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BackgroundPartial lesions of the anterior cruciate ligament (ACL) are more common than is generally thought, accounting for about 10–12% of ACL injuries. Selective reconstruction may be considered as an option in isolated bundle rupture. The purpose of this study is to evaluate both subjective and objective clinical results, as well as functional recovery time, after selective arthroscopic single-bundle reconstruction in a consecutive series of patients affected by partial ACL rupture.Materials and methodsThirty-six patients undergoing selective reconstruction of a single ACL bundle were retrospectively evaluated from a series of 354 ACL reconstructions performed over a 3-year period. Although the suspicion of partial lesions was present at clinical and magnetic resonance imaging (MRI) evaluation, final diagnosis was obtained during arthroscopy. All patients were operated using the same technique and type of fixation, and undergoing the same functional recovery protocol.ResultsMean follow-up was 64 months (48–84 months). All patients but one achieved good functional recovery and returned to their sports within a mean period of 6.1 months. A single patient complained of postoperative instability 1 year after the index operation and needed further surgery. No complications were recorded.ConclusionsSelective reconstruction of partial ACL injury is a method to bear in mind because it offers quick functional recovery. Specific technical and diagnostic steps should be performed and discussed with patients preoperatively.Level of evidenceLevel 4, retrospective study.

Background/Objectives: Proximal femoral fractures (PFF) are associated with substantial morbidity and mortality in elderly patients. Early identification of individuals at increased risk of death remains challenging. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and readily available biomarker reflecting systemic inflammation and physiological stress, but its role as a risk stratification tool in surgically treated PFF patients is not fully established. The aim of this study was to validate NLR as a prognostic biomarker for mortality risk stratification in elderly hip fracture patients by evaluating its independent association with mortality, establishing clinically relevant risk categories, and assessing its ability to identify distinct mortality risk groups. Methods: This retrospective cohort study included 1113 patients aged ≥ 65 years who underwent surgery for AO/OTA 31.A (trochanteric) or 31.B (femoral neck) proximal femoral fractures between January 2021 and February 2024 at a single institution. NLR was calculated from routine admission bloodwork. The primary outcome was all-cause mortality. Kaplan–Meier survival analysis stratified patients by clinically relevant NLR categories (<5, 5–10, >10). Cox proportional hazards regression identified independent predictors of mortality. ROC analysis was performed secondarily to identify an optimal binary threshold. Results: At mean follow-up of 33.9 months, overall mortality was 36.2% (352/972). Stratified survival analysis demonstrated a clear dose–response relationship, with mortality rates of 26.2%, 36.5%, and 54.4% for NLR < 5, 5–10, and >10, respectively (log-rank p < 0.001). In multivariable Cox regression, NLR remained independently associated with mortality (HR = 1.042, 95% CI: 1.032–1.053, p < 0.001) after adjusting for age and time to surgery. ROC analysis identified an optimal binary cut-off of 6.59 (AUC 0.614). Conclusions: Elevated preoperative NLR is independently associated with increased mortality following surgery for proximal femoral fractures, particularly in very elderly patients. Given its simplicity and universal availability, NLR may represent a useful adjunct for early perioperative risk stratification.

Background Knee varus alignment represents a notorious cause of knee osteoarthritis. It can be caused by tibial deformity, combined tibial–femoral deformity and/or ligament imbalance. Understanding malalignment is crucial in total knee arthroplasty to restore frontal plane neutral mechanical axis. The aim of this study was to determine which factor contributes the most to varus osteoarthritic knee and its related surgical implications in performing a total knee arthroplasty. Methods We retrospectively evaluated 140 patients operated for total knee arthroplasty due to a varus knee. Full-leg hip to ankle preoperative X-rays were taken. Radiological parameters recorded were: mechanical axis deviation, hip–knee–ankle, anatomical–mechanical angle, medial neck shaft angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), lateral proximal femoral angle, lateral distal tibial angle (LDTA), femoral bowing, and length of tibia and femur. We also determined ideals tibial and femoral cuts in mm according to mechanical alignment technique. A R2 was calculated based on the linear regression between the predicted values and the observed data. Results The greatest contributor to arthritic varus ( R  = 0.444) was MPTA. Minor contributors were mLDFA ( R  = 0.076), JLCA ( R  = 0.1554), LDTA ( R  = 0.065), and femoral bowing ( R  = 0.049). We recorded an average of 7.6 mm in lateral tibial cut thickness to restore neutral alignment. Conclusions The radiological major contributor to osteoarthritic varus knee alignment is related to proximal tibia deformity. As a surgical consequence, during performing total knee arthroplasty, the majority of the correction should therefore be made on tibial cut.

