Purpose: The association between fluoroquinolone intake and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) is widely documented. However, it is not clear whether different molecules have the same effect on these complications. The purpose of this study was to document Achilles tendon complications for the most prescribed fluoroquinolones molecules. Methods: A literature search was performed on Pubmed, Cochrane, Embase, and Web of Science databases up to April 2023. Inclusion criteria: studies of any level of evidence, written in English, documenting the prevalence of AT/ATR after fluoroquinolone consumption and stratifying the results for each type of molecule. The Downs and Black’s ‘Checklist for Measuring Quality’ was used to evaluate the risk of bias. Results: Twelve studies investigating 439,299 patients were included (59.7% women, 40.3% men, mean age: 53.0 ± 15.6 years). The expected risk of AT/ATR was 0.17% (95% CI: 0.15–0.19, standard error (s.e.): 0.24) for levofloxacin, 0.17% (95% CI: 0.16–0.19, s.e.: 0.20) for ciprofloxacin, 1.40% (95% CI: 0.88–2.03, s.e.: 2.51) for ofloxacin, and 0.31% (95% CI: 0.23–0.40, s.e.: 0.77) for the other molecules. The comparison between groups documented a significantly higher AT/ATR rate in the ofloxacin group (P < 0.0001 for each comparison). Levofloxacin and ciprofloxacin showed the same risk (P = n.s.). The included studies showed an overall good quality. Conclusion: Ofloxacin demonstrated a significantly higher rate of AT/ATR complications in the adult population, while levofloxacin and ciprofloxacin showed a safer profile compared to all the other molecules. More data are needed to identify other patient and treatment-related factors influencing the risk of musculoskeletal complications.

Purpose: This study examines the efficacy of the Pennock Bone Age Atlas, which utilizes knee magnetic resonance imaging (MRI), in accurately assessing skeletal maturity in paediatric patients with anterior cruciate ligament (ACL) injuries. Specifically, it investigated the differences between chronological and bone ages in skeletally immature patients to inform clinical decision‐making for ACL reconstruction. Methods: A total of 79 skeletally immature patients with ACL injuries, treated between February 2022 and June 2024, were included in this study. Bone age was assessed using the Pennock Atlas. The differences between chronological and bone ages were calculated, and the remaining growth potential was estimated. Statistical analyses were conducted to identify any significant discrepancies in growth expectations based on these measures. Results: On average, bone age closely matched chronological age. However, 25.3% of patients showed discrepancies greater than 1 year, particularly in the 12–14 age group. About 15% of patients who were expected to have no further growth according to chronological age had remaining growth potential when assessed by bone age, while 11% showed completed growth despite their chronological age suggesting otherwise. This discrepancy emphasizes the need to consider skeletal maturity rather than relying solely on chronological age in clinical decisions. Conclusion: In the setting of ACL injury in skeletally immature patients, the Pennock Bone Atlas was able to accurately detect differences between bone age and chronological age, identifying a mismatch of more than 1 year between the two ages in up to 25% of cases. This information can be used to guide surgeons in choosing different treatments optimized for the patient's growth potential. Level of Evidence: Level IV case series.

