Background: The present Bayesian network meta-analysis compared the efficacy of intra-articular injections of different molecular weights of hyaluronic acid (HA) in patients with knee osteoarthritis. Methods: In November 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All randomised controlled trials investigating the efficacy of intra-articular HA injections for knee osteoarthritis were accessed. The outcome of interest was to evaluate pain according to the visual analogue scale (VAS). The groups included for comparison were the ultra-high molecular weight (UHMW), high molecular weight (HMW), medium molecular weight (MMW), and low molecular weight (LMW). Results: Data from 9822 patients were collected. The mean age of the patients was 62.1 ± 5.0 years with given comparability at baseline. Different follow-up periods were compared. The longest control period ranged from four to six months, and the UHMW and HMW injections were the interventions associated with the greatest reduction in the VAS. LMW HA was the intervention associated with the lowest decrease in VAS, falling short of the control group. Conclusions: The main findings of the present Bayesian network meta-analysis, with a current level I of evidence, suggests that the UHMW and HMW HA has a beneficial effect on pain at 6 months post intervention in patients with knee osteoarthritis.

Background: Low back pain is common. For patients with mechanic or non-specific chronic LBP (cLBP), the current guidelines suggest conservative, nonpharmacologic treatment as a first-line treatment. Among the available strategies, physiotherapy represents a common option offered to patients presenting with cLBP. The present systematic review investigates the prognostic factors of patients with mechanic or non-specific cLBP undergoing physiotherapy. Methods: In September 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy programme in patients with LBP were accessed. All studies evaluating non-specific or mechanical LBP were included. Data concerning the following PROMs were collected: the pain scale, Roland Morris Disability Questionnaire (RMQ), and Oswestry Disability Index (ODI). A multiple linear model regression analysis was conducted using the Pearson Product–Moment Correlation Coefficient. Results: Data from 2773 patients were retrieved. The mean length of symptoms before the treatment was 61.2 months. Conclusions: Age and BMI might exert a limited influence on the outcomes of the physiotherapeutic management of cLBP. Pain and disability at baseline might represent important predictors of health-related quality of life at the six-month follow-up. Further studies on a larger population with a longer follow-up are required to validate these results.

Background: The impact of smoking in arthroscopic surgery for femoroacetabolar impingement (FAI) is controversial. This systematic review updates and discusses current evidence on the influence of cigarette smoking on the outcome of arthroscopic management of FAI. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. Methods: The present systematic review followed the PRISMA guidelines. Embase, Web of Science, and PubMed were accessed in June 2024 without additional filters or temporal constraints. All the clinical investigations comparing smokers versus nonsmokers in patients who underwent arthroscopic management for FAI were considered. The risk of bias in nonrandomised controlled trials was assessed using the Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I). Results: Data from 368 patients were retrieved. The mean length of follow-up was 34.1 ± 7.1 months. The mean age was 40.4 ± 4.0 years and the mean BMI was 27.1 ± 1.6 kg/m². No significant difference was evidenced in the visual analogue scale, Harris hip score, Hip Outcome Score—Sport subscale, and Non-Arthritic Hip Score. No difference was observed in the complication rate: reoperation (p = 0.6) and progression to THA (p = 0.4). Conclusions: Tobacco smoking does not appear to influence the outcomes of arthroscopic management for FAI. At approximately 34 months of follow-up, no difference was found in pain, PROMs, reoperation rate, and progression to THA.

Background: This systematic review evaluates the use of single-shot adductor canal block (ACB) as a pain management strategy following total knee arthroplasty (TKA). The outcome of interest was to compare the different drugs used in single-shot ACB using visual analogue scale (VAS) values during the first postoperative days. Methods: The present systematic review followed the 2020 PRISMA guidelines. PubMed, EMBASE, and Web of Science were accessed in May 2025 without additional filters or temporal constraints. All clinical studies concerning single-shot ACB for pain management following TKA were considered. Studies on unicompartmental knee arthroplasty and revision settings were not included. Only studies reporting data on the VAS during the postoperative days were included. Results: Data from 15 RCTs were retrieved. The drugs included in the analyses were levobupivacaine, bupivacaine and ropivacaine in isolation or combined with clonidine or butorphanol. A statistically significant difference was found in VAS during activity in post-operative day (POD) 2 ( P < 0.01): the bupivacaine group demonstrated the highest values, and the group receiving ropivacaine had the lowest values. No other statistically significant difference in VAS during activity was found for any group in POD 0 and 1 ( P = 0.3 and P = 0.1, respectively). No statistically significant difference was found in VAS at rest values between any group in POD 0 ( P = 0.3), POD 1 ( P = 0.1), and POD 2 ( P = 0.5). Conclusions: Single shot ACB offers adequate analgesia with a potentially motor-sparing profile following total knee arthroplasty, facilitating early mobilisation and reducing opioid consumption. The addition of adjuvants such as dexmedetomidine, dexamethasone, and clonidine may further enhance analgesic duration, though their use requires standardisation and ongoing safety monitoring. While single shot ACB is a strong candidate for routine inclusion in multimodal analgesia protocols, further research is necessary to optimise its application and evaluate long-term outcomes.