Osteoarthritis is the most common joint disease and a major cause of disability. The knee is the large joint most affected. While chronological age is the single most important risk factor of osteoarthritis, the pathogenesis of knee osteoarthritis in the young patient is predominantly related to an unfavorable biomechanical environment at the joint. This results in mechanical demand that exceeds the ability of a joint to repair and maintain itself, predisposing the articular cartilage to premature degeneration. This review examines the available basic science, preclinical and clinical evidence regarding several such unfavorable biomechanical conditions about the knee: malalignment, loss of meniscal tissue, cartilage defects and joint instability or laxity.Level of evidence IV.

Objectives To summarise recommendations and appraise the quality of international clinical practice guidelines (CPGs) for rehabilitation after ACL reconstruction. Design Systematic review of CPGs (PROSPERO number: CRD42017020407). Data sources Pubmed, EMBASE, Cochrane, SPORTDiscus, PEDro and grey literature databases were searched up to 30 September 2018. Eligibility criteria English-language CPGs on rehabilitation following ACL reconstruction that used systematic search of evidence to formulate recommendations. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report the systematic review. Two appraisers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to report comprehensiveness, consistency and quality of CPGs. We summarised recommendations for rehabilitation after ACL reconstruction. Results Six CPGs with an overall median AGREE II total score of 130 points (out of 168) and median overall quality of 63% were included. One CPG had an overall score below the 50% (poor quality score) and two CPGs scored above 80% (higher quality score). The lowest domain score was ‘applicability’ (can clinicians implement this in practice?) (29%) and the highest ‘scope and purpose’ (78%) and ‘clarity of presentation’ (75%). CPGs recommended immediate knee mobilisation and strength/neuromuscular training. Early full weight-bearing exercises, early open and closed kinetic-chain exercises, cryotherapy and neuromuscular electrostimulation may be used according individual circumstances. The CPGs recommend against continuous passive motion and functional bracing. Conclusion The quality of the CPGs in ACL postoperative rehabilitation was good, but all CPGs showed poor applicability. Immediate knee mobilisation and strength/neuromuscular training should be used. Continuous passive motion and functional bracing should be eschewed.

World population has been continuously increasing and progressively aging. Aging is characterized by a complex and intraindividual process associated with nine major cellular and molecular hallmarks, namely, genomic instability, telomere attrition, epigenetic alterations, a loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication. This review exposes the positive antiaging impact of physical exercise at the cellular level, highlighting its specific role in attenuating the aging effects of each hallmark. Exercise should be seen as a polypill, which improves the health-related quality of life and functional capabilities while mitigating physiological changes and comorbidities associated with aging. To achieve a framework of effective physical exercise interventions on aging, further research on its benefits and the most effective strategies is encouraged.

Background: Mosaicplasty has been associated with good short‐ to long‐term results. Nevertheless, the osteochondral harvesting is restricted to the donor‐site area available and it may lead to significant donor‐site morbidity.Purpose: Provide an overview of donor‐site morbidity associated with harvesting of osteochondral plugs from the knee joint in mosaicplasty procedure.Methods: Comprehensive search using Pubmed, Cochrane Library, SPORTDiscus and CINAHL databases was carried out through 10^th October of 2016. As inclusion criteria, all English‐language studies that assessed the knee donor‐site morbidity after mosaicplasty were accepted. The outcomes were the description and rate of knee donor‐site morbidity, sample’s and cartilage defect’s characterization and mosaicplasty‐related features. Correlation between mosaicplasty features and rate of morbidity was performed. The methodological and reporting quality were assessed according to Coleman’s methodology score.Results: Twenty‐one studies were included, comprising a total of 1726 patients, with 1473 and 268 knee and ankle cartilage defects were included. The defect size ranged from 0.85 cm² to 4.9 cm² and most commonly 3 or less plugs (averaging 2.9 to 9.4 mm) were used. Donor‐site for osteochondral harvesting included margins of the femoral trochlea (condyles), intercondylar notch, patellofemoral joint and upper tibio‐fibular joint. Mean donor‐site morbidity was 5.9 % and 19.6 % for knee and ankle mosaicplasty procedures, respectively. Concerning knee‐to‐knee mosaicplasty procedures, the most common donor‐site morbidity complaints were patellofemoral disturbances (22 %) and crepitation (31 %), and in knee‐to‐ankle procedures there was a clear tendency for pain or instability during daily living or sports activities (44 %), followed by patellofemoral disturbances, knee stiffness and persistent pain (13 % each). There was no significant correlation between rate of donor‐site morbidity and size of the defect, number and size of the plugs (p > 0.05).Conclusions: Osteochondral harvesting in mosaicplasty often results in considerable donor‐site morbidity. The donor‐site morbidity for knee‐to‐ankle (16.9 %) was greater than knee‐to‐knee (5.9 %) mosaicplasty procedures, without any significant correlation between rate of donor‐site morbidity and size of the defect, number and size of the plugs. Lack or imcomplete of donor‐site morbidity reporting within the mosaicplasty studies is a concern that should be addressed in future studies.Level of evidence: Level IV, systematic review of Level I‐IV studies.