Purpose: Osteoarthritis (OA) is one of the most common chronic diseases in the world. It is frequently accompanied by high levels of persistent pain, as well as substantial impairments in function and functional capacity. This review aims to systematically analyze the changes in proprioception and related mechanoreceptors in OA patients. Methods: Studies from September 2013 to September 2023 were identified by conducting searches on the PubMed, Web of Science, and Scopus electronic databases following the PRISMA statement. One reviewer independently assessed and screened the literature, extracted the data, and graded the studies. The body of evidence underwent an evaluation and grading process using the ROBINS-I tool, which was specifically designed to assess the risk of bias in non-randomized studies of interventions. Results were summarized using descriptive methods. Results: A search through 37 studies yielded 14 clinical studies that were ultimately included. The primary focus of the studies was on the knee joint, particularly the posterior cruciate ligament (PCL). The studies found that PCL in OA patients had impaired proprioceptive accuracy, possibly due to changes in mechanoreceptors (Ruffini, Pacini, and Golgi Mazzoni corpuscles). This suggests that dysfunctional articular mechanoreceptors, especially in severe cases of OA, may contribute to reduced proprioception. Dynamic stabilometry also identified significant proprioceptive deficits in patients with knee articular cartilage lesions, underscoring the impact of such lesions on knee proprioception. Conclusions: Literature data have shown that proprioceptive accuracy may play an important role in OA, particularly in the knee PCL and cartilage. However, the role of proprioception and related mechanoreceptors needs to be further clarified. Future studies focusing on the relationship between proprioception, OA disease, and symptoms, considering age and gender differences, and exploring OA joints other than the knee should be conducted to improve clinical and surgical outcomes in cases where proprioception and mechanoreceptors are impaired in OA patients.

Introduction: Calcaneal fractures (CF) are the most common tarsal fractures, representing up to 75% of foot fractures and 2% of all fractures. The aim of this retrospective study is to analyze fixation with Kirschner wires through a mini-invasive approach and dedicated plate and screws through an extended approach at long-term follow-up. Materials and Methods: Patients were radiographically and clinically evaluated at final follow-up, by using the validated American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score for the clinical–functional assessment, the Short-Form 12 (SF-12) for the physical and psychological domain assessment, and the Visual Analog Scale (VAS) for pain. Results: In total, 38 patients (42 CF) met the inclusion criteria and were retrospectively evaluated and divided into two groups (Kirschner group and plate group) consisting of 19 patients each. The overall mean follow-up was 59.4 ± 11.8 months. The average values of the post-operative clinical outcomes of the two groups KG and PG were, respectively, 70.7 ± 11.9 and 70.1 ± 10.9 (AOFAS), 45.7 ± 6.8 and 46.5 ± 10.8 (SF-12 PCS), 54.7 ± 9.9 and 50.9 ± 11.8 (SF-12 MCS) at the final follow-up. Conclusions: The present study showed that in the cases analyzed, the two surgical approaches used for the treatment of CF achieved comparable clinical outcomes. The only substantial difference found between the two groups of patients was the re-intervention rate that afflicted them.

Purpose: Treatment strategies for osteochondral defects (OCDs) of the ankle have substantially increased over the last decade. The development of a small metallic implant to fill the defect has led to the second‐generation patient‐specific metal implant (Episealer Talus® Implant) designed based on computed tomography and magnetic resonance imaging images.Methods: There is a pool of patients falling into the so‐called ‘treatment gap’, a grey zone composed of active patients with symptomatic OCDs in the context of an otherwise healthy joint, or patients with a failed primary treatment. To minimize the risk of perioperative complications, there are a series of tips and tricks that can be considered.Results: Correct execution of the operative approach, proper positioning of the guides, posterior capsule and deep deltoid ligament release and the use of Hintermann spreader allow a perfect visualization of the OCDs minimizing the risk of iatrogenic lesions. Correct execution of the medial malleolus osteotomy, release of soft tissue, proper triplanar alignment of the custom‐made guide, its strong stabilization during the reaming and the use of vigorous washes minimizes the potential damage on healthy cartilage. Correct sinking of the implant is crucial; the goal is to place the Episealer Talus at least 0.5 mm below the cartilage surface. Filling a large subchondral cyst with the cancellous bone can be useful to provide better stability of the implant.Conclusion: Episealer Talus for talar OCDs possibly represents an additional tool for surgeons and patients. It is important to avoid mistakes during implant placement.Levels of Evidence: Level V, expert opinion.

