Operative Techniques in Sports Medicine最新文献

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Editorial Board (pick up from previous issue) 编辑委员会（接上一期）

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-03-01 DOI: 10.1053/S1060-1872(24)00015-7

引用次数: 0

Acetabular Impingement Management Including Focal and Global Retroversion and the Subspine 髋臼撞击管理，包括病灶和整体后翻以及脊柱下部

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-03-01 DOI: 10.1016/j.otsm.2024.151063

Stephanie A. Boden, Salvador G. Ayala, Jose R. Garcia, Rodrigo Saad Berreta, Felicitas Allende, Jorge Chahla

Symptomatic acetabular impingement represents a distinct subgroup of patients with femoroacetabular impingement syndrome (FAIS). Acetabular-based impingement, or pincer-type FAIS, is characterized by anterior acetabular over-coverage. Pincer subtypes include focal anterior over-coverage, global anterior over-coverage, relative anterior over-coverage (acetabular retroversion), and anterior inferior iliac spine (AIIS) or subspine impingement. These morphological variants can cause abnormal contact between the acetabulum and the femoral head-neck junction during functional hip motion, leading to a variety of labral and chondral injuries. Diagnosis of pincer-type FAIS requires a thorough history and physical exam as well dedicated imaging, and these aspects should all corroborate the symptoms and diagnosis. When symptoms are refractory to conservative management, surgery should be considered with the approach tailored to the individual patient's specific morphology and pathology. Both open and arthroscopic techniques have been shown to be safe and effective in patients with pincer-type FAIS when patients are appropriately indicated and with careful preoperative planning and surgical execution.

有症状的髋臼撞击是股骨髋臼撞击综合征（FAIS）患者中的一个独特亚群。髋臼型撞击或钳型 FAIS 的特点是髋臼前部过度覆盖。钳型亚型包括局灶性前方过度覆盖、整体性前方过度覆盖、相对性前方过度覆盖（髋臼后翻）以及髂下棘前方（AIIS）或脊柱下撞击。这些形态变异可导致髋关节功能性运动时髋臼与股骨头颈交界处的异常接触，从而引发各种髋臼唇和软骨损伤。钳夹型FAIS的诊断需要全面的病史和体格检查以及专门的影像学检查，这些方面都应与症状和诊断相互印证。当保守治疗无效时，应根据患者的具体形态和病理情况考虑手术治疗。事实证明，如果患者有适当的适应症，并经过仔细的术前规划和手术实施，开放式和关节镜技术对钳型FAIS患者都是安全有效的。

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引用次数: 0

Cam-Type Impingement: Ensuring an Ideal Femoroplasty 凸轮型撞击：确保理想的股骨成形术

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-03-01 DOI: 10.1016/j.otsm.2024.151064

Hansel E. Ihn, Ameen Z. Khalil, Elaine Z. Shing, Travis G. Maak, Stephen K. Aoki

When conservative measures have failed, arthroscopic femoroplasty has proven highly efficacious in treating femoroacetabular impingement (FAI) and improving hip joint mechanics. It is best to approach this in a systematic manner with preoperative planning and intraoperative confirmation. Plain radiographs, MRI and/or CT are helpful in the preoperative assessment in identifying the location and shape of the cam deformity. Understanding the extent of the cam lesion prior to surgical intervention will aid in the resection process. The resection can then be confirmed by an intra-operative fluoroscopic exam and arthroscopic dynamic motion evaluation under direct visualization. Using the trough technique, the resection can be marked using the cortical-cancellous border as a depth landmark. When performing the resection, a smooth contour should be