Purpose: This study systematically reviewed the literature on the postoperative rehabilitation protocols after lateral meniscus posterior root tears (LMPRTs) repair related with anterior cruciate ligament reconstruction (ACLR) regarding range of motion (ROM) exercise, weight‐bearing (WB) and brace use, to ascertain whether there are univocal views among authors. Methods: The literature was systematic searched in the PubMed (MEDLINE), Scopus, EMBASE and Cochrane Library databases. Level I–IV studies which reported data on rehabilitation protocols in patients treated surgically for combined ACLR and LMPRTs repair were included. For each study, predefined rehabilitation variables (ROM limits, WB restrictions, brace use) were extracted, and descriptive statistical analysis were conducted. The selected studies were qualitatively evaluated using the Methodological Index for Nonrandomized Studies (MINORS) score. Results: Twelve studies were included. The cohort of patients consisted of 277 participants. Among the patients, 192 were male, with a mean age at surgery of 28 ± 4 years, and a mean follow‐up of 34 ± 11 months. Regarding the initiation of ROM exercise, eight studies suggested a limited ROM (0°−90°) for 4–6 weeks, one study a limited ROM (0°−90°) for 16 weeks, while two studies reported no ROM limitations. Regarding WB, seven studies suggested non‐WB for at least 4–6 weeks, four studies suggested partial‐WB from 2 to 12 weeks, while one study suggested immediate full‐WB. Regarding the use of bracing, five studies suggested the use of bracing, one study did not recommend bracing, while in the other six, it was not specified. Conclusions: Most included studies suggested cautious rehabilitation with a restricted ROM and limited WB postoperatively. However, the protocols were heterogeneous, without consensus. Further studies are needed to clarify which protocol offers optimal outcomes after combined LPMRT repair and ACLR. Level of Evidence: Level IV.

Background: Anterior shoulder dislocation is an injury that can impair a professional goalkeeper's career. However, few studies have examined return to play (RTP) after surgery in professional goalkeepers. Purpose: To assess the RTP, pre- and postinjury performances, and market value of professional goalkeepers who suffered a shoulder dislocation. Study Design: Descriptive epidemiology study. Methods: Professional goalkeepers with a shoulder dislocation between 2011 and 2021 were included. Top European leagues were considered: Serie A (Italy), Premier League (England), Ligue 1 (France), LaLiga (Spain), and Bundesliga (Germany). Player age, height, position, injury history, RTP, and market value were retrieved from a publicly available website. The preinjury season (season −1), the injury season (season 0), and the 2 postinjury seasons (season +1 and season +2) were compared. Results: A total of 19 goalkeepers were included in the study with a mean age of 27.2 ± 5.22 years at the time of injury. All players underwent surgery. The mean RTP was 147.53 ± 64.23 days. The mean percentage minutes per season (MPS) in season −1 was 86.57% ± 13.89%, with a decrease to 37.34% ± 24.66% in the injury season and an increase to 72.72% ± 25.79% in season +1 and 62.69% ± 33.23% in season +2. Significant changes were found in MPS across the 4 analyzed seasons ( P < .001). Post hoc comparisons revealed statistically significant differences between season −1 and season 0 ( P < .001), season −1 and season +1 ( P = .019), and season −1 and season +2 ( P = .005). The difference between season +1 and season +2 was not statistically significant ( P = .284). The mean market values were €7.13M ±€8.33M (season −1), €8.05M ±€8.25M (season 0), €8.71M ±€11.45M (season +1), and €11.47M ±€22.89M (season +2). Regarding market value, no significant differences were detected among the seasons ( P = .285). All goalkeepers returned to play after the surgery, with 1 case (5.3%) at a lower level. Conclusion: All professional goalkeepers returned to play at a competitive level with a significant reduction in the percentage of available minutes played in the 2 seasons after surgery. However, this injury does not seem to influence the market value of these players.

To evaluate the impact of surgical timing on mortality and functional outcomes in elderly patients with proximal femoral fractures (PFFs), specifically investigating whether a 72-h threshold provides a more sensitive clinical discriminator than the traditional 48-h guideline. A retrospective cohort study was conducted on 314 patients aged ≥ 65 years surgically treated for low-energy PFF (AO/OTA 31-A and B) between January 2018 and December 2019. Patients were initially dichotomized by a 48-h threshold (Group A ≤ 48 h, n = 139; Group B > 48 h, n = 175) and subsequently analyzed using a 72-h cutoff. Primary endpoints were 3-month and 1-year mortality. Multivariate logistic regression was performed to adjust for age, sex, and Charlson Comorbidity Index (CCI). Secondary outcomes included postoperative length of stay (LOS), transfusion requirements, and functional recovery assessed via the Barthel Index. No statistically significant difference in 3-month mortality was observed using the 48-h cutoff (Group A: 11.6% vs. Group B: 12.3%; p > 0.05). Conversely, the 72-h threshold emerged as a significant independent predictor of mortality ( p < 0.05). Mortality rates for patients operated beyond 72 h were significantly higher at both 3 months (21.2% vs. 9.2%; p < 0.05) and 1 year (25.6% vs. 19.4%). Multivariate analysis confirmed surgical delay > 72 h as an independent risk factor (OR 2.1; 95% CI 1.3–3.4). The highest risk was observed in males aged > 85 years with extracapsular fractures operated beyond 72 h (1-year mortality: 37.5%). Mean LOS was significantly shorter in the early surgery group (7.6 ± 2.1 vs. 8.4 ± 2.8 days; p = 0.044). No significant differences were found in 3-month functional recovery between groups. In a real-world clinical setting, the 72-h threshold represents a critical “red line” for survival in elderly hip fracture patients. While striving for stabilization within 48 h remains ideal, maximum priority should be shifted toward preventing organizational delays that push vulnerable patients, particularly elderly males with extracapsular patterns, beyond the third day. Level of evidence : Level III (Retrospective cohort study)

