Journal of Hand Surgery-American Volume最新文献

{"title":"Fixation Strategies for Metacarpal Shaft Fractures: A Comparison of Plate-and-Screw, Intramedullary Screw, and Percutaneous Wire Techniques.","authors":"Zachary Jodoin, William Walsh, Doha Hussien, Abigail Wheeler, Tyler K Williamson, Katerina Papanikolaou, Brian Sager, Ryan Rose","doi":"10.1016/j.jhsa.2026.08.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.015","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal fixation for metacarpal shaft fractures remains a topic of debate. This study compares clinical outcomes of three fixation methods-closed reduction with percutaneous Kirschner wire pinning, open reduction internal fixation (ORIF), and intramedullary fixation (IMN)-focusing on time to motion, range of motion (ROM), and complications. We hypothesized that IMN would allow earlier and more reliable return of ROM without increasing complications.</p><p><strong>Methods: </strong>A retrospective review of 84 patients (104 diaphyseal fractures) treated at a level I trauma center between 2018 and 2024 was performed. Patients undergoing nonoperative treatment, multiple fixation methods, or requiring nerve/vascular repair were excluded. Demographic, injury, surgical, and follow-up data were collected. Postoperative motion initiation and complete ROM data, time to union, complications, and reoperation rates were analyzed; multivariate analyses controlled for patient and fracture characteristics. Statistical significance was set at P < .05.</p><p><strong>Results: </strong>IMN and ORIF achieved faster initiation of motion (IMN: 16 days [interquartile range, 11-19]; ORIF: 14 days [interquartile range, 12-22]) compared with closed reduction with percutaneous Kirschner wire pinning (33 days [27-39]). IMN fixation had faster return to full ROM (37 days [26-48]) compared with both ORIF (44 [33-81]) and closed reduction with percutaneous Kirschner wire pinning (114 [70-151]) (P < .001). IMN patients were more likely to achieve full ROM at final follow-up than ORIF patients (odds ratio: 12.3, 95% CI: 2.1-73.5). Complication and union rates were similar among the groups.</p><p><strong>Conclusions: </strong>IMN provides robust, minimally invasive fixation enabling early and reliable return of full ROM while maintaining low complication rates. These results support IMN as the optimal fixation method for appropriately selected metacarpal shaft fractures.</p><p><strong>Type of study/level of evidence: </strong>Level III (retrospective cohort study Therapeutic III.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Algorithm: A Stewardship Framework for the Hand Surgeon Adopting Artificial Intelligence.","authors":"Maxime Cievet-Bonfils, Marion Burnier, Vincent Locquet","doi":"10.1016/j.jhsa.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.006","url":null,"abstract":"<p><p>Artificial intelligence is entering hand surgery through imaging, outcome prediction, and patient communication. Neural networks read scaphoid and distal radius radiographs. Machine learning models predict outcomes after carpal tunnel release. Large language models are being tested for patient communication and chart drafting. Adoption, however, has outpaced validation. Most hand surgery artificial intelligence tools are tested only on data resembling their training set, deployed in workflows that have not been audited, and rarely remeasured after release. The hand surgeon remains the clinical decision maker into whose workflow these tools are integrated, and is therefore accountable for the patient outcomes they shape, even when the model's internal workings remain opaque. We propose a four-part stewardship framework for the hand surgeon adopting these tools: external validation on the population the model will actually see; transparent disclosure of intended use and known failure modes; defined escalation paths when the model and surgeon disagree; and prospective audit after deployment. We set out the specific questions to ask a vendor, the reporting checklist items that support each question, and the performance metrics a surgeon needs to interpret before adopting a tool. This framework has implications for residency training, board certification, the editorial standards of hand surgery journals, and the regulatory pathways that bring such tools to the clinic.