In December 2024, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) released a joint update of their 2017 clinical practice guideline (CPG) for the rehabilitation of individuals with lower limb amputation (LLA). This synopsis highlights the key aspects of the guideline development process and describes the CPG recommendations. The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development work group (WG) that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline WG conducted a patient focus group, developed key questions, and systematically searched and evaluated the literature from a eight year time frame (English-language publications from 6 July 2016 to 15 March 2024). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was utilized to evaluate the evidence and formulate recommendations. The WG developed 26 recommendations along with algorithms and supplemental materials to guide providers in providing evidence-based, interdisciplinary, patient-centered care through all phases of LLA rehabilitation. The CPG was reviewed by stakeholders outside the WG prior to approval by the VA/DoD Evidence Based Practice WG. This article summarizes key features of the guideline to help clinicians utilize the CPG to support patient-centered care.

This study aimed to systematically evaluate postoperative activity participation and functional recovery after robotic-assisted unicompartmental knee arthroplasty (RA-UKA). A systematic review and single-arm meta-analysis was conducted according to PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to May 2026. Eligible studies included adults undergoing RA-UKA and reporting postoperative activity participation, return to sport, range of motion, or validated functional outcomes. Methodological quality was assessed using MINORS, RoB 2, and ROBINS-I according to study design. Pooled estimates with 95% confidence intervals (CIs) were calculated using Stata version 18.0. Twelve studies involving 486 RA-UKA cases were included. The pooled Forgotten Joint Score was 64.58 (95% CI 49.38, 79.77), and the pooled range of motion was 110.92° (95% CI 91.83, 130.02). The pooled estimate for return to sport after RA-UKA was 0.93 (95% CI, 0.87, 1.00). The pooled postoperative pain-related score at the last follow-up was 6.06 (95% CI 3.56, 8.57). The pooled proportion of patients reporting being "very satisfied" with return to recreational activities was 0.57 (95% CI 0.29, 0.86). Sensitivity analyses indicated that the main findings were generally stable. Single-arm evidence suggests that RA-UKA may be associated with encouraging postoperative recovery profiles, including acceptable joint awareness, functional knee motion, return-to-sport signals, and patient-reported outcomes. However, these findings are descriptive and hypothesis-generating rather than evidence of clinical superiority. Further prospective comparative studies with standardized activity outcomes are needed.

The meniscus is a fibrocartilaginous structure crucial for load distribution, shock absorption and knee stability. With advancing age, its biomechanical and biochemical integrity declines through progressive cellular senescence, accumulation of advanced glycation end-products, reduced vascularity and altered collagen cross-linking. These changes predispose to structural damage most often seen as horizontal cleavage lesions-the hallmark of meniscal ageing-best understood as 'wrinkles' of the meniscus rather than true pathology. Such lesions are often asymptomatic and incidental on MRI. However, in some individuals they may cause pain or mechanical symptoms requiring targeted, conservative management. This narrative review integrates biological, epidemiological and clinical data to provide an evidence-based framework for managing the ageing meniscus. We discuss the natural history of degenerative lesions and detail practical strategies for orthopaedic clinicians, including exercise therapy, metabolic optimization, nutritional supplementation, biomechanical offloading and injection-based interventions. Surgical treatment should remain a second-line option, reserved for patients with persistent symptoms or biomechanically significant lesions.

Patellofemoral pain syndrome (PFPS) is a prevalent chronic knee disorder that poses significant clinical challenges due to its high incidence and suboptimal long-term outcomes. Current diagnostic approaches, primarily reliant on static imaging and subjective assessment, fail to capture the underlying dynamic biomechanical dysfunction. To address this gap, this study integrates dynamic radiography with three-dimensional gait analysis to construct a dynamic biomechanical model of the knee joint. We will quantify key parameters such as patellar tracking. The research is designed to achieve three core Objectives: firstly, to quantify dynamic biomechanical parameters in PFPS patients using dynamic DR and gait analysis; secondly, to compare the effects of biomechanically monitored targeted exercise combined with TCM vs. conventional exercise combined with TCM on pain and function; thirdly, to develop a biomechanics-guided clinical rehabilitation protocol for PFPS patients.

Giant cell tumor of bone (GCTB) is a benign yet locally aggressive neoplasm that commonly arises in the epiphyseal metaphyseal region of long bones, particularly around the knee, where management is challenged by the need to achieve complete tumor excision while preserving joint function in young, active individuals. We describe a 26-year-old female who presented with acute left knee pain and mechanical locking after squatting during exercise. Imaging demonstrated a well-defined 1.7 × 1.7 × 1.7 cm eccentric lesion in the posterior medial tibial plateau with minimal cortical breakthrough and surrounding marrow edema, and CT guided biopsy confirmed the diagnosis of GCTB. She underwent surgery through a posterior Löbbenhofer approach, including meticulous curettage, high speed burring, and phenol application. To shield the articular cartilage from the thermal effects of PMMA cement and avoid long term subchondral stiffness, a protective layer of autologous morselized bone graft was interposed between the cement and the joint surface. Recovery was uneventful, and this single-stage technique provided definitive management with no need for further surgery, ensuring structural support while minimizing recurrence risk. This case highlights the value of combining extended curettage with a graft cement interface to optimize joint preservation in periarticular GCTB and underscores the need for future studies evaluating long term radiological and functional outcomes of such hybrid reconstructions.

This systematic review and meta-analysis evaluated pain and functional outcomes, safety, and differences between embolic agents in genicular artery embolization (GAE) for knee osteoarthritis. Forty-five studies including 2205 patients were analyzed. Across predominantly uncontrolled studies, clinically relevant improvements were observed, with pooled Visual Analogue Scale reductions of - 37.5 points at 1 month and - 37.1 at 12 months. Western Ontario and McMaster Universities Osteoarthritis Index improved by - 28.9 at 1 month, and Knee Injury and Osteoarthritis Outcome Score-Pain by + 23.6 at 6 months. Mean changes exceeded clinically important thresholds. No significant subgroup interaction between permanent and temporary embolic agents was observed. The most frequent adverse events were transient skin discoloration (11%) and hematoma (3%). Overall, the certainty of evidence ranged from very low to low.Graphical Abstract.