Microfracture in the hip should not be limited to the criteria of knee lesions (<400 mm) or to younger patients (age <50 years). However, the results also indicate that patients with full-thickness cartilage defects can anticipate a high rate of conversion to total hip arthroplasty within 2 years of their microfracture surgery and that only 60% of them will have good/excellent results over that time period.

Patients with type 1 diabetes mellitus (T1DM) often suffer from osteopenia or osteoporosis. Although most agree that T1DM‐induced hyperglycemia is a risk factor for progressive bone loss, the mechanisms for the link between T1DM and bone loss still remain elusive. In this study, we found that bone marrow‐derived mesenchymal stem cells (BMSCs) isolated from T1DM donors were less inducible for osteogenesis than those from non‐T1DM donors and further identified a mechanism involving bone morphogenetic protein‐6 (BMP6) that was produced significantly less in BMSCs derived from T1DM donors than that in control cells. With addition of exogenous BMP6 in culture, osteogenesis of BMSCs from T1DM donors was restored whereas the treatment of BMP6 seemed not to affect non‐T1DM control cells. We also demonstrated that bone mineral density (BMD) was reduced in streptozotocin‐induced diabetic mice compared with that in control animals, and intraperitoneal injection of BMP6 mitigated bone loss and increased BMD in diabetic mice. Our results suggest that bone formation in T1DM patients is impaired by reduction of endogenous BMP6, and supplementation of BMP6 enhances osteogenesis of BMSCs to restore BMD in a mouse model of T1DM, which provides insight into the development of clinical treatments for T1DM‐assocaited bone loss. stem cells translational medicine 2019;8:522–534

Based on the current data, graft depth is an important consideration for surgeons when sizing osteochondral allograft transplant for chondral lesions of the knee.

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Symptom relief of recalcitrant metatarsalgia can be achieved through surgical shortening of the affected metatarsal, thus decreasing plantar pressure. Theoretically an oblique metatarsal osteotomy can be oriented distal to proximal (DP) or proximal to distal (PD). We characterized the relationship between the amount of second metatarsal shortening, osteotomy plane, and plantar pressure. We hypothesized that the PD osteotomy is more effective in reducing metatarsal peak pressure and pressure time integral. We performed eight DP and eight PD second metatarsal osteotomies on eight pairs of cadaveric feet. A custom designed robotic gait simulator (RGS) generated dynamic in vitro simulations of gait. Second metatarsals were incrementally shortened, with three trials for each length. We calculated regression lines for peak pressure and pressure time integral vs. metatarsal shortening. Shortening the second metatarsal using either osteotomy significantly affected the metatarsal peak pressure and pressure time integral (first and third metatarsal increased, p < 0.01 and <0.05; second metatarsal decreased, p < 0.01). Changes in peak pressure (p ¼ 0.0019) and pressure time integral (p ¼ 0.0046) were more sensitive to second metatarsal shortening with the PD osteotomy than the DP osteotomy. The PD osteotomy plane reduces plantar pressure more effectively than the DP osteotomy plane. Keywords: second metatarsal; plantar pressure; metatarsalgia; lesser metatarsal osteotomies; gait simulation Metatarsalgia is defined as pain, often during weight bearing, of the plantar aspect of the foot under and related to the lesser metatarsal heads. Primary metatarsalgia is associated with biomechanical insufficiencies, and secondary metatarsalgia is associated with systemic conditions. 1 Initially, metatarsalgia is managed with rest, stretching exercises, cushioning, plantar callosity shaving, and anti-inflammatory medications, but data confirming their effectiveness is limited.2 If symptoms persist, surgery is employed to correct the alignment of the metatarsals and/or muscle/ligament balance. Numerous surgical treatments are used, each with its benefits and complications.2-6 Surgical treatment redistributes pressure under the metatarsal heads 7 by either dorsally displacing the head or by shortening the length of the metatarsal. 3 The amount of shortening is determined by the surgeon's experience considering the preoperative length of the metatarsals. 4,8 In this study, we compared the effects of two different osteotomy planes and the overall amount of second metatarsal shortening on plantar pressure. Insight into the relationship between osteotomy plane, metatarsal shortening, and plantar pressure contributes to a more effective treatment of metatarsalgia by providing the surgeon with greater knowledge of biomechanical principles that can be used to make intraoperative osteotomy decisions.The oblique distal to proximal (DP) sliding osteotomy and the oblique proximal to distal (PD) sliding osteotomy are designed to reduce sec...