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping Nerve Transfer Adoption in Brachial Plexus Birth Injury Reconstruction, 2005-2024.","authors":"Alejandro J Friedman, Ahren Alberto, Janet Hsu, Mandana Behbahani, Lynn Ann Forrester, Steven M Koehler","doi":"10.1016/j.jhsa.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.jhsa.2026.08.001","url":null,"abstract":"<p><strong>Purpose: </strong>Brachial plexus birth injury (BPBI) affects up to 3 per 1,000 live births, with many children experiencing persistent disability. Although autologous nerve grafting has traditionally served as the primary reconstructive strategy for BPBI, nerve transfers are being used with increasing frequency. We analyzed national trends in nerve reconstruction for BPBI using the Pediatric Health Information System administrative database from 2005 to 2024.</p><p><strong>Methods: </strong>We used Current Procedural Terminology (CPT) codes associated with nerve autografting or nerve transfer to identify patients in the Pediatric Health Information System database under 24 months of age who underwent surgery for BPBI. The primary outcome was the presence of procedural CPT coding events. Trends in procedures were analyzed using Cochran-Armitage analyses. Chi-square analyses and multivariate logistic regression were used to evaluate differences between autograft and transfer groups.</p><p><strong>Results: </strong>We identified 1,047 procedural coding events between 2005 and 2024, comprising 585 autografts (55.9%) and 462 nerve transfers (44.1%). Patients who underwent autografts were notably younger than patients who underwent nerve transfer at time of surgery (6.3 ± 3.5 vs 10.2 ± 4.9 months, P < .001). Multivariable analysis confirmed year, patient age, and region as independent predictors of nerve transfer. The odds of receiving a transfer increased 21% with each calendar year (P < .001). Patient age strongly influenced procedure selection, with patients older than 8 months demonstrating nearly 7-fold greater odds of undergoing a transfer. Among patients older than 8 months, treatment by orthopedic surgeons was associated was a 68-fold increase in the odds of nerve transfer during the contemporary study period, whereas treatment by plastic surgeons was associated with a 5-fold increase. Transfers predominated in the West census region and were performed less frequently in the Northeast.</p><p><strong>Conclusions: </strong>These findings demonstrate increasing adoption of nerve transfers in pediatric BPBI reconstruction across specialties and regions. Further investigation into long-term functional outcomes and subspecialty-specific training is needed to refine surgical decision making in this population.</p><p><strong>Type of study/level of evidence: </strong>Prognostic III.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus General Anesthesia for Pediatric Trigger Thumb Release: Clinical Outcomes, Efficiency, and Costs","authors":"Aidan Shulkin MD,&nbsp;Xiya Ma MD, MSc,&nbsp;Daniel Borsuk MD, FRCSC,&nbsp;Charlotte Jaloux MD, PhD,&nbsp;Emilie Bougie MD, FRCSC","doi":"10.1016/j.jhsa.2026.03.010","DOIUrl":"10.1016/j.jhsa.2026.03.010","url":null,"abstract":"<div><h3>Purpose</h3><div>The wide-awake local anesthesia no tourniquet (WALANT) approach has been proposed as a promising alternative to general anesthesia (GA) for hand surgery. However, evidence in the pediatric population remains limited. The objective of this study was to evaluate its impact on clinical outcomes, procedural efficiency, and institutional costs for pediatric trigger thumb (PTT) release.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted on all patients (≤18 years) who underwent open PTT release by a single surgeon at a tertiary pediatric hospital between August 2020 and May 2025. Patients were grouped by approach: WALANT, executed in a minor procedure room, or GA, executed in a traditional operating room. Patient demographics, clinical findings, surgical details, and postoperative outcomes were extracted and compared. An efficiency analysis was performed to assess time parameters, and a cost analysis was performed to assess financial implications.</div></div><div><h3>Results</h3><div>Fifty-six patients were included; 39 underwent WALANT, and 17 received GA. Patients receiving WALANT were significantly older (6.5 vs 3.6 years). Both groups achieved comparable clinical outcomes, with 91% of WALANT and 90% of GA cases demonstrating complete symptom resolution. No complications were reported, and no cases performed using WALANT required conversion to GA. WALANT procedures had significantly shorter minor procedure room/operating room duration (22 vs 36 minutes) and hospital stay (52 vs 442 minutes). The total cost was considerably lower for WALANT, resulting in savings of $7,006.59 Canadian dollars per case.