Morya VK, et al. Clin Orthop Surg. 2024 Jun;16(3):347-356. https://doi.org/10.4055/cios23181

Degenerative tendinopathy results from the accumulation of minor injuries following unsuccessful tendon repair during acute tendon injuries. The process of tendon repair is prolonged and varies between individuals, making it susceptible to reinjury. Moreover, treating chronic tendinopathy often requires expensive and extensive rehabilitation, along with a variety of combined therapies to facilitate recovery. This condition significantly affects the quality of life of affected individuals, underscoring the urgent need for more efficient and cost-effective treatment options. Although traditional treatments have improved significantly and are being used as substitutes for surgical interventions, the findings have been inconsistent and conflicting. This review aims to clarify these issues by exploring the strengths and limitations of current treatments as well as recent innovations in managing various forms of degenerative tendinopathy.

SP7, also known as Osterix, is a zinc finger-containing transcription factor, plays a crucial role in osteoblast differentiation and bone formation. This review examines the molecular mechanisms underlying SP7's regulatory functions, highlighting its interactions with key signaling pathways such as BMP-SMAD, Wnt/β-catenin, and HIF-1α. SP7 acts downstream of RUNX2 to regulate osteogenic gene expression, including collagen Type I Alpha 1 (COL1A1), alkaline phosphatase (ALP) and osteocalcin (OCN). The review also explores the role of post-translational modifications, such as phosphorylation and ubiquitination, in modulating SP7's stability and activity. Emerging therapeutic strategies targeting SP7, including gene editing, RNA-based approaches, and small-molecule modulators, are discussed as innovative solutions for treating osteoporosis and other skeletal disorders. The potential for future research into SP7's interactions with non-coding RNAs and angiogenesis pathways is emphasized, underscoring its significance in skeletal health and regenerative medicine. This comprehensive overview consolidates current knowledge of SP7's molecular functions, therapeutic potential, and its pivotal role in bone biology.

Morya VK, et al. Clin Orthop Surg. 2025 Jun;17(3):359-371. https://doi.org/10.4055/cios24424

Purpose: To compare the clinical outcomes and complications between latissimus dorsi tendon transfer (LDTT) and muscle advancement (MA) for irreparable rotator cuff tears (IRCTs). Methods: A PRISMA-guided systematic review included 24 studies (956 shoulders: 750 LDTT, 206 MA) from MEDLINE, Embase, and Cochrane Library (searched October 2024). Eligible studies involved arthroscopic-assisted procedures for Patte stage 3 tears with Goutallier stage 3–4 fatty degeneration and ≥12-month follow-up. The analyzed outcomes included functional scores (Constant-Murley, UCLA, ASES), pain (VAS), acromiohumeral distance (AHD), range of motion (ROM), and complications. Risk of bias was assessed using the ROBINS-I and Cochrane tools, and statistical synthesis employed RevMan and R. Results: In this analysis, 24 studies (1 RCT, 13 cohort, 10 case series) involving 956 shoulders were included: 206 in the MA group (mean age 64.6 years, mean follow-up 19.7 months) and 750 in the LDTT group (mean age 60.8 years, mean follow-up 31.2 months). Both techniques resulted in significant functional improvement. Comparative analysis revealed no significant differences in the pooled mean improvements for the Constant-Murley Score, UCLA score, ASES score, VAS pain, forward flexion, or abduction, however, the LDTT group demonstrated significantly greater improvement in external rotation. The MA group experienced significantly higher rates of total complications (25.7% vs. 18.0%, P = 0.0206) and failure/retear/reoperation (20.8% vs. 8.9%, P = 0.0003). The rates of infection, nerve palsy, and stiffness were comparable between groups. Significant heterogeneity was observed in most continuous outcomes. Conclusions: LDTT and MA effectively restore shoulder function in IRCTs; however, their mechanisms differ. The LDTT excels in dynamic biomechanical compensation for external rotation, whereas MA achieves superior static joint stability. LDTT’s lower retear rates and higher complication risks associated with MA highlight the need for patient-specific surgical selection.

Degenerative rotator cuff disease (RCD) is a common musculoskeletal condition that disproportionately affects individuals with diabetes mellitus, leading to pain, functional impairment, and a reduced quality of life. Emerging evidence suggests that sodium-glucose co-transporter 2 inhibitors (SGLT2is), which are widely used for glycemic control in type 2 diabetes, offer additional musculoskeletal benefits beyond their metabolic effects. This review explores the potential protective role of SGLT2is in diabetic RCD by examining the epidemiological link between diabetes and tendon degeneration and evaluating the biological mechanisms through which SGLT2 is influence tendon health. These potential benefits include reducing inflammation, altering metabolism to a more tendon-friendly state, combating oxidative stress with ketones, encouraging a healing environment through macrophage modulation, and improving overall health via weight and blood sugar management. Preclinical and observational studies provide preliminary support for therapeutic benefits, although high-quality randomized clinical trials are lacking. Understanding the multifaceted role of SGLT2is in tendon biology will open new avenues for prevention and management of RCD, particularly in patients with metabolic disorders.