Climate change (CC) has a significant impact on human health, resulting in both physical and mental illnesses. Eco-anxiety—the excessive and pervasive fear about the consequences of CC—is the most studied psychoterratic state. This study presents the validation of Italian versions of Hogg’s Eco-Anxiety Scale (HEAS) and the Eco-Paralysis Scale. It also investigates the effects of worry on eco-anxiety and eco-paralysis. The study was conducted on 150 Italian individuals who responded to the two scales and to other questionnaires to make comparisons with the two above. Internal consistency and factorial structure were assessed through Cronbach’s alpha, Confirmatory Factor Analysis and Exploratory Factor Analysis. A median regression was used to assess the association between the EPS and the HEAS and Climate Change Worry Scale (CCWS) and their interaction. HEAS and EPS showed good psychometric properties: HEAS resulted in good internal consistency (Cronbach’s α = 0.986), and the Eco-Paralysis scale had good test-retest reliability (r = 0.988). In both cases, a one-factor structure was suggested to be retained. The interaction terms between HEAS and CCWS (β = −0.02; 95% CI: −0.03, −0.01; p < 0.001) and between HEAS and education (β = −0.05; 95% CI: −0.08, −0.02; p < 0.001) were significant. Therefore, the feeling of worry seems to act as a moderator between climate change anxiety and eco-paralysis since it may appear to influence individuals and their ability to transform anxiety into action. Education plays a role in reducing the risk of Eco-Paralysis in subjects affected by climate change anxiety. Thus, data suggest that working on reinforcing a more cognitive concern might result in more problem-solving-focused strategies to face climate change anxiety and eco-paralysis.

Cocaine use disorder (CUD) is a global health issue with no effective treatment. Repetitive Transcranial Magnetic Stimulation (rTMS) is a recently proposed therapy for CUD. We conducted a single-center, randomised, sham-controlled, blinded, parallel-group research with patients randomly allocated to rTMS (15 Hz) or Sham group (1:1) using a computerised block randomisation process. We enrolled 62 of 81 CUD patients in two years. Patients were followed for eight weeks after receiving 15 15 Hz rTMS/sham sessions over the left dorsolateral prefrontal cortex (DLPFC) during the first three weeks of the study. We targeted the DLFPC following the 5 cm method. Cocaine lapses in twice a week urine tests were the primary outcome. The secondary outcomes were craving severity, cocaine use pattern, and psychometric assessments. We randomly allocated patients to either an active rTMS group (32 subjects) or a sham treatment group (30 subjects). Thirteen (42%) and twelve (43.3%) of the subjects in rTMS and sham groups, respectively, completed the full trial regimen, displaying a high dropout rate. Ten/30 (33%) of rTMS-treated patients tested negative for cocaine in urine, in contrast to 4/27 of placebo controls (p = 0.18, odd ratio 2.88, CI 0.9-10). The Kaplan-Meier survival curve did not state a significant change between the treated and sham groups in the time of cocaine urine negativisation (p = 0.20). However, the severity of cocaine-related cues mediated craving (VAS peak) was substantially decreased in the rTMS treated group (p<0.03) after treatment at T1, corresponding to the end of rTMS treatment. Furthermore, in the rTMS and sham groups, self-reported days of cocaine use decreased significantly (p<0.03). Finally, psychometric impulsivity parameters improved in rTMS-treated patients, while depression scales improved in both groups. In CUD, rTMS could be a useful tool for lowering cocaine craving and consumption. The study number on clinicalTrials.gov is NCT03607591.

