The treatment of bone defects remains a challenging clinical problem with high reintervention rates, morbidity, and resulting significant healthcare costs. Surgical techniques are constantly evolving, but outcomes can be influenced by several parameters, including the patient’s age, comorbidities, systemic disorders, the anatomical location of the defect, and the surgeon’s preference and experience. The most used therapeutic modalities for the regeneration of long bone defects include distraction osteogenesis (bone transport), free vascularized fibular grafts, the Masquelet technique, allograft, and (arthroplasty with) mega-prostheses. Over the past 25 years, three-dimensional (3D) printing, a breakthrough layer-by-layer manufacturing technology that produces final parts directly from 3D model data, has taken off and transformed the treatment of bone defects by enabling personalized therapies with highly porous 3D-printed implants tailored to the patient. Therefore, to reduce the morbidities and complications associated with current treatment regimens, efforts have been made in translational research toward 3D-printed scaffolds to facilitate bone regeneration. Three-dimensional printed scaffolds should not only provide osteoconductive surfaces for cell attachment and subsequent bone formation but also provide physical support and containment of bone graft material during the regeneration process, enhancing bone ingrowth, while simultaneously, orthopaedic implants supply mechanical strength with rigid, stable external and/or internal fixation. In this perspective review, we focus on elaborating on the history of bone defect treatment methods and assessing current treatment approaches as well as recent developments, including existing evidence on the advantages and disadvantages of 3D-printed scaffolds for bone defect regeneration. Furthermore, it is evident that the regulatory framework and organization and financing of evidence-based clinical trials remains very complex, and new challenges for non-biodegradable and biodegradable 3D-printed scaffolds for bone regeneration are emerging that have not yet been sufficiently addressed, such as guideline development for specific surgical indications, clinically feasible design concepts for needed multicentre international preclinical and clinical trials, the current medico-legal status, and reimbursement. These challenges underscore the need for intensive exchange and open and honest debate among leaders in the field. This goal can be addressed in a well-planned and focused stakeholder workshop on the topic of patient-specific 3D-printed scaffolds for long bone defect regeneration, as proposed in this perspective review.

This systematic literature review aimed to examine the effects of Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR) head-mounted displays (HMDs) on patient understanding, satisfaction, and anxiety during preoperative informed consent. Following PRISMA-P guidelines (Prospero ID: CRD42023487281), we searched four major databases from their inception to March 24, 2023. Studies were eligible if they utilized VR, AR, or MR HMDs to visualize patient-specific data during informed consent across any medical specialty. Two reviewers independently conducted all steps of the systematic review process, and the risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Sixteen studies involving a total of 1067 patients were identified and included. These comprised 10 Randomized Controlled Trials (RCTs) and 6 Non-Randomized Controlled Trials (non-RCTs), including one comparative study and five non-comparative studies. The literature reviewed was heterogeneous, encompassing patients with diverse conditions across various medical specialties, including cardiology, neurosurgery, transplantation surgery, vascular surgery, plastic surgery, and urology. The results demonstrated that VR, AR, and MR HMDs positively impact patient understanding, satisfaction, and anxiety reduction. Notably, the findings were more consistent for VR HMDs compared to the limited and variable literature on AR and MR HMDs. VR, AR, and MR HMDs generally show positive effects on patient understanding, satisfaction, and anxiety in preoperative informed consent. While VR HMDs consistently yield positive outcomes, further research is needed to elucidate the effectiveness and benefits of AR and MR HMDs in preoperative consultations.

