The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous activity. There are different surgical techniques and different possible usable grafts. The graft used for ACLR surgery undergoes a bone incorporation process and an intra-articular remodelling named ligamentization until it reaches characteristics similar to the native ligament. After the first incorporation stage, the remodelling process is divided into an early stage that could last 4 weeks, a proliferative stage that lasts 4 to 12 weeks, and a final stage of ligamentization that could last over 1 year. The period of return to sport (RTS) after ACLR, which is becoming shorter and shorter, can be a high-risk period for athletes due to the risk of graft failure. This systematic review aims to define the phases of the ligamentization process considering graft type and fixation techniques, as well as the graft’s anatomopathological and biomechanical characteristics, to evaluate a criterion-based rehab progression and maximize patient outcomes for an RTS respecting graft biology. The rehabilitative program has to promote and optimize the graft remodelling and incorporation processes; moreover, it has to accommodate physiological graft healing and avoid overloading. An early RTS and noncompliance with the biological characteristics of the graft in the various phases are associated with a high incidence of re-injury.

Background: Acute posterior cruciate ligament (PCL) injuries are uncommon and often challenging to treat. While conservative treatment is frequently proposed in the acute phase, conventional rigid bracing may lead to complications such as joint stiffness and quadriceps atrophy. Dynamic braces applying posterior to anterior force during flexion have been proposed as a more functional alternative. Purpose: To evaluate the biomechanical efficacy of a dynamic PCL brace in reducing posterior tibial translation during the acute post-traumatic phase using standardized stress radiographs. Methods: The study was conducted on 11 patients with acute PCL injuries (four isolated, seven multiligamentous) treated within 15 days from trauma. Posterior tibial translation was measured with X-rays at 90° of flexion under four conditions: static (resting), stress (150 N), brace unloaded, and brace loaded (50 N posterior force). Three blinded orthopedic surgeons performed all measurements independently. Results: The dynamic brace significantly reduced posterior tibial translation across all conditions. Translation under stress was reduced from a mean of 7.1 mm to 2.68 mm with the loaded brace (p < 0.001). Conclusions: The study demonstrates that dynamic bracing provides effective biomechanical control of posterior tibial translation in the acute PCL injury. These findings support the potential role of dynamic bracing in conservative treatment protocols.

Background/Objectives: The purpose of this study was to evaluate the outcomes of meniscal suture repair in patients over 50 years of age with a minimum follow-up of 6 months, following failure of at least 6 months of conservative treatment. Methods: We retrospectively reviewed patients older than 50 years treated between 1 January 2017 and 30 June 2023 at the Orthopaedics and Traumatology Division of ASST Papa Giovanni XXIII (Bergamo, Italy) who underwent meniscal repair after failed conservative management. Patients underwent clinical, radiological and functional assessments. Meniscal healing was evaluated by MRI at 6 months postoperatively. Patient-reported outcome measures (PROMs), including KOOS, IKDC, Lysholm and Tegner Activity Scale, were collected preoperatively and at final follow-up. Results: Eleven patients were included, with a mean age of 53.4 ± 4.1 years (range, 50–64). Nine patients had lateral meniscus tears, and two had medial meniscus tears. At a mean follow-up of 22.0 ± 16.8 months (range, 6–66), significant improvements were observed in KOOS, IKDC and Lysholm scores (p < 0.05), with mean postoperative values of 95.4 ± 5.1, 87.5 ± 8.3 and 97.1 ± 3.5, respectively. All patients returned to their pre-injury activity level according to the Tegner scale. One complete failure and one partial failure were observed, both in patients with medial meniscus tears. Conclusions: In this small cohort, arthroscopic meniscal repair in patients over 50 years of age was associated with significant improvements in clinical and functional outcomes, with a failure rate of 18.2%. These findings suggest that meniscal repair may be a viable joint-preserving option in carefully selected middle-aged patients, particularly in lateral meniscus lesions. However, results should be interpreted cautiously given the limited sample size and retrospective design.