</div></div><div><h3>Conclusions</h3><div>WALANT is a safe and effective alternative to GA for PTT release. It offers equivalent clinical outcomes while considerably improving procedural efficiency and reducing institutional costs. These findings strongly support the wider adoption of WALANT in pediatric hand surgery, aligning with goals to optimize resource use without compromising patient care.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic 2b</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 999.e1-999.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Simplified Method for Determining the Safe Zone in Proximal Radial Plate Fixation","authors":"Piyabuth Kittithamvongs MD, MSc,&nbsp;Prapasiri Chareonsri MD,&nbsp;Sopinun Siripoonyothai MD,&nbsp;Navapong Anantavorasakul MD,&nbsp;Kanchai Malungpaishrope MD,&nbsp;Chairoj Uerpairojkit MD","doi":"10.1016/j.jhsa.2026.02.003","DOIUrl":"10.1016/j.jhsa.2026.02.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The radial head and neck feature a unique anatomical structure, whereby the application of a plate in certain areas can lead to impingement, subsequently restricting the forearm rotation. Various techniques have been suggested to identify the appropriate region for plate fixation. We propose an alternative method to locate a safe zone for plate placement and conduct a comparative analysis with previously established methods.</div></div><div><h3>Methods</h3><div>The study included 30 embalmed cadavers. All specimens demonstrated a full passive range of forearm rotation. A plate was positioned on the most anterior aspect of the radial head/neck with the forearm in full pronation (anteroposterior position) and on the most posterior aspect with the forearm in full supination (P-S position). We assessed the range of motion to identify proximal radioulnar joint impingement and compared the plate's positioning to the safe zone described by Caputo and Smith.</div></div><div><h3>Results</h3><div>All specimens maintained a full passive range of motion following plate fixation in all positions. The plate placement fell within the boundaries of Caputo's radial styloid direction and Smith's Lister's tubercle direction. The average plating zone measured 94°.</div></div><div><h3>Conclusions</h3><div>Positioning the plate at the most anterior aspect during forearm pronation or at the most posterior aspect during forearm supination may serve as an alternative method for identifying a safe fixation zone that avoids proximal radioulnar joint impingement. Using this technique, all specimens demonstrated a full passive range of motion after plate placement, and the plates were positioned within the standard safe zone of the proximal radius.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 971.e1-971.e7"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Trapeziometacarpal Dual Mobility Implant Arthroplasty Compared to Resection Arthroplasty","authors":"Miriam Marks PhD,&nbsp;Kei Mathis MSc,&nbsp;Stephan Schindele MD,&nbsp;Daniel B. Herren MD, MHA","doi":"10.1016/j.jhsa.2025.12.005","DOIUrl":"10.1016/j.jhsa.2025.12.005","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of our study was to perform a cost-utility analysis comparing trapeziometacarpal joint (TMJ) implant arthroplasty with resection-suspension-interposition arthroplasty (RSIA) during 1 year after surgery.</div></div><div><h3>Methods</h3><div>We compared 80 working patients undergoing TMJ implant arthroplasty with 39 working patients receiving RSIA. Over 1 year, we assessed return to work, costs because of loss of productivity, quality-adjusted life-years (QALYs), and direct medical costs. Sensitivity analyses were conducted to extrapolate data over 5 years as well as to account for the data of nonworking patients.</div></div><div><h3>Results</h3><div>Implant arthroplasty patients returned to work significantly faster (mean 52 vs 84 days), leading to reduced costs due to productivity loss. Patients with TMJ implant arthroplasty had significantly higher QALYs (0.89 vs 0.85) and lower total costs (USD 26,809 vs USD 33,953), resulting in a negative incremental cost-effectiveness ratio. At a threshold of USD 110,000 per QALY, implant arthroplasty was found to be cost effective with 99% probability. Sensitivity analyses showed that implant arthroplasty was cost effective over 5 years, despite higher revision risks and also if nonworking patients were included in the population.