Operative Techniques in Sports Medicine最新文献

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Update on Patellofemoral Anatomy and Biomechanics 髌骨解剖与生物力学最新进展

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-12-01 DOI: 10.1016/j.otsm.2023.151029

Evan T. Zheng , Chris M. Powers , Miho J. Tanaka

The patellofemoral joint experiences substantial physiologic loads with normal daily activity. Anatomic risk factors can place certain patients at risk for patellofemoral pathology including patellar instability. Stability and load capacity of the joint are a result of numerous factors including the unique configuration of osseous and cartilaginous structures, static and dynamic soft tissue stabilizers, and global lower limb alignment. A thorough understanding of the anatomy and biomechanics of the patellofemoral joint is required to identify patient-specific sources of dysfunction and to tailor individualized treatment specific to a given patient's anatomy. Identification and correction of patient specific risk factors must form the basis for successful treatment strategies. Using novel imaging techniques, dissection methods, and technology for biomechanical evaluation, our understanding of the patellofemoral joint has continued to evolve and in turn can help improve patient specific treatment and outcomes in the management of patellar instability.

髌股关节在正常的日常活动中承受着巨大的生理负荷。解剖危险因素可使某些患者有髌股病变的危险，包括髌骨不稳定。关节的稳定性和承载能力是许多因素的结果，包括骨和软骨结构的独特配置，静态和动态软组织稳定剂，以及下肢整体对齐。透彻了解髌股关节的解剖结构和生物力学是确定患者特定的功能障碍来源和针对特定患者解剖结构量身定制个性化治疗的必要条件。识别和纠正患者特定的风险因素必须成为成功治疗策略的基础。利用新的成像技术、解剖方法和生物力学评估技术，我们对髌股关节的理解不断发展，反过来有助于改善患者对髌骨不稳定的特异性治疗和结果。

引用次数: 0

Lower Limb Rotational Malalignment: Derotational Osteotomies of the Femur and Tibia in the Setting of Recurrent Patellar Instability 下肢旋转错位:复发性髌骨不稳患者行股骨和胫骨旋转截骨术

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-12-01 DOI: 10.1016/j.otsm.2023.151038

Matthew Stiebel , Jack Farr , Dror Paley

Valgus lower extremity alignment with excessive femoral anteversion and tibial external torsion (miserable malalignment syndrome) results in patellar maltracking. Sagittal plane deformities (rotational alignment) should be quantified along with typical frontal plane alignment. Femoral and tibial rotation can be assessed with both physical examination and radiographic studies. Derotational osteotomies of both the femur and the tibia can then be used for correction. In this chapter, we attempt to provide guidelines for assessing lower extremity rotation and an understanding of normal femoral and tibial rotational values. We then provide examples of corrective femoral osteotomies and tibial rotational osteotomies.

下肢外翻与过度股骨前倾和胫骨外扭转(悲惨错位综合征)导致髌骨错位。矢状面畸形(旋转对齐)应与典型的额平面对齐一起量化。股骨和胫骨旋转可以通过体格检查和x线检查来评估。然后可以对股骨和胫骨进行旋转截骨术进行矫正。在本章中，我们试图提供评估下肢旋转和理解正常股骨和胫骨旋转值的指南。然后我们提供矫正股骨截骨术和胫骨旋转截骨术的例子。

引用次数: 0

Cartilage Restoration of the Patellofemoral Joint: Techniques and Outcomes 髌股关节软骨修复:技术和结果

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-12-01 DOI: 10.1016/j.otsm.2023.151039

Chilan B.G. Leite , Logan W. Huff , Giovanna I.S. Medina , Brian J. Cole , Christian Lattermann