Background: High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investigated. Purpose: To assess RTS and RTW rates, risk factors for RTS, complications, and activity levels at long-term follow-up in young and active patients after isolated HTO. Study Design: Case series; Level of evidence, 4. Methods: Consecutive HTO procedures performed at a single institution with a minimum 2-year follow-up were screened. Data were collected regarding clinical scores (Lysholm score, visual analog scale for pain, Tampa Scale for Kinesiophobia, Subjective Patient Outcome for Return to Sports score, Tegner activity score, Likert scale), RTS and RTW rates, type of sport, and impact activity level. Multivariate regression analysis evaluated the effect of sex, age, body mass index, Tegner score, and Tampa score on RTS. Differences were considered statistically significant if P < .05. Results: A total of 60 patients with a mean age at the time of surgery of 28.9 ± 7.5 years were included at a mean follow-up of 8.8 ± 3.8 years. There were 4 (6.7%) major complications. The overall RTS rate was 86.7%, and 68.3% of patients were still participating in sports at the final follow-up (mean, 3.7 ± 2.1 h/wk). Additionally, 34.6% returned to the same sport level, 21.2% improved their status, and 44.2% decreased their sport level. Moreover, patients playing soccer had a lower RTS rate compared with the rest of the patients (72.7% vs 94.7%, respectively; P = .04). The overall RTW rate was 100.0%, with a mean time to RTW of 5.9 ± 6.2 months. The Tampa score was the only predictor of absolute RTS ( P = .015; coefficient = –0.13). Conclusion: HTO performed in a young and active population resulted in high RTS rates and continuous sport participation even up to 9 years after surgery. Interestingly, the Tampa score was the only predictive factor for a reduced RTS rate. Finally, soccer participation was associated with a lower RTS rate compared with other sports.

Background: Anterior cruciate ligament (ACL) injury among professional footballers represents a career-threatening injury with a high burden for athletes and teams. Debated issues in professional footballers after ACL reconstruction (ACLR) include time to return to play (RTP), level of play after surgery, and incidence and timing of sustaining a second ACL injury. Purposes: To analyze RTP and performance 2 seasons after surgery of professional footballers who underwent ACLR, to evaluate factors influencing the timing of RTP and second injury risk, and to assess the level of RTP and performance after surgery. Study Design: Case series; Level of evidence, 4. Methods: All professional male footballers who underwent ACLR using a hamstrings graft with or without a lateral extra-articular procedure at a single institution between 2002 and 2013 were retrospectively included. Demographic and intraoperative findings were extracted from the medical records. Data regarding the number of matches played in 5 seasons (injury season, the 2 seasons before, and the 2 seasons after the injury), the level of play in those 5 seasons, the time to return to the first official match, and reinjuries were extracted from publicly available databases, and patients were contacted to confirm. Univariate and multivariate analyses were conducted to identify factors influencing RTP and risk factors for second ACL injury. Results: A total of 58 primary ACLRs were included; 20 (34.5%) participated in the first division (Serie A). RTP was 96.6% (56/58) after a mean of 6.4 ± 2.3 months, and return to match occurred after a mean of 7.5 ± 3.3 months. Patients without meniscal injury had a faster RTP (5.6 ± 1.6 months; P = .0016), while athletes with cartilage injury showed a longer time to RTP (10.2 ± 3.7 months; P = .0001) and resulted as a predictor for longer RTP (+4.4 months; P = .0047). In the second season after an ACL injury, 23% of footballers participated in a lower division with respect to the injury season, playing a mean of 20 ± 11 matches, with 65% of them participating in >20 games. The second injury rate was 15.8% (9 patients). The ipsilateral reoperation rate, including ACL revisions, was 28.1%. Additionally, returning to competitive play within 5 months of surgery was a significant predictor of a second ACL injury. Conclusion: Almost all patients returned to play after ACLR using hamstrings graft with over-the-top techniques, typically regaining preinjury performance by the second season after the injury. RTP time was shorter for isolated ACL injuries and longer when associated with meniscal or cartilage injury. Given the high risk of a second ACL injury on either knee and the high reoperation rate, RTP before 5 months should be discouraged, particularly in athletes <21 years.

