Despite advancements in understanding and treating anterior knee pain linked to lower limb torsional deformities, a definitive consensus on diagnostic criteria, clinical indications, and therapeutic strategies for "miserable malalignment syndrome" remains elusive. This systematic review synthesizes current research to unify understanding of this complex condition. Findings highlight varied definitions and surgical approaches, underscoring standardization challenges. This systematic review aimed to synthesize current research to provide a more unified understanding of this complex condition. While studies report favorable anatomical correction and symptomatic relief, inconsistent clinical outcome scores and limited long-term follow-up hinder robust comparisons. Conservative measures are often ineffective due to underlying mechanical imbalance; surgical interventions, primarily derotational osteotomies of the femur and/or tibia, offer the most direct anatomical correction. However, optimal level, extent, and timing of these osteotomies-whether single or double level, staged or simultaneous-are debated. Liße et al.'s proposed diagnostic criteria offer a valuable step towards standardized identification of true miserable malalignment syndrome. Future research, particularly robust multi-center studies with standardized outcome measures, is critically needed to establish clearer, evidence-based guidelines, ultimately improving patient care and long-term outcomes for this challenging condition.
Arthroscopic bone block surgery for the treatment of recurrent posterior glenohumeral instability (PGHI) is currently a valid option in the hands of an experienced surgeon. The aim of this retrospective study is to evaluate the clinical and radiological results of this procedure at a minimum 2-year follow-up, emphasizing the importance of a proper rehabilitation protocol. Eleven patients with a history of recurrent posterior shoulder instability underwent arthroscopic bone block surgery from autologous iliac crest graft, from 2019 to 2024. All the patients were selected considering Moroder’s ABC classification, the level of pain (Numeric Pain Rating Scale, NPRS), functional abilities assessed via the Constant–Murley Score (CMS), the Rowe score, imaging, at baseline and least 2 years after surgery. The Constant–Murley Score improved from 66 to 87 points, the Rowe score improved from 16 to 77 points, the level of pain (NPRS) decreased after treatment. The bone block was found to be intact in 8 patients, while the presence of a focus of resorption was observed in 3 patients, especially around the screws. This single-center, retrospective study of 11 patients shows how the surgical bone block procedure for recurrent forms of glenohumeral instability produces good clinical and functional outcomes when performed in the presence of an expert surgeon and with a specific post-operative rehabilitation program.
Heterotopic ossification (HO) is a well-known complication after joint arthroplasty but remains poorly characterized following total ankle arthroplasty (TAA). This study evaluated the temporal progression and anatomical distribution of HO after an anterior approach TAA and explored the potential influence of postoperative rehabilitation protocols on its development. This retrospective observational study included a consecutive series of patients undergoing primary TAA via an anterior approach. Standardized clinical and radiographic assessments were performed from 12 months postoperatively. HO was evaluated radiographically, graded, and analysed according to anatomical quadrant and temporal evolution. Postoperative rehabilitation protocols were recorded and examined as potential factors influencing HO severity. Radiographic HO was observed in all patients, yielding a 100
While revision-specific stems are standard for revision total hip arthroplasty (rTHA), cementless primary stems are an emerging alternative for patients with preserved bone stock. However, their long-term reliability remains under debate. To systematically evaluate the safety, fixation durability, and functional outcomes of cementless primary femoral stems in rTHA. Following PRISMA guidelines (PROSPERO: CRD420251232433), we searched MEDLINE, Embase, Cochrane, and Web of Science through November 2025. Risk of bias was assessed using RoB-2 and ROBINS-I. Pooled event rates were calculated using a random-effects model. Twenty-one studies involving 2,109 rTHAs were analyzed over a mean follow-up of 97.6 months, primarily involving Paprosky type I and II defects. The pooled aseptic loosening rate was 2.96
To compare medium- to long-term patient-reported outcomes, objective function, pain, range of motion, and revision/reoperation risk between kinematic (KA) and mechanical alignment (MA) in primary total knee arthroplasty (TKA) using randomized trials. A systematic review and meta-analysis followed PRISMA and Cochrane guidelines. Randomized controlled trials comparing KA and MA in primary TKA with ≥ 24 months follow-up were identified through PubMed, Scopus, Cochrane, and Web of Science. Pooled mean or standardized mean differences and risk ratios were calculated using random-effects models. Outcomes were stratified into mid-term (24–60 months) and long-term (> 60 months) windows. Certainty of evidence was assessed using GRADE. Ten unique RCTs (13 articles, 934 knees, follow-up 2–13 years) were included. Mid-term analyses favored KA in Forgotten Joint Score (MD 4.06, 95
The ankle joint complex is a sophisticated structure whose kinematic behaviour is frequently oversimplified in both clinical and biomechanical practice. The hinge model, with a fixed axis aligned with the line joining medial and lateral malleoli, remains prevalent despite evidence of a migrating centre of rotation (COR) and three-dimensional motion. This paper addresses common misconceptions surrounding the COR and axis of rotation (AOR) at the ankle joint, clarifying their purely kinematic nature. A conceptual framework is provided, introducing mechanical notions of COR, centrode, helical axis and axode with reference to their application in the ankle joint analysis. The clinical relevance of accurate COR localisation is discussed, spanning the topics of muscles moment arm estimation and total ankle arthroplasty (TAA). Current limitations are critically reviewed, including the absence of standardised in vivo protocols and the insufficient integration of subject-specific kinematic assessment. Emerging acquisition technologies are proposed as the most promising avenue to bridge the gap between biomechanical knowledge and clinical translation, ultimately moving beyond the oversimplified single-axis model in the management of ankle pathology.
