Carina L. Blaker

Background: Musculoskeletal (MSK) conditions are a leading cause of disability worldwide, yet MSK research often underrepresents diverse populations and inadequately reports considerations related to diversity, inclusion, culture, and equity. Inconsistent reporting limits the interpretability, transferability, and real-world impact of research findings, particularly for priority populations. Currently, there is no MSK-specific reporting guidance that systematically integrates equity-focused principles.Objective: To develop a DICE (Diversity, Inclusion, Culture, and Equity) Checklist, a reporting guideline designed to strengthen transparency, reflexivity, and equity considerations across all stages of musculoskeletal health research.Methods: The DICE Checklist was developed using a multi-phase, modified Delphi approach. This included (1) a short report describing existing equity-focused reporting frameworks, methods, and guidelines. (2) synthesis of key domains relevant to MSK research, and (3) iterative refinement through expert consultation (in-person workshops followed by individual follow up) involving clinicians, researchers, methodologists, and lived-experience contributors.Results: The final DICE Checklist comprises 25 recommendations across four key reporting domains spanning the research lifecycle: (1) community partnerships, leadership, and governance; (2) inclusive research design and ethical practice; (3) equity-driven data collection, analysis, and interpretation; and (4) communication and knowledge sharing. The checklist prompts authors to explicitly reflect on diversity, inclusion, culture, and equity considerations, justify methodological or practical limitations where relevant, and consider implications for generalisability, implementation, and translation. DICE is designed to complement, rather than replace, existing reporting guidelines.Conclusion: The DICE Checklist provides a practical, MSK-specific reporting tool to enhance equity-focused transparency in research. Its adoption may improve the quality, relevance, and inclusivity of musculoskeletal research, supporting more equitable evidence generation and translation into practice and policy.

Background: Upper limb tendon/ligament injuries are common in sport and may require reconstruction using grafts or tendon transfers. Understanding tissue-specific properties is key to improving graft selection criteria and developing new interventions. Purpose: To characterize morphological, biomechanical, and biochemical properties of clinically important upper limb tendons, expanding available data on upper and lower limb tissues that are commonly injured or used as grafts. Study Design: Descriptive laboratory study. Methods: A total of 31 individual upper limb tendons were each retrieved from 8 fresh-frozen human cadavers (3 female, 5 male; aged 49-65 years): supraspinatus, infraspinatus, subscapularis, long head of biceps, distal biceps, distal triceps, brachioradialis, flexor carpi radialis, flexor carpi ulnaris, palmaris longus, extensor carpi radialis longus and brevis, extensor carpi ulnaris, flexor pollicis longus, abductor pollicis longus, extensor pollicis brevis and longus, extensor indicis proprius, extensor digiti minimi, and from the second to fifth digits, flexor digitorum superficialis and profundus and extensor digitorum communis. Outcome measures included tissue length; cross-sectional area, and major/minor axes; failure load; ultimate tensile strength (UTS); failure strain; elastic modulus; sulfated glycosaminoglycan (sGAG) and hydroxyproline content. Differences were analyzed using mixed linear regression models. Results: Rotator cuff tendons were distinct, exhibiting large, flat cross-sections with high failure loads and sGAG, and low UTS. Supraspinatus was significantly weaker with more sGAG than infraspinatus and subscapularis. Tendon UTS and elastic modulus were largely similar between elbow, wrist, and hand tendons. Exceptions included higher and lower material properties of the extensor pollicis brevis and flexor carpi ulnaris, respectively, than other distal upper limb tendons. Extensor tendons generally had higher sGAG than flexors with significant differences at the wrist and thumb, while hydroxyproline content was significantly higher in digital flexors versus extensors in the fingers. Conclusion: These findings enhance understanding of upper limb tendon properties, providing novel data to inform graft selection and tailor alternative engineered or regenerative strategies. Clinical Relevance: The combined upper/lower limb data sets include 48 unique appendicular tendons and ligaments sourced from the same donors and evaluated using consistent methodologies, providing a robust comparative database to aid selection of suitable donor tendons for the repair/reconstruction of injured tendons/ligaments and the development of graft materials.