Patellofemoral cartilage injuries present a complex challenge due to the unique anatomy and biomechanics of the joint. The daily activities involving the knee, such as weight-bearing, stair ambulation, and squatting, impose high loads on the joint, increasing the risk of cartilage overload and subsequent cartilage injury. Additionally, several anatomical abnormalities, including patellar malalignment, patella alta, and trochlear dysplasia, can influence the behavior of the patellofemoral joint, leading to instability and further elevating the risk of cartilage injuries. Surgical management of patellofemoral cartilage injuries remains a topic of modern debate. The effectiveness and suitability of different techniques depend on individual indications and the characteristics of the cartilage defect. This chapter explores the use of cartilage repair and restoration techniques for patellofemoral cartilage defects. Here, we discuss aspects of the surgical techniques, their outcomes, and provide insights into when staging arthroscopy or concomitant stability surgery should be considered.

髌股软骨损伤是一个复杂的挑战，由于独特的解剖和生物力学的关节。涉及膝关节的日常活动，如负重、爬楼梯和下蹲，对关节施加了高负荷，增加了软骨过载和随后的软骨损伤的风险。此外，一些解剖异常，包括髌骨错位、上髌骨和滑车发育不良，可影响髌股关节的行为，导致不稳定并进一步增加软骨损伤的风险。髌骨股软骨损伤的手术治疗仍然是现代争论的话题。不同技术的有效性和适用性取决于个体适应症和软骨缺损的特点。本章探讨髌骨股软骨缺损的软骨修复和修复技术的应用。在这里，我们讨论了手术技术的各个方面及其结果，并就何时应考虑关节镜检查或同时进行稳定性手术提供了见解。

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引用次数: 0

Medial Patellofemoral Ligament Repair: Still a Relevant Treatment for Patellar Instability? 髌股内侧韧带修复-仍然是髌骨不稳的相关治疗方法?

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-12-01 DOI: 10.1016/j.otsm.2023.151033

Natalie K. Kucirek, Drew A. Lansdown

Medial patellofemoral ligament (MPFL) repair is a historically relevant treatment option for patellar instability, though it has been increasingly supplanted by MPFL reconstruction. Although several comparative studies report superior functional outcomes and a lower risk of recurrent patellar dislocation after MPFL reconstruction, MPFL repair may still be a viable treatment for a select group of patients. Patients with normal trochlear morphology, a normal TT-TG distance, lack of patella alta, and older age may be the best candidates for MPFL repair. MPFL repair also appears to be most effective when performed in the acute setting for avulsion-type tears. In an effort to improve repair outcomes, suture tape augmentation of MPFL repair has emerged recently and has shown promising early results. While our practice is typically to perform MPFL reconstruction for patellar instability, MPFL repair in appropriately selected patients may provide good clinical outcomes while avoiding some of the risks associated with reconstruction.

髌股内侧韧带(MPFL)修复是一种历史上与髌骨不稳定相关的治疗选择，尽管它已越来越多地被MPFL重建所取代。尽管几项比较研究报告了MPFL重建后较好的功能结果和较低的复发性髌骨脱位风险，但MPFL修复可能仍然是一组特定患者的可行治疗方法。滑车形态正常、TT-TG距离正常、上髌骨缺失和年龄较大的患者可能是MPFL修复的最佳选择。在撕脱型撕裂的急性情况下，MPFL修复似乎也是最有效的。为了改善修复效果，最近出现了缝合带增强MPFL修复，并显示出有希望的早期结果。虽然我们的做法通常是对髌骨不稳定进行强韧带重建，但在适当选择的患者中进行强韧带修复可以提供良好的临床结果，同时避免与重建相关的一些风险。

引用次数: 0

Lateral Patellofemoral Ligament Reconstruction: Anatomy, Biomechanics, Indications, and Surgical Techniques 外侧髌股韧带重建:解剖，生物力学，适应症和手术技术

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-12-01 DOI: 10.1016/j.otsm.2023.151036

Benjamin Kerzner , Daniel J. Kaplan , Luc M. Fortier , Zeeshan A. Khan , Johnathon R. McCormick , Betina B. Hinckel , Jorge Chahla

Medial patellar instability is less common than lateral instability and is almost always iatrogenic in nature. The lateral patellofemoral complex, and in particular the lateral patellofemoral ligament, is a major restraint to medial displacement of the patella. When considering surgical intervention, a comprehensive evaluation including understanding of previous procedures and presence of additional risk factors for instability, such as trochlear dysplasia, malalignment, or patella alta must be ruled out. This paper highlights recent anatomic and biomechanical evidence for the treatment of medial patellar instability as well as the pearls and pitfalls for a successful lateral patellofemoral ligament reconstruction.

