Focal chondral defects of the knee occur commonly in the young, active population due to trauma. Damage can insidiously spread and lead to osteoarthritis with significant functional and socioeconomic consequences. Implants consisting of autologous chondrocytes or mesenchymal stem cells (MSC) seeded onto scaffolds have been suggested as promising therapies to restore these defects. However, the degree of integration between the implant and native cartilage still requires optimization. A PRISMA systematic review and meta-analysis was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, CINAHL) to identify studies that used autologous chondrocyte implants (ACI) or MSC implant therapies to repair chondral defects of the tibiofemoral joint. Data on the integration of the implant-cartilage interface, as well as outcomes of clinical scoring systems, were extracted. Most eligible studies investigated the use of ACI only. Our meta-analysis showed that, across a total of 200 patients, 64% (95% CI (51%, 75%)) achieved complete integration with native cartilage. In addition, a pooled improvement in the mean MOCART integration score was observed during post-operative follow-up (standardized mean difference: 1.16; 95% CI (0.07, 2.24), p = 0.04). All studies showed an improvement in the clinical scores. The use of a collagen-based scaffold was associated with better integration and clinical outcomes. This review demonstrated that cell-seeded scaffolds can achieve good quality integration in most patients, which improves over time and is associated with clinical improvements. A greater number of studies comparing these techniques to traditional cartilage repair methods, with more inclusion of MSC-seeded scaffolds, should allow for a standardized approach to cartilage regeneration to develop.

Osteoarthritis remains an unfortunate long-term consequence of focal cartilage defects of the knee. Associated with functional loss and pain, it has necessitated the exploration of new therapies to regenerate cartilage before significant deterioration and subsequent joint replacement take place. Recent studies have investigated a multitude of mesenchymal stem cell (MSC) sources and polymer scaffold compositions. It is uncertain how different combinations affect the extent of integration of native and implant cartilage and the quality of new cartilage formed. Implants seeded with bone marrow-derived MSCs (BMSCs) have demonstrated promising results in restoring these defects, largely through in vitro and animal studies. A PRISMA systematic review and meta-analysis was conducted using five databases (PubMed, MEDLINE, EMBASE, Web of Science, and CINAHL) to identify studies using BMSC-seeded implants in animal models of focal cartilage defects of the knee. Quantitative results from the histological assessment of integration quality were extracted. Repair cartilage morphology and staining characteristics were also recorded. Meta-analysis demonstrated that high-quality integration was achieved, exceeding that of cell-free comparators and control groups. This was associated with repair tissue morphology and staining properties which resembled those of native cartilage. Subgroup analysis showed better integration outcomes for studies using poly-glycolic acid-based scaffolds. In conclusion, BMSC-seeded implants represent promising strategies for the advancement of focal cartilage defect repair. While a greater number of studies treating human patients is necessary to realize the full clinical potential of BMSC therapy, high-quality integration scores suggest that these implants could generate repair cartilage of substantial longevity.

Flexor tendon lacerations are primarily treated by surgical repair. Limited intrinsic healing ability means the repair site can remain weak. Furthermore, adhesion formation may reduce range of motion post-operatively. Mesenchymal stromal cells (MSCs) have been trialled for repair and regeneration of multiple musculoskeletal structures. Our goal was to determine the efficacy of MSCs in enhancing the biomechanical properties of surgically repaired flexor tendons. A PRISMA systematic review was conducted using four databases (PubMed, Ovid, Web of Science, and CINAHL) to identify studies using MSCs to augment surgical repair of flexor tendon injuries in animals compared to surgical repair alone. Nine studies were included, which investigated either bone marrow- or adipose-derived MSCs. Results of biomechanical testing were extracted and meta-analyses were performed regarding the maximum load, friction and properties relating to viscoelastic behaviour. There was no significant difference in maximum load at final follow-up. However, friction, a surrogate measure of adhesions, was significantly reduced following the application of MSCs (p = 0.04). Other properties showed variable results and dissipation of the therapeutic benefits of MSCs over time. In conclusion, MSCs reduce adhesion formation following tendon injury. This may result from their immunomodulatory function, dampening the inflammatory response. However, this may come at the cost of favourable healing which will restore the tendon’s viscoelastic properties. The short duration of some improvements may reflect MSCs’ limited survival or poor retention. Further investigation is needed to clarify the effect of MSC therapy and optimise its duration of action.

Background: This literature review examines the prevalence and severity of depression and anxiety symptoms in adolescents following ACL injury, with a focus on gender-disaggregated data. Methods: An electronic search was conducted across databases, including Ovid MEDLINE (R), PUBMED, and the Cochrane Library, covering articles from 1964 to 13 February 2024. Primary search terms were “ACL,” “depression,” “anxiety,” and “adolescent,” expanded using medical subject headings (MeSH). Manual searches of the references supplemented the database search. Inclusion criteria included studies on depression or anxiety post-ACL injury in adolescents. The exclusion criteria were studies without adolescent participants or those focusing exclusively on one sex. Results: The search identified 62 studies, of which 5 were ultimately selected for comprehensive analysis. Four studies reported on depression using various scales, and three measured anxiety symptoms. No studies provided gender-disaggregated data. One study found no significant difference in depression scores between adolescent and adult patients. Another study noted that socioeconomic disadvantage correlated with increased depressive and anxiety symptoms post-surgery. An additional study highlighted a significant increase in depression scores from pre- to post-injury among ACL-injured participants compared to uninjured controls. Conclusions: Our understanding of the psychological consequences of ACL rupture on female adolescent patients is incomplete. Given the high incidence of ACL injuries in this patient group and their potential psychological vulnerability, improving the evidence base in this area could address a previously neglected aspect of care, with positive impacts on returning to sport and quality of life. Future studies of high methodological quality are needed to address this gap in the literature.

Objectives: To evaluate the clinical applications and translation readiness of model-based synthetic tabular data in healthcare, and identify gaps in governance reporting that may hinder translation. Materials and Methods: We systematically searched Ovid MEDLINE and Embase (2010-August 2025; PROSPERO: CRD42025635514) for studies that generated and applied model-based synthetic tabular data in clinical contexts. Screening used a “human-in-the-loop” large language model workflow alongside independent manual review, achieving 100% sensitivity for included studies. Unlike prior reviews focused primarily on evaluation methodology, we mapped use-cases and deployment paradigms, and audited translation-readiness reporting using a predefined governance framework (validation depth, privacy, fairness, regulatory alignment). Results: Thirty-seven studies (2019-2025) were included. GANs predominated; other approaches included VAEs, diffusion models, LLM-based synthesis, and Bayesian networks. Dataset augmentation was the primary application, often improving downstream model performance for rare outcomes. Emerging applications included synthetic control cohorts and algorithmic bias mitigation. Translation-readiness reporting was limited: 34/37 studies (92%) relied solely on internal validation, 9/37 (24%) used formal privacy models, 6/37 (16%) reported explicit fairness evaluations, and 6/37 (16%) addressed regulatory alignment. Few studies distinguished “no-release” from “delayed-release” paradigms. Discussion: A systemic gap exists between methodological innovation and deployment-readiness reporting. Model-based synthetic data show clear value for augmentation and class balancing, but inconsistent reporting of validation, privacy, fairness, and regulatory considerations limits confidence in clinical deployment. Conclusion: We propose TRUST-SD (Transparency and Reporting for Utility, Safety, and Translation of Synthetic Data), an author-derived, preliminary, evidence-informed reporting checklist spanning 7 domains, as a starting point for community refinement and consensus-building.