Editorial Commentary: Meniscal Root Repairs: Let the Biology Help You!

Meniscal root tears are increasingly being recognized as important entities by the orthopaedic community. This is probably due to the catastrophic consequences of not identifying or addressing a root tear in a timely fashion, leading to the need for a total meniscectomy. The majority of the studies on root tears have been focused on natural history, diagnosis, biomechanical consequences, and fixation techniques. Conversely, rehabilitation concepts have been extrapolated from those applied after other meniscal tears/repairs, even though root tears probably constitute a completely different pathology from biological and biomechanical standpoints. Time zero studies are important to determine the effect of certain loads on the repaired structure without taking into consideration the healing process. This allows for examination of the effects that an accelerated protocol would have in the immediate postoperative phase after a root repair. As with any repaired structure, allowing time for the repaired tissue to heal is vital because failing to do so might lead to unrecoverable failure of the root fixation.     

Current and novel injectable hydrogels to treat focal chondral lesions: Properties and applicability

Focal chondral lesions and early osteoarthritis (OA) are responsible for progressive joint pain and disability in millions of people worldwide, yet there is currently no surgical joint preservation treatment available to fully restore the long term functionality of cartilage. Limitations of current treatments for cartilage defects have prompted the field of cartilage tissue engineering, which seeks to integrate engineering and biological principles to promote the growth of new cartilage to replace damaged tissue. Toward improving cartilage repair, hydrogel design has advanced in recent years to improve their utility. Injectable hydrogels have emerged as a promising scaffold due to their wide range of properties, the ability to encapsulate cells within the material, and their ability to provide cues for cell differentiation. Some of these advances include the development of improved control over in situ gelation (e.g., light), new techniques to process hydrogels (e.g., multi‐layers), and better incorporation of biological signals (e.g., immobilization, controlled release, and tethering). This review summarises the innovative approaches to engineer injectable hydrogels toward cartilage repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:64–75, 2018.     

Editorial Commentary: Hype,Hope and Everything in Between. What Produces the Real Effect for Blood-derived Products Including Platelet-Rich Plasma?

Biological approaches have a promising future in the orthopaedic field because of their potential benefits that include their minimal invasiveness, potential for accelerated healing, and promise for rapid recovery. However, as the initial hype for these therapies starts to fade, it should be replaced by solid basic and clinical science research to tailor each compound to a determined patient/pathology. Blood contains several products that can be both beneficial and detrimental for every specific tissue, and therefore a one-fits-all approach should be avoided. Although beneficial effects have been consistently reported for certain pathologies such as lateral elbow tendinopathy, as an adjunct for rotator cuff repairs and the symptomatic treatment of osteoarthritis, other conditions' outcomes with biologic treatment remain nebulous such as for Achilles tendinopathy. To determine the real effect of these therapies, it is important to maintain strict inclusion criteria in an attempt to isolate the effect of one biologic product that already has many inherent intrinsic variables per se.