a well-described treatment option for a broad range of patellofemoral joint disorders, including patellofemoral instability, focal chondral lesions of the patellofemoral joint, and pa...Tibial tuberosity osteotomy (TTO) is a well-described treatment option for a broad range of patellofemoral joint disorders, including patellofemoral instability, focal chondral lesions of the patellofemoral joint, and patellofemoral arthritis. The purpose of this article is to review the indications and highlight the surgical technique for the more commonly performed TTO procedures and discuss outcomes, as well as surgical pearls for this technique.
Rocca MS, Grandberg C, Lucidi GA
… +4 more, Thiel B, Runer A, Zaffagnini S, Musahl V
Clin Sports Med
· 2026 Jan · PMID 41207748
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Lateral closing wedge high tibial osteotomy (LCW-HTO) is a powerful surgical technique to treat symptomatic varus deformity of the knee, particularly when associated with medial compartment osteoarthritis, meniscal injur...Lateral closing wedge high tibial osteotomy (LCW-HTO) is a powerful surgical technique to treat symptomatic varus deformity of the knee, particularly when associated with medial compartment osteoarthritis, meniscal injuries, or cartilage defects. Realigning the mechanical axis, a wedge of bone is removed from the lateral side of the tibia, shifting the load away from the potentially damaged medial compartment. When performed and indicated correctly, this procedure provides significant improvement in pain and function, and a delay in the need for knee arthroplasty. This review discusses the indications, techniques, outcomes, advantages, and disadvantages of LCW-HTO for treating varus knee deformity.
Clin Sports Med
· 2026 Jan · PMID 41207747
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Osteotomies around the knee are technically demanding procedures that are indicated for joint preservation and stability. Surgical execution relies on a carefully planned incision, soft-tissue respecting approach, a cont...Osteotomies around the knee are technically demanding procedures that are indicated for joint preservation and stability. Surgical execution relies on a carefully planned incision, soft-tissue respecting approach, a controlled osteotomy, and definitive stabilization. Intraoperative and postoperative complications are important to recognize and address as they arise.
Sachs JP, Mufti YN, Bi AS
… +2 more, Jesse JE, Cole BJ
Clin Sports Med
· 2025 Oct · PMID 41101913
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The economic dynamics of orthobiologics are complex and influenced by insurance coverage, regulatory pathways, marketing practices, health care settings, and geographic location. Limited insurance coverage and ambiguous...The economic dynamics of orthobiologics are complex and influenced by insurance coverage, regulatory pathways, marketing practices, health care settings, and geographic location. Limited insurance coverage and ambiguous guidelines may lead to significant out-of-pocket expenses to patients and variable costs for the health care system. In addition, aggressive marketing and misleading claims further complicate patient decision-making. Addressing these challenges requires clear guidelines, increased research funding, standardized transparent pricing, and regulated marketing. Collaboration among policymakers and stakeholders is crucial to making orthobiologics more regulated, accessible, and cost-effective.
Dallo I, Bernáldez P, Lana JF
… +2 more, Everts PA, Gobbi A
Clin Sports Med
· 2025 Oct · PMID 41101912
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Subchondral bone pathology (SBP) includes a wide range of pathologies, including trauma, postcartilage surgery, osteoarthritis, transient bone marrow syndromes, spontaneous insufficiency fractures, and osteonecrosis. The...Subchondral bone pathology (SBP) includes a wide range of pathologies, including trauma, postcartilage surgery, osteoarthritis, transient bone marrow syndromes, spontaneous insufficiency fractures, and osteonecrosis. They show joint MRI findings termed bone marrow lesions. However, the etiology and evolution of SBP in multiple conditions remain unclear. A key factor to address in a patient with BME is the distinction between reversible and irreversible lesions. MRI plays a significant role in the differential diagnosis based on recognizable typical patterns considered together with coexistent abnormalities, age, and clinical history. This article will focus on the current understanding of the biologics of SBP.
Mufti YN, Sachs JP, Bi AS
… +3 more, Sardesai KS, Yanke AB, Cole BJ
Clin Sports Med
· 2025 Oct · PMID 41101911
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Orthobiologics are substances derived from biological sources and are increasingly used in cartilage repair. Mesenchymal signaling cells (MSCs) play a crucial role in cartilage regeneration, but face challenges in clinic...Orthobiologics are substances derived from biological sources and are increasingly used in cartilage repair. Mesenchymal signaling cells (MSCs) play a crucial role in cartilage regeneration, but face challenges in clinical application. Platelet-rich plasma, concentrated bone marrow aspirate, adipose tissue, and human umbilical cord blood have all demonstrated potential as sources for MSCs and growth factors necessary for cartilage repair. Existing cartilage repair techniques have shown good outcomes with additional orthobiologic augmentation. Emerging techniques involving third-generation and fourth-generation matrix-induced autologous chondrocyte implantation, decellularized or cryopreserved osteochondral grafts, and artificial scaffolds have demonstrated promising results long-term with cartilage repair procedures.