</div></div><div><h3>Conclusions</h3><div>The study indicates that TMJ implant arthroplasty is less expensive and improves quality of life more effectively than RSIA.</div></div><div><h3>Type of study/level of evidence</h3><div>Economic 1c.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 946-955"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restoration of Pinch Strength After Traumatic Ulnar Nerve Injury: Outcomes of Transfer of the Opponens Pollicis Branch to the Terminal Division of the Deep Branch of the Ulnar Nerve","authors":"Madeline Rieker MD,&nbsp;Richard Arendale BS,&nbsp;Julia Mastracci MD,&nbsp;Ryan Serbin MD,&nbsp;Kayla Hietpas MPH,&nbsp;Bryan Loeffler MD,&nbsp;Glenn Gaston MD","doi":"10.1016/j.jhsa.2026.04.013","DOIUrl":"10.1016/j.jhsa.2026.04.013","url":null,"abstract":"<div><h3>Purpose</h3><div>Ulnar nerve injury causes weak pinch strength through paralysis of the first dorsal interosseus and adductor pollicis muscles. Current reconstructive strategies provide variable reanimation of these muscles. It has been suggested that nerve transfer of the opponens pollicis (OPB) motor branch to the terminal division of the deep branch of the ulnar nerve (TDDBUN) may successfully restore pinch strength. The true effectiveness of this intervention remains unknown as there are few cases in the literature with all originating from a single author.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients who underwent transfer of OPB to TDDBUN at a single institution between 2019 and 2025 with at least 1-year clinical follow-up. Patients were excluded if they were unavailable to return for in-office strength testing. Key and subterminal key pinch, pinch-to-zoom, and grip strength (kg) were measured using dynamometers and compared with the contralateral side. First web space bulk (mm), Kapandji score, Froment’s sign, and patient-reported outcomes (Disability of the Shoulder and Hand and Visual Analog Pain Scale) were assessed.</div></div><div><h3>Results</h3><div>Twelve patients underwent transfer of OPB to TDDBUN and were available for in-office strength testing at greater than 1 year follow-up. The median patient age was 42 years (range, 19–66 years). Mean key pinch and subterminal key pinch strength were 48% (SD 17) and 43% (SD 23) of the uninjured side, respectively. Average pinch-to-zoom strength was 58% (SD 31) of the uninjured side. Average grip strength was 56% (SD 36) of the uninjured side. Mean first web space bulk was 81% (SD 15) of the contralateral. Interestingly, at final follow-up, 10 of 12 patients retained a positive Froment sign, despite pinch strength recovery. All patients retained thumb opposition with a Kapandji score ≥5.</div></div><div><h3>Conclusions</h3><div>Transfer of OPB to TDDBUN may reliably reinnervate the first dorsal interosseous and adductor pollicis, restoring approximately half of the pinch strength observed in the uninjured hand.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 974-981"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Journal CME Instructions","authors":"","doi":"10.1016/S0363-5023(26)00542-3","DOIUrl":"10.1016/S0363-5023(26)00542-3","url":null,"abstract":"","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Page A14"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Influence of Evaluator Experience, Dynamic Versus Static Ultrasound Image Interpretation, and Probe Frequency on Fascicle Differentiation","authors":"Luka Pušnik MD,&nbsp;Natalie Winter MD,&nbsp;Maks Matej Cuzak,&nbsp;Igor Serša PhD,&nbsp;Nejc Umek MD, PhD,&nbsp;Žiga Snoj MD, PhD,&nbsp;Gregor Omejec PT, PhD","doi":"10.1016/j.jhsa.2026.04.004","DOIUrl":"10.1016/j.jhsa.2026.04.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the influence of evaluator experience, dynamic versus static ultrasound (US) image interpretation, and probe frequency on fascicle differentiation.