Pub Date : 2025-03-01DOI: 10.1016/j.otsm.2025.151158
Michael M. Chau , Nirav K. Pandya
Anterior cruciate ligament injury and subsequent reconstruction surgery are becoming more common among young athletes in the setting of early sports specialization, intensive involvement, and year-round training. Children and adolescents have a higher rate of graft failure compared to adults and this may be due to differences in graft choice, surgical technique, timing of surgery, neuromuscular development, psychological readiness, compliance with physical therapy, and/or longer duration of exposure to high-risk activities. The purpose of this article is to discuss potential complications and pitfalls of anterior cruciate ligament reconstruction as well as methods to decrease the risk of graft failure in young athletes.
{"title":"Complications and Pitfalls of ACL Reconstruction and Graft Failure in Young Athletes","authors":"Michael M. Chau , Nirav K. Pandya","doi":"10.1016/j.otsm.2025.151158","DOIUrl":"10.1016/j.otsm.2025.151158","url":null,"abstract":"<div><div>Anterior cruciate ligament injury and subsequent reconstruction surgery are becoming more common among young athletes in the setting of early sports specialization, intensive involvement, and year-round training. Children and adolescents have a higher rate of graft failure compared to adults and this may be due to differences in graft choice, surgical technique, timing of surgery, neuromuscular development, psychological readiness, compliance with physical therapy, and/or longer duration of exposure to high-risk activities. The purpose of this article is to discuss potential complications and pitfalls of anterior cruciate ligament reconstruction as well as methods to decrease the risk of graft failure in young athletes.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151158"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.otsm.2025.151163
Philip L. Wilson , Charles W. Wyatt , Benjamin Johnson , Henry B. Ellis
Osteochondritis dissections of the knee is a challenging condition to treat in both skeletally-immature and mature individuals. Guiding treatment principles are the improvement of both the biology and stability of the lesion. Advances in both imaging and arthroscopic assessment have aided surgeons in the treatment of these aspects of osteochondritis lesions. However, level of evidence for best treatment remains low overall. Both arthroscopic and open techniques may be utilized to treat these lesions. Subchondral drilling, injection of bone marrow aspirate concentrate, and debridement with retro-articular or open bone grafting have all been described as methods of biologic augmentation. Bioabsorbable and metallic implants traversing the progeny and parent aspects of the lesion, as well as surface compressive suture fixation may be appropriate techniques for augmenting lesion stability. These techniques are further described with recognition that further study regarding indications and outcomes remains ongoing.
{"title":"Advances in Surgical Treatment of Osteochondritis Dissecans of the Knee","authors":"Philip L. Wilson , Charles W. Wyatt , Benjamin Johnson , Henry B. Ellis","doi":"10.1016/j.otsm.2025.151163","DOIUrl":"10.1016/j.otsm.2025.151163","url":null,"abstract":"<div><div>Osteochondritis dissections of the knee is a challenging condition to treat in both skeletally-immature and mature individuals. Guiding treatment principles are the improvement of both the biology and stability of the lesion. Advances in both imaging and arthroscopic assessment have aided surgeons in the treatment of these aspects of osteochondritis lesions. However, level of evidence for best treatment remains low overall. Both arthroscopic and open techniques may be utilized to treat these lesions. Subchondral drilling, injection of bone marrow aspirate concentrate, and debridement with retro-articular or open bone grafting have all been described as methods of biologic augmentation. Bioabsorbable and metallic implants traversing the progeny and parent aspects of the lesion, as well as surface compressive suture fixation may be appropriate techniques for augmenting lesion stability. These techniques are further described with recognition that further study regarding indications and outcomes remains ongoing.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151163"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.otsm.2025.151157
Stephanie S. Pearce, Hannah Rossing, Samuel Noonan, Matthew Brewer, C. Giachino, Jay C. Albright
There has been an increase of anterior cruciate ligament (ACL) injuries in the pediatric population due to multiple factors. The potential complications of traditional ACL reconstructions have led to the development of physeal-sparing techniques. The goal with this technique is to preserve growth potential while provide long-term knee stability. This procedure involves a small, centrally-placed tibial transphyseal suture fixation with an all-epiphyseal graft tunnel on the tibial side along with an all-epiphyseal femoral tunnel. Over a 7-year period of this physeal-respecting technique being performed, no clinically significant growth disturbances, angular deformities, or major leg length discrepancies were reported. The most common finding has been mild overgrowth of the surgical side (<15 mm) but has led to no functional concerns. As pediatric ACL injuries continue to rise, improving surgical approaches to enhance both safety and function should remain a priority. However, further research is needed to review patient long-term outcomes.
