Operative Techniques in Sports Medicine最新文献

This chapter will discuss relevant topics regarding management of meniscus pathology, with focus on the aging athlete. It is now commonly accepted that meniscal repair should be performed whenever possible to preserve the meniscus, which is crucial in load transmission, chondroprotection, and function as a secondary stabilizer. Despite knowing the benefits of meniscal repair, resection is still often performed. The chapter will discuss how age and involvement in sports are important variables to consider when treating the aging athlete. A broad overview of meniscus repair, centralization, and resection will be provided with emphasis on the aging athlete, outlining benefits and limitations of each technique.

As female athletes age, their risk of musculoskeletal injuries increases. These injuries can have a negative impact on their health and athletic abilities. This article explores the most common conditions that aging female athletes may face, such as osteoarthritis, meniscal injuries, joint instability, rotator cuff injuries, and stress fractures. Hormonal and physiological changes, anatomical differences, and changes in bone mineral density can cause these injuries. To prevent such injuries, it is crucial to incorporate comprehensive injury prevention programs that include strength training, flexibility exercises, balance training, and appropriate warm-up and cool-down routines. These programs should be tailored to the individual's fitness level and musculoskeletal issues. Additionally, the article offers valuable insights into various techniques for managing and treating these injuries, such as non-surgical interventions, surgical options, and rehabilitation programs. Healthcare professionals, coaches, and athletes themselves must recognize and address these issues to improve performance, prevent injuries, and support the overall health and well-being of aging female athletes. In conclusion, maintaining physical fitness and engaging in structured exercise programs are crucial for aging female athletes to slow the decline in musculoskeletal strength and integrity. Proper first aid measures, appropriate medications, and a comprehensive exercise regimen can aid in recovery and regain strength, function, and mobility, enabling a return to competitive sports or other athletic pursuits.

Athletes are at higher risk of knee injuries than the general population especially those in pivoting sports. Meniscal injuries account for a substantial amount of these knee injuries. Although meniscal repair is the gold standard treatment for symptomatic tears in young patients some individuals are still treated by meniscectomy. Meniscal allograft transplantation (MAT) can be considered as a salvage procedure in patients with ‘post meniscectomy syndrome’. Appropriate patient selection is critical to ensure successful outcomes following MAT. A meniscal deficient knee in an aging athlete wishing to continue with their preinjury level of sport is commonly encountered by clinicians. We promote utilizing an individualized approach to each patient, rather than treating a patient based on their chronological age assessment of the condition of chondral surfaces of their knee, lower limb alignment and stability are more important.

Anterior cruciate ligament reconstruction (ACLR) is a well-established procedure utilized in the setting of ACL injuries in patients under age 40. The management of ACL injuries in older populations is controversial as best practices are not clear with regard to candidacy for surgery, graft choice, fixation, and rehabilitation. In this review, we examined the body of literature surrounding controversies in management of ACL tears in older patients. Specific foci include nonoperative management, clinical course of osteoarthritis with ACLR, graft choice, graft fixation, complications, and alternative surgical options. The aging athlete with ACL-deficiency may benefit from non-operative management with rehabilitation if they are low demand, have minimal instability, and do not have moderate to severe or multi-compartmental osteoarthritis. Prehabilitation may also be beneficial to patients in the to determine if they can recover from injury to achieve an acceptable state of function before deciding upon surgery. ACLR is a viable option in older patient populations with minimal osteoarthritis and instability who have failed conservative management. Patients undergoing ACLR are likely to develop worsening radiographic OA. Despite this radiographic OA, majority of patients have improvements in PROMs and return to function. Given the risks of TKA after ACLR, shared clinical decision making should be prioritized with each patient regarding pursuit of ACLR versus conservative management.

The proximal hamstring origin and gluteal insertion are 2 common sources of hip pain in elite athletes. Acute proximal hamstring tendon injuries may occur secondary to rapid simultaneous hip flexion and knee extension. Chronic proximal hamstring tendinopathy and partial tearing typically is observed in endurance athletes and most commonly seen in runners. A frequent mechanism responsible for this is ischiofemoral impingement from the lesser trochanter with repetitive damage to the proximal hamstring origin. A weak abductor moment and narrowing of the ischiofemoral space results in the attritional injury, beginning anteriorly at the junction of the quadratus femoris and semimembranosus. Gluteal tendon pathology is a common inciting event for proximal hamstring pain. The cornerstone of nonsurgical treatment for proximal hamstring is education-driven supervised and skilled physical therapy. Endoscopic repair may be performed for partial-thickness and full-thickness tears without significant retraction. Open repair may be performed for both partial- and full-thickness tears with or without retraction. Symptomatic gluteal tendon pathology most frequently occurs in older individuals. Lateral peritrochanteric hip pain with walking is a common chief complaint. Nocturnal symptoms are also often reported. The mainstay of nonsurgical treatment is education-driven supervised physical therapy. Surgical treatment, similar to that of the proximal hamstring, can be safely and effectively performed with either endoscopic or open approaches. Endoscopic repair may be performed for partial- and small full-thickness tears without significant retraction. Open repair may be performed for all tear types and patterns.

The hip joint is a ball and socket joint supported by static and dynamic stabilizers. The hip capsule and its constituent ligaments provide support during weight-bearing activities. Hip arthroscopy requires capsulotomy for visualization and instrumentation and a thorough understanding of the anatomy and biomechanics of the hip capsule allows surgeons to select the appropriate capsulotomy technique for each procedure. This chapter describes capsular access techniques including periportal, interportal, and T-capsulotomy, as well as puncture and extracapsular access techniques. Capsular closure techniques are reviewed and outcomes after varying capsular management techniques are summarized.

Hip pathology is a common source of pain and dysfunction in athletes. Taking a layered approach to the history and physical examination of the athlete's hip is imperative to deciphering the vast differential diagnoses for an athlete's hip pain. Systematic evaluation of the (1) osteochondral, (2) capsulolabral, (3) musculotendinous, (4) neurovascular, and (5) kinematic chain layers of the hip allow for the comprehensive consideration of hip pain etiologies, including femoroacetabular impingement syndrome, labral tears, osteoarthritis, Coxa Saltans, hamstring and gluteal tendinopathy, and sacroiliac joint dysfunction, among numerous other conditions. A thorough history, including the location, acuity, quality, radiation, and sport-specific limitations of the hip pain, followed by a methodologic physical examination, with ordered inspection, gait, palpation, range of motion, strength testing, and provocative maneuvers, allows clinicians to arrive at an early and accurate diagnosis of hip pain. Only after a thorough history and physical examination can more specific diagnostic and therapeutic modalities be applied.

Focal chondral and chondrolabral injuries of the hip have become more commonly recognized lesions of hip joint pathology in the last decade. These injuries are associated with worse clinical outcomes, risk of global degenerative disease, and future conversion to hip arthroplasty. Recent technological advances have expanded the indications and improved outcomes associated with joint preserving hip procedures to address chondral and chondrolabral defects. Options for surgical management include both open and arthroscopic procedures focusing on 3 general treatment goals: chondral flap stabilization, cartilage regeneration, and cartilage restoration. We provide a comprehensive review of these procedures, discuss their outcomes, and provide future directions for research and development.