内侧髌骨不稳定比外侧不稳定更少见，而且基本上都是医源性的。外侧髌股复合体，特别是外侧髌股韧带，是抑制髌骨内侧移位的主要因素。在考虑手术干预时，必须排除综合评估，包括了解既往手术和是否存在其他不稳定风险因素，如滑车发育不良、排列不当或上髌骨。本文重点介绍了最近治疗内侧髌骨不稳的解剖和生物力学证据，以及成功重建外侧髌骨股骨韧带的要点和缺陷。

引用次数: 0

Lateral Lengthening and Lateral Release 侧伸和侧松

IF 0.4 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-12-01 DOI: 10.1016/j.otsm.2023.151031

Erik Haneberg, Andrew Phillips, Eric Cotter, Adam B. Yanke

The lateral retinaculum is a complex, layered structure that is the primary constraint to medial translation of the patella. Patients can develop patellar hypercompression syndrome and arthritis of the lateral patellofemoral joint from an overly tight lateral retinaculum. Conservative treatments include physical therapy and bracing but if relief is not achieved, surgical treatment in the form of lateral retinacular lengthening or release may alleviate symptoms. This chapter provides a thorough background of the risks, indications, outcomes, and techniques regarding treatment of the lateral retinaculum.

外侧支持带是一个复杂的分层结构，是髌骨内侧平移的主要限制。患者可发展髌骨过度压迫综合征和外侧髌骨股骨关节关节炎从过度紧的外侧支持带。保守治疗包括物理治疗和支具，但如果不能缓解，手术治疗以外侧支持带延长或释放的形式可以缓解症状。本章提供了关于外侧视网膜带治疗的风险、适应症、结果和技术的全面背景。

引用次数: 0

Introduction: The Female Athlete 简介:女运动员

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-09-01 DOI: 10.1016/j.otsm.2023.151020

Caitlin A. Nicholson

引用次数: 0

Concussion in Female Athletes 女运动员的脑震荡

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-09-01 DOI: 10.1016/j.otsm.2023.151026

Elizabeth M. Pieroth , Alissa Wicklund

The majority of research on sport-related concussions is conducted on male athletes. The paucity of research focused on female athletes creates a challenge in developing protocols for prevention and treatment of female athletes with concussions. This paper reviews the current epidemiology, injury mechanisms and treatment of concussions in female athletes. Theories on sex-based differences in sport-related concussions are presented. Areas for future research are also reviewed.

大多数关于运动相关性脑震荡(SRC)的研究都是针对男性运动员进行的。针对女运动员的研究的缺乏为制定预防和治疗女运动员脑震荡的协议带来了挑战。本文综述了目前女运动员脑震荡的流行病学、损伤机制和治疗方法。提出了基于性别的SRC差异理论。并对今后的研究方向进行了展望。

引用次数: 0

Relative Energy Deficiency in Sport (RED-S) and Bone Stress Injuries 运动中的相对能量缺乏(RED-S)和骨应激损伤

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-09-01 DOI: 10.1016/j.otsm.2023.151025