Foot and ankle procedures are frequently associated with significant acute pain, with studies reporting moderate-to-severe pain measured on the Visual Analog Scale (VAS) at 5–6, in up to 67
Pediatric supracondylar humerus fractures are among the most common elbow injuries in childhood. Although K-wire fixation is widely accepted, the optimal surgical technique and pin configuration remain controversial. Additionally, the Modified Flynn criteria, which assess both functional and cosmetic outcomes, have been less frequently utilized in the literature. This study aimed to evaluate whether surgical technique and pin configuration influence clinical and radiological outcomes in pediatric supracondylar humerus fractures using Modified Flynn criteria. This retrospective study included 78 pediatric patients who underwent surgical treatment for supracondylar humerus fractures between 2012 and 2021. Patients were categorized according to surgical technique (open vs. closed reduction) and pin configuration (lateral-only vs. medial-lateral fixation). Radiological parameters, including Baumann angle, carrying angle, and humerocapitellar angle, were assessed. Functional and cosmetic outcomes were evaluated using the Modified Flynn criteria. Range of motion was compared with the contralateral side. Statistical analyses were performed using SPSS, with p < 0.05 considered statistically significant. Closed reduction was associated with a significantly shorter hospital stay compared to open reduction (p < 0.001). Gartland type II fractures demonstrated significantly shorter pin removal times than type III and IV fractures (p = 0.036). No significant differences were observed between surgical techniques or pin configurations in terms of radiological parameters or Modified Flynn functional and cosmetic outcomes (p > 0.05). According to the Modified Flynn cosmetic score, carrying angle and supination differed significantly between excellent and good outcome groups (p = 0.002 and p < 0.001, respectively). Based on the Modified Flynn functional score, flexion–extension arc and supination were significantly different between excellent–good and fair–poor outcome groups (p < 0.001 and p = 0.003, respectively). All observed nerve injuries resolved during follow-up, consistent with neuropraxia. No significant differences were observed between lateral-only and crossed pin fixation regarding clinical, radiological, or Modified Flynn outcomes in this retrospective study. Both fixation methods provided satisfactory clinical and radiological outcomes when stable fracture reduction was achieved. These findings suggest that the choice of pin configuration should be individualized according to fracture characteristics and intraoperative stability rather than applied routinely. Larger prospective studies are warranted to confirm these findings.
Concomitant ipsilateral clavicle and scapula fractures are uncommon injuries, and their optimal management remains controversial. While surgical treatment has been advocated for selected unstable patterns, the role of conservative treatment, particularly in minimally displaced fractures, has not been clearly established. The aim of this study was to evaluate the prevalence of concomitant clavicle and scapula fractures and to compare the clinical outcomes of conservatively treated patients with those of a matched cohort of patients with isolated clavicle fractures. We retrospectively reviewed all adult patients treated conservatively for clavicle fractures at our institution between January 2020 and December 2022. After applying the inclusion and exclusion criteria, 84 patients were included in the final analysis. Nine patients (10.7
Previous meta-analyses have shown that systematic deltoid repair (DR) in patients with bimalleolar equivalent ankle fractures improves post-operative functional outcomes and reduces reoperations. However, these studies were retrospective and are subject to the biases inherent in the nature of observational studies. Therefore, by including only randomized controlled trials (RCTs), this meta-analysis will assess the benefits of DR in these patients. Following the PRISMA guidelines, PubMed, Embase, Cochrane, and Google Scholar were accessed and explored until November 2025. The extracted data consisted of the risk of complications, post-operative and improvement in medial clear space (MCS), operative time, post-operative pain and post-operative American Orthopedic Foot and Ankle Society (AOFAS) score. Five RCTs were included, consisting of 244 patients, with 121 in the DR group and 123 in the control group. There was no difference between the two groups in adverse events. In addition, there were no differences in post-operative MCS, pain, or AOFAS between the two groups. However, the control group had a shorter operative time (Mean Difference = 46.75 min, p = 0.05). The results of this meta-analysis revealed that systematic DR did not have additional benefits in patients with bimalleolar equivalent ankle fractures. Future studies are needed in order to figure out the characteristics of patients that benefit from DR in this type of ankle fractures.