{"title":"Tibial Physeal-Respecting, All Epiphyseal ACL Reconstruction Technique in Skeletally Immature Athletes","authors":"Stephanie S. Pearce, Hannah Rossing, Samuel Noonan, Matthew Brewer, C. Giachino, Jay C. Albright","doi":"10.1016/j.otsm.2025.151157","DOIUrl":"10.1016/j.otsm.2025.151157","url":null,"abstract":"<div><div>There has been an increase of anterior cruciate ligament (ACL) injuries in the pediatric population due to multiple factors. The potential complications of traditional ACL reconstructions have led to the development of physeal-sparing techniques. The goal with this technique is to preserve growth potential while provide long-term knee stability. This procedure involves a small, centrally-placed tibial transphyseal suture fixation with an all-epiphyseal graft tunnel on the tibial side along with an all-epiphyseal femoral tunnel. Over a 7-year period of this physeal-respecting technique being performed, no clinically significant growth disturbances, angular deformities, or major leg length discrepancies were reported. The most common finding has been mild overgrowth of the surgical side (<15 mm) but has led to no functional concerns. As pediatric ACL injuries continue to rise, improving surgical approaches to enhance both safety and function should remain a priority. However, further research is needed to review patient long-term outcomes.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151157"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.otsm.2025.151160
Kristen Combs, Elise Bixby, Breann Tisano, Yi-Meng Yen
{"title":"Suture Fixation of Tibial Eminence Fractures: Optimizing Postoperative Knee Range of Motion and Stability","authors":"Kristen Combs, Elise Bixby, Breann Tisano, Yi-Meng Yen","doi":"10.1016/j.otsm.2025.151160","DOIUrl":"10.1016/j.otsm.2025.151160","url":null,"abstract":"","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151160"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.otsm.2025.151161
Ian Hollyer , Benton E. Heyworth
Discoid meniscus is the most common congenital anomaly of the knee, representing an abnormal variant of the normal crescent-shaped meniscus. The lateral meniscus is almost exclusively involved, although case reports and small series of medial discoid meniscus have emerged. Discoid menisci have increased meniscal width and—in most instances—height, abnormal collagen arrangement, and decreased vascularity. A subset of cases exhibit abnormal meniscotibial or meniscocapsular attachments, leading to meniscal instability. Management of discoid meniscus has evolved, with modern treatment emphasizing recontouring and stabilization of the tissue to maintain or restore the long-term function of the meniscus. This review explores modern surgical techniques in managing discoid meniscus to help surgeons maximize patient outcomes.
{"title":"Discoid Meniscus: Advanced Techniques of Meniscal Stabilization and Reconstruction","authors":"Ian Hollyer , Benton E. Heyworth","doi":"10.1016/j.otsm.2025.151161","DOIUrl":"10.1016/j.otsm.2025.151161","url":null,"abstract":"<div><div>Discoid meniscus is the most common congenital anomaly of the knee, representing an abnormal variant of the normal crescent-shaped meniscus. The lateral meniscus is almost exclusively involved, although case reports and small series of medial discoid meniscus have emerged. Discoid menisci have increased meniscal width and—in most instances—height, abnormal collagen arrangement, and decreased vascularity. A subset of cases exhibit abnormal meniscotibial or meniscocapsular attachments, leading to meniscal instability. Management of discoid meniscus has evolved, with modern treatment emphasizing recontouring and stabilization of the tissue to maintain or restore the long-term function of the meniscus. This review explores modern surgical techniques in managing discoid meniscus to help surgeons maximize patient outcomes.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151161"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.otsm.2025.151159
Kevin M. Landrum , Neeraj M. Patel , Morgan E. Swanson , Theodore J. Ganley
Graft rupture following ACL reconstruction is 1 of the major concerns for both patients and providers. Young athletes are the group with the highest risk for reinjury due to the demand they place on the reconstructed ACL. As a result, much consideration has been directed toward reducing the risk of graft rupture. Lateral extraarticular tenodesis (LET) is an adjunct procedure performed along with ACL reconstruction in an attempt to reduce the risk of reinjury. During this procedure, an additional soft tissue structure is constructed on the lateral portion of the knee to reduce residual rotatory instability, which is considered a risk factor for ACL graft rupture. This procedure has been shown in both pediatric and adult cohorts to significantly reduce reinjury rates and has been incorporated into the practice of many pediatric orthopedic surgeons. However, variation exists in the indications for LET, and concerns regarding the addition of a nonanatomical structure to the knee remain, making some surgeons hesitant to adopt this procedure. Promising findings suggest that LET is a strong option to reduce the risk of ACL graft rupture with low risk for additional complications, but more research is necessary regarding this procedure, particularly in pediatric cohorts.
