Posterior cruciate ligament (PCL) injuries, though less common than other knee ligament injuries, pose significant management challenges. This study aimed to systematically review and analyze the current evidence on the use of point-of-care ultrasound (POCUS) for the evaluation and management of PCL injuries. It was hypothesized that POCUS has comparable diagnostic accuracy to magnetic resonance imaging (MRI) and that the use of POCUS improves patient outcomes and reduces healthcare costs. A comprehensive systematic review of articles published up to April 2023 was conducted using PubMed, Web of Science, Cochrane, and Scopus databases and adhered to the PRISMA guidelines. Studies were selected based on relevance to the research question, with a focus on diagnostic accuracy, reliability, clinical utility, and cost-effectiveness of POCUS in PCL injuries. Seven studies, analyzing a total of 242 patients with PCL injuries, were included. The reported sensitivity and specificity of POCUS for diagnosing PCL injuries ranged from 83.3% to 100% and 86.7% to 100%, respectively, across the studies. In one study, POCUS demonstrated a positive predictive value (PPV) of 87.9% and a negative predictive value (NPV) of 82.4%. Additionally, three studies reported 100% accuracy in PCL injury detection using POCUS, suggesting a substantial potential for cost savings by eliminating the need for MRI. This systematic review supports the use of POCUS in the evaluation and management of PCL injuries, suggesting that POCUS is a reliable, cost-effective tool with high diagnostic accuracy comparable to that of MRI, offering the potential to improve patient outcomes and reduce healthcare costs. The data collated in this review can inform clinical practice and guide future research in the field.

Background: Osteoarthritis (OA) is a prevalent joint condition causing pain and disability, especially in the elderly. Currently, OA diagnosis relies on clinical data and imaging, but recent interest in metabolomics suggests that early biochemical changes in biofluids, particularly synovial fluid (SF), could enable an earlier diagnosis and understanding of the disease. Methods: In this regard, we conducted a lipidomics study in 33 plasma and SF samples from OA patients and 20 OA-free controls to assess the diagnostic value of various lipid metabolites, using UHPLC-QTOF-ESI+MS. Results: In plasma samples, 25 metabolites had area-under-the-curve (AUC) values higher than 0.9, suggesting a very good diagnostic potential for phosphatidic acid PA (16:0/16:0), PA (34:0), phosphatidylethanolamine PE (34:2), glucosylceramide, phosphatidylcholine PC (32:1), and other metabolites while in SF 20, metabolites had AUC values higher than 0.8, the vast majority belonging to lipid metabolism as well. Conclusions: Although the results align with the previous literature, larger cohort studies are necessary to confirm the diagnostic value of the lipid metabolites.

Background/Objectives: Frailty has emerged as a relevant marker of biological vulnerability in patients undergoing complex orthopedic procedures, yet its specific prognostic value in revision total hip and knee arthroplasty remains incompletely synthesized. This systematic review evaluated whether validated preoperative frailty assessment tools are associated with adverse postoperative outcomes after revision total joint arthroplasty and whether available studies allow comparison of prediction performance across instruments. Methods: A systematic search of PubMed/MEDLINE, Embase, the Cochrane Library, Web of Science, Scopus, citation lists, and selected gray-literature sources was performed from inception through January 2026. Gray-literature records and conference abstracts were used only for citation tracking; the synthesis included only full-length peer-reviewed original research articles involving adult patients undergoing revision total hip arthroplasty, revision total knee arthroplasty, or both, with quantitative outcomes according to a validated frailty measure. Because of heterogeneity in frailty tools, outcome definitions, revision indications, and adjustment strategies, findings were synthesized narratively and certainty was assessed by outcome domain. Results: Eleven full-length studies were included, with cohorts ranging from 117 patients to 576,920 admissions, and most were retrospective database analyses. Higher frailty burden was consistently associated with worse short-term outcomes, including complications, prolonged hospital stay, readmission, non-home discharge, resource use, and mortality-related risk stratification. Representative findings included 30-day readmission of 23.8% versus 9.9%, surgical complications of 28.6% versus 7.8%, and odds ratios of up to 10.79 for complications across escalating frailty strata. Prediction studies suggested stronger discrimination for revision-specific or broader models, such as CARDE-B, RAI-rev, and machine-learning approaches, than for simpler generic frailty indices. Conclusions: Frailty is a consistent preoperative marker of elevated short-term perioperative risk after revision arthroplasty. The available evidence supports incorporating frailty assessment into preoperative risk stratification and counseling, but it remains insufficient to establish one universally preferred tool or to prove that frailty screening alone improves outcomes without targeted intervention.