Spondylodesis is performed to stabilize and immobilize spinal regions impacted by conditions such as degenerative disorders, deformities, trauma, tumors, or infections. To improve the accuracy of pedicle screw placement, computer-assisted navigation systems were introduced in spine surgery. The objective of this study was to compare the accuracy of pedicle screw placement and the patient outcomes in robotic-guided versus intraoperative 3D navigation techniques for thoraco-lumbar spine surgery. The search was conducted on 30 September 2025 on Scopus, Cochrane Central Library and PubMed. Prospective and retrospective studies that compared pedicle screw placement, clinical outcomes and complications using robotic versus intraoperative 3D navigation technique in the thoracolumbar segment were included. Hospital stay, operative time and blood loss were evaluated as continuous outcomes with mean difference. Screw accuracy, FJV, intraoperative and postoperative screw revisions, complications and complications were evaluated as dichotomous outcomes with odds ratio. Statistical significance was set at p < 0.05. Among the 14 studies included in the meta-analysis, statistically significant results in favor of robotic group were described for hospital stay (p = 0.003) and pedicle screw accuracy (p < 0.00001). However, no significant differences were observed in terms of intraoperative or postoperative screw revisions, facet joint violations, operative time and blood loss. Robotic-guided pedicle screw fixation represents a safe and highly effective technique, showing statistically significant superiority in screw placement accuracy compared to CT-guided navigation.
Treatment of metastatic bone fractures could be challenging, especially in elderly oncologic patients. Recent treatment options like photodynamic nailing are a mini-invasive procedure that allows fractures stabilization and early recovery. We reviewed five studies following the PRISMA guidelines obtaining 148 patients treated with Photodynamic Bone Stabilization (PBS). Mean follow-up period after surgery was 10.5 months as reported in 4 of 5 studies (range 1.5–24 months). All patients evaluated have been treated due to metastasis from other primary tumors. IlluminOss® System demonstrated positive outcomes in the reviewed studies, decreasing mean VAS score from pre-surgery values (7.71) to post-surgery values (4.19). As reported in 3 of 5 studies evaluated, mean preoperatively MSTS score was 30.38
To evaluate the impact of surgical timing on mortality and functional outcomes in elderly patients with proximal femoral fractures (PFFs), specifically investigating whether a 72-h threshold provides a more sensitive clinical discriminator than the traditional 48-h guideline. A retrospective cohort study was conducted on 314 patients aged ≥ 65 years surgically treated for low-energy PFF (AO/OTA 31-A and B) between January 2018 and December 2019. Patients were initially dichotomized by a 48-h threshold (Group A ≤ 48 h, n = 139; Group B > 48 h, n = 175) and subsequently analyzed using a 72-h cutoff. Primary endpoints were 3-month and 1-year mortality. Multivariate logistic regression was performed to adjust for age, sex, and Charlson Comorbidity Index (CCI). Secondary outcomes included postoperative length of stay (LOS), transfusion requirements, and functional recovery assessed via the Barthel Index. No statistically significant difference in 3-month mortality was observed using the 48-h cutoff (Group A: 11.6
Background: Glenoid bone loss represents a major challenge in primary reverse shoulder arthroplasty (RSA), directly influencing implant fixation, positioning, and reconstructive strategy. Existing classification systems describe glenoid morphology but do not provide a unified framework for treatment-oriented decision-making. The SPA-CE classification was developed as a CT-based system integrating defect depth, location, and version abnormality. Methods: A retrospective analysis of 211 consecutive primary RSA procedures was performed. Preoperative CT scans were used to classify glenoid morphology according to the SPA-CE system and the Walch classification. Reconstructive strategies were analyzed in relation to SPA-CE types. The distribution of morphologic patterns and their association with surgical techniques and underlying diagnosis were assessed. Results: The most common SPA-CE pattern was simple central (SC), observed in 62.1% of cases. Overall, simple (S) defects predominated (75.4%), whereas plastic (P) defects accounted for 24.2% and advanced (A) defects were rare (0.5%). Defects managed without structural reconstruction (SC and SEI) accounted for 73.9% of shoulders, whereas 1.4% required version correction without lateralization (SEII), 24.2% required lateralization (plastic types), and 0.5% required patient-specific reconstruction. A consistent relationship was observed between SPA-CE types and reconstructive strategies. In contrast, substantial variability in SPA-CE patterns was identified within individual Walch groups, particularly in Walch B2 glenoids. Underlying diagnosis influenced defect morphology: post-traumatic conditions, fractures, and rotator cuff tears were predominantly associated with SC defects, whereas osteoarthritis demonstrated the widest distribution of SPA-CE patterns, including complex and reconstructively demanding defects. Conclusion: The SPA-CE classification provides a structured, CT-based and treatment-oriented framework for the assessment of glenoid bone loss in RSA. It demonstrates a consistent relationship with reconstructive strategies and may improve preoperative planning and surgical decision-making.
