Foot & Ankle

Key Takeaways *  Nomenclature Shift:  BMLs are not "edema" (fluid); they are active lesions of fibrosis, microfracture, and necrosis.  *  Predictive Power:  Progressive BMLs carry a  threefold higher risk  of rapid radiographic OA onset (Moradi et al., 2024).  *  The Spine Connection:  In the vertebral column, these lesions are clinically recognized as  Modic Changes , sharing the same inflammatory pathology as knee BMLs.  *  Therapeutic Target:  Long-term data suggest subcho

Every surgeon has seen it: the first 1–2 mL of aspirate is thick and cellular... and everything after that becomes progressively thinner until it looks like pure venous blood. If the marrow cavity is “full of marrow,” why does peripheral blood replace it so quickly? The answer lies in marrow structure, pressure physiology, and fluid dynamics. 𝗠𝗮𝗿𝗿𝗼𝘄 𝗦𝘁𝗿𝗼𝗺𝗮 𝗜𝘀 𝗮 𝗦𝘁𝗿𝘂𝗰𝘁𝘂𝗿𝗲, 𝗡𝗼𝘁 𝗮 𝗟𝗶𝗾𝘂𝗶𝗱 The marrow cavity is not a fluid-filled space—it’s a semi-

If you’ve been around orthobiologics, you’ve heard of 𝗜𝗥𝗔𝗣 — 𝗜𝗻𝘁𝗲𝗿𝗹𝗲𝘂𝗸𝗶𝗻-𝟭 𝗥𝗲𝗰𝗲𝗽𝘁𝗼𝗿 𝗔𝗻𝘁𝗮𝗴𝗼𝗻𝗶𝘀𝘁 𝗣𝗿𝗼𝘁𝗲𝗶𝗻. Its job: block 𝗜𝗟-𝟭, the cytokine that drives joint inflammation and cartilage loss. When IL-1 is blocked by 𝗜𝗟-𝟭𝗥𝗮, inflammation cools — often dramatically. 𝗪𝗵𝗲𝗿𝗲 𝗜𝘁 𝗦𝘁𝗮𝗿𝘁𝗲𝗱 In the early 2000s, 𝗗𝗿. 𝗣𝗲𝘁𝗲𝗿 𝗪𝗲𝗵𝗹𝗶𝗻𝗴 (Germany) discovered that incubating blood with treated glass beads triggered white ce

𝗧𝗵𝗲 𝗲𝘃𝗶𝗱𝗲𝗻𝗰𝗲 𝘀𝘂𝗴𝗴𝗲𝘀𝘁𝘀 𝗣𝗥𝗣 𝗮𝗻𝗱 𝗕𝗠𝗔𝗖 𝗱𝗼𝗻’𝘁 𝗿𝗲𝗴𝗿𝗼𝘄 𝗰𝗮𝗿𝘁𝗶𝗹𝗮𝗴𝗲, 𝘀𝗼 𝘄𝗵𝘆 𝗱𝗼 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘁𝗵𝗶𝗻𝗸 𝘁𝗵𝗲𝘆 𝘄𝗶𝗹𝗹? There’s no question PRP and BMAC can deliver value. Studies consistently show pain relief, improved function, and in some cases slowing of degeneration. For the right patient, those gains matter. But here’s the problem: patients hear “𝘀𝘁𝗲𝗺 𝗰𝗲𝗹𝗹𝘀” or “𝗴𝗿𝗼𝘄𝘁𝗵 𝗳𝗮𝗰𝘁𝗼𝗿𝘀” and expect regenerat