Following a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of a preparation containing alpha‐galactosidase (EC 3.2.1.22) and endo‐1,4‐beta‐xylanase (EC 3.2.1.8) (Capsozyme SB Plus) as a zootechnical feed additive (functional group: digestibility enhancers). The additive is already authorised for use in feed for chickens for fattening, chickens reared for laying, minor poultry species for fattening and reared for laying and ornamental birds. The applicant is seeking an extension of use to turkeys for fattening and reared for breeding at the minimum inclusion level of 14 alpha‐galactosidase activity units (GALU) and 18 endo‐1,4‐beta‐xylanase activity units (AXC) per kg of complete feed and a maximum inclusion level of 20 GALU and 25 AXC units per kg of complete feed. Based on the results observed in a tolerance trial in chickens for fattening that had been previously evaluated, the FEEDAP Panel concluded that Capsozyme SB Plus is safe for turkeys for fattening and reared for breeding at the maximum recommended level of 20 GALU and 25 AXC units per kg complete feed. The use of the feed additive in turkeys for fattening and reared for breeding under the proposed conditions of use is considered safe for consumers and the environment. Regarding safety for the user, Capsozyme SB Plus is considered a respiratory sensitiser and exposure by inhalation is considered a risk. No conclusions could be reached on the potential of the additive to be irritant to the skin or eyes or a skin sensitiser. Capsozyme SB Plus is considered to be efficacious in turkeys for fattening and reared for laying at the proposed minimum use level of 14 GALU and 18 AXC units per kg complete feed.

Background This study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the proposed threshold was evaluated. Materials and methods Between January 2020 and April 2022, patients with failed or painful knee arthroplasty who were admitted to a tertiary referral institution undergoing the standardized diagnostic protocol to identify those with a periprosthetic joint infection (PJI) were analyzed. The 2018 International Consensus Meeting (ICM) criteria were used to classify patients with PJIs and aseptic joints. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve (AUC) of AGR were calculated to define the test’s diagnostic accuracy. Results The ROC curve showed that the optimal cutoff value of AGR was 1.43. AGR registered a sensitivity of 95% (95% CI 91–197%), a specificity of 63% (95% CI 56–69%), a positive predictive value of 75% (95% CI 69–81%), and a negative predictive value of 91% (95% CI 86–94%). Receiver operator curve analysis demonstrated an AUC of 0.85 (95% CI 0.77–0.88). Although body mass index (BMI), uremia, glutamic-oxaloacetic transaminase (GOT), international normalized ratio (INR), and alkaline phosphatase showed significant differences between the false positive cases and those cases affected by aseptic failure with AGR higher than 1.43, indicating potential confounding effects ( p  < 0.05), no parameter was found to be a significant predictor of false positives cases ( p  > 0.05). Conclusions For its high sensitivity, AGR showed potential as a screening tool for detecting infections in PJI diagnostics. Level of evidence : III.

Introduction: Octogenarians undergoing unicompartmental knee arthroplasty (UKA) face increased risks of complications due to reduced bone support following osteoporosis. The aim of this study was to describe our preferred technique to balance robotic-assisted UKA in this specific patient population and to present its results. Methods: This retrospective analysis of prospectively collected data examined 121 consecutive octogenarian patients (median age 84 years, IQR 82–86) who underwent robotic-assisted medial UKA between September 2018 and December 2022 with ≥24 months follow-up. Patients aged ≤80 years, with ≤2 years of follow-up, or without informed consent were excluded. Data collection included radiographic measurements (HKA, LDFA, MPTA, joint line height), patient-reported outcome measures (Oxford Knee Score, Knee Society Score), and complications. Statistical analysis employed descriptive statistics, paired t-tests, Cohen’s d for effect sizes, and the McNemar test for categorical variables. Results: The hip–knee–ankle angle improved significantly from 174.43° to 178.04° (mean difference 3.61°, 95% CI 3.13–4.09, p < 0.001). Patient-reported outcomes demonstrated substantial improvements: the Knee Society Score increased by 83.09 points (95% CI 79.76–86.42, p < 0.001, Cohen’s d = 4.53), and the Oxford Knee Score increased by 17.09 points (95% CI 15.42–18.76, p < 0.001), with both exceeding minimal clinically important differences. Only 7.4% (9/121) of cases exhibited joint line lowering of >2 mm, with 1.7% (2/121) having both post-operative HKA <175° and joint line lowering of >2 mm. The implant survival rate was 100% with minimal complications, including two conservatively managed tibial plateau fractures and two cases of wound dehiscence with no further surgery needed. Conclusions: Robotic-assisted medial UKA can consistently preserve joint line height while achieving excellent alignment correction and clinical outcomes in octogenarians, potentially addressing failure risks in this specific population.