Purpose: The optimal surgical approach for total ankle arthroplasty (TAA) remains debated. The anterior and lateral transfibular approaches differ in surgical exposure and may influence complication patterns. This systematic review and meta‐analysis aimed to compare revision rates, overall complication rates and specific complication profiles between anterior and lateral approaches in TAA. Methods: A PRISMA‐compliant systematic review of PubMed, Embase and Scopus databases was performed. Studies reporting complications following primary TAA performed through either approach were included if they met predefined methodological quality criteria (QualSyst score ≥ 75%). Complication rates were compared using Fisher's exact test, and correlations between complication rates and patient or surgical factors were explored. Results: Fifty‐one studies were included, comprising 7959 TAA procedures (7225 anterior and 734 lateral). Revision rates were higher in the anterior approach group (7.5% vs. 1.9%, p < 0.001), as were rates of malleolar fractures (1.7% vs. 0.3%, p = 0.001) and aseptic loosening (2.8% vs. 0.14%, p < 0.001). Deep infections were reported more frequently in lateral approach cohorts (3.1% vs. 0.57%, p < 0.001), although this finding was influenced by outlier studies. Wound complications and polyethylene‐related complications were comparable between approaches. No association was observed between complication rates and patient age, body mass index or surgical time. Conclusion: Anterior and lateral approaches in TAA appear to be associated with different complication patterns rather than clear differences in overall safety. Both approaches remain valid surgical options, but awareness of their distinct complication profiles may help guide intraoperative precautions and post‐operative surveillance. However, heterogeneity in implant design, follow‐up duration and study methodology limits definitive conclusions regarding the superiority of one approach. Level of Evidence: Level I, systematic review/meta‐analysis.

Background: Total ankle arthroplasty (TAA) is increasingly used as an alternative to arthrodesis for end-stage ankle arthritis. The extent to which implant bearing type and design evolution influence outcomes and survival remains debated. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251073944). PubMed, Embase, and Scopus were searched for English-language studies (2004-2025) reporting anterior-approach TAA with specified implant generation (I–IV) and bearing type (fixed [FB] vs mobile [MB]). Studies with a QualSyst score ≥ 75% were included. Primary outcomes were American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS), range of motion (ROM), complications, and revisions. Results: Forty-two studies comprising 4,271 implants were analyzed (FB: 1,546; MB: 2,725). Functional improvements were mainly driven by implant generation rather than bearing type. ΔAOFAS increased from 33.7 ± 22.3 in Gen II to 44.5 ± 28.3 in Gen IV (P < .001). ΔVAS varied across generations (Gen II 5.8 ± 2.1; Gen III 4.6 ± 2.8; Gen IV 5.46 ± 1.60; all P < .001 vs baseline). MB implants showed lower pre- and postoperative AOFAS scores but comparable ΔAOFAS to FB designs (36.4 vs 37.5; P = .358). MB systems provided greater pain relief (ΔVAS 5.62 vs 4.60; P < .001) but had higher revision rates (12.0% vs 6.2%; P < .001). FB implants achieved superior postoperative ROM gains in plantarflexion (+6.0° vs −2.9°; P < .001) and dorsiflexion (+2.71° vs +0.75°; P < .001). Excluding Gen I, complication rates decreased from 32.6% in Gen II to 18.8% in Gen III and 10.3% in Gen IV (all P < .01); revision rates declined from 16.5% (Gen II) and 9.6% (Gen III) to 0.5% (Gen IV) (P < .01). Conclusions: Implant generation is the primary determinant of outcomes, complications, and survival in anterior-approach TAA. Bearing type played a secondary role: MB devices provided greater pain relief, whereas FB systems achieved superior ROM recovery and lower revision risk. Fourth-generation implants yielded the most reliable results. Further prospective studies with standardized functional and kinematic assessments are warranted. Level of Clinical Evidence: Level I—Systematic Review/Meta-Analysis