Yaohua He

This study aimed to develop a BMSC-laden polyethylene glycol diacrylate/methacrylated hyaluronic acid (PEGDA/HAMA) dual-crosslinked hydrogel and evaluate its effects on osteochondral defect repair. Two PEGDA concentrations, 3.75% and 7.5% (w/v), were used to prepare representative soft and stiff hydrogel formulations, respectively. The hydrogels were characterized in terms of morphology, cytocompatibility, and compressive behavior, and their ability to support BMSC-associated matrix deposition was evaluated in vitro. Repair outcomes were further assessed in a rat osteochondral defect model at 4 and 8 weeks. The 7.5% PEGDA/HAMA hydrogel exhibited higher stiffness than the 3.75% formulation and supported BMSC viability and matrix deposition in vitro. In vivo, the stiff hydrogel group showed improved defect filling and subchondral bone remodeling compared with the soft hydrogel and defect groups. However, histological and immunohistochemical analyses revealed predominant collagen type I deposition and limited collagen type II expression in the repair region, indicating fibrocartilaginous rather than hyaline-like cartilage repair. These findings suggest that BMSC-laden PEGDA/HAMA hydrogels may provide a useful platform for osteochondral defect repair, while further optimization of degradation behavior, matrix maturation, and collagen type II deposition is required to improve hyaline cartilage-oriented repair.

Introduction: To evaluate the biomechanical and clinical outcomes of superior capsular reconstruction (SCR) with autologous tendon (AT) for the irreparable rotator cuff tears (IRCTs). Methods: Ten fresh-frozen human upper limb specimens were used to create three models (intact, rotator cuff-deficient, and reconstruction). Superior translation of the humeral head and subacromial pressure were measured at different abduction angles under standardized loading. Mechanical comparability between tendons was also evaluated by measuring cross-sectional area and basic tensile properties. For clinical evaluation, a prospective case series of nine patients with IRCTs tears who underwent SCR with AT was conducted. Shoulder joint range of motion, American Shoulder and Elbow Surgeons (ASES), and Constant-Murley (CM) were recorded before surgery, at 6 months and 12 months after surgery. Magnetic resonance imaging (MRI) was performed preoperatively, the day after surgery, and at 6 months. Results: The reconstruction reduced superior translation of the humeral head and subacromial pressure compared with the rotator cuff-deficient condition. No significant differences were observed in basic mechanical properties between the tested tendons. ASES scores improved significantly at both 6 and 12 months after surgery, whereas Constant score did not remain statistically significant in the 12-month pairwise comparison after adjustment for multiple comparisons. No significant differences were observed in shoulder joint range of motion. MRI showed 6/9 (67%) patients had reduced thickness of the implanted peroneus longus tendon (PLT) graft at 6 months postoperatively, while the PLT grafts of the other patients remained intact. Conclusion: SCR with AT may help restore superior glenohumeral stability under controlled biomechanical conditions and shows promising preliminary clinical results in patients with IRCTs.

Chronic inflammation‐driven bone loss in aging compromises bone regeneration and further impairs the bone‐tendon interface (BTI). However, the cellular mechanisms by which inflammation exacerbates cellular senescence and consequently disrupts BTI healing remain unclear. Here, we identify M1 macrophage‐mediated inflammation as a key driver of bone marrow‐derived mesenchymal stem cells (BMSCs) senescence and bone microstructural deterioration. This senescence‐associated decline in BMSCs ultimately compromises osteogenesis and delays BTI repair. To counteract these effects, we engineered a senomorphic and immunomodulatory platform by incorporating quercetin‐primed senomorphic small extracellular vesicles (Sm‐sEV) into a tissue‐adhesive α‐lipoic acid hydrogel (αLA‐Gel) for sustained local delivery. The composite material modulates the inflammatory‐senescent microenvironment by attenuating M1 macrophage‐driven inflammation and enhancing BMSC resilience to inflammation‐exacerbated senescence. Mechanistic analyses revealed that Sm‐sEV/αLA‐Gel suppresses cGAS‐STING‐NF‐κB signaling, thereby reducing inflammation and improving BMSC resistance to senescence. In an osteoporotic rat rotator cuff repair model, Sm‐sEV/αLA‐Gel enhanced bone formation and fibrocartilage maturation, thereby promoting superior BTI integration and mechanical strength. Together, these findings identify inflammation‐exacerbated BMSC senescence as a key pathological driver and demonstrate that dual regulation of inflammation and stem cell resilience enables robust regeneration of bone and the BTI under osteoporotic conditions.