The advent of disease-modifying therapies (DMTs) has fundamentally altered the clinical course of spinal muscular atrophy type 1 (SMA-I), resulting in prolonged survival and a higher incidence of early onset scoliosis (EOS). Although growth-friendly surgery is a keystone of management, specific evidence regarding magnetically controlled growing rods (MCGR) in the SMA-I population remains sparse. We evaluate the safety and efficacy of MCGR in a specific, homogeneous cohort of SMA-I patients. A retrospective investigation was performed on 8 consecutive children with genetically confirmed SMA-I who underwent MCGR implantation for progressive EOS at our institution. To overcome profound osteopenia, we utilized a proximal rib-based “ring hook” foundation and distal pelvic/sacroiliac fixation. Outcomes included coronal Cobb angle correction, pelvic alignment, and annualized T1-S1 spinal growth. Distractions were performed at 10-12-week intervals and validated via ultrasonography. Complications and unplanned returns to the operating room (UPRORs) were recorded. Eight patients (mean age 6.9 ± 0.92 years) were followed for a mean of 29.25 ± 4.0 months. The mean Cobb angle improved from 71.9° ± 20.8° to 38.9° ± 15.7° postoperatively (45.9% initial correction; P < .001) and was 44.5° ± 14.1° at the final follow-up. Pelvic obliquity significantly improved from a mean of 25.6° ± 6.3° to 6.6° ± 3.0° (P < .001) and was at the last follow-up (8.7° ± 2.0°; P = .08). Annualized T1-S1 growth was 11.6 ± 3.2 mm/y, with a mean “distraction efficiency” of 86.7% compared to the programmed 3 mm target. One mechanical complication (12.5%) occurred (distal iliac screw failure), resulting in a UPROR rate of 6.25 per 100 patient-years. No perioperative respiratory or infectious complications were observed. In this medically fragile SMA-I cohort, MCGR provided effective deformity control and supported longitudinal spinal growth. A multidisciplinary perioperative pathway and rib-based proximal anchoring are essential for optimizing results. While mid-term outcomes are encouraging, further research is needed to evaluate the long-term impact on pulmonary function and construct durability in the post-disease-modifying therapy era. (1) Meaningful deformity correction (45.9% mean Cobb reduction) achieved with preservation of linear spinal growth (11.6 ± 3.2 mm/y). (2) Low perioperative risk, with no infections, no transfusions, and no perioperative respiratory deterioration. (3) A 12.5% mechanical complication rate (one unplanned revision for distal iliac screw failure) over a mean follow-up of 29.25 months. IV: Case series

Background: The surgical management of chronic Achilles tendon ruptures (CATR) with significant tissue defects (Myerson Type II/III) presents a clinical challenge. Traditional reconstructive methods relying on free hamstring autografts or flexor hallucis longus transfers are often limited by donor-site morbidity, infection risks, or are unavailable in patients with a history of anterior cruciate ligament (ACL) reconstruction. This technical note describes a refined, tissue-preserving surgical technique utilising a doubled free autologous peroneus longus (PL) tendon graft. Methods: Under regional anaesthesia and thigh tourniquet control, a targeted 4 cm mini-open lateral incision is performed. The PL tendon is identified, harvested proximally using a tendon stripper, and a concomitant distal side-to-side tenodesis of the PL to the PB is performed to minimise eversion weakness. On the back table, the free PL autograft is doubled to achieve a 10 mm diameter construct. A calcaneal tunnel is drilled using progressive reaming. The free graft is routed through the proximal Achilles stump, passed subcutaneously, and drawn through the calcaneus. Final rigid stabilisation is secured with a 10 × 30 mm Bio-Interference Screw (Arthrex®) with the ankle held in maximum forced equinus to ensure optimal tensioning. Postoperatively, a 4-phase accelerated protocol begins with 3 weeks in a short-leg fibreglass cast under protected weight-bearing. Results/technical advantages: This technique achieves reliable primary mechanical stability, allowing for early protected loading while minimising soft-tissue stripping in the hypovascular distal Achilles watershed area. The free PL autograft provides an adequate structural match, and complements the translational framework of the Soft Tissue Healing Diamond (ST-Diamond) concept. Furthermore, this approach serves as a potential alternative for middle-aged patients who have a history of prior ACL reconstruction using hamstring autografts, avoiding contralateral donor-site morbidity or the use of allografts. Conclusion: The described mini-open free peroneus longus autograft reconstruction with interference screw fixation represents a cautious, reproducible, and biologically sound salvage option for large chronic Achilles tendon defects, balancing mechanical stability with minimal surgical morbidity.