Osgood-Schlatter disease (OSD), also known as tibial tubercle apophysitis, is a traction apophysitis of the tibial tuberosity that disproportionately affects adolescents during periods of rapid skeletal growth (1). First described independently by Robert Osgood and Carl Schlatter in 1903, this condition represents the most prevalent cause of knee pain in the skeletally immature athletic population (3). Despite its self-limiting nature, OSD can result in prolonged symptoms lasting up to 24 months, with approximately 10
The optimal timing of definitive fixation for tibial plafond (pilon) fractures remains controversial. While staged protocols aim to reduce soft-tissue complications, early definitive fixation may reduce morbidity associated with prolonged external fixation. This systematic review and meta-analysis evaluated whether early fixation is associated with different complication rates compared with delayed or staged management. A systematic search of PubMed, Web of Science, Scopus, and the Cochrane Library was conducted from inception to December 2025. Comparative studies evaluating early versus delayed or staged surgical management of adult pilon fractures were included. Early management was defined as definitive plate fixation performed within 48–72 h after injury, while delayed or staged management involved initial external fixation followed by delayed definitive surgery. Primary outcomes were infection or wound complications and reoperation. Secondary outcomes included malunion and nonunion. Random-effects meta-analyses were performed using risk ratios (RR) with 95
The direct anterior approach (DAA) in total hip arthroplasty (THA) offers advantages in muscle preservation and early recovery but is challenged by a steep learning curve that may affect outcomes. This systematic review analyzed complication and reoperation rates during the learning phase of DAA in primary THA. A comprehensive search of PubMed, Cochrane Library, and Web of Science, was performed according to PRISMA guidelines. Studies reporting complications and reoperations during the DAA learning curve were included. Data on demographics, surgical volume, and adverse events were extracted. The primary outcomes were complication and reoperation prevalence with 95
Patellar management during revision TKA (rTKA) remains challenging. Metal-backed patella (MBP) with highly porous titanium coating applied by 3D printing may provide improved fixation in TKA, especially in patients with limited bone stock. The primary aim of this study was to assess implant survivorship among patients who received a new-generation MBP during revision TKA. Secondary aims were to assess (1) healthcare utilization, and (2) preoperative and 1-year PROMs. This was a retrospective review of patients who received a MBP during rTKA from 2017 to 2022. In total, 31 patients achieved an average follow-up of 3.0 years (SD 1.5 years). Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, KOOS Physical Function Shortform (PS), KOOS Joint Replacement (JR) and Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS) were obtained preoperatively and at 1-year. Most patients had prior ipsilateral prosthetic joint infection (PJI; n = 22, 71
Shoulder disorders are the third most common musculoskeletal presentation in primary care. Injuries to the structures surrounding this joint are closely related to oxidative stress and can lead to rotator cuff (RC) disease, including subacromial impingement syndrome, tendinopathy, and partial thickness tears, all characterized by pain, functional impairment, and reduced quality of life. This exploratory pilot investigation evaluates the effects of 2
Total knee arthroplasty (TKA) provides reliable pain relief and implant survival; however, a clinically relevant proportion of patients still report residual symptoms, functional limitations, or an unnatural joint perception. Instrumented gait analysis may objectively assess postoperative function and clarify whether alignment strategies influence gait recovery. This systematic review followed PRISMA 2020 recommendations. PubMed/MEDLINE and the Cochrane Library were searched from January 1990 to November 2024. Eligible studies reported instrumented gait-analysis outcomes after primary fixed-bearing TKA performed with mechanical, kinematic, anatomical, functional, inverse kinematic, restricted kinematic, or other personalized alignment techniques, with at least 12 months of follow-up. Revision TKA, unicompartmental knee arthroplasty, case reports, reviews, and studies without an appropriate comparison group were excluded. Six studies met the inclusion criteria, underscoring the limited available evidence. The studies were heterogeneous in design, alignment strategy, gait-analysis protocol, and reported outcomes. Four studies compared kinematic and mechanical alignment, one inverse kinematic and adjusted mechanical alignment, and one gap-balanced TKA with healthy controls. No consistent gait advantage of one alignment strategy was demonstrated. Some studies reported lower knee adduction moment or gait patterns closer to healthy controls after kinematic or inverse kinematic alignment, but findings were inconsistent. Evidence on gait analysis after TKA with different alignment strategies remains limited and heterogeneous. Current data do not allow firm conclusions regarding the superiority of any alignment strategy. Larger prospective studies using standardized gait-analysis protocols are needed.
