Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques.

Background: Use of a prosthesis to replace small hand joints, mainly in patients with degenerative osteoarthritis or with sequelae of fractures, is more and more common. As for other joints, use of a prosthesis usually leads to good functional results but is not free of complications such as implant infection. We discuss a possible solution by presenting a single case treated by means of a custom-made spacer in our hospital and comparing it to the very few options available in the literature. Methods: A 30-year-old active male, treated in another hospital two years before for an articular fracture of the middle phalanx of the ring finger of his left hand, came to our center with a rigid digit. He was therefore treated with a Swanson proximal interphalangeal (PIP) joint prosthesis. At one-month follow-up, the patient presented clear signs of infection of his implant. The authors removed the infected implant and replaced it with a small custom-made antibiotic-impregnated cement spacer. The patient underwent a long-lasting postoperative oral antibiotic therapy. Four months later, a new Swanson prosthesis was successfully implanted. A literature review was performed. Results: When the patient first came to our hospital, he presented with a rigid digit, reaching a PIP joint range of motion (ROM) in flexion–extension of 0–90° the day after our first surgery. At one-month follow-up, with the infected prosthesis, the ROM was 10–40°. After the last surgery, with the implant of a new Swanson prosthesis, at the two-year (24-month) follow-up, the patient was infection-free, the PIP joint ROM was 10–90°, and the patient was very satisfied. Conclusions: The literature discusses few cases of PIP prosthesis infection, and most of those are treated with implant removal and arthrodesis. The use of a custom-made antibiotic-loaded cement spacer should be considered by hand surgeons managing this complication as a motion-preserving alternative to more definitive salvage procedures.

PURPOSE: Use of prosthesis to replace small hand joints, mainly in patients with de-generative osteoarthritis or with sequelae of fractures, is more and more common. As for other joints, use of prosthesis usually leads to good functional results, but is not free of complications such as implant infection. We discuss a possible solution presenting a single case treated by means of a custom-made spacer in our hospital comparing it to the very few options available in literature. METHODS: A 30-year-old active male, treated in another hospital two years before for an articular fracture of the middle phalanx of the ring finger of his left hand, came to our center with a rigid digit. He was therefore treated with a Swanson proximal interpha-langeal (PIP) joint prosthesis. At one month follow-up the patient presented clear infection signs of his implant. Authors removed the infected implant and replaced it with a small custom-made antibiotic impregnated cement spacer. The patient underwent a long lasting post-operative oral antibiotic therapy. Four months later a new Swanson prosthesis has been successfully implanted. Literature review has been performed. RESULTS: When the patient first came to our hospital, he presented with a rigid digit, reaching the day after our first surgery a PIP joint range of motion (ROM) in flex-ion-extension of 0-90°. At one-month follow-up, with the infected prosthesis, the ROM was 10-40°. After the last surgery, with the implant of a new Swanson prosthesis, at the six-month follow-up the patient was infection free, the PIP joint ROM was 10-90° and the patient was very satisfied. CONCLUSIONS: The literature discusses few cases of PIP prosthesis infection, and most of those are treated with implant removal and arthrodesis. The possibility of using a cus-tom-made antibiotic-impregnated cement spacer to achieve good results, as is universally accepted for other joints, should be kept in mind by all hand surgeons who face to prevent more drastic solutions.