{"title":"Lateral Extra-Articular Tenodesis in the Young Athlete: Can We Reduce the Risk of Re-Injury?","authors":"Kevin M. Landrum , Neeraj M. Patel , Morgan E. Swanson , Theodore J. Ganley","doi":"10.1016/j.otsm.2025.151159","DOIUrl":"10.1016/j.otsm.2025.151159","url":null,"abstract":"<div><div>Graft rupture following ACL reconstruction is 1 of the major concerns for both patients and providers. Young athletes are the group with the highest risk for reinjury due to the demand they place on the reconstructed ACL. As a result, much consideration has been directed toward reducing the risk of graft rupture. Lateral extraarticular tenodesis (LET) is an adjunct procedure performed along with ACL reconstruction in an attempt to reduce the risk of reinjury. During this procedure, an additional soft tissue structure is constructed on the lateral portion of the knee to reduce residual rotatory instability, which is considered a risk factor for ACL graft rupture. This procedure has been shown in both pediatric and adult cohorts to significantly reduce reinjury rates and has been incorporated into the practice of many pediatric orthopedic surgeons. However, variation exists in the indications for LET, and concerns regarding the addition of a nonanatomical structure to the knee remain, making some surgeons hesitant to adopt this procedure. Promising findings suggest that LET is a strong option to reduce the risk of ACL graft rupture with low risk for additional complications, but more research is necessary regarding this procedure, particularly in pediatric cohorts.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151159"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1053/S1060-1872(25)00014-0
{"title":"Editorial Board (pick up from previous issue)","authors":"","doi":"10.1053/S1060-1872(25)00014-0","DOIUrl":"10.1053/S1060-1872(25)00014-0","url":null,"abstract":"","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151169"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.otsm.2025.151162
Patrick England, Bryce Maxwell, Neeraj Patel
Patellar instability is a common problem in the pediatric population. When surgery is indicated, skeletal immaturity poses unique challenges due to the risk of deformity or limb length discrepancy if the physis are injured. Therefore, the optimal combination of procedures in prepubescent patients with patellar instability remains unclear. Several stabilization procedures have been described for the treatment of patellar instability. The medial patellofemoral ligament (MPFL) or similar structures are commonly reconstructed, as they function as the primary restraint to lateral translation in early flexion and are commonly incompetent after lateral patellar dislocations. Traditional MPFL reconstruction can pose a risk to the distal femoral physis in skeletally immature patients because of the proximity of the insertion of the MPFL to the physis. Therefore, modified techniques are necessary. Distal realignment procedures have been used as accessory operations and, when necessary, must consider the presence of the proximal tibial physis. This article describes physeal-sparing MPFL reconstruction with quadriceps autograft and patellar tendon transfer for the management of patellofemoral instability in the skeletally immature patient.
{"title":"Physeal-Sparing Medial Patellofemoral Ligament Reconstruction With Quadriceps Turndown and Patellar Tendon Transfer","authors":"Patrick England, Bryce Maxwell, Neeraj Patel","doi":"10.1016/j.otsm.2025.151162","DOIUrl":"10.1016/j.otsm.2025.151162","url":null,"abstract":"<div><div>Patellar instability is a common problem in the pediatric population. When surgery is indicated, skeletal immaturity poses unique challenges due to the risk of deformity or limb length discrepancy if the physis are injured. Therefore, the optimal combination of procedures in prepubescent patients with patellar instability remains unclear. Several stabilization procedures have been described for the treatment of patellar instability. The medial patellofemoral ligament (MPFL) or similar structures are commonly reconstructed, as they function as the primary restraint to lateral translation in early flexion and are commonly incompetent after lateral patellar dislocations. Traditional MPFL reconstruction can pose a risk to the distal femoral physis in skeletally immature patients because of the proximity of the insertion of the MPFL to the physis. Therefore, modified techniques are necessary. Distal realignment procedures have been used as accessory operations and, when necessary, must consider the presence of the proximal tibial physis. This article describes physeal-sparing MPFL reconstruction with quadriceps autograft and patellar tendon transfer for the management of patellofemoral instability in the skeletally immature patient.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"33 1","pages":"Article 151162"},"PeriodicalIF":0.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143855392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01DOI: 10.1016/j.otsm.2024.151137
Christiaan Sonke , Ivan Wong
This chapter explores the use of distal tibia allograft (DTA) for addressing glenoid bone deficiencies in revision surgery for anterior glenohumeral instability. Traditional approaches have often overlooked glenoid bone loss, which can negatively impact functional outcomes of a shoulder instability repair. The DTA offers a promising solution, effectively reconstructing the glenoid vault while minimizing damage to surrounding tissues when performed arthroscopically. This approach not only simplifies the surgical technique but also enhances stability when combined with soft tissue procedures. By allowing for personalized graft sizing, the DTA presents an adaptable option for various patients facing revision surgeries for anterior instability, making it a leading consideration in modern orthopaedic practice for the management of shoulder instability repair.
{"title":"Treatment of Failed Anterior Instability Repair With DTA","authors":"Christiaan Sonke , Ivan Wong","doi":"10.1016/j.otsm.2024.151137","DOIUrl":"10.1016/j.otsm.2024.151137","url":null,"abstract":"<div><div>This chapter explores the use of distal tibia allograft (DTA) for addressing glenoid bone deficiencies in revision surgery for anterior glenohumeral instability. Traditional approaches have often overlooked glenoid bone loss, which can negatively impact functional outcomes of a shoulder instability repair. The DTA offers a promising solution, effectively reconstructing the glenoid vault while minimizing damage to surrounding tissues when performed arthroscopically. This approach not only simplifies the surgical technique but also enhances stability when combined with soft tissue procedures. By allowing for personalized graft sizing, the DTA presents an adaptable option for various patients facing revision surgeries for anterior instability, making it a leading consideration in modern orthopaedic practice for the management of shoulder instability repair.</div></div>","PeriodicalId":54678,"journal":{"name":"Operative Techniques in Sports Medicine","volume":"32 4","pages":"Article 151137"},"PeriodicalIF":0.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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