Background The synovial chondromatosis is an uncommon proliferative metaplastic process of the synovial cells that can develop in any synovial joint. An isolated primary chondromatosis of the posterior compartment of the knee is uncommon and few cases are reported in literature. Our purpose is to describe a rare case of primary chondromatosis of the knee posterior compartment and report the arthroscopic loose bodies excision through a difficult posteromedial portal, avoiding the use of the accessory posterior portal, most commonly reported for approaching this disease. Case presentation We report a rare case of a 35-year-old Caucasian male patient with diagnosis of chondromatosis of the posterior knee compartment. The radiographs showed multiple loose bodies of the posterior compartment. The MRI revealed minimal synovial hypertrophy areas, multiple osteophytes in the intercondylar notch, and loose bodies in the posteromedial compartment. The CT allowed us to assess the bony structures, the morphology of the intercondylar notch, and the presence osteophytes of the medial and lateral femoral condyles. The CT images were crucial to plan how to reach the posterior compartments of the knee through a trans-notch passage. The patient underwent arthroscopic surgery using anteromedial, anterolateral, and posteromedial portals. The tunneling through the intercondylar osteophytes was performed to allow the arthroscope to pass trans-notch. To avoid additional accessory posterior portals, we used a 70° arthroscope to better explore the posterior knee compartment. The cartilage-like bodies were removed and synovectomy of the inflamed areas was performed. The clinical and radiological follow-up was 12 months and the patient showed excellent clinical outcomes, returning to his activities of daily living and sport activity. Conclusion Our case report highlights the importance of the arthroscopic approach to treat synovial chondromatosis, despite the involvement of the posterior compartment of the knee. An optimal preoperative imaging allows to plan for the proper surgical procedure even in patients with severe osteoarthritis. Moreover, the adoption of an intercondylar notch tunneling and a 70° arthroscope can help surgeons to better explore the posterior knee compartment, avoiding an accessory posterior trans-septal portal. Therefore, a synovectomy of the inflamed foci may be useful to prevent recurrence.

IntroductionBurch–Schneider-like antiprotrusio cages (B-SlAC) still remain helpful implants to bridge severe periacetabular bone losses. The purpose of this study was to evaluate outcomes and estimate both cages’ failures and complication risks in a series of B-SlAC implanted in revision of failed total hip arthroplasties (THA) or after resection of periacetabular primary or secondary bone malignancies. Risk factors enhancing the chance of dislocations and infections were checked.Materials and methodsWe evaluated 73 patients who received a B-SlAC from January 2008 to January 2018. Group A, 40 oncological cases (22 primary tumors; 18 metastases); Group B, 33 failed THAs. We compared both Kaplan–Meier estimates of risk of failure and complication with the cumulative incidence function, taking account the competing risk of death. Cox proportional hazards model was utilized to identify possible predictors of instability and infection. Harris hip score HHS was used to record clinical outcomes.ResultsMedium follow-up was 80 months (24–137). Average final HHS was 61 (28–92), with no differences within the two groups (p > 0.05). The probabilities of failure and complications were 57% and 26%, respectively, lower in the oncologic group than in the rTHA group (p =0 .176; risk 0.43) (p = 0.52; risk 0.74). Extended ileo-femoral approach and proximal femur replacement (p =0.02, risk ratio = 3.2; p = 0.04, rr = 2.1) were two significant independent predictors for dislocations, while belonging to group B (p = 0.04, rr = 2.6) was predictable for infections.ConclusionBurch–Schneider-like antiprotrusio cages are a classical non-biological acetabular reconstruction method that surgeons should bear in mind when facing gross periacetabular bone losses, independently of their cause. However, dislocation and infection rates are high. Whenever possible, we suggest preserving the proximal femur in revision THA, and to use a less-invasive postero-lateral approach to reduce dislocation rates in non-oncologic cases.