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Injection therapy for knee osteoarthritis continues to be a controversial topic. Commonly accepted treatment options are corticosteroid and hyaluronic acid injections, but recently platelet-rich plasma also has been a promising biologic treatment option. Adipose and bone marrow-derived mesenchymal stem cells have been applied clinically, but there is no strong supporting evidence for their use. It is also currently unknown whether stem cells can regenerate cartilage. As there is no cure for painful knee osteoarthritis, injection therapy can provide symptom relief. Recent network meta-analyses suggest that platelet-rich plasma provides the best functional improvement and safety for knee osteoarthritis, and adipose-derived mesenchymal stem cells provide excellent pain relief. We must bear in mind that other network meta-analyses report different results, and a challenge of network meta-analysis is inconsistency that can lead to biased treatment effect estimates.In today's health care climate, the patient perspective is becoming increasingly important. As the health care paradigm shifts toward value-based health care, patient-reported outcomes are becoming increasingly important for not only research but for routine clinical care. While there are many outcome instruments used for musculoskeletal care, the addition of the simple question of "how are you doing" or "are your symptoms manageable" can provide additional valuable insight to the provider and help improve care using a shared decision model. In other words, if you want to know how the patient is doing, you have to ask them. This biopsychosocial approach demonstrates caring for the entire patient. The Patient-Reported Outcomes Measurement Information System (PROMIS) is a patient-reported outcome instrument that was developed using the biopsychosocial model and has the advantage of being administered as a computer adaptive test. It can be used across health care and is comparable across medical specialties as the scores are standardized to US population-based norms. When used in isolation, PROMIS provides an idea of how the patient is doing compared with the population but does not give the insight as to how the patient is coping with their condition. The addition of an anchor question, such as their patient acceptable symptom state, adds further understanding to the individual patient.Osteochondral lesions of the talus remain a challenging pathologic entity facing orthopaedic foot and ankle surgeons. Although multiple treatment options exist, there is limited evidence supporting one technique over another. The ultimate goal of surgical intervention is to achieve lesion infill with tissue properties that best mimic those of hyaline articular cartilage. Restoring the anatomic surface of the talus may provide long-term clinical success and improve function. Augmentation of bone marrow stimulation with extracellular matrix cartilage allograft aims to achieve this goal.The range of biological agents to treat osteoarthritis is in constant expansion, and recent trials suggest that amnion-derived products (such as umbilical cord stem cells or amniotic allograft suspension) may provide significant symptomatic relief and functional improvement compared with traditional injectables. Anyway, in many countries, stringent limitations exist on the manipulation and homologous use of placenta-derived products, and therefore, collecting more data is mandatory to endorse their use for musculoskeletal diseases in a safe and clearly regulated way. More in general, an increasing interest toward orthobiology has been observed in recent years, which led to the introduction in clinical practice of many minimally invasive strategies to treat osteoarthritis, from platelet-rich plasma to mesenchymal stem cells. On the basis of this trend, which involves physicians from different specialties, it would be fundamental to have clear guidelines establishing the correct use of these products in the setting of clinical routine not only to safely provide patients the most advanced therapeutic options but also to protect our practice from potential legal issues.How to restore native knee kinematics following complex knee injuries is still debated and under investigation. To better reproduce the native anterior cruciate ligament (ACL), surgeons have a host of different options, including graft choice, technique, fixation method, and single-, double-, and triple-bundle techniques, etc. Isolated ACL reconstruction alone is not effective in controlling complex instability patterns, especially regarding internal and external rotations. Several techniques have been described to address such instabilities, like single- or double- bundle ACL reconstruction plus lateral extra-articular tenodesis. In truth, chronic ACL injury requires reconstruction plus lateral tenodesis to control rotational instability. NX-2127 solubility dmso Additional technical complexity may result in complications without improved outcomes. Neither single-bundle nor double-bundle techniques are "truly" anatomic. Keep it simple; keep it safe.Medial and lateral root injuries are different clinical entities. Medial root injuries are of a degenerative nature and frequently are associated with obesity and varus deformity. Lateral root injuries, however, are more often of traumatic origin and usually associated with injuries to the anterior cruciate ligament. There is also a biomechanical difference between the 2 injuries. In the case of medial root injuries, the loss of circular hoop tension leads to an increase in peak contact pressure. In the case of lateral root lesions, the loss of hoop stress can be compensated for by