Stability of the knee joint depends on soft tissues integrity and bony balance in the frontal and sagittal planes during gait. Although frontal plane imbalance is a well-known knee pathology, commonly treated by high tibial osteotomy, sagittal plane imbalance is less common, with fewer and more challenging surgical treatment options. The purpose of this review is to describe the biomechanical effects of sagittal knee imbalances and to outline the indications, techniques, and outcomes of sagittal knee osteotomies. The article details the reference axes and methods to measure posterior tibial slope (PTS), the principal indicator of sagittal imbalance, and its influence on anteroposterior tibial translations and rotational stability of the joint. The authors also outline the roles of the anterior and posterior cruciate ligaments in maintaining sagittal balance, with focus on the associations between PTS and ligament deficiencies, as well as posterolateral corner injuries. Different techniques and indications of tibial osteotomy in the sagittal plane, both above and below the anterior tibial tubercle, are compared in terms of technical difficulty, clinical benefits, and complication rates. The authors conclude on the importance of understanding sagittal knee imbalance, particularly in cases of ligament deficiencies, where the deformity can be the primary cause for lesions. Surgeons must identify the underlying deformities associated with sagittal imbalance, which can be recognized on weight-bearing X-rays and magnetic resonance imaging scans. Different techniques of sagittal osteotomies offer effective treatments for certain indications and should be considered in selected cases for unstable knees with ligament lesions.

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Osteoporosis can significantly impact on the risk of developing a fracture. Thus, fragility fractures represent a challenge for health professionals and decision makers of the twenty-first century. The aim of this work is to review the literature concerning osteoporotic fractures in Italy in terms of incidence, rate of hospitalization, relative risk of a new fragility fracture, and costs for the national health system. It was estimated that the costs of treating proximal femur fragility fractures in 2002 summed up to 1 billion Euros. The number of fragility fractures in Italy was calculated as follows: 91.494 hip fractures, 61.009 clinical vertebral fractures, 57.401 humeral fragility fractures, and 94.045 forearm/wrist fragility fractures. The incidence of fragility fractures in Italy is very high, and osteoporosis is the leading cause of morbidity in the Italian population.

Purpose: the unstable osteochondritis dissecans (oCD-type ii and iii according to the iCRs classification) of the knee largher than > 2.5 cm 2 in adults are uncommon lesions and there is no consensus on how to treat them. Medium-term studies have reported good re sults using autogenous osteochondral plugs (mosaicplasty). the aim of this study is to analyze the long-term results of this technique for the treatment of unstable oCD in a selected group of adult patients. Methods: four patients with oCD at either one of the femoral condyles were included in this prospective study. the average age was 21.2 years (range, 18-24 years). the oCD lesions were classified as type ii in three patients and type iii in one patient and the average size was 3.8 cm 2 (range, 2.55-5.1 cm 2 ). the lesions were treated in situ with a variable number of autogenous osteochondral plugs (Ø 4.5 mm 2 ). the Modified Cincinnati, Lysholm ii and tegner scores were used for clinical and functional evaluation. Magnetic resonance arthrography (MRA) was performed before surgery and at 2, 5 and 10 years after surgery. A modified MoCARt score was used to evaluate MRA findings.Results: the average follow-up duration was ten years and 6 months (range, 10-11 years). no complications occurred. At the final follow-up, all scores (clinical, functional and MoCARt) improved. in all but one of the patients MRA showed complete osteochondral repair. Conclusions: the fixation of large and unstable oCD lesions with mosaicplasty may be a good option for treating type ii or iii oCD lesions in adults. the advantages of this technique include stable fixation, promotion of blood supply to the base of the oCD fragment, and grafting of autologous cancellous bone that stimulates healing with preservation of the articular surface. Level of evidence: Level iV, therapeutic case series.