Background: Kinematic alignment (KA) restores native limb alignment following total knee arthroplasty (TKA). The association of this technique with a medial pivot implant design attempts to re-establish the physiological kinematics of the knee. This study aims to analyze the clinical and radiological outcomes of patients undergoing MP-TKA with kinematic alignment and to assess the effect of limb alignment on the clinical outcomes. Methods: We retrospectively analyzed 55 patients who underwent kinematic aligned medial pivot TKA from September 2018 to January 2020. Patient-related outcomes (PROMs) were collected at baseline, 3, 12, and 24 months after surgery. Long-standing weight-bearing radiographs were performed three months after surgery. Results: We demonstrated a significant improvement in clinical outcomes from 3 months after surgery up to 24 months of follow-up. This clinical improvement was independent of limb alignment. The radiological analysis showed that the patient’s native limb alignment was restored and that their joint line orientation was parallel to the floor. Conclusion: The association of kinematic alignment and a medial pivot TKA implant allows for a fast recovery, with good clinical and functional outcomes up to a minimum of 2 years of follow-up, independent of the final limb alignment.

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.

Purpose: The purpose of this study was to investigate the influence of sex on patients undergoing total hip arthroplasty (THA) for hip osteoarthritis (HOA), aiming to assess the clinical and functional outcomes using patient‐reported outcome measures (PROMs).Methods: A retrospective analysis of patients undergoing THA at Ospedale Galeazzi‐Sant'Ambrogio between 2016 and 2022 was conducted. Inclusion criteria encompassed Kellgren–Lawrence grade III or IV HOA, with preoperative and 12‐month postoperative PROMs. Enroled patients have been selected from a larger cohort without matching design for confounders. The analyses were performed using R software v4.0.3 (R Core Team) and data distributions were assessed using the Shapiro–Wilk normality test.Results: One hundred ninety patients (72 male and 118 female) who had both preoperative and postoperative PROMs have been analysed from our institutional prosthesis registry (Datareg). Baseline and 12‐month post‐THA PROMs showed significant improvements overall. VAS score dropped notably from baseline to 3 months postsurgery (7.1 ± 2.1 vs. 0.9 ± 1.7). Functional and mental PROMs, including Harris Hip Score‐functional (HHS‐F), Harris Hip Score‐total (HHS‐t), SF‐12PS and SF‐12MS, exhibited substantial improvements post‐THA. Stratifying by sex, males had lower baseline VAS, higher HHS‐F, SF‐12MS and hip disability and osteoarthritis outcome score‐physical function short form (HOOS‐PS). At 12 months, males displayed significantly better VAS, HHS‐F, SF‐12PS and HOOS‐PS scores. Complication rates were minimal (1.5%), with stable rates across genders, mostly involving dislocation and periprosthetic fractures. Implant survival at 12 months reached an impressive 99%.Conclusion: THA remains an effective treatment for severe HOA. However, females presented with worse baseline conditions and showed relatively less improvement at 1‐year postsurgery compared to males. This difference could be attributed to physiological and psychosocial factors associated with sex, including hormonal changes, muscle mass decline and perception of pain. Longer follow‐ups and prospective studies are necessary to validate these findings and facilitate personalised approaches in HOA treatment, emphasising the need for careful consideration of sex‐related variables in clinical decision‐making for THA patients.Level of Evidence: Level III.

Background: The rapid diffusion of Coronavirus disease (COVID-19) in Northern Italy led the Italian government to dictate a national lockdown from 12 March 2020 to 5 May 2020. The aim of this observational cohort study is to analyze the differences in the number of pediatric patients’ admission to the Emergency Room (ER) and in the type and causes of injury. Methods: The pediatric population during the pandemic was compared to a similar group of patients admitted to the ER in 2019. Sex, age, triage color-code at admission, cause of trauma and presence of symptoms related to COVID-19 infection, discharge diagnosis and discharge modes were investigated. Results: The lockdown period led to a reduction of 87.0% in ER admissions with a particular decrease in patients older than 12 years old. Moreover, a trend towards more severe codes and an increase in home-related injuries were observed during the pandemic, whereas the diagnosis of fracture was less frequent in the pre-pandemic group (p < 0.0001). Conclusions: A significant decrease in the ER attendances was reported during the lockdown. A shift in the cause and type of injury was observed; only the most serious traumas sought medical care with a higher percentage of severe triage codes and fractures.

Strategies to repair the meniscus have achieved limited success; thus, a cell-based therapy combined with an appropriate biocompatible scaffold could be an interesting alternative to overcome this issue. The aim of this project is to analyze different cell populations and a collagen gel scaffold as a potential source for meniscus tissue engineering applications. Dermal fibroblasts (DFs) and mesenchymal stem cells (MSCs) isolated from adipose tissue (ASCs) or bone marrow (BMSCs) were analyzed. Two different fibro-chondrogenic media, M1 and M2, were tested, and qualitative and quantitative analyses were performed. Significant increases in glycosaminoglycans (GAGs) production and in fibro-cartilaginous marker expression were observed in MSCs in the presence of M1 medium. In addition, both ASCs and BMSCs cultured in M1 medium were used in association with the collagen hydrogel (MSCs-SCF) for the development of an in vitro meniscal-like tissue. Significant up-regulation in GAGs production and in the expression of aggrecan, collagen type I, and collagen type II was observed in BMSCs-SCF. This study improves knowledge of the potential of combining undifferentiated MSCs with a collagen gel as a new tissue engineering strategy for meniscus repair.

Photochemical sealing of a nerve wrap over the repair site isolates and optimizes the regenerating nerve microenvironment. To facilitate clinical adoption of the technology, we investigated photosealed autologous tissue in a rodent sciatic nerve transection and repair model. Rats underwent transection of the sciatic nerve with repair performed in three groups: standard microsurgical neurorrhaphy (SN) and photochemical sealing with a crosslinked human amnion (xHAM) or autologous vein. Functional recovery was assessed at four-week intervals using footprint analysis. Gastrocnemius muscle mass preservation, histology, and nerve histomorphometry were evaluated at 120 days. Nerves treated with a PTB-sealed autologous vein improved functional recovery at 120 days although the comparison between groups was not significantly different (SN: −58.4 +/− 10.9; XHAM: −57.9 +/− 8.7; Vein: −52.4 +/− 17.1). Good muscle mass preservation was observed in all groups, with no statistical differences between groups (SN: 69 +/− 7%; XHAM: 70 +/− 7%; Vein: 70 +/− 7%). Histomorphometry showed good axonal regeneration in all repair techniques. These results demonstrate that peripheral nerve repair using photosealed autologous veins produced regeneration at least equivalent to current gold-standard microsurgery. The use of autologous veins removes costs and foreign body concerns and would be readily available during surgery. This study illustrates a new repair method that could restore normal endoneurial homeostasis with minimal trauma following severe nerve injury.