Purpose: To compare the clinical outcomes and complications of mini-open (MOT) and percutaneous techniques (PT) in the surgical repair of acute Achilles tendon rupture (AATR). Methods: We systematically searched PubMed, Scopus, Web of Science, Clinical Trials, and the Cochrane Library for studies comparing MOT with PT for AATR. We assessed functional outcomes, complication rates, and operation time. Statistical analyses were performed using RevMan Web. Odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) were pooled with a fixed-effects model for dichotomous and continuous endpoints, respectively. Heterogeneity was evaluated with I² statistics. Results: Eight studies, comprising 484 patients, were included, of whom 226 (46%) underwent MOT. MOT was associated with a significantly lower re-rupture rate (1.48% vs. 6.11%; OR 0.28; 95% CI 0.09–0.86; p = 0.03; I² = 6%) and sural nerve injury rate (0.57% vs. 5.64%; OR 0.24; 95% CI 0.07–0.81; p = 0.02; I² = 0%). No significant differences were observed in venous thrombosis (OR 0.81; 95% CI 0.17–3.94; p = 0.33; I² = 0%), wound infection (OR 0.56; 95% CI 0.12–2.62; p = 0.46; I² = 0%), or operation time (MD 1.83 min; 95% CI -1.13–4.79; p = 0.23; I² = 88%). Functional outcomes showed higher American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores in the MOT group (MD 1.52 points; 95% CI 0.62–2.42; p = 0.001; I² = 3%), while (Achilles Tendon Total Rupture Score) ATRS, time to return to activities, and ankle plantar and dorsiflexion were comparable. Conclusions: MOT for AATR repair seems to reduce re-ruptures and sural nerve injuries while improving AOFAS scores, with no significant differences in other complications compared to PT. These findings suggest that the MOT may offer a safer and equally effective alternative to PT for AATR.

Computer-assisted technology offers better component alignment and surgical precision than conventional TKA. However, whether robotic-assisted total knee arthroplasty (RA-TKA) shows clear benefits over navigation-assisted total knee arthroplasty (NA-TKA) is still contentious. Therefore, we aimed to perform a meta-analysis exploring the accuracy and safety of RA-TKA compared to NA-TKA in patients with knee osteoarthritis. We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library for studies comparing RA-TKA with NA-TKA. We assessed radiological alignment outliers, polyethylene (PE) insert thickness, surgical time, and safety outcomes. Statistical analyses were performed using RevMan Web. Odds ratios (ORs) and mean differences (MDs) with 95 % confidence intervals (CIs) were pooled for dichotomous and continuous endpoints, respectively. A random-effects model was used due to anticipated heterogeneity and measured with the I² test. We included 19,209 patients from sixteen studies, of whom 3764 (19.6 %) were assigned to the RA-TKA. We found no statistically significant difference between RA-TKA and NA-TKA in terms of hip-knee-ankle angle outliers (OR 0.91; 95 % CI 0.56 to 1.48; p = 0.71; I² = 25 %), femoral coronal angle outliers (OR 0.46; 95 % CI 0.16 to 1.38; p = 0.17; I² = 60 %), tibial coronal angle outliers (OR 0.51; 95 % CI 0.13 to 2.08; p = 0.09; I² = 58 %), periprosthetic joint infection (OR 0.76; 95 % CI 0.27 to 2.15; p = 0.61; I² = 0 %), and length of stay MD -0.17 days; 95 % CI -1.08 to 0.74; p = 0.72; I² = 98 %). RA-TKA used 1.03 mm thinner PE inserts compared with NA-TKA (MD -1.03 mm; 95 % CI -1.60 to -0.46; p = 0.71; I² = 98 %), whereas surgical time was 9.87 min shorter with NA-TKA (MD 9.87 min; 95 % CI 0.62 to 19.11; p = 0.04; I² = 99 %). RA-TKA and NA-TKA had comparable radiological alignment. While RA-TKA allows for thinner polyethylene inserts, it requires longer surgical time than NA-TKA. These findings suggest that both techniques are adequate, with specific differences that may influence surgical decision-making.

