Operative Techniques in Sports Medicine最新文献

Athletes are prone to patellofemoral arthritis, a multi-factorial condition including patellofemoral malalignment, instability, overuse, and trauma incurred across diverse sporting disciplines. Surgical options for treating this condition include extensor mechanism realignment osteotomy and patellofemoral arthroplasty. Each procedure carries distinct advantages and considerations. Selection of the most suitable approach requires a comprehensive understanding of the procedures and patient specific factors such as severity of cartilage defects, malalignment, and the patient's preferences, and activity goals. For early-stage patellofemoral osteoarthritis, particularly in cases involving malalignment, tibial tubercle osteotomy can be an effective treatment, while arthroplasty becomes more valuable in more advanced and progressive cases. This chapter aims to establish a clear algorithmic approach for the utilization of realigning tibial tubercle osteotomy and patellofemoral arthroplasty in the management of patellofemoral osteoarthritis.

Osteotomies are classically utilized in the treatment of unicompartmental knee osteoarthritis (OA) in young active patients as part of a joint preservation strategy. As unicompartmental knee OA is often associated with malalignment, the osteotomy procedure is designed to shift the patient's mechanical axis to neutral alignment. By shifting the mechanical axis, there is decreased contact pressures in the affected compartment providing both pain relief and offloading of the affected compartment. Osteotomies can be performed in the proximal tibia or distal femur depending on the location of deformity. Both procedures have demonstrated successful improvement in clinical and functional outcomes and a delay in progression to total knee arthroplasty. The use for osteotomy in the treatment of unicompartmental knee osteoarthritis and the outcomes associated with osteotomies are discussed in detail in this review.

Tendinous extensor mechanism injuries of the knee (i.e., quadriceps and patellar tendon injuries) have become more common in aging athletes as the general population continues to remain active. Structural changes within the quadriceps and patellar tendons can occur with aging, as well as with certain medical comorbidities and medications. There is currently a lack of published data on return to sport after knee extensor mechanism injury in the aging population. Return to some level of sport after tendinous knee extensor mechanism injuries in the aging athlete is possible in the majority of patients, with similar rates of return to sport after quadriceps and patellar tendon injuries.

As professional and recreational athletes increasingly extend their participation in sports, the prevalence of cartilage injuries, both acute and chronic, rises substantially. This article addresses the evolving landscape of care for aging athletes with knee cartilage injuries. A comprehensive diagnostic process, including a detailed patient history, thorough physical exam, and appropriate imaging, provides the foundation for effective and personalized treatment. Non-operative strategies, such as tailored physical therapy regimens and intraarticular injections, may play a pivotal role in preserving joint function, providing symptomatic relief, and delaying the need for surgical intervention. For cases necessitating operative intervention, an array of options, including debridement to stable borders, surface restoration procedures, osteochondral replacement procedures, and procedures addressing mechanical alignment, are available, and often performed in combination. In navigating the complexities of treating knee cartilage injuries in aging athletes, a commitment to refining current approaches and adapting to emerging evidence is crucial to achieving optimal outcomes and enhancing the longevity of joint health in this distinct population.

Orthobiologics are being investigated to treat a variety of sports medicine pathologies. This article provides an evidence-based approach summarizing currently available options, including viscosupplementation, platelet-rich plasma, bone marrow aspirate concentration, adipose-derived mesenchymal stem cells, and amniotic-derived mesenchymal stem cells. Orthobiologic use in clinical practice necessitates an understanding of the indications, supporting evidence, risks, and benefits. It should maintain a safe, cost-effective, and resource-conscious approach while adhering to regulatory guidelines. This article provides a foundation for understanding when, why, and how to implement orthobiologics.

This chapter explores the management of end stage knee osteoarthritis (OA) in the aging athlete.

In this population, the focus shifts from solely pain relief to enabling a return to specific athletic activities. Different and higher patient expectations cause the need for more careful consideration of surgical techniques, implant selection, and rehabilitation.

Total knee arthroplasty (TKA) remains the gold standard, offering broad indications, and a high success rate overall. Unicompartmental Knee Arthroplasty (UKA) targets isolated OA and demonstrates higher return-to-sport rates. Literature suggests both options favour low-impact activities.

Both UKA and TKA are successful options in the treatment of end stage knee OA, even in an active and athletic population.

Multiligamentous knee injuries (MLKIs) are a rare, devastating, heterogenous group of injuries defined by injury to at least 2 of the 4 major ligaments in the knee and are often associated with a knee dislocation (KD). They can result from high-velocity accidents, pivoting knee injuries during athletic activity, or even ultra-low velocity mechanisms in older, obese individuals. Management is complex and should be centered around re-establishing stability of the knee joint. Surgical intervention is considered standard, however, the type and timing of intervention are heavily studied and debated, especially as athletic individuals continue to age. Traditional options include both ligament repair and reconstruction; however, total knee arthroplasty (TKA) with revision-type, constrained prosthetic components may also have a role. This chapter provides an overview of the evaluation of KDs and MLKIs, with a focus on management strategies and outcomes and complications in aging athletes based on the current available evidence.