an intact meniscofemoral ligament. Nevertheless, a repair also seems to make sense on the lateral meniscus, as the posterior root also has a stabilizing effect on the knee. The most suitable technique for lateral root repair depends on the type of lesion. A transtibial pull out repair is suitable for frequent avulsion injuries (type 1). In the case of type 2 injuries, which are also common, a side-to-side suture is an option.Medial open-wedge high tibial osteotomy is an established treatment option for relatively young patients with medial-compartment osteoarthritis and varus deformity. This procedure is mainly focused on correcting coronal malalignment; however, it inevitably affects the posterior tibial slope (PTS) in the sagittal plane. The alteration of the PTS significantly affects knee stability and kinematics. When medial open-wedge high tibial osteotomy is performed, incomplete osteotomy of the posterior cortex could lead to a cortical hinge shift from the lateral side to the posterolateral side, which indicates the alteration of the axial hinge axis. In this case, there is a risk of an increasing PTS. In addition, incomplete posterior cortex osteotomy can lead to a lateral hinge fracture.The tibial slope usually increases after open-wedge high tibial osteotomy (OWHTO) because of several factors. The anteromedial cortex of the proximal tibia is angulated 45° relative to the posterior cortex, whereas the lateral cortex is nearly perpendicular. Therefore, an OWHTO with equal anterior and posterior gaps will increase the tibial slope. In addition, an anteromedial approach to the proximal tibia because of concern about neurovascular injury results in the failure to perform a proper osteotomy of the posterolateral cortex. Slope-optimization methods include a sagittally oriented hinge, posterior bone grafting, posterior plating, and forcefully extending the knee to compress the anterior gap sagittally oriented hinge, posterior positioning of the wedged plate, and knee extension during fixation. However, if the tibial slope is easily controlled using knee extension, this may indicate fracture of the lateral hinge, whereas a preserved lateral hinge is a prerequisite for a successful OWHTO. Most of all, a proper posterior cortical osteotomy is the key step to preventing increased tibial slope in OWHTO. Again, if an incomplete osteotomy is performed posterolaterally, the opening gap is increased anteriorly, leading to an unnecessary increase in posterior tibial slope; for biplanar osteotomy, retrotubercular osteotomy should be performed close to the patellar tendon and not be advanced to the posterolateral side of the hinge.Hip arthroscopy for the treatment of femoroacetabular impingement syndrome requires access to the central compartment of the hip, which is more easily obtained with hip distraction. However, surgeons must balance improved surgical access with the risks of postoperative complications. Hip joint venting describes the disruption of the suction seal by introducing a large-gauge needle into the joint space and injecting air or fluid into the joint. Joint venting performed before initiating axial traction may reduce the force required to obtain central compartment access while mitigating postoperative complications.Advancements in hip arthroscopy are astounding. Circumferential labral reconstruction, labral augmentation, and capsular reconstruction are valuable tools. Beyond the "comfort zone" of the hip intra-articular realm, new frontiers include the peritrochanteric space, and a similarity to the subacromial space of the shoulder makes the transition attainable. In contrast, the subgluteal space is seen as outside the box. Sciatic nerve entrapment (SNE), ischiofemoral impingement (IFI), and tears of the proximal origin of the hamstring are among the subgluteal space pathologies. Clinical assessment of deep gluteal syndrome, defined as nondiscogenic sciatic nerve entrapment, can be particularly difficult but is critical and one of the skills that we as hip sports surgeons need to master. The respective treatments for SNE, IFI, and hamstring tears are nerve decompression, lesser trochanteric resection, and hamstring repair. Complications can occur, most commonly temporary injury of the sciatic nerve and permanent injury of the posterior femoral cutaneous nerve. While all located in the deep gluteal space, SNE, IFI, and proximal hamstring tears are unique entities. When thinking outside the box, it's important to consider the complicated contents of Pandora's box.Surgical management of iliopsoas pathology that fails conservative treatment is controversial. Potential complications following iliopsoas tenotomy include recurrent painful internal snapping, postoperative pain, and hip flexor weakness. Concerns are even greater in dysplastic patients, in whom the iliopsoas may play a role as an anteromedial hip stabilizer. Although data demonstrate arthroscopic iliopsoas tenotomy for painful internal snapping as safe and effective, its use has declined for the reasons stated above. On the other hand, procedures such as capsular plication with inferior shift and anatomic labral repair, augmentation, and reconstruction have made it possible to restore the primary stabilizers in many cases of hip instability. In these cases, iliopsoas fractional lengthening (IFL) with avoidance of collateral damage to the musculature or capsule can successfully treat painful internal snapping hip. We recommend iliopsoas lengthening when (1) there is painful internal snapping, (2) IFL can be performed without collateral damage, (3) the primary soft tissue stabilizers can be restored or augmented, and (4) there is no bony morphology likely to cause continued instability.