Purpose: This study aimed to assess the clinical and cost-effectiveness of telerehabilitation (TELE) compared to face-to-face rehabilitation (FTF) in patients following arthroscopic ACL reconstruction. Given the increasing demand for accessible rehabilitation methods, this trial investigates the feasibility of implementing TELE in a middle-income country like China. Methods: A prospective, non-inferiority randomized controlled trial (RCT) was conducted with 68 participants randomly assigned to either TELE or FTF rehabilitation. Participants were followed for 12 weeks, with assessments at baseline, 6 weeks, and 12 weeks after surgery. Primary outcomes included knee function (measured using the International Knee Documentation Committee Subjective Knee Form, IKDC). Secondary outcomes included pain, mobility, and functional status. Cost-effectiveness was analyzed using the incremental cost-effectiveness ratio (ICER). Results: Both groups showed similar improvements in clinical outcomes, with no significant differences in IKDC scores, pain levels, or range of motion at 12 weeks. However, TELE rehabilitation was significantly less expensive, with a total cost of 58,303.18 CNY compared to 82,358.90 CNY for FTF ( p < 0.001). The ICER analysis demonstrated that TELE was a cost-effective alternative, with substantial cost savings per unit of effectiveness. Conclusion: Telerehabilitation may be a cost-effective and clinically comparable alternative to traditional face-to-face rehabilitation following ACL reconstruction. These findings may support the broader implementation of TELE in regions with limited access to in-person rehabilitation, especially in low- and middle-income countries like China. Further studies with longer follow-up periods are needed to confirm the long-term cost-effectiveness and health benefits of TELE. Trial registration: Chinese Clinical Trial Registry ( https://www.chictr.org.cn/ ). Trial registration ChiCTR2100053313.

To evaluate the clinical and radiological outcomes of a novel side-to-side triple-row repair combined with long head of biceps tendon augmentation for the

Introduction: The high rate of retear following rotator cuff repair is largely attributed to the absence of a fibrocartilage layer and limited bone regeneration capacity. We aim to evaluate a bioadhesive derived from decellularized porcine annulus fibrosus extracellular matrix, loaded with zeolitic imidazolate framework-8 (ZIF-8), and to promote rotator cuff tendon–bone healing.Methods: Three adhesive formulations were developed: (1) silk fibroin/tannic acid (ST group), (2) ST combined with decellularized porcine annulus fibrosus extracellular matrix (ST/dECM group), and (3) ST/dECM supplemented with ZIF-8 (ST/dECM/ZIF-8 group). Optimal component ratios were determined using lap shear strength testing. The microstructure, Fourier transform infrared (FTIR) spectra, swelling behavior, and degradation properties of the materials were characterized. In vitro studies assessed the adhesives’ effects on cytotoxicity, proliferation, and the chondrogenic and osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells (BMSCs). A rat rotator cuff repair model was used to evaluate in vivo anti-inflammatory effects, fibrocartilage and bone regeneration, and biomechanical performance.Results: All adhesive formulations exhibited comparable tissue adhesion strength and biocompatibility. Both the ST/dECM and ST/dECM/ZIF-8 groups enhanced BMSC chondrogenic differentiation compared to the ST group, with the ST/dECM/ZIF-8 group showing superior osteogenic induction. In vivo, the ST/dECM/ZIF-8 hydrogel effectively reduced interfacial inflammation and promoted fibrocartilage and bone regeneration. Biomechanical testing demonstrated significantly higher ultimate load, tensile stress, and stiffness in all adhesive-treated groups compared to untreated controls.Conclusion: The ST/dECM/ZIF-8 bioadhesive hydrogel promotes fibrocartilage and bone regeneration. These findings highlight its potential as a promising biomaterial-based strategy to enhance tendon-to-bone interface healing following rotator cuff repair.

Osteoporotic tendon-to-bone healing remains a major challenge, as cellular senescence disrupts tissue regeneration and impairs repair outcomes. Although the role of cellular senescence in rotator cuff repair is increasingly recognized, current strategies often overlook the complex pathological context, particularly the dual impacts of senescence on both bone marrow-derived mesenchymal stem cells (BMSCs) and tendon-derived stem cells (TDSCs). This gap hampers effective tendon-to-bone healing and integration, especially under osteoporotic conditions. Herein, a composite hydrogel system, quercetin-loaded aligned ultralong hydroxyapatite nanowire/gelatin-hyaluronic acid hydrogel (Que-AHNW/GH), has been developed to address these challenges. By integrating senolytic quercetin as a biological cue with highly aligned ultralong hydroxyapatite (HAP) nanowires as a topographical cue, the system remodels the senescent microenvironment, alleviating senescence in both BMSCs and TDSCs and promoting osteogenesis and tenogenesis. Que-AHNW/GH suppresses the PI3K/AKT pathway, enhances autophagy, and reduces senescence in both cell types. In vivo, Que-AHNW/GH improves bone tunnel regeneration, tendon repair, and tendon-to-bone integration in osteoporotic rats with rotator cuff injury. This system enhances biomechanical strength and gait performance and demonstrates excellent biosafety. These findings highlight the promising potential of Que-AHNW/GH as a multifunctional biomaterial for effectively promoting senescence-related tendon-to-bone healing, offering a promising solution for treating osteoporotic tendon-to-bone injuries.