Sex bias in cohorts occurs when one sex is overrepresented. This study evaluated sex bias in study cohorts among abstracts accepted for the International Society of Biomechanics (ISB) Congress in 2025. Analyses focused on subject inclusion and abstract characteristics by lead author affiliated country, research topic, and cohort type. Using NotebookLM Gemini 1.5 Pro and a predefined prompt, data were extracted and analysed from 1,394 accepted abstracts. Overall, 43% of relevant abstracts did not report sex distribution, 13% had very small samples sizes (<6 subjects), 18% had an unbalanced cohort (<30% representation of one sex), and only 26% had a balanced cohort. Among unbalanced abstracts, 64% showed an overrepresentation of male subjects, for which a scientific justification was provided in only 1% of cases; in female‑biased abstracts, justification was provided in 18% of cases. Variation in sex representation and reporting was observed across countries, topics, and cohort types, with applied domains such as Military and Sport biomechanics and Animal studies demonstrating lower levels of balance or transparency. Taken together, these findings indicate that sex distribution is frequently insufficiently reported or unevenly represented at the conference abstract stage, a critical point in research dissemination at which study design and recruitment may still be modified prior to journal publication.

Osteoarthritis and polypharmacy are common in older adults. While not consistent with guidelines, opioid analgesia is commonly prescribed to older adults with osteoarthritis and other causes of chronic non-cancer pain. Long term use of opioids is associated with tolerance, addiction, loss of efficacy and adverse events. Thus, deprescribing (reducing or ceasing) opioids is often required. The effect of polypharmacy on the efficacy and safety of opioid prescribing and deprescribing in this setting is poorly understood. Here we aimed to assess the effects of chronic oxycodone, as monotherapy and in polypharmacy (oxycodone, citalopram, simvastatin, oxybutynin, and metoprolol), and of deprescribing oxycodone, on allodynia, physical and cognitive function, and daily activities in middle-aged, osteoarthritic male and female C57BL/6J mice (n=11-15/ group). Only oxycodone monotherapy reduced mechanical allodynia after 6 weeks of treatment. Chronic polypharmacy with oxycodone transiently increased mechanical allodynia in the injured limb and caused marked reductions in mobility, maximum walking speed, activities of daily living, and increased anxiety. Polypharmacy also altered daily activities detected by an automated animal behaviour recognition cage. Sex differences in treatment response were observed in frailty measurements and activity over 23 hours. Deprescribing oxycodone was well tolerated and did not alter physical or cognitive function but did reverse some of the daily activity changes and mechanical allodynia in polypharmacy treated animals only. This clinically relevant preclinical model provides an opportunity to understand the effects of prescribing and deprescribing opioids in older adults with osteoarthritis, including the impact of comedications and sex.

Osteoarthritis (OA) is one of the most common health conditions worldwide leading to immense individual and societal burden. Current treatments for OA are inadequate with no approved structural disease modifying therapies, and existing options for chronic pain only moderately successful long-term. Improving this bleak picture requires a better understanding of OA molecular pathophysiology, how this differs between individuals and over time. Critical in this goal are animal models. There have been four key advancements in this field that have dramatically improved OA pathophysiology discovery research: (1) initial studies showing mouse OA-risk is modified by the same factors as humans-age, sex/sex-hormones, diet and genetics (1952-65); (2) first studies of naturally-occurring OA in mice with spontaneous (1972-81) and induced (1993) genetic mutations (GMs); (3) developing reproducible inducible models with good structural and symptomatic fidelity to human OA (1990-2005); and (4) using inducible and spontaneous OA-models in GM-mice to show disease and symptom modification and define molecular causality (1999-present). These milestones revolutionized OA pathophysiology research, such that there are now >500 unique genes/gene-products identified as having significant effects on OA (beneficial or detrimental). Studies in different mouse OA-models have underpinned the concept of OA-phenotypes, and more particularly endotypes and theratypes, with ~35% of tested molecular targets having different effects on post-traumatic (pt)OA versus spontaneous/age-associated-OA. Deciphering and translating the enormous and growing data from animal-models into effective therapeutics for people remains challenging. This will require better identification and stratification of patients with different OA pheno/endotypes, and improved collaboration between clinical and pre-clinical researchers.