Villarreal-Espinosa JB, Gomez-Verdejo F, Bi AS
… +2 more, Fortier L, Chahla J
Clin Sports Med
· 2025 Oct · PMID 41101910
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The biologic enhancement of meniscal tears aims to improve healing outcomes by upregulating growth factors and regenerative cells. While preclinical studies show promise, clinical results are mixed, and more prospective,...The biologic enhancement of meniscal tears aims to improve healing outcomes by upregulating growth factors and regenerative cells. While preclinical studies show promise, clinical results are mixed, and more prospective, longer follow-up research is needed to confirm their efficacy as routine treatment strategies.
Clin Sports Med
· 2025 Oct · PMID 41101909
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Ligament injuries are a common type of musculoskeletal condition, with an estimated 17 million occurring annually in the United States, resulting in an economic burden exceeding US$40 billion. The growing demand for fast...Ligament injuries are a common type of musculoskeletal condition, with an estimated 17 million occurring annually in the United States, resulting in an economic burden exceeding US$40 billion. The growing demand for faster recovery and better surgical outcomes has led to increased interest in orthobiologics. However, the wide variability in ligament healing, surgical techniques, biological factors, and preparation methods makes it challenging to generalize research results. More studies are needed to fully understand the impact of current orthobiologics on ligament healing. Although current research in ligament repair and reconstruction enhanced with orthobiologics shows promise, it is still not fully evidence-based.
Clin Sports Med
· 2025 Oct · PMID 41101908
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The treatment of tendinopathies can be challenging due to the wide heterogeneity in their clinical presentation, variable disease chronicity, and the lack of standardized treatment approaches. Orthobiologics such as plat...The treatment of tendinopathies can be challenging due to the wide heterogeneity in their clinical presentation, variable disease chronicity, and the lack of standardized treatment approaches. Orthobiologics such as platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and patch augmentation have been utilized with increasing frequency for the treatment of tendon injuries, but the evidence to support their routine use is mixed. This review summarizes the current clinical literature evaluating the efficacy of PRP, BMAC, and patch augmentation in the treatment of common tendon disorders.
Clin Sports Med
· 2025 Oct · PMID 41101907
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Muscle injuries are a frequent concern in competitive athletes and military personnel, often hindering their ability to continue in their sport or service. Due to the significant impact of these injuries and the urgency...Muscle injuries are a frequent concern in competitive athletes and military personnel, often hindering their ability to continue in their sport or service. Due to the significant impact of these injuries and the urgency of returning to activity, orthobiologics such as prolotherapy, platelet-rich plasma, and mesenchymal stem cells have been explored as treatment options aimed at promoting tissue regeneration through immunomodulation toward tissue regeneration. However, despite growing interest and numerous preclinical studies, high-level clinical evidence supporting the efficacy of these treatments remains lacking, underscoring the need for further research.
Clin Sports Med
· 2025 Oct · PMID 41101906
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Mesenchymal exosomes may offer a nonsurgical therapeutic option for patients with symptomatic knee osteoarthritis (KOA). Currently, there is no peer reviewed clinical research to support the widespread use of exosomes fo...Mesenchymal exosomes may offer a nonsurgical therapeutic option for patients with symptomatic knee osteoarthritis (KOA). Currently, there is no peer reviewed clinical research to support the widespread use of exosomes for treating patients with KOA. In the United States, exosomes are regulated as a drug by the FDA (Food and Drug Administration). There is no current FDA approved treatment indication for exosomes, and so clinicians in the United States cannot buy, sell, or use exosomes for human use. Regardless, the potential utility of exosomes as an injection treatment option for KOA is compelling and merits further clinical research.
Clin Sports Med
· 2025 Oct · PMID 41101905
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Adipose-derived therapies, including micronized adipose tissue, enzymatically extracted stromal vascular fraction, or culture-expanded adipose-derived stromal cells, have become promising within the field of orthobiologi...Adipose-derived therapies, including micronized adipose tissue, enzymatically extracted stromal vascular fraction, or culture-expanded adipose-derived stromal cells, have become promising within the field of orthobiologics due to their potential to support tissue healing and possible utility as a treatment of knee osteoarthritis (KOA). Several recent randomized controlled trials have shown the efficacy of adipose-derived therapies in improving pain and function in patients with knee KOA. However, despite the growing interest and numerous studies conducted, follow-up is often short-term and there is significant variability in preparation methods and cell concentration in the literature.
Shapiro SA, Arthurs JR, Williams CJ
… +2 more, Mufti YN, Sachs JP
Clin Sports Med
· 2025 Oct · PMID 41101904
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Perinatal orthobiologics, or birth-associated products for musculoskeletal pathologies are autologous or allogeneic therapeutics sourced from biomaterials donated and recovered from healthy individuals during or around t...Perinatal orthobiologics, or birth-associated products for musculoskeletal pathologies are autologous or allogeneic therapeutics sourced from biomaterials donated and recovered from healthy individuals during or around the birthing process. As popularity related to stem cell therapy for knee osteoarthritis (OA) has grown, perinatals are often purported to be a type of stem cell therapy for operative and nonoperative use. Though several such products have already been trialed in humans for knee OA, these products will require premarket authorization in the form of a biologics license application (BLA). We review the nomenclature, basic science and clinical research for perinatal orthobiologics to date.