Background and Clinical Significance: Adverse reactions to metal debris (ARMD) are a rare but increasingly recognized complication following total hip arthroplasty (THA), with some studies suggesting upwards of 5% of metal-on-metal (MoM) and 3% of metal-on-polyethylene (MoP) prostheses being attributed to this. Historically, metallosis due to MoM implant design was the primary cause of ARMD. However, ARMD can also arise in metal-on-polyethylene (MoP) prostheses due to trunnionosis, which involves wear and corrosion at the modular femoral head–neck interface. Clinically, ARMD can resemble periprosthetic joint infection (PJI), complicating both diagnosis and management. Case Presentation: We present the case of a 40-year-old female with a history of systemic degenerative joint disease with bilateral MoP THAs who developed progressive pain and swelling in the upper left thigh, in which the prosthesis was first put in 22 years prior. The patient presented initially in a vascular surgery department for an infected iliopsoas cyst communicating with the hip where she had received surgery 2 years prior. The symptomatology reoccurred, and imaging revealed a large mass near the prosthesis and elevated inflammatory markers. Intraoperatively, a large volume of sero-purulent fluid was encountered, prompting a diagnostic workup for PJI. All cultures returned negative, and histopathology revealed macrophage-dominant infiltration with metallic debris, consistent with ARMD. After infection was definitively excluded, a revision THA was performed with an exchange of all modular components. The patient recovered without complications, and at six months follow-up, she demonstrated stable implant positioning, restored function, and no recurrence of symptoms. Conclusions: This case highlights the diagnostic complexity of PJI in joint arthroplasty and reveals the importance of a protocol-driven approach to exclude it prior to surgical revision. As the incidence of trunnion-related failure becomes more recognized in the literature, clinicians must consider ARMD in the differential diagnosis of late THA complications. Appropriate diagnosis is essential for guiding treatment and avoiding unnecessary complications, morbidity, and treatment related side-effects.

Introduction: Intramedullary nailing is widely used for long bone fractures. Traditional systems are reliable, but they present some complications regarding lack of modularity or possible growth plate damage. Methods: A novel locking rod–screw system featuring a central rod and a grooved screw with a secondary interlocking mechanism was developed and tested. Mechanical testing followed ASTM F543 and ISO 6475 standards using a 3.0 mm steel alloy prototype. Results: The system withstood mechanical testing >200,000 cycles at loads up to 200 N with no rates of failure or loosening, significantly outperforming other implants of the same size (3.0 mm TENS). Conclusions: The proposed implant demonstrates superior biomechanical performance in vitro, enabled by its unique hollow screw and secondary locking configuration. This modular and minimally invasive system shows promise for use in cases of smaller long bones, personalized paediatric fractures, and all types of diaphyseal fractures, but does warrant in vivo validation.

Background and objectives: Anterior cruciate ligament reconstruction (ACLR) is often associated with significant postoperative pain. Effective pain control is vital for early mobilization and reducing opioid use. While femoral nerve block (FNB) and adductor canal block (ACB) are common, they can cause motor weakness and incomplete analgesia. The genicular nerve block (GNB), typically used for chronic knee pain and arthroplasty, may offer a motor-sparing alternative for ACLR pain management. This review evaluates the evidence on GNB’s effectiveness for pain control, opioid reduction, and recovery after ACLR. Materials and Methods: A literature search (January 2014–May 2025) identified five studies involving adult ACLR patients receiving GNB. Data on demographics, techniques, pain scores, opioid use, and complications were analyzed. Results: Among 115 patients, GNB provided effective analgesia and reduced opioid needs. Randomized trials showed GNB was comparable to ACB and more effective when combined. Ultrasound, especially with Doppler, enhances precision and safety. No major motor deficits or adverse events were noted. Landmark-based approaches also showed utility in low-resource settings. Conclusions: GNB is a promising, motor-sparing option for postoperative pain in ACLR. Further high-quality trials are needed to confirm the benefits and standardize its use. The findings should be interpreted with caution, as the current evidence is of limited quality and lacks generalizability.