Background and Objectives: The ten-year survivorship of unicompartmental knee arthroplasty (UKA) is up to 96%, varying from implants and hospitals; however, most of registry studies do not distinguish between metal-back (MB) tibial implants and all-polyethylene (AP) tibial implants. The aim of the present retrospective clinical study was to analyze the clinical outcomes and survivorship of medial and lateral UKA with a newly designed all-polyethylene tibial plateau at short-term follow-up. Materials and Methods: A retrospective analysis of prospectively collected consecutive patients who underwent medial or lateral UKA with AP tibial plateau was conducted, with a minimum follow-up of 1 year. Primary outcomes were clinical score (VAS, OKS, and KOOS) variations from baseline up to the latest follow-up. Secondary outcomes were Likert scale variations from baseline to the follow-up, evaluation of the influence of demographic factors (age and BMI) at the time of surgery on the clinical outcomes, and evaluation of revision rate up to the last follow-up. Results: The final study population included 99 knees. The mean VAS score for the medial group significantly decreased from 7.61 ± 1.65 (pre-intervention) to 2.74 ± 2.26 (post-intervention). Similar improvements were registered for the OKS as well, for both the medial group (from 22.5 ± 12.6 to 36.6 ± 10.6, with a delta of 14.11 (10.05 to 18.17)) and the lateral group (from 22.6 ± 12.6 to 36.9 ± 11.8, with a delta of 14.24 (8.65 to 19.83)). Moreover, all the KOOS subscales reported an amelioration, both in medial UKA and lateral UKA. Furthermore, a logistic regression of delta VAS was performed in relation to the other clinical questionnaires and the demographic factors. For both medial and lateral UKAs, no statistically significant correlation was found between the VAS scale regression and the demographic factors. The survival rate free from any revision of the cohort at the latest follow-up was 96.32%. Conclusions: All-polyethylene tibial component in unicompartmental knee arthroplasty demonstrates significant improvements in clinical scores and a low failure rate at short-term follow-up.

Purpose: To evaluate failure rates, survivorship, patient‐reported outcome measurements (PROMs), and prognostic factors following all‐inside arthroscopic repair of bucket‐handle tears (BHT) and full‐thickness radial meniscal tears (RT). Methods: A retrospective cohort study included consecutive patients undergoing all‐inside repair of BHT or RT by a single surgeon (2019–2025) with a minimum 2‐year follow‐up. Inclusion required primary repair using all‐inside devices. Demographic data, tear morphology, chronicity, and concomitant procedures were recorded. Failure was defined as surgical re‐intervention or magnetic resonance imaging‐confirmed re‐tear. PROMs included subjective International Knee Documentation Committee (IKDC), Tegner Activity Scale, Patient Acceptable Symptom State (PASS), and Visual Analog Scale (VAS) scores. Return to sport (RTS) rates and the achievement of IKDC‐PASS threshold were assessed. Kaplan–Meier survival analyses for each lesion type were performed at 1, 2, 3, and 4 years; subgroup comparisons (location, ACL reconstruction, aetiology) were performed using the log‐rank test. Results: Fifty‐five repairs (34 BHTs, 21 RTs; 72.7% males; mean age 27.0 ± 11.7 years) were analysed. BHTs were medial in 24 cases and lateral in 10; all RTs were lateral. Overall, 52.7% were chronic, 54.6% treated with concomitant ACL reconstruction, and 83.7% were traumatic. Five repairs failed (mean 22.3 ± 11.9 months), yielding cumulative failure rates of 0.0% at 1 year, 6.0% at 2 years, 8.7% at 3 years and 17.8% at 4 years. Failures were more frequent in medial BHTs (35.5%), degenerative tears ( p = 0.0194) and isolated repairs ( p = 0.0321). Overall satisfaction was 97.9%, with 87.2% patients returning to sport and 48.9% reaching their preinjury level. Conclusions: Meniscal repair of BHTs and RTs achieved 98% patient satisfaction and high return‐to‐sport rates with a 17% mid‐term failure. Medial BHTs and degenerative lesions demonstrated a higher risk of failure, whereas repairs performed concomitantly with ACL reconstruction showed lower failure rates. These findings support early repair and highlight the importance of tear pattern, aetiology, lesion chronicity and concomitant procedures in predicting outcomes. Level of Evidence: Level IV, therapeutic case series.