The presence of chondral lesions in patients with chronic ankle instability is common and has been suggested as a possible cause of persistent pain in some cases, even after successful ligament reconstruction. For this reason, some authors have proposed combining ankle stabilization with cartilage microfracture; however, the results reported in literature are contradictory. The study was designed as a prospective randomized clinical study with two parallel arms. Patients with an anterior talofibular ligament tear causing pain and instability, associated with a Berndt–Harty stage I–IIb talar osteochondral lesion of < 150 mm2 that had not responded to conservative treatment, were blindly assigned to either isolated ligament reconstruction (REC) or reconstruction plus microfracture (REC + MIC). Evaluators were also blinded. A total of 71 patients were included in the study, with 36 in the REC group and 35 in the REC + MIC group. The groups were comparable in terms of anthropometry and pathology. The operating time was significantly longer in the REC + MIC group (48.0 ± 4.5 min) compared with the REC group (24.9 ± 3.9 min; p < 0.001). At the end of follow-up, both patient groups showed similar results on the American Orthopaedic Foot and Ankle Society (AOFAS) score (p = 0.755), Self-Reported Foot and Ankle Score (SEFAS) (p = 0.862), Karlsson score (p = 0.993), and visual analog scale (VAS) (p = 0.870). However, the time to recovery differed between the groups, with patients in the REC group recovering faster from before the operation (pre-op) through the third month after the operation (post-op). The difference in recovery at 3 months post-op was statistically significant on the AOFAS (p < 0.001), SEFAS (p < 0.001), and Karlsson (p < 0.001) scores. No statistically significant difference was observed in terms of pain (p = 0.342). The failure rate was also comparable between the groups, with four (11.1%) reoperations in the REC group and five (14.3%) in the REC + MIC group (p = 0.735). At 2 years post surgery, no differences were observed in function (according to the AOFAS, SEFAS, and Karlsson scores), pain, or complications in patients with ankle instability and associated chondral damage treated with or without microfractures. However, patients who underwent microfractures experienced a significantly slower recovery of function. Level of evidence: Level 1. Trial registration: ClinicalTrials.gov Identifier NCT06947317 (retrospectively registered). Date: 1 May 2025. ( https://clinicaltrials.gov/study/NCT06947317 ).

Background: Disproportionate short stature is one of the most characteristic clinical traits of achondroplasia, a condition with a significant impact on patients’ autonomy that results in a series of limitations leading to poorer health-related quality of life. Limb lengthening surgery is an effective therapeutic alternative for increasing the stature of persons with achondroplasia. The purpose of this study was to evaluate the cost-effectiveness of bone lengthening in patients with achondroplasia and to estimate the economic impact of the procedure on the Spanish health system by means of a Markov model. Results: Patients with achondroplasia who undergo a limb lengthening procedure gain, on average, 5.954 quality-adjusted life years (QALYs) more than unoperated patients (27.197 vs. 21.243 QALYs). As the procedure entails a mean incremental cost of €49,480, the resulting incremental cost-effectiveness ratio (ICER) is €8,310/QALY. The probabilistic sensitivity analysis (PSA) performed yielded a mean quality of life gain of 6.287 QALYs and a mean cost increase of €49,131, which translates into an ICER of €7,814/QALY. The budget impact analysis was based on the hypothesis that all patients with achondroplasia born every year in the country used as a reference (Spain, n = 15) undergo the procedure. Under this assumption, a cumulative cost increase of €8,896,196 can be estimated over a 15-year period (€8,836,931 following the PSA). Conclusions: Limb lengthening surgery in patients with achondroplasia can be considered a cost-effective intervention according to the most commonly accepted willingness-to-pay thresholds in Spain and other Western countries.

Background: Although several studies have evaluated the cost-effectiveness of total knee arthroplasty (TKA) compared with conservative treatment, few have explored how implant revision rates may influence its long-term cost-effectiveness. The objective of this study was to evaluate the impact of implant revision rates on quality of life and cost-effectiveness in patients undergoing TKA. Methods: A cost-utility analysis from a healthcare system perspective was conducted using an individualized discrete-event simulation model parameterized with data from a Spanish cohort of patients undergoing TKA. Quality-adjusted life years were calculated with the SF-6D index, and implant alternatives were compared by assigning age- and sex-specific revision rates to each simulated patient while projecting long-term quality of life and life expectancy according to general population standards. The prosthetic models compared were those associated with the highest (WorstKnee) and lowest (BestKnee) revision rates in the UK National Joint Registry. The primary outcome was the incremental cost-effectiveness ratio. Secondary analyses included budget impact and deterministic sensitivity analyses. Results: The projected quality-adjusted life expectancy over 15 years was 9.767 QALYs for WorstKnee, compared with 10.004 QALYs for BestKnee. The incremental cost-effectiveness ratio was €6,219/QALY, which remained below the cost-effectiveness thresholds commonly used in Spain. Use of BestKnee was associated with an additional cost of €332.3 M over 15 years; however, it also led to a substantial reduction in revision surgeries, with 27,878 fewer procedures performed, resulting in gradual cost savings over time. Conclusion: Within the price ranges currently observed in the Spanish National Health System, total knee prostheses associated with lower revision rates provide a favorable long-term cost-effectiveness profile and may reduce future revision burden despite their higher acquisition cost.

Diabetic foot is a severe complication of diabetes mellitus, with a significant impact on patients’ quality of life. The traditional treatment has be