Daniel R. Kim, Kathleen Weber

Relative Energy Deficiency in Sport (RED-S) is a syndrome caused by low energy availability that has significant physiological consequences. Bone stress injuries (BSIs), including stress fractures, are overuse injuries that occur when there is an imbalance of bone microdamage and its removal and replacement via bone remodeling. Female athletes are at particular risk of RED-S, which can manifest as bone stress injury, as well as associated pathologies including disordered eating and oligomenorrhea/amenorrhea. Female athletes should be screened for risk factors for RED-S so that it can be identified and treated early. BSIs can be diagnosed by patient history and physical examination, with imaging used for confirmation. Management of BSIs differ according to their location, with high-risk injuries requiring a highly nuanced treatment approach in the context of shared decision-making. These athletes should also be concurrently evaluated for low energy availability, which if identified may require addressing disordered eating, hormone deficiency, and inadequate nutrition with an interdisciplinary team. Return to sport decisions should be individualized while informed by published guidelines.

运动中相对能量缺乏症(RED-S)是一种由能量不足引起的综合征，具有显著的生理后果。骨应激性损伤(Bone stress injury, bsi)，包括应力性骨折，是由于骨微损伤及其通过骨重塑的移除和替换不平衡而发生的过度使用性损伤。女运动员患RED-S的风险特别高，表现为骨应激性损伤，以及饮食失调和少经/闭经等相关病理。女性运动员应筛查RED-S的危险因素，以便及早发现和治疗。bsi可通过病史和体格检查诊断，影像学检查证实。脑损伤的处理因其位置不同而不同，高风险损伤需要在共同决策的背景下采用高度细致的治疗方法。这些运动员也应该同时评估低能量可用性，如果确定可能需要解决饮食失调，激素缺乏和营养不足的跨学科团队。回归运动的决定应根据已公布的指导方针进行个性化。

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引用次数: 0

Knee Injuries: ACL Tears and Patellofemoral Pathology 膝关节损伤:前交叉韧带撕裂和髌骨病理学

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2023-09-01 DOI: 10.1016/j.otsm.2023.151022

Ophelie Lavoie-Gagne, Miho J. Tanaka

Female athletes are at a greater risk of knee injuries than males, which has been attributed to anatomic, biologic, and kinematic risk factors. Knee conditions such as anterior cruciate ligament tears and patellofemoral disorders are more commonly reported in females. There exist sex-specific differences in anatomy that may influence assessment and surgical treatment of knee injuries, such as intercondylar width in the case of ACL injuries and different numerical thresholds for defining trochlear dysplasia in patellar instability. In addition, female athletes may benefit from targeted rehabilitation and injury prevention programs that focus on sex-specific kinetic training to optimize dynamic muscular control, motion pattern techniques, and fatiguability. Postoperative rehabilitation with a specific focus on minimizing kinesiophobia and addressing psychological readiness for return to sport during rehabilitation may increase rates of return to play in female athletes followinginjury. Rates of return to play at the same competitive level following knee injuries are currently reported to be generally similar between male and female athletes, however, the types of sports in which female athletes participate continue to evolve. Continued research is needed to understand sex-specific considerations in the evaluation and treatment of knee injuries in this evolving population.

女性运动员比男性运动员有更大的膝关节损伤风险，这归因于解剖学、生物学和运动学的风险因素。膝关节疾病如前交叉韧带撕裂、髌股疼痛综合征和髌股不稳定在女性中更为常见。解剖学上存在性别特异性差异，这可能会影响膝关节损伤的评估和手术治疗，例如前交叉韧带损伤时的髁间宽度，以及髌骨不稳定时界定滑车发育不良的不同数值阈值。此外，女性运动员可以从针对性的康复和损伤预防计划中获益，这些计划侧重于针对性别的动力训练，以优化动态肌肉控制、运动模式技术和疲劳性。术后康复特别注重减少运动恐惧症，并在康复期间解决重返运动的心理准备问题，这可能会增加女运动员受伤后的重返比赛率。据报道，男性和女性运动员在膝盖受伤后恢复到相同竞技水平的比率大致相似，然而，女性运动员参加的运动类型仍在不断发展。在这一不断发展的人群中，评估和治疗膝关节损伤需要进一步的研究来了解性别特异性因素。

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Operative Techniques in Sports Medicine

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