</div></div><div><h3>Methods</h3><div>Evaluator experience and dynamic versus static US image interpretation were assessed on 12 cadaveric forearms. Median nerves were scanned using a 23-MHz US probe, followed by nerve excision and high-field magnetic resonance imaging (MRI) at 9.4-T. Five independent evaluators with different experience levels delineated fascicles twice, using static and dynamic US images. Delineations were compared with high-field MRI. The influence of probe frequency was evaluated on 12 median nerves of healthy volunteers. Median nerves at wrist were scanned using 14-, 18-, 24-, and 70-MHz US probes. Images were cross-referenced, and fascicle counts were compared relative to the highest-frequency probe.</div></div><div><h3>Results</h3><div>Dynamic imaging improved fascicle differentiation by 27.6% to 51.2% compared to static (<em>P</em> &lt; .001), with a greater benefit for less experienced evaluators. The most experienced evaluator identified on average 62.3% more fascicles in dynamic assessment compared to the least experienced. The 70-MHz probe showed the highest mean fascicle count (27.6 ± 3.7), while 24-, 18-, and 14-MHz probes differentiated 26%, 46%, and 63% fewer fascicles, respectively (<em>P</em> &lt;. 0001).</div></div><div><h3>Conclusions</h3><div>Fascicle differentiation improves significantly with evaluator experience, using dynamic US image interpretation, and higher probe frequency. These findings support the clinical utility of ultrahigh-frequency US for detailed evaluation of superficial nerves.</div></div><div><h3>Clinical relevance</h3><div>Experience and dynamic image interpretation are important for reliable fascicle recognition and to minimize misinterpretation. Ultrahigh-frequency US probes substantially improve fascicle differentiation, but their limited penetration requires careful selection of probe frequency based on nerve depth.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 983.e1-983.e9"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesenchymal Stem Cell−Derived Exosomes Combined With 3-Dimensional Hyaluronan-Based Scaffold Promote Tendon-to-Bone Tunnel Healing","authors":"Sergen Karatas MD,&nbsp;Gokce Yildiran MD,&nbsp;Gulsemin Cicek MD,&nbsp;Hande Akdeniz MD,&nbsp;Fatma Oz Bagci MD,&nbsp;Zekeriya Tosun MD","doi":"10.1016/j.jhsa.2026.05.009","DOIUrl":"10.1016/j.jhsa.2026.05.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Tendon-to-bone healing remains a major clinical challenge due to poor regenerative capacity at the enthesis. This study aimed to evaluate the effects of mesenchymal stem cell−derived exosomes combined with a 3-dimensional hyaluronan-based scaffold on graft healing within bone tunnels. This study was conducted in accordance with the ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines.</div></div><div><h3>Methods</h3><div>A total of 128 tendon–bone models were created in 64 Sprague-Dawley rats, randomized into four groups: control, exosome-only, scaffold-only, and exosome-loaded scaffold. At weeks 4 and 8 postoperatively, samples were analyzed histologically (hematoxylin-eosin, Masson Trichrome), immunohistochemically (fibroblast growth factor 2, bone morphogenetic protein 2), and biomechanically (maximum failure load).</div></div><div><h3>Results</h3><div>At both time points, the exosome-loaded scaffold group demonstrated significantly enhanced vascularization, cellular activity, and collagen fiber continuity and parallelism compared to all other groups (<em>P</em> &lt; .05). Fibroblast growth factor 2 and bone morphogenetic protein 2 expression levels were highest in the exosome-loaded scaffold group, indicating early activation of proregenerative pathways. Biomechanically, this group also exhibited the greatest maximum failure load (15.64 ± 0.86 N at week 4; 22.97 ± 2.86 N at week 8), suggesting superior tendon-to-bone integration. The exosome-only group showed delayed but comparable improvements by week 8.</div></div><div><h3>Conclusions</h3><div>Combining mesenchymal stem cell−derived exosomes with a 3-dimensional hyaluronan-based polycaprolactone/tricalcium phosphate scaffold enhances early and sustained healing at the tendon–bone interface. This cell-free, biocompatible strategy significantly improves vascularization, growth factor expression, collagen organization, and mechanical strength. These findings support its potential as a clinically translatable approach for improving tendon-to-bone healing outcomes.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic V.</div></div>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":"51 9","pages":"Pages 1004-1017"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}