Background: The endothelial glycocalyx is a luminal layer of the endothelium composed of proteoglycans and glycoproteins. It plays an important role in maintaining vascular homeostasis, alongside providing structural integrity to the endothelium. Shedding of the glycocalyx in trauma patients can have profound impacts on vascular permeability and tissue integrity, causing inflammation and tissue damage. Objectives: The phenomenon of glycocalyx shedding in trauma patients, primarily as a result of coagulopathy and endothelial injury, has been increasingly documented. We aimed to systematically review the correlation between plasma glycocalyx biomarker levels and adverse outcomes in trauma patients. Methods: A systematic review was performed using PubMed, Medline, Embase, and Cochrane library databases. The search terms included the following: Glycocalyx, Syndecan, Syndecan-1, Hyaluronic, Hyaluronic acid, and Outcomes. The inclusion criteria consisted of human in vivo studies of major trauma patients that presented acutely to a major trauma center. Results: Out of the seven included studies, five investigated the correlation between the levels of the glycocalyx biomarker syndecan-1 (SDC-1) and mortality. Four out of these five studies demonstrated that higher SDC-1 levels were significantly and independently associated with a higher risk of mortality. Two out of the seven included studies reported a significant association between glycocalyx biomarker levels and an increased odds of developing trauma-induced coagulopathy. Three studies further demonstrated a significant correlation between glycocalyx levels and other outcomes including higher blood transfusion requirements, longer hospital length of stay (LOS), higher odds of developing an acute kidney injury (AKI), and higher Sequential Organ Failure Assessment (SOFA) scores. Conclusion: Elevated plasma levels of glycocalyx components can independently predict mortality and other adverse outcomes in trauma patients. These findings suggest the prospective value of these biomarkers for predicting the prognosis of trauma patients and for exploring their role in the development of therapeutic strategies in the future.

Background and Objectives: While multiple studies have compared mechanical alignment (MA) and kinematic alignment (KA) in total knee arthroplasty (TKA), the effect of alignment philosophy on the patellofemoral joint (PFJ) remains unclear. This systematic review evaluates PFJ-related outcomes following KA- versus MA-TKA indirectly through functional knee scores. Materials and Methods: A comprehensive search of Ovid MEDLINE, PubMed Central, and Embase was undertaken in October 2025 using search strategies developed by two independent librarians. Screening and data extraction were performed independently by two reviewers. All primary studies, including randomised and non-randomised studies, comparing KA- and MA-TKA that included functional Knee Society Score (KSS-F) or the Knee Injury and Osteoarthritis Outcome Score (KOOS) Sports subscale were included. Results: Of the 1570 identified studies, 13 met the inclusion criteria for the systematic review and meta-analysis. KA demonstrated a significant improvement in KSS-F at 1-year follow-up compared with MA (p < 0.05). At longer follow-up intervals, differences did not reach statistical significance (p = 0.07); however, outcomes consistently favoured KA, suggesting maintenance of the early functional advantage over time. Conclusions: KA-TKA is associated with superior PFJ-related functional outcomes at 1 year and shows a sustained trend towards improved performance in longer-term follow-up based on the surrogate scores. Further prospective studies incorporating PFJ-sensitive outcome measures are warranted to clarify long-term benefits.