Background: Extensive defects in long bones, resulting from trauma, disease, or other etiologies, impose significant morbidity on patients and may necessitate amputation, long-term disability, or premature mortality. While three-dimensional (3D)-printed, patient-specific implants offer promising regenerative solutions, their clinical implementation remains hindered by regulatory challenges, lack of standardized guidelines, and gaps in translational research. Addressing these barriers is critical to improving patient outcomes and optimizing healthcare resource utilization. Materials and methods: A multidisciplinary group of 29 experts – including clinicians (surgeons, anesthesiologists), biomaterial scientists, biomedical engineers, legal/regulatory professionals, health economists, meta-researchers, artificial intelligence experts, trialists, and biomaterial industry representatives – convened for the Consensus Meeting on 3D-printed patient-specific Bone Implants (CoMBI). Preceding the meeting, key questions were discussed in individual interviews and categorized into fundamental research, preclinical studies, and clinical trials and implementation (CoMBI themes). Experts presented on each theme, followed by structured discussions. Statements were synthesized, iteratively refined, and validated through open review. Results: The consensus meeting resulted in 20 key statements addressing the CoMBI themes, outlining a framework to advance regulatory compliance and facilitate the clinical adoption of 3D-printed implants. Key statements include the need for harmonized regulatory pathways, clear guidelines on preclinical validation, and innovative trial designs tailored to complex, patient-specific implants. Strengthening collaboration among policymakers, regulatory agencies, and clinicians is crucial to overcoming current implementation barriers and ensuring equitable patient access to these advanced technologies. Conclusion: This Consensus Statement presents 20 key statements across fundamental research, preclinical studies, and clinical trials and implementation, offering a roadmap for accelerating the regulatory and clinical translation of 3D-printed patient-specific bone implants. The findings emphasize the critical role of interdisciplinary collaboration in overcoming challenges, such as standardizing implant development and navigating complex regulatory landscapes. By addressing these barriers and outlining practical strategies, the consensus highlights actionable steps to bridge the gap between innovation and clinical application.

Background: The evaluation of tibial plateau fractures (TPF) encompasses the assessment of clinical–functional and radiological parameters. In this study, the authors aimed to investigate the potential correlation between these parameters by utilizing both the clinical–functional and the modified radiological Rasmussen score. Methods: In this retrospective monocentric study conducted at a level-I trauma center, patients who underwent surgery between January 2014 and December 2019 due to a TPF were included. The clinical–functional Rasmussen score prior to the injury, at 1-year postoperatively, and during the last follow-up (minimum 18 months) was assessed using a standardized questionnaire. Additionally, the modified radiological Rasmussen score was determined at the 1-year postoperative mark using conventional radiographs in two planes. Results: A total of 50 patients were included in this study, comprising 40% (n = 20) men, and 60% (n = 30) women, with an average age of 47 ± 11.8 years (range 26–73 years old). Among them, 52% (n = 26) had simple fractures (classified according to Schatzker I–III), while 48% (n = 24; according to Schatzker IV–VI) had complex fractures. The mean follow-up was 3.9 ± 1.6 years (range 1.6–7.5 years). The functional Rasmussen score assessed before the injury and at follow-up showed an “excellent” average result. However, there was a significant difference in the values of complex fractures compared to before the injury. One year postoperatively, both the clinical–functional score and the modified radiological score demonstrated a “good” average result. The “excellent” category was more frequently observed in the functional score, while the “fair” category was more common in the radiological score. There was no agreement between the categories in both scores in 66% of the cases. Conclusions: The data from this retrospective study demonstrated that patients with TPF are able to achieve a nearly equivalent functional level in the medium-term after a prolonged recovery period, comparable to their pre-injury state. However, it is important to note that the correlation between clinical–functional and radiological parameters is limited. Consequently, in order to create prospective outcome scores, it becomes crucial to objectively assess the multifaceted nature of TPF injuries in more detail, both clinically and radiologically.

Calcification of the medial collateral ligament (MCL) of the knee is a very rare disease. We report on a case of a patient with a calcifying lesion within the MCL and simultaneous calcifying tendinitis of the rotator cuff in both shoulders. Calcification of the MCL was diagnosed both via x-ray and magnetic resonance imaging (MRI) and was successfully treated surgically. Calcifying tendinitis of the rotator cuff was successfully treated applying conservative methods. This is the first case report of a patient suffering from both a calcifying lesion within the medial collateral ligament and calcifying tendinitis of the rotator cuff in both shoulders. Clinical symptoms, radio-morphological characteristics and macroscopic features were very similar and therefore it can be postulated that the underlying pathophysiology is the same in both diseases. Our experience suggests that magnetic resonance imaging and x-ray are invaluable tools for the diagnosis of this inflammatory calcifying disease of the ligament, and that surgical repair provides a good outcome if conservative treatment fails. It seems that calcification of the MCL is more likely to require surgery than calcifying tendinitis of the rotator cuff. However, the exact reason for this remains unclear to date.