Anterior cruciate ligament (ACR) rupture is a frequent injury in professional sports players. We conducted a retrospective cohort study, including 41 professional female handball players, undergoing ACR reconstruction surgery, using a Ligament Advanced Reinforcement System (LARS) graft (n = 12) or a Soft Tissue (ST) graft (n = 29). After return-to-play, the patients were asked to take a survey, reporting subjective and objective performance indexes before the injury and after return-to-play. Time from surgery to first practice and to return-to-play were significantly shorter in the LARS group (3.92 ± 1.14 vs. 6.93 ± 2.19 months, p < 0.001 and 4.71 ± 1.2 vs. 8.81 ± 2.9, respectively). While there was no difference between postoperative mean time on court, number of goals/match, number of matches played at 6 months return-to-play and 50 m, 100 m and gate-to-gate sprint times, there was a significantly greater increase in preoperative times in the ST group than in the LARS group (1.45 ± 1.05 s vs. 0.21 ± 0.58 s slower than preoperatively, p < 0.001 for 50 m; 1.09 ± 0.95 s vs. 0.08 ± 1 s, p = 0.01 for 100 m; 1.66 ± 1 s vs. 0.21 ± 0.66 s for gate-to-gate). In conclusion, LARS grafts provide a faster recovery time and better functional outcome, significantly impacting the performance of professional handball players.

Background/Objectives: Microfracture remains the most widely used first-line procedure for focal chondral defects of the knee, but its fibrocartilaginous repair deteriorates over time. This review asked whether adding an orthobiologic or scaffold to marrow stimulation changes clinical, structural or safety outcomes compared with isolated marrow stimulation, by augmentation type. Methods: PubMed, Scopus and the Cochrane Library (January 2016 to July 2026) and ClinicalTrials.gov were searched for randomized and non-randomized comparative studies with at least 12 months of follow-up (PROSPERO CRD420261484998, registered retrospectively). Risk of bias was assessed with RoB 2 and ROBINS-I; findings were synthesized without meta-analysis (SWiM) by effect direction, exploratory sign tests and unpooled standardized mean differences, and certainty was rated with GRADE. Results: Fifteen studies (six randomized; 630 patients; follow-up 12 months to 10 years) were included. Across augmentation types, the point estimate for function favored augmentation in eight out of nine independent evidence sources (p = 0.039) but not when the four unclassifiable studies were counted as unfavorable (8 of 13; p = 0.58), and clinically important IKDC differences occurred only in non-randomized cohorts. A structural advantage was statistically supported in two out of ten studies, in one only on a group-by-time interaction. Further surgery occurred mainly after isolated marrow stimulation, but events were few, and harms were inconsistently reported. Conclusions: Effects differ by augment and should not be generalized to augmentation as a class. Type I/III collagen membranes may improve patient-reported function, and cellular or autologous tissue products, chiefly adipose-derived, may improve pain and symptoms (low certainty); effects on structure, reoperation and safety are very uncertain. Adequately powered randomized trials of each augment are needed.

Background: Vitamin K2 (menaquinone) has been studied as a molecule with important effects on bone metabolism and has been proposed as a potential adjuvant in fracture healing, particularly under osteoporotic conditions. However, its functional impact on osteoporotic fracture healing remains largely undefined. The aim of this study was to evaluate the effects of vitamin K2 supplementation, in the form of menaquinone-4 (MK-4) and menaquinone-7 (MK-7), on fracture healing in an ovariectomized rat model of osteoporosis. Methods: Forty Wistar rats were included in this study and allocated to four equal groups: Sham control, ovariectomized control, MK-4, and MK-7. Osteoporosis was induced by bilateral ovariectomy, and 12 weeks after ovariectomy, a femoral fracture was produced and fixed by intramedullary nailing. Starting on postoperative day 2, the MK-4 group received 5 mg/kg/day of MK-4, while the MK-7 group received MK-7 at a dose of 0.05 mg/kg/day. Fracture healing was assessed primarily by biomechanical testing using a three-point bending test and was further analyzed by histological and biochemical parameters, including CTXI, PINP, ucOC, BALP, and ALT. Results: Vitamin K2 supplementation did not improve functional fracture healing. In both treatment groups, fractures showed nonunion-like mechanical behavior, precluding meaningful quantitative biomechanical comparison. Although histological and biochemical findings, particularly in the MK-4 group, showed some degree of biological activity, these changes did not translate into mechanically competent bone union. Both treatment groups showed a tendency toward impaired healing, with progression toward nonunion-like behavior under the present experimental conditions. No significant hepatic toxicity was observed. Conclusions: In this ovariectomized rat femoral fracture model, vitamin K2 supplementation with either MK-4 or MK-7 did not enhance functional fracture healing despite evidence of biological activity of the treatment. These findings suggest a discrepancy between molecular or histological effects and biomechanical outcomes, indicating that, under the conditions tested, vitamin K2 is insufficient to overcome impaired healing in osteoporotic bone and may adversely influence fracture repair under these experimental conditions, although the mechanism remains uncertain.