Cartilage lesions do not heal spontaneously and predispose to osteoarthritis. Functional cartilage tissues, engineered using autologous chondrocytes, have a therapeutic advantage over conventional cellular therapies in preclinical studies. Here, we tested whether ex vivo maturation of engineered grafts for cartilage repair leads to improved patient benefit. Using autologous nasal chondrocytes (NCs), we tested whether implantation of in vitro–matured NC-tissue-engineered cartilage (N-TEC) versus undifferentiated NC-cell-activated matrices (N-CAM) in focal cartilage lesions would result in a superior clinical outcome. The prospective, randomized, parallel, open-label phase-2 trial ( ClinicalTrials.gov , NCT02673905) enrolled 108 patients in five hospitals from four countries. Patients ranging in age from 30 to 46 years with full-thickness knee cartilage defects (size, 2.7 to 6.0 square centimeters) were equally randomized and treated with N-TEC or N-CAM. The primary preregistered outcome was the overall Knee Injury Osteoarthritis Outcome Score (KOOS) at 24 months. N-TEC, which underwent a longer NC culture time, was phenotypically, structurally, and functionally more like hyaline cartilage than N-CAM. The overall KOOS increased with clinical relevance in both groups compared with preoperative values. KOOS was higher at 24 months for N-TEC [85; interquartile range (IQR), 74 to 91] than for N-CAM (79; IQR, 65 to 85). N-TEC, but not N-CAM, was similarly effective in patients with larger defects or revision surgery. Radiologically, N-TEC resulted in a superior composition of both repair tissue and surrounding cartilage, whereas structural scores were similar. This trial validates the clinical efficacy of NC-based grafts for articular cartilage repair and supports the clinical relevance of engineering mature tissues, even for patients with more challenging cartilage defects.

Purpose With the ability to overcome specific anatomical and pathological challenges, 3D printing technology is setting itself as an important tool in patient-specific orthopaedics, delivering anatomical models, patient-specific instruments, and custom-made implants. One of the most demanding procedures in limb salvage surgery is the reconstruction of bony defects after tumour resection. Even though still limited in clinical practice, early results of the use of 3D technology are gradually revealing its potentially huge impact in bone tumour surgery. Here, we present a case series illustrating our experience with the use of 3D printing technology in the reconstruction of bone defects after tumour resection, and its impact on cosmesis and quality of life. Methods We performed a retrospective analysis of 11 patients in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumour. Ten out of 11 patients were children (aged between 5 and 16 years) with osteosarcoma or Ewing sarcoma of the pelvis (2 children) or the arm (8 children), and one patient was a 67-year-old lady with a chondrosarcoma of the pelvis. All underwent wide resections resulting in considerable bone defects necessitating further reconstruction. Results Custom-made implants were extremely useful both in reconstruction of bone defects and in terms of cosmesis, recovery facilitation, and quality of life. In this respect, pelvic and humeral reconstructions with 3D-printed custom implants particularly showed a great potential. The mean follow-up was 33 months. Four patients died of disease (36%) and overall the major and minor complication rate was 54% (6 out of 11 patients). Three patients had implant dislocation (27% [3/11 cases]), one had leg-compartment syndrome, and one patient reported limited range of motion. Only two out of 11 patients developed local recurrence. Conclusion Use of 3D customized implant helped us achieve two major goals in orthopaedic oncology—clear surgical resection and functional recovery with a good quality of life. Large studies with long-term follow-up are needed to reveal the value and future of 3D printing in orthopaedic oncology.