Tendons are force‐transmitting structures which facilitate musculoskeletal functioning. Characterizing variations between different anatomical tendons, regions within tendons, as well as between the sexes and with age can improve understanding of tendon physiology and pathology. A systematic search of the literature was conducted to identify and summarize microscopic structural (histological) variations in normal/healthy tendons in relation to these variables (Tendon, Region, Age, Sex, and Other). Regional differences within individual tendons have been investigated in numerous studies, however investigations comparing histological variations between a range of different tendons are sparse, with most focusing on a few select tendons. When injured, ageing tendons typically have a greater degree of pathological changes than younger tendons, but few studies have documented variations in tendon histology throughout typical (uninjured) ageing or across large age spans. Similarly, sex‐related observations of tendon structure are underreported. This narrative review summarizes studies on these topics and explores interactions between these variables, as well as the implications of these in the context of selecting control samples for studies of tendon pathology. Future studies should endeavour to improve knowledge of tendon structural variations—specifically focusing on normal tendons—to facilitate understanding of tendon structure‐function relationships, physiological mechanisms involved in tendon damage/healing, and to aid clinical research and practice.

Background: Methodological heterogeneity hinders data comparisons across isolated studies of tendon and ligament properties, limiting clinical understanding and affecting the development and evaluation of replacement materials. Purpose: To create an open-access data set on the morphological, biomechanical, and biochemical properties of clinically important tendons and ligaments of the lower limb, using consistent methodologies, to enable direct tendon/ligament comparisons. Study Design: Descriptive laboratory study. Methods: Nineteen distinct lower limb tendons and ligaments were retrieved from 8 fresh-frozen human cadavers (5 male, 3 female; aged 49-65 years) including Achilles, tibialis posterior, tibialis anterior, fibularis (peroneus) longus, fibularis (peroneus) brevis, flexor hallucis longus, extensor hallucis longus, plantaris, flexor digitorum longus, quadriceps, patellar, semitendinosus, and gracilis tendons; anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments; and 10 mm–wide grafts from the contralateral quadriceps and patellar tendons. Outcomes included morphology (tissue length, ultrasound-quantified cross-sectional area [CSA _US ], and major and minor axes), biomechanics (failure load, ultimate tensile strength [UTS], failure strain, and elastic modulus), and biochemistry (sulfated glycosaminoglycan [sGAG] and hydroxyproline contents). Tissue differences were analyzed using mixed-model regression. Results: There was a range of similarities and differences between tendons and ligaments across outcomes. A key finding relating to potential graft tissue suitability was the comparable failure loads, UTS, CSA _US , sGAG, and hydroxyproline present between hamstring tendons (a standard graft source) and 5 tendons not typically used for grafting: fibularis (peroneus) longus and brevis, flexor and extensor hallucis longus, and flexor digitorum longus tendons. Conclusion: This study of lower limb tendons and ligaments has enabled direct comparison of morphological, biomechanical, and biochemical human tissue properties—key factors in the selection of suitable graft tissues. This analysis has identified 6 potential new donor tissues with properties comparable to currently used grafts. Clinical Relevance: This extensive data set reduces the need to utilize data from incompatible sources, which may aid surgical decisions (eg, evidence to expand the range of tendons considered suitable for use as grafts) and may provide congruent design inputs for new biomaterials and computational models. The complete data set has been provided to facilitate further investigations, with the capacity to expand the resource to include additional outcomes and tissues.

Tendon allograft and xenograft processing often involves one or more steps of freezing and thawing. As failure strength is an important graft consideration, this study aimed to evaluate effects on failure properties when varying freeze‐thaw conditions. Kangaroo tendons, a potential xenograft source, were used to evaluate changes in ultimate tensile strength (UTS), failure strain and elastic modulus after exposure to different freezer‐storage temperatures (−20°C vs. −80°C), storage durations (1, 3, 6, 9, or 12 months), number of freeze‐thaw cycles (1, 2, 3, 4, 5, or 10), or freeze‐thaw temperature ranges (including freezing in liquid nitrogen to thawing at 37°C). Tendons stored for 6 or more months had significantly increased UTS and elastic modulus compared with 1 or 3 months of storage. This increase occurred irrespective of the freezing temperature (−20°C vs. −80°C) or the number of freeze‐thaw cycles (1 vs. 10). In contrast, UTS, failure strain and the elastic modulus were no different between storage temperatures, number of freeze‐thaw cycles and multiple freeze‐thaw cycles across a range of freeze and thaw temperatures. Common freeze‐thaw protocols did not negatively affect failure properties, providing flexibility for graft testing, storage, transportation and decellularisation procedures. However, the change in properties with the overall storage duration has implications for assessing the consistent performance of grafts stored for short versus extended periods of time (6 months), and the interpretation of data obtained from tissues of varying or unknown storage durations.