Purpose The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament. Methods Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes. Results Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported. Conclusion LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery. Level of Evidence Level IV, retrospective case series.

Background. Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration. Materials and Methods. Sixty cases with grade II-III knee osteoarthritis according to the KellgrenLawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment. Results. At 6-month follow-up, Group C (PRP+HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded. Conclusion. The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.

Vascular complications after femoral fixation are rare and not only easy to recognize but also potentially life-threatening. The aim of this case report is to describe how a pseudoaneurysm of the deep femoral artery can complicate an intramedullary nailing after a pertrochanteric fracture and how it can be treated. We report the case of a 90-year-old female who developed a pseudoaneurysm of the profunda femoris artery 16 days after intramedullary femoral nailing for a pertrochanteric hip fracture. Stenting of the artery was urgently performed with a consequent resolution of the symptoms. Diagnosis of vascular complications after hip surgery may be very challenging because symptoms are often nonspecific. Despite their rarity, it is important to know this type of complications to address the diagnostic pathway in the right direction and to treat them promptly.

A new philosophy of science and medicine had spread throughout the 17th-century Italy: the “Scientific Revolution.” Giovanni Alfonso Borelli (1608–1679) was one of the most charismatic and brilliant scientists of his generation in Europe. He extended to biology the rigorous analytic methods developed by his indirect mentor Galileo in the field of mechanics. In his masterpiece “De Motu Animalium,” Borelli analyzed structure, motion, balance, and forces concerning almost all the principal joints of the human body, in static and dynamic situations. In particular, he accurately studied the anatomy and biomechanics of the knee joint. He sustained that femoral condyles shift backward during flexion, allowing a wider range of movement. Furthermore, he observed that, when the knee flexes, the lateral condyle moves backward more than the medial condyle: this concept is nowadays known as medial pivoting. The aim of this article is to describe the life and work of this important Italian scientist and to present his unrecognized contribution to modern knee biomechanics.

Introduction: Although Total Knee Arthroplasty (TKA) is a successful procedure, a significant number of patients are still unsatisfied, reporting instability at the mid-flexion range (Mid-Flexion Instability-MFI). To avoid this complication, many innovations, including load sensors (LS), have been introduced. The intraoperative use of LS may facilitate the balance of the knee during the entire range of motion to avoid MFI postoperatively. The objective of this study was to perform a Gait Analysis (GA) evaluation of a series of patients who underwent primary TKA using a single LS technology. Methods: The authors matched and compared two groups of patients treated with the same posterior stabilized TKA design. In Group A, 10 knees were intraoperatively balanced with LS technology, while 10 knees (Group B) underwent standard TKA. The correct TKA alignment was preoperatively determined aiming for a mechanical alignment. Clinical evaluation was performed according to the WOMAC, Knee Society Score (KSS) and Forgotten Joint Score, while functional evaluation was performed using a state-of-the-art GA platform. Results: We reported excellent clinical results in both groups without any statistical difference in patient reported outcome measurements (PROMs); from a functional standpoint, several GA space–time parameters were closer to normal in the sensor group when compared to the standard group, but a statistically significant difference was not reached. Conclusions: Gait Analysis represents a valid method to evaluate TKA kinematics. This study, with its limitations, showed that pressure sensitive technology represents a valid aid for surgeons aiming to improve the postoperative stability of TKA; however, other factors (i.e., level of intra-articular constraint and alignment) may play a major role in reproducing the normal knee biomechanics.