Revision reconstruction of the anterior cruciate ligament (ACL) presents a considerable challenge - due to its technical complexity, variable clinical presentations, and the interplay of multiple risk factors and concomitant pathologies. Optimal treatment requires a thorough analysis of the causes of failure. The preoperative evaluation should include full-leg radiographs, lateral X-rays of the entire lower leg, magnetic resonance imaging (MRI) to assess soft tissue pathologies, and computed tomography (CT) to evaluate tunnel position and tunnel widening. Graft failure is usually multifactorial and may be related to technical, biological, demographic, or biomechanical causes. Technical issues include malpositioning of the tunnels, unaddressed primary instabilities, fixation failure, or inadequate graft tensioning. Biological factors comprise impaired graft incorporation and infections. Biomechanical and anatomical factors-such as increased posterior tibial slope (PTS), coronal plane malalignment, or persistent peripheral or rotational instabilities-must also be recognised and addressed. For this purpose, additional surgical techniques are available - such as slope-reducing osteotomy, varus and valgus osteotomies, as well as lateral extra-articular tenodesis. A successful revision ACL reconstruction is based on a comprehensive analysis of the underlying causes, individually tailored surgical strategies, correction of modifiable predisposing factors, and realistic patient counseling. These measures are crucial for achieving good functional outcomes and long-term stability, while enabling a safe return to the desired level of activity without recurrent injury.

The additional qualifications "Special Orthopaedic Surgery" and "Special Trauma Surgery" are well-established and recognised credentials for specialised care within the field of orthopaedics and trauma surgery. However, given the increasing prevalence of subspecialised care structures, the question arises as to whether the content and requirements of these additional qualifications remain up to date and relevant to clinical practice.The aim of this study was to conduct a systematic analysis of the content and requirements based on the Model Training Regulations (MWBO) of the German Medical Association (BÄK) from 2003 and 2018, as well as the current training regulations (WBO) of all regional medical chambers (LÄK). The number and types of required surgical procedures were examined, along with their distribution across subspecialised areas such as endoprosthetics, spine surgery, shoulder and elbow surgery, and foot and ankle surgery.The analysis reveals a general reduction in the total number of required surgical procedures in both additional qualifications and considerable harmonisation of requirements across regional chambers. In the "Special Orthopaedic Surgery" qualification, up to 49% of procedures involve endoprosthetics, particularly of the lower extremity. In contrast, subspecialised fields such as shoulder and elbow or foot and ankle surgery are underrepresented, despite their growing importance in clinical practice. Furthermore, modern minimally invasive techniques such as arthroscopy are still scarcely addressed.To address the gap between training content and the realities of clinical care-and to ensure high-quality training and long-term healthcare provision-reform of the current training regulations is needed. The Introduction of defined subspecialty tracks, such as shoulder and elbow surgery or foot and ankle surgery, could offer more differentiated and practice-oriented training, and help to ensure high-quality patient care in the future.

Chronic osteomyelitis remains a significant challenge in orthopaedic and trauma surgery, despite substantial advancements in surgical techniques, antimicrobial therapy, and microbiological diagnostics. The progression from acute to chronic infection is characterised by the formation of bacterial biofilms, which result in profoundly reduced antibiotic susceptibility and pathogen persistence. The Cierny-Mader classification provides a critical clinical framework, by integrating the anatomical extent of the infection with the host's physiological condition. This review summarises current understanding of the pathophysiology of osteomyelitis and delineates stage-appropriate surgical strategies, including radical debridement, dead-space management with local antibiotic carriers, soft-tissue reconstruction, and subsequent bone reconstruction. Furthermore, recent developments in single-stage surgical approaches, shortened systemic antibiotic therapy, and the necessity of interdisciplinary treatment concepts are discussed. A comprehensive understanding of the mechanisms underlying biofilm-associated infection and the implementation of evidence-based, classification-guided treatment protocols are essential for achieving definitive infection control and optimal functional outcomes.

Injuries to the lateral ankle ligaments are among the most common sports injuries in both professional athletes and the general population. Adequate management with consequent bracing after excluding relevant concomitant injuries, and functional aftertreatment, including balance and proprioceptive training, are crucial in preventing chronic lateral ankle instability (CLAI). It is estimated that CLAI develops in approximately 25% of patients following an ankle sprain. The condition is divided into mechanical and functional instability. Diagnosis is primarily clinical, but imaging such as X-rays and magnetic resonance imaging can be very useful in detecting additional pathologies. Most patients improve with non-operative treatment. When this fails, surgery is indicated. Surgical treatment of CLAI is divided into direct ligament repair and indirect reconstruction. Extra-anatomical tenodesis is generally not indicated. Currently, the gold standard is ligament repair with the Broström-Gould technique, with excellent results. Early rehabilitation, including balance and proprioceptive training, plays a pivotal role in regaining postural stability in both acute and chronic lateral ankle instability.