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Osteotomy for Unicompartmental Knee Osteoarthritis: Indications and Outcomes 单室膝关节骨关节炎截骨术:适应症和疗效
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151084
Ariana Lott , M. Enes Kayaalp , Yoshiyuki Yahagi , Joseph D. Giusto , Jonathan D. Hughes , Volker Musahl

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.

截骨术是治疗活跃的年轻患者膝关节单髁骨关节炎(OA)的经典方法,也是关节保护策略的一部分。由于膝关节单间室骨关节炎通常与关节错位有关,截骨术的目的是将患者的机械轴线移至中立位。通过移动机械轴,减少受累椎间隙的接触压力,既能缓解疼痛,又能减轻受累椎间隙的负荷。根据畸形的位置,可在胫骨近端或股骨远端进行截骨手术。这两种手术都能成功改善临床和功能效果,并延缓全膝关节置换术的进展。本综述将详细讨论截骨术在单关节膝关节骨性关节炎治疗中的应用以及截骨术的相关疗效。
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引用次数: 0
Table of Contents (pick up from previous issue w/updates) 目录(接上一期/更新内容)
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1053/S1060-1872(24)00036-4
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引用次数: 0
Patellofemoral Osteoarthritis, Should We Replace or Osteotomize? 髌骨骨关节炎,应该置换还是截骨?
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151083
Anna Bartsch , Jacob F. Oeding , Yazdan Raji , Monica Sri Vel , Kinsley Pierre , Seth L. Sherman

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.

运动员很容易患上髌骨关节炎,这是一种多因素疾病,包括髌骨对位不良、不稳定性、过度使用和不同运动项目的创伤。治疗这种疾病的手术方案包括伸肌机构重新定位截骨术和髌股关节成形术。每种手术都有其独特的优势和注意事项。要选择最合适的方法,需要全面了解手术方法和患者的具体因素,如软骨缺损的严重程度、错位情况、患者的偏好和活动目标等。对于早期髌骨骨关节炎,尤其是涉及错位的病例,胫骨结节截骨术是一种有效的治疗方法,而对于晚期和进展期病例,关节成形术则更有价值。本章旨在为在髌骨骨关节炎的治疗中使用重新排列胫骨结节截骨术和髌骨关节成形术建立明确的算法。
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引用次数: 0
Cartilage Restoration in the Aging Athlete 老年运动员的软骨修复
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151081
Allen A. Yazdi , Alexander C. Weissman , Sarah A. Muth , Jared M. Rubin , Richard M. Danilkowicz , Brian J. Cole

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.

随着职业和休闲运动员参与体育运动的时间越来越长,软骨损伤(包括急性和慢性损伤)的发病率也大幅上升。本文探讨了为膝关节软骨损伤的高龄运动员提供护理的演变情况。全面的诊断过程,包括详细的病史、全面的体格检查和适当的影像学检查,为有效的个性化治疗奠定了基础。非手术治疗策略,如量身定制的物理治疗方案和关节内注射,可在保护关节功能、缓解症状和延迟手术治疗需求方面发挥关键作用。对于需要手术干预的病例,可以选择一系列方案,包括清创至稳定边界、表面修复术、骨软骨置换术和解决机械排列问题的手术,这些方案通常会联合使用。在治疗高龄运动员膝关节软骨损伤的复杂过程中,致力于改进现有方法并适应新出现的证据,对于在这一特殊人群中获得最佳治疗效果和延长关节健康寿命至关重要。
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引用次数: 0
Extensor Mechanism Injuries: Is Return to Sport Feasible? 伸肌机制损伤:重返运动场是否可行?
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151090
Nicholas A. Apseloff , Guttu Maskalo , Garcia Findlay , Jonathan D. Hughes

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.

膝关节肌腱伸展机制损伤(即股四头肌和髌骨肌腱损伤)在老龄运动员中越来越常见,因为普通人群仍在继续运动。股四头肌和髌骨肌腱的结构会随着年龄的增长以及某些并发症和药物的使用而发生变化。目前还缺乏关于老年人膝关节伸肌机制损伤后恢复运动的公开数据。大多数老年运动员在膝关节伸肌肌腱损伤后都有可能恢复某种程度的运动,股四头肌和髌骨肌腱损伤后恢复运动的比例相似。
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引用次数: 0
Biologics Approaches—When, Why, and How? 生物制剂方法--何时、为何、如何?
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151082
Daniel J. Stokes , Nicholas A. Felan , Kade S. McQuivey , Beau M. McGinley , Rachel M. Frank

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.

目前正在研究矫形生物制剂,以治疗各种运动医学病症。本文以证据为基础,总结了目前可用的方案,包括粘液补充剂、富血小板血浆、骨髓抽吸物浓缩、脂肪间充质干细胞和羊膜间充质干细胞。在临床实践中使用正生物技术必须了解适应症、支持证据、风险和益处。在遵守监管准则的同时,还应保持安全、成本效益高和资源意识强的方法。本文为了解何时、为何以及如何使用矫形生物学奠定了基础。
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引用次数: 0
Editorial Board (pick up from previous issue) 编辑委员会(接上一期)
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1053/S1060-1872(24)00037-6
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引用次数: 0
Unicompartmental and Total Knee Arthroplasty: Why Mess with Success? 单间室和全膝关节置换术:为什么要破坏成功?
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151085
Simon L.E. Walgrave, David A. Parker

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.

本章探讨了老年运动员膝关节骨性关节炎(OA)终末期的治疗方法。在这一人群中,治疗重点从单纯缓解疼痛转向使其恢复特定的体育活动。全膝关节置换术(TKA)仍然是黄金标准,具有广泛的适应症和较高的总体成功率。单间室膝关节置换术(UKA)主要针对孤立的膝关节OA,恢复运动率较高。文献表明,这两种方案都偏向于低冲击活动。UKA和TKA都是治疗膝关节OA终末期的成功方案,即使在活跃的运动人群中也是如此。
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引用次数: 0
Operative Techniques in Sports Medicine Focusing on the Aging Athlete 以老年运动员为重点的运动医学手术技术
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151080
Janina Kaarre MD, MSc , Jonathan D. Hughes MD, PhD , Volker Musahl MD
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引用次数: 0
Multiligamentous Injuries in the Aging Athlete, to Reconstruct or Replace? 老年运动员的多韧带损伤,重建还是置换?
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-06-01 DOI: 10.1016/j.otsm.2024.151087
Zachary J. Herman, Ariana Lott, Bryson P. Lesniak

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.

多韧带膝关节损伤(MLKIs)是一种罕见、破坏性强的异质性损伤,其定义是膝关节 4 条主要韧带中至少有 2 条受到损伤,通常与膝关节脱位(KD)有关。膝关节脱位可能源于高速事故、运动中的膝关节旋转损伤,甚至是老年肥胖者的超低速度损伤。处理方法很复杂,应以重建膝关节的稳定性为中心。手术治疗被认为是标准的治疗方法,然而,对于手术治疗的类型和时机还存在大量的研究和争论,尤其是随着运动员年龄的增长。传统的选择包括韧带修复和重建;不过,使用翻修型受限假体组件的全膝关节置换术(TKA)也有可能发挥作用。本章概述了 KDs 和 MLKIs 的评估,并根据现有证据重点介绍了老龄运动员的管理策略、疗效和并发症。
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Operative Techniques in Sports Medicine
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