The second anterior cruciate ligament (ACL) injury after ACL reconstruction is a well-known complication. Several studies have suggested that the risk of contralateral ACL injury is comparable to that of graft re-rupture. However, this comparison is not well established in previous reviews for studies with minimum five-year follow-up and mean ten-year outcomes. This systematic review and meta-analysis aimed to evaluate the ten-year risk of graft re-rupture and contralateral ACL injury after primary ACL reconstruction and to assess the influence of graft type, return-to-sport, and other factors on second ACL injuries. A systematic search was conducted across the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Cochrane from 2000 to 2025. The literature search strategy included the following keywords: "anterior cruciate ligament reconstruction," "ACL reconstruction," "graft rupture," "graft failure," "contralateral anterior cruciate ligament injury," and "contralateral ACL injury." All studies that compare the risk of re-rupture and contralateral ACL injuries after ACL reconstruction and with a follow-up of at least five years after ACL reconstruction were included. Exclusion criteria included case reports, reviews, studies using allografts or artificial ligaments, and multi-ligament injuries. A total of 18 studies were included in this meta-analysis with 5,735 participants. The pooled rates of graft rupture and contralateral injuries were 11 % and 12 %, respectively, with no statistically significant difference (p = 0.421). The ipsilateral graft-rupture rate was higher in patients with hamstring tendon (HT) autografts compared with bone-patellar tendon-bone (BPTB) autografts, at 13.0 % and 7.74 %, respectively (odds ratio [OR] = 1.75, 95 % confidence interval [CI]: 1.33-2.31; p = 0.004). Younger age (<18 years) was identified as the most substantial risk factor, with patients under 18 years showing nearly a threefold increased risk of graft rupture (OR 2.22, 95 % CI: 1.16-4.23, p = 0.016). Age <18 years also conferred increased risk for contralateral injury (OR 1.87, 95 % CI: 1.32-2.65, p = 0.001). Return to sport (RTS) was achieved by 51 %-73 % of patients in the included studies. However, delaying RTSs did not result in a statistically significant reduction in the risk of reinjury. Contralateral anterior cruciate ligament injuries and graft re-ruptures occurred at similar rates (12 % and 11 %, respectively, p = 0.421), which suggests that risk of second injury is similar between ipsilateral graft failure and contralateral anterior cruciate ligament injury. Therefore, second ACL injuries remain a crucial concern over extended follow-up periods (mean: 10.3 years), driven primarily by younger age, hamstring graft use, and participation in high-demand sports. Level III.

Chiari pelvic osteotomy (CPO) or medial displacement pelvic osteotomy is a surgical procedure of making a congruent shelf above intact hip joint by using the cancellous bone of ilium along with capsular interpositioning to contain the femoral head and bear weight. CPO is usually considered a salvage procedure indicated in patients with dysplastic acetabular sockets as a part of developmental hip dysplasia. It has been widely performed for several decades but since 1990s number of CPO procedures has decreased because of use of other pelvic osteotomies, total hip arthroplasty (THA), ultrasound screening and narrowing indications for this procedure. However, CPO is not a historical procedure and it has viable indications in modern orthopaedic surgery, especially in patients who prefer joint-conservating procedure or in situations when THA is not feasible. Moreover, keeping the native hip as long as possible should be preferred modern orthopaedic approach. The Chiari osteotomy can produce excellent results in patients who have right indications and when other procedures are not suitable. On the other hand, there are several disadvantages of this procedure such as narrowing of the pelvis, shortening of the limb and risk of sciatic nerve palsy. With in-depth analysis of literature, we discuss indications for CPO, surgical technique of CPO, THA conversion rate after CPO, the interval from the CPO to THA and CPO survival rate.

Increased knowledge of the long-term destructive consequences of meniscectomy has created a shift towards operative repair of isolated meniscus lesions. However, in the literature the results of isolated meniscal repair in athletes currently remain underreported. Our objective was to investigate the clinical and functional outcomes as well as survival and return to sport in patients who underwent meniscal repair after isolated meniscal tear, with a focus on athletes (both professional and recreational) in the study population. This retrospective study included 52 athletes who underwent knee surgery for isolated meniscal tear between 2014 and 2020. Patients with concomitant ligamentous and/or chondral injury were not included in this study. The mean age of the patients was 25.5 years (ranging from 12 to 57 years). The mean follow-up period of all patients was 33.3 months (ranging 10 to 80 months). The mean purpose of the study was to report the return to sport. The International Knee Documentation Committee rating (IKDC), Lysholm score, the Knee Osteoarthritis Outcome Score (KOOS) and Tegner activity level were determined at the follow-up. Failure was defined as re-operation with meniscectomy or revision meniscal repair. In total, 44 out of 52 patients (85%) returned to their previous sports activities. At follow-up, the mean Lysholm score was 90, representing a good to excellent result. Assessment of KOOS (mean value 88.8) and IKDC (mean value 89) scores also showed good to excellent results. A mean level of Tegner scale was 6.2, indicating a relatively high level of sports participation. Failure was encountered in 8 out of 52 knees (15%). Therefore, isolated meniscal repair resulted in good to excellent knee function and most athletes can return to their previous level of sports participation.