Abdullah I. Alturki

Objectives: Distraction osteogenesis (DO) is an established technique for bone regeneration but is associated with prolonged consolidation time and extended external fixation. Biophysical and biologic adjuncts have been proposed to accelerate regenerative maturation. This systematic review aimed to comparatively evaluate the available clinical evidence regarding low-intensity pulsed ultrasound (LIPUS) and biologic augmentation strategies in distraction osteogenesis. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420251125456). MEDLINE, Embase, Scopus, and Google Scholar were searched from inception to October 2025. Randomized controlled trials and cohort studies evaluating LIPUS, platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), culture-expanded mesenchymal stem cells, or hyperbaric oxygen therapy in distraction osteogenesis were included. Risk of bias was assessed using RoB 2 for randomized trials and structured domain-based criteria for observational studies. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Results: Nine studies involving 304 participants met the inclusion criteria, including randomized controlled trials and cohort studies across multiple anatomical sites and fixation techniques. Randomized trials evaluating LIPUS demonstrated inconsistent reductions in healing index and consolidation time, with no consistent effect on complication rates. Biologic adjuncts such as PRP, BMAC, and cell-based therapies showed signals of improved consolidation parameters in selected studies; however, evidence was limited by small sample sizes and methodological heterogeneity. Hyperbaric oxygen therapy lacked sufficient high-quality evidence to support routine use. Overall, the certainty of evidence was constrained by variability in study design, outcome definitions, and risk of bias. Conclusions: Although both biophysical and biologic adjuncts demonstrate compelling biological rationale, current clinical evidence in distraction osteogenesis remains heterogeneous and inconclusive. Biologic strategies may offer theoretical advantages through direct cellular and growth factor supplementation, whereas LIPUS provides non-invasive mechanotransductive stimulation; however, neither approach can currently be recommended for routine clinical use. High-quality, adequately powered trials with standardized outcome reporting are required to define their true clinical role. Level of Evidence: Level III (Systematic review of Level I–III studies).

Background: Varus malalignment accelerates medial compartment knee osteoarthritis, for which high tibial osteotomy (HTO) is the standard joint-preserving treatment but involves implants and delayed rehabilitation. Proximal fibular osteotomy (PFO) has emerged as a less invasive, implant-free alternative, yet comparative evidence between the 2 procedures remains limited. Purpose: This study aimed to clarify how PFO compares with HTO for managing varus medial knee osteoarthritis. We sought to determine whether PFO offers comparable pain relief, functional recovery, radiographic correction, and safety at short-term follow-up. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we systematically searched major databases through April 2025. We included randomized and observational comparative studies evaluating adults undergoing PFO versus HTO. Data were synthesized using random-effects models, with risk of bias appraised using RoB 2 and Methodological Index for Non-Randomized Studies, and evidence certainty graded through GRADE methodology. Results: Eleven studies encompassing 550 knees (266 PFO, 284 HTO) met the inclusion criteria. At the most consistent follow-up point of approximately 12 months, pain outcomes were nearly identical (MD 0.01; 95% confidence interval −0.35 to 0.37), and improvements in functional scores did not differ in a clinically meaningful way. Radiographic alignment changes varied across studies without demonstrating a clear advantage for either procedure. Overall complication rates were similar, although transient peroneal irritation occurred only after PFO and hardware-related symptoms only after HTO. Conclusion: Current short-term evidence analyzed in this systematic review and meta-analysis suggests that PFO and HTO achieve broadly comparable improvements in symptoms and function for varus medial knee osteoarthritis, while PFO offers a simpler, implant-free alternative with immediate weight-bearing. Level of Evidence: Level III: Systematic review and meta-analysis of level-I to Level-III studies.

Introduction : The optimal timing to initiate the Ponseti method for congenital idiopathic clubfoot remains uncertain. This systematic review and meta-analysis aimed to evaluate whether starting treatment within the first four weeks of life improves outcomes compared to later initiation. Methods : Following PRISMA guidelines (PROSPERO ID: CRD42025650117), MEDLINE, Embase, Cochrane Library, and Google Scholar were searched for studies comparing early (≤4 weeks) versus late (>4 weeks) initiation of the Ponseti method. Outcomes included the number of casts, the relapse rate, and the need for tenotomy. Data were pooled using a random-effects model, and study quality was assessed using the MINORS tool. Results : Six studies involving 467 patients (689 feet) met the inclusion criteria. Early initiation was associated with a slightly higher mean number of casts (MD = 0.72, 95% CI [0.33–1.10], p = 0.0002), but this difference was not significant in the overall pooled analysis (MD = 0.06, 95% CI [−1.08–1.21], p = 0.91). Relapse (OR = 0.70, p = 0.68) and tenotomy rates (OR = 0.68, p = 0.41) were comparable between groups. Discussion : Although earlier treatment may require more casts, it does not reduce relapse or tenotomy rates. These findings suggest that initiating treatment after four weeks yields comparable outcomes, offering flexibility in clinical practice without compromising results. Variability across studies highlights the need for standardized treatment protocols and well-designed randomized controlled trials to confirm the optimal initiation age.