Hip fractures are among the most serious health events in older adults, frequently leading to disability, loss of independence, and elevated mortality. In 2019, an estimated 9.6 million new cases occurred globally among adults aged ≥ 55 years, with an incidence rate of 681 per 100,000. Despite improved surgical care, one-year mortality remains high (15–30%), and fewer than half of survivors regain their pre-fracture functional status. Traditionally regarded as mechanical injuries, hip fractures are now increasingly recognized as systemic events reflecting and accelerating biological vulnerability and frailty progression. We synthesize evidence across biological, clinical, and social domains to explore the systemic implications of hip fracture, from the acute catabolic response and immune dysfunction to long-term functional decline. The concept of intrinsic capacity, introduced by the World Health Organization, offers a resilience-based framework to assess the multidimensional impact of hip fracture on physical, cognitive, and psychological function. We highlight the importance of orthogeriatric co-management, early surgical intervention, and integrated rehabilitation strategies tailored to the individual’s functional reserves and personal goals. Innovations such as digital health tools, biological aging biomarkers, and personalized surgical approaches represent promising avenues to enhance recovery and autonomy. Ultimately, we advocate for a shift toward interdisciplinary, capacity-oriented models of care that align with the goals of healthy aging and enable recovery that transcends survival, focusing instead on restoring function and quality of life.

Background: Patients with total hip arthroplasty (THA) under the age of 35 represent a small and heterogeneous group of 1% of all THA performed. This systematic review aims to analyse the diagnosis, implant type, complications, and long-term results in these patients. Methods: A search was performed on PubMed, Scopus, and Cochrane Library up to 31 July 2023. We included observational prospective and retrospective studies published in the last 20 years, which evaluated diagnosis, implant types, long-term results, and return to sports in patients ⩽35 years who underwent THA. We excluded case reports, case series, and studies with <35 patients. We extracted age, diagnosis, surgical information, follow-up, complications, revision rate, implant survival, and clinical outcomes for each study. The methodology of the included studies was evaluated using the MINORS score. Results: 18 studies with 1955 patients and 2383 THAs were included. Osteonecrosis (40.6%), posterior approach (81%), the uncemented press-fit implants (73.4%), metal-polyethylene bearings (31.3%) were the most frequently found items. All the clinical outcomes reported improvement from the preoperative to postoperative. The most frequent complication was aseptic loosening (4.3%). The survival rate was 92.4% at a mean follow-up of 10 years. Conclusions: THA is a good option for specific hip diseases in the young, but aseptic loosening still is the major point of concern.

Background: Graft choice, together with operative technique, remains the most controversial topic surrounding ACL reconstruction. The ideal graft choice should recreate normal anatomy and biomechanics, allow for rapid return to play and have minimal harvest‐site morbidity. The purposes of this study were to compare donor‐site morbidity in all‐soft‐tissue quadriceps autograft vs. hamstring autografts based on Hacken et al.’s ACL Donor‐Site Morbidity Questionnaire (32,587,874) and to assess the role played by external factors such as sex, mood, activity level and smoking status. Materials and Methods: We performed a retrospective analysis of our patients’ records to identify individuals who were 30 years old or younger at the time of surgery and underwent ACL reconstruction using the anteromedial portal technique, without any additional treatments for ligament or meniscal injuries. At 12 months postintervention, donor‐site morbidity was evaluated using the ACL donor‐site morbidity questionnaire by Hacken et al. (2020). Analyses were performed using Jamovi freeware Version 2.3.19.0 (the Jamovi project, 2021). Independent samples t‐test with Cohen’s d as the effects’ size statistics were used to compare donor‐site morbidity and functional outcomes. Results: Significant differences between quadriceps tendon (QT) and STG groups were found for ACL donor‐site morbidity questionnaire total score, numbness, size of numbness and muscle atrophy, all in favour of the QT cohort. Weak associations were found between female sex and low mood, both negatively impacting the reported donor site morbidity. No statistically significant differences were found for functional outcomes. Conclusion: ACL reconstruction with all‐soft‐tissue QT autograft showed overall superior donor‐site morbidity outcomes when compared with HT autograft. Statistically significant results were also found in favour of QT when comparing numbness and size of numbness at the donor site and self‐perceived muscle atrophy. Female sex and low mood have been found to impact donor‐site morbidity negatively although larger samples are necessary to confirm this association. Graft choice in ACL reconstruction should always remain an individualized choice, but QT should be considered an equal, if not superior, alternative to other autologous autografts when comparing donor‐site morbidity. Trial Registration: CINECA: 6458

