This narrative review provides an overview of the various diagnostic tools used to assess cartilage health, with a focus on early detection, nutrition intervention, and management of osteoarthritis. Early detection of cartilage damage is crucial for effective patient management. Traditional diagnostic tools like radiography and conventional magnetic resonance imaging (MRI) sequences are more suited to detecting late-stage structural changes. This paper highlights advanced imaging techniques, including sodium MRI, T2 mapping, T1ρ imaging, and delayed gadolinium-enhanced MRI of cartilage, which provide valuable biochemical information about cartilage composition, particularly the glycosaminoglycan content and its potential links to nutrition-related factors influencing cartilage health. Cartilage degradation is often linked with inflammation and measurable via markers like CRP and IL-6 which, although not specific to cartilage breakdown, offer insights into the inflammation affecting cartilage. In addition to imaging techniques, biochemical markers, such as collagen breakdown products and aggrecan fragments, which reflect metabolic changes in cartilage, are discussed. Emerging tools like optical coherence tomography and hybrid positron emission tomography–magnetic resonance imaging (PET-MRI) are also explored, offering high-resolution imaging and combined metabolic and structural insights, respectively. Finally, wearable technology and biosensors for real-time monitoring of osteoarthritis progression, as well as the role of artificial intelligence in enhancing diagnostic accuracy through pattern recognition in imaging data are addressed. While these advanced diagnostic tools hold great potential for early detection and monitoring of osteoarthritis, challenges remain in clinical translation, including validation in larger populations and integration into existing clinical workflows and personalized treatment strategies for cartilage-related diseases.

Background: A previous short-term retrospective analysis from our center suggested early improvement in pain, function, and sleep outcomes after fixed-dose tramadol/paracetamol therapy in patients with early-stage symptomatic knee osteoarthritis (KOA). However, the durability of these outcomes beyond the initial treatment phase remains insufficiently described in routine clinical practice. Objective: To describe short- and mid-term patient-reported outcomes and safety during extended follow-up in adults with symptomatic KOA treated with fixed-dose tramadol/paracetamol in routine outpatient care. Methods: This single-center retrospective observational extension study analyzed a fixed cohort of 30 adults with symptomatic knee osteoarthritis and Kellgren–Lawrence grade I–II treated with fixed-dose tramadol/paracetamol in routine outpatient care. Patients were evaluated at baseline (T0), 15 days (D15), 3 months (M3), and 6 months (M6), where evaluable follow-up data were available. The primary outcome was change in pain intensity measured by the Numeric Rating Scale (NRS). Secondary outcomes included WOMAC total and subscale scores, Pittsburgh Sleep Quality Index (PSQI) score, adverse events, and treatment discontinuation. Results: Patients had a mean age of 64.8 ± 9.6 years and a mean BMI of 27.3 ± 5.0 kg/m². NRS pain improved from a median of 6.0 (5.0–7.0) at baseline to 4.0 (2.0–5.3) at D15 and 3.0 (2.0–5.0) at both M3 and M6. WOMAC total score improved from 47.8 ± 12.8 at baseline to 35.6 ± 13.8 at D15, 33.8 ± 13.6 at M3, and 33.9 ± 13.5 at M6. Sleep score improved from 9.5 (7.0–15.0) at baseline to 7.0 (5.0–9.0) at D15 and remained improved at M3 and M6. Mild adverse events were reported in 10.0% of patients, and discontinuation occurred in 6.7%. Conclusions: In this small, uncontrolled, single-center retrospective cohort of adults with early-stage symptomatic KOA, fixed-dose tramadol/paracetamol was associated with early improvement in pain, WOMAC outcomes, and sleep, with group-level benefits remaining evident through 6 months. These findings should be considered exploratory and hypothesis-generating rather than comparative evidence of effectiveness. Larger controlled studies are needed to confirm durability, comparative benefit, and long-term safety.

Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving tolerance of active rehabilitation. Osteoarthritis (OA) is a heterogeneous whole-joint disorder in which cartilage degeneration, subchondral bone remodeling, synovitis, peri-articular tissue dysfunction, neuromuscular impairment, and pain sensitization may interact to produce pain, stiffness, and activity restriction. As conservative therapy for OA, education, progressive therapeutic exercise, weight management when indicated, and self-management remain the core of care. Nevertheless, some patients cannot fully participate in exercise because of pain, fear of movement, load intolerance, comorbidity, or limited access to supervised rehabilitation. This narrative review synthesizes evidence published mainly between 2016 and 2026 for extracorporeal shock wave therapy (ESWT), photobiomodulation/low-level laser therapy (PBMT/LLLT), pulsed electromagnetic field therapy (PEMF), transfer energy capacitive and resistive/capacitive–resistive electric transfer (TECAR/CRET) therapy, body weight support and aquatic unloading strategies, and mechanosonic vibration therapies. The available literature suggests that ESWT and PBMT/LLLT may provide short- to mid-term pain and function benefits in selected patients with knee OA when parameters are aligned with evidence-supported dosing windows. PEMF and vibration therapies show promising but less consistent effects because protocols, devices, sham conditions, and populations vary. TECAR/CRET and unloading approaches are best interpreted as enabling tools that may reduce guarding, improve walking tolerance, or increase the quality of therapeutic exercise, rather than stand-alone disease-modifying treatments. Current national and society guidelines consistently prioritize exercise, education, and weight management; most of the modalities reviewed here are absent from guidelines or are supported only indirectly, which justifies cautious wording and individualized use. A practical application model is, therefore, time-limited and goal-oriented: identify the barrier to rehabilitation, select a modality with a plausible mechanism and published protocol, monitor pain and functional response, and discontinue the modality if it does not improve participation in active care.

