The role of nutrition intervention in surgical settings is constantly developing and evolving. Immunonutrition represents a viable option to reduce perioperative and postoperative complications in surgical oncology. However, as far as we know, little research has been conducted in the orthopedic field. With this review, we aim to summarize the state of the art in the application of immune-enhanced compounds to surgical, orthopedic, and traumatic patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adopted. A comprehensive search was carried out using the PubMed (MEDLINE), EMBASE, and Cochrane Library databases. All the studies dealing with immunonutrition fed to traumatic and orthopedic patients were pooled, the data were extracted, and the studies were discussed. A total of eight studies were included: six focused on trauma surgery and two on elective orthopedic surgery. The epidemiological characteristics of participants and the assessment of results were reported. Data were analyzed using R software (2020; R Core Team). Based on the current available literature, a positive impact of immunonutrition in orthopedic and trauma surgical settings was registered. All studies analyzed showed the favorable impact of the immunonutrition diet on clinical outcomes. The full effect of this type of nutrition and its different applications in the orthopedic and traumatic fields should be critically investigated through more extensive randomized controlled trials.

Osteochondral regeneration remains a major clinical challenge due to the complex architecture and biomechanical demands of the osteochondral unit. Bioactive hydrogels have emerged as promising materials capable of supporting repair through their capacity to mimic the extracellular matrix (ECM), enable cell encapsulation, and deliver bioactive cues. However, recent insights reveal that simply engineering hydrogels for structural and cellular support is insufficient. A new paradigm is emerging—one that embraces the complexity of the osteochondral niche by integrating immunomodulatory and mechanobiological cues into biomaterial design. In particular, the hydrogel’s capacity to modulate macrophage polarization and support the immunoregulatory function of mesenchymal stem cells (MSCs) is critical to orchestrate regenerative outcomes. Simultaneously, the mechanical properties of hydrogels—such as stiffness, porosity, and viscoelasticity—can profoundly influence stem cell fate and local tissue morphogenesis. This review discusses recent advances in hydrogel-based strategies for osteochondral repair, highlighting the interplay between immunological signals and the mechanical microenvironment, and calls for a shift from reductionist tissue-engineering approaches to systems-level design of tunable, immuno-mechanobiological microenvironments.

The patellar height measurement is fundamental for surgical planning in patellar instability. The Caton–Deschamps index (CDI) is a widely employed method, but a gold standard is still lacking. The aim of this study was to evaluate the reliability and reproducibility of the CDI in a patellar height assessment and to hypothesize its employment in the preoperative planning of patellar stabilization surgery. A total of 29 cases of recurrent patellar instability undergoing surgical treatment were analyzed. The preoperative and postoperative CDI were measured by six different raters (three seniors and three juniors). The interclass correlation coefficient (ICC) of the six raters was calculated to evaluate the interobserver agreement. The seniors’ and juniors’ measurements were compared to assess the CDI reproducibility. The Fleiss kappa was calculated among the six raters to estimate the agreement in favor of an anterior tibial apophysis (ATA) transposition surgery. This study shows excellent absolute agreement in terms of the ICC for the raters’ average and for single raters as units, both preoperatively (p < 0.001) and postoperatively (p < 0.001). The agreement of the surgical choice between the six observers corresponds to “substantial agreement”. This study demonstrates that the CDI is reliable and reproducible, and it could represent a valuable tool in the clinical assessment, treatment choice and pre-surgical planning of patellar instability surgery.

The second anterior cruciate ligament (ACL) injury after ACL reconstruction is a well-known complication. Several studies have suggested that the risk of contralateral ACL injury is comparable to that of graft re-rupture. However, this comparison is not well established in previous reviews for studies with minimum five-year follow-up and mean ten-year outcomes. This systematic review and meta-analysis aimed to evaluate the ten-year risk of graft re-rupture and contralateral ACL injury after primary ACL reconstruction and to assess the influence of graft type, return-to-sport, and other factors on second ACL injuries. A systematic search was conducted across the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Cochrane from 2000 to 2025. The literature search strategy included the following keywords: "anterior cruciate ligament reconstruction," "ACL reconstruction," "graft rupture," "graft failure," "contralateral anterior cruciate ligament injury," and "contralateral ACL injury." All studies that compare the risk of re-rupture and contralateral ACL injuries after ACL reconstruction and with a follow-up of at least five years after ACL reconstruction were included. Exclusion criteria included case reports, reviews, studies using allografts or artificial ligaments, and multi-ligament injuries. A total of 18 studies were included in this meta-analysis with 5,735 participants. The pooled rates of graft rupture and contralateral injuries were 11 % and 12 %, respectively, with no statistically significant difference (p = 0.421). The ipsilateral graft-rupture rate was higher in patients with hamstring tendon (HT) autografts compared with bone-patellar tendon-bone (BPTB) autografts, at 13.0 % and 7.74 %, respectively (odds ratio [OR] = 1.75, 95 % confidence interval [CI]: 1.33-2.31; p = 0.004). Younger age (<18 years) was identified as the most substantial risk factor, with patients under 18 years showing nearly a threefold increased risk of graft rupture (OR 2.22, 95 % CI: 1.16-4.23, p = 0.016). Age <18 years also conferred increased risk for contralateral injury (OR 1.87, 95 % CI: 1.32-2.65, p = 0.001). Return to sport (RTS) was achieved by 51 %-73 % of patients in the included studies. However, delaying RTSs did not result in a statistically significant reduction in the risk of reinjury. Contralateral anterior cruciate ligament injuries and graft re-ruptures occurred at similar rates (12 % and 11 %, respectively, p = 0.421), which suggests that risk of second injury is similar between ipsilateral graft failure and contralateral anterior cruciate ligament injury. Therefore, second ACL injuries remain a crucial concern over extended follow-up periods (mean: 10.3 years), driven primarily by younger age, hamstring graft use, and participation in high-demand sports. Level III.

Background/Objectives: Aseptic loosening is a major challenge in hip and knee arthroplasty. While radiostereometric analysis (RSA) is the gold standard for detecting early migration, it is static, costly, and requires metal beads. Provocation CT-based analysis studies implants under physiological stresses and offers a marker-free alternative with comparable accuracy. This systematic review evaluates its effectiveness, cost, and role in orthopedic imaging. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were searched, with no date restrictions, using keywords related to the research area. The risk of bias was assessed using the RoB-1 tool. Results: The initial search identified 42 studies, with 6 ultimately included in the review. These studies involved 198 patients with an average age of 65.0 years. Provocation CT demonstrated higher sensitivity and specificity than standard radiographs, particularly in cases with inconclusive X-rays. Additionally, the radiation dose for CT scans varied across studies, with effective doses ranging from 0.2 mSv to 4.5 mSv per scan. Compared to X-ray, CT-based methods showed comparable or superior performance in motion detection, though direct clinical comparisons with RSA remain lacking. Conclusions: Provocation CT-based analysis is a valuable diagnostic tool for early detection of implant loosening, offering a potentially feasible, accurate, and cost-effective alternative to traditional methods. However, standardized protocols, broader economic evaluations, and prospective multicenter trials are needed to confirm its routine clinical applicability.