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is the gold-standard treatment for ACL rupture; however, graft failure remains a significant concern, particularly in young, active, or high-risk patients. The addition of a Lateral Extra-Articular Procedure (LEAP) has been proposed to enhance rotational stability and reduce the risk of graft rupture. This systematic review and meta-analysis aimed to determine whether adding LEAP to primary ACLR reduces graft failure rates compared to isolated ACLR, with a minimum follow-up of two years. Methods: A comprehensive literature search was conducted across PubMed, Scopus, Embase and Cochrane Library databases in accordance with PRISMA guidelines. Eighteen comparative studies with a minimum 24-month follow-up were included, encompassing 7336 patients (3857 undergoing isolated ACLR and 3479 undergoing ACLR with LEAP). The primary outcome was graft failure rate. Data were analyzed using the Mantel–Haenszel method with a fixed-effects model to calculate pooled risk ratios (RR) and 95% confidence intervals (CI). Results: Pooled analysis demonstrated a significant increase in graft rupture risk in the ACLR-alone group compared to ACLR + LEAP (RR 2.72; 95% CI: 2.23–3.32; p < 0.00001), with negligible heterogeneity (I² = 0%). LEAP was particularly beneficial in high-risk populations such as young athletes and individuals with high-grade pivot shift or ligamentous laxity. Secondary outcomes showed improved rotational stability and comparable patient-reported outcomes and complication rates between groups. Conclusions: ACLR alone presents a higher risk of graft failure in comparison with the ALCR + LEAP technique. Furthermore, the addition of LEAP to ACLR improves rotational stability without increasing complications. LEAP should be selectively considered in patients with high-risk profiles or persistent intraoperative instability. These findings support the incorporation of LEAP as a valuable adjunct in modern ACL reconstruction strategies.

Purpose: To evaluate the prevalence of undiagnosed ligamentous knee injuries in patients surgically treated for high-energy pelvic ring or acetabular fractures and propose a mechanism to diagnose these briefly post-hospital discharge. Methods: A retrospective case series (level of evidence IV) was conducted at Italy’s largest trauma center. Medical records from 2018 to 2023 were reviewed to identify patients who underwent surgical treatment for pelvic or acetabular fractures. Eligible patients were contacted for a structured telephone interview, which included a questionnaire on knee symptoms and the International Knee Documentation Committee (IKDC) score. Associations between demographic factors, trauma mechanism, and knee outcomes were statistically analyzed. Results: Fifty-nine patients (mean age 55 years, 72.9% male) were enrolled. Undiagnosed knee ligament injuries were present in 11.9%, with an additional 8.5% reporting persistent knee symptoms. The average time to diagnosis was 6.4 months post-discharge. Patients involved in road traffic accidents showed a significantly higher incidence of knee injuries (34.8%) compared to those who fell from a height (3.9%) (p = 0.049). Patients who had undergone ligament reconstruction had significantly lower IKDC scores (62.0 ± 8.2) than non-surgical cases (82.4 ± 12.1, p = 0.0002). No association was found with age or sex. Conclusions: Ligamentous knee injuries are frequently overlooked in the acute management of high-energy pelvic fractures, particularly in road traffic accidents. A systematic knee assessment before discharge or early outpatient imaging should be considered to improve detection and outcomes.

Anterior cruciate ligament reconstruction continues to evolve as surgical techniques aim to optimize graft placement, increase rotational control, and reduce graft failure in high‐risk populations. This technical note describes an inverse anterior cruciate ligament reconstruction combined with an anatomic anterolateral ligament reconstruction, incorporating a retrograde tibial half‐tunnel and outside‐in femoral drilling. The technique is compatible with hamstring, quadriceps tendon, and bone–patellar tendon–bone autografts. Tibial fixation is achieved using a suspensory button that can be directly visualized on the anteromedial cortex, while femoral fixation is performed with an interference screw. The remaining semitendinosus strand or the FiberTape reinforcement is routed beneath the iliotibial band and lateral collateral ligament and anchored at Gerdy's tubercle to anatomically recreate the anterolateral ligament. This procedure is indicated for young athletes, patients with high rotational demands, positive pivot‐shift or Jerk tests, primary cases with high rerupture risk, and selected revision scenarios. Advantages of the technique include enhanced anteroposterior and rotational stability, improved graft‐bone interface healing through circumferential tunnel contact, preservation of the iliotibial band, minimized morbidity of anterolateral ligament augmentation, and reliable intraoperative visualization of tibial fixation. Additionally, the outside‐in femoral approach offers versatility for revision surgery and physeal‐sparing application in skeletally immature patients.