Background: To investigate the association between symptomatic flexible flatfoot, pronated foot, and genu valgum and global postural alignment in children and adolescents, with particular focus on pelvic and spinal parameters and patterns of pain localization. Methods: A cross-sectional observational study was conducted on a cohort of 2,130 individuals evaluated for postural dysfunction. A paediatric subgroup (=126) between the ages of 6 and 10 years (Mage = 8.50, SD = 1.78), presenting with symptomatic lower-limb deformities was selected. Participants were classified into three groups: symptomatic flexible flatfoot (n = 64), pronated foot (n = 38), and genu valgum (n = 24), based on clinical and radiographic criteria including Foot Posture Index (FPI-6), Staheli Arch Index, Meary’s angle, talo-calcaneal angle, and femoro-tibial angle. Global postural alignment was assessed using optoelectronic analysis and weight-bearing radiographs. Results: Neutral postural alignment was infrequently observed. Recurrent patterns included pelvic anteversion and mild variations in sagittal spinal curves, generally within paediatric reference ranges. Frontal-plane deviations were common but predominantly mild. Differences between groups were mainly related to distribution rather than magnitude of postural variations. Pain was described according to anatomical location. Conclusions: Lower-limb deformities in children appear to be associated with specific patterns of postural adaptation rather than isolated segmental alterations. However, findings should be interpreted cautiously due to the absence of a control group and the cross-sectional design. Further studies are required to determine clinical relevance.

Background and Objectives: Foot bone marrow edema of presumed algodystrophic or bone marrow edema syndrome-like origin is clinically difficult to classify, and the relationship between MRI extent, pain severity, and functional impairment remains insufficiently defined. This study aimed to describe MRI distribution patterns and short-term clinical changes in a small real-world cohort of patients with persistent NSAID-resistant foot pain and presumed algodystrophic/BMES-like bone marrow edema. Materials and Methods: This retrospective single-center observational cohort study included 19 consecutive patients with persistent foot pain; MRI-demonstrated bone marrow edema; inadequate response to NSAIDs; management with a multimodal protocol that included neridronate, vitamin D supplementation, and, in selected patients, adjunctive physiotherapy and magnetotherapy; and available 3-month follow-up. The protocol consisted of intramuscular neridronate 25 mg once daily for 16 consecutive days, resulting in a total cumulative dose of 400 mg, together with vitamin D supplementation. Eleven patients also underwent adjunctive physiotherapy and magnetotherapy. MRI findings were categorized by anatomical location group, multilocalization, and compartment involvement. Clinical outcomes included baseline and 3-month Visual Analog Scale scores, WOMAC scores, and descriptive changes in NSAID use. Nonparametric paired and exploratory subgroup analyses were performed. Results: Mean age was 51.3 ± 14.9 years, and 52.6% of patients were female. MRI showed predominant midfoot involvement, with the navicular and third cuneiform most frequently affected. Median VAS changed from 8.0 at baseline to 3.0 at 3 months, and median WOMAC changed from 80.0 to 41.0; because no control group was available, these paired changes should be interpreted descriptively. Daily NSAID use decreased from 78.9% at baseline to 0% at follow-up. These findings describe clinical improvement after a multimodal management approach but do not establish the independent treatment effect of neridronate. In exploratory analyses, only two patients had multi-compartment involvement; therefore, any apparent pain-severity signal in this subgroup was considered unstable and hypothesis-generating only. Edema location group and multilocalization were not statistically associated with VAS or WOMAC outcomes. Conclusions: In this small retrospective single-center case series, presumed algodystrophic/BMES-like foot bone marrow edema most commonly involved the midfoot, particularly the navicular and cuneiform region. Pain scores, WOMAC scores, and daily NSAID use decreased over 3 months after multimodal care. However, the uncontrolled design, small sample size, concomitant vitamin D supplementation, adjunctive physiotherapy or magnetotherapy in many patients, and self-limiting nature of BMES-like conditions prevent attribution of these changes to neridronate or to any single treatment component. The apparent relationship between multi-compartment edema and greater pain severity was based on only two patients and should be regarded only as a weak exploratory observation.