Background: Osteoarthritis involves the degeneration of cartilage, subchondral bone, and the synovial membrane, often associated with rotator cuff (RC) tears, causing pain and functional limitations. While non-surgical treatments can provide relief, surgery is sometimes necessary. Autologous adipose-derived mesenchymal stem cells (ADMSCs) have shown promise in tissue repair. Objective: This study compared clinical outcomes between patients treated with arthroscopic RCR alone and those treated with RCR combined with intra-articular AdMSC injection. Methods: This retrospective study included 61 patients. Group A (n = 30) underwent standard RCR, while Group B (n = 31) received RCR combined with intra-articular ADMSC injections. Participants had comparable baseline age, BMI, height, CMS, and VAS scores. Shoulder function was assessed using the Constant–Murley Score, and pain intensity was assessed using the visual analog scale at baseline, 3, 6, and 12 months. Statistical significance was set at p < 0.05. Results: At 3 months, Group B showed lower VAS scores than Group A (13.09 ± 8.34 vs. 25.14 ± 13.57, p < 0.001), while CMSs did not differ significantly (70.55 ± 23.46 vs. 63.01 ± 24.33, p = 0.223). At 6 months, Group B showed better VAS and CMSs than Group A (VAS: 5.31 ± 4.38 vs. 23.74 ± 15.72, p < 0.001; CMS: 83.29 ± 18.98 vs. 65.66 ± 11.58, p < 0.001). At 12 months, Group B maintained better VAS and CMSs than Group A (VAS: 4.45 ± 5.67 vs. 18.34 ± 12.65, p < 0.001; CMS: 85.55 ± 13.12 vs. 66.36 ± 9.38, p < 0.001). Conclusions: In this preliminary retrospective non-randomized cohort, AdMSC use as an adjunct to arthroscopic rotator cuff repair was associated with better pain and functional scores over 12 months. Because of the retrospective design and lack of imaging follow-up, these findings should be interpreted as clinical associations and require confirmation in randomized studies.

Background: Chronic pain after unicompartmental knee arthroplasty (UKA) represents a significant clinical issue, often unrelated to mechanical causes and resistant to standard therapies. This work combines a narrative review and a case report to explore the pathophysiological mechanisms underlying persistent post-UKA pain and to propose genicular artery embolization (GAE) with Imipenem/Cilastatin (IPM/CS) as a novel minimally invasive treatment option. Methods: A comprehensive literature review was conducted to analyze current diagnostic and therapeutic approaches to chronic post-UKA pain, with emphasis on vascular and inflammatory mechanisms. Additionally, a patient with chronic lateral knee pain refractory to conservative management underwent selective GAE targeting hypervascularized genicular branches. Results: Following the procedure, the patient experienced substantial and sustained pain reduction, functional improvement, and no complications. The literature supports synovial neovascularization as a potential pain generator and confirms the safety of IPM/CS due to its transient embolic effect and preservation of normal perfusion. Conclusions: The combination of literature review and clinical evidence suggests that GAE may represent a promising therapeutic alternative for chronic post-UKA pain. Further studies are needed to confirm its efficacy, long-term outcomes, and appropriate indications within this challenging clinical setting.

Background: Cubital Tunnel Syndrome (CuTS) is the second most common compressive neuropathy of the upper limb, traditionally associated with prolonged elbow flexion, trauma, or anatomical constraints. With the widespread adoption of smartphones, sustained upper-limb postures have emerged as potential novel risk factors for ulnar nerve compression. This retrospective study aimed to investigate the potential correlation between smartphone use patterns and the development of CuTS. Methods: A retrospective observational study was conducted on 100 subjects recruited between 2021 and 2024, including 50 patients with EMG-confirmed CuTS who underwent surgical decompression and 50 matched controls without clinical or electrophysiological evidence of ulnar neuropathy. Demographic variables, daily smartphone use (hours/day), predominant activity type, and habitual posture during device handling were collected through clinical records and questionnaires. Group comparisons were performed using t-tests and Chi-square analyses, with significance set at p < 0.05. Results: Daily smartphone use was higher in the CuTS group compared with controls (4.94 ± 1.8 vs. 4.04 ± 1.5 hours/day), although the difference did not reach statistical significance (p = 0.0716). Posture during device use showed a significant association with CuTS: 82% of affected patients reported using smartphones with the elbow flexed, compared with 56% of controls, whereas supportive postures were less frequent among CuTS patients (16% vs. 38%) (p = 0.019). No significant differences were found between groups regarding smartphone activity type (p = 0.858). Conclusions: Smartphone use may contribute to ulnar nerve compression primarily through ergonomically disadvantageous postures, particularly sustained elbow flexion, rather than total usage time. These findings highlight a modifiable behavioral risk factor relevant to the rising prevalence of CuTS in the digital era. Increased clinical attention to device-handling habits and public-health strategies promoting ergonomic posture may support CuTS prevention. Prospective and biomechanically informed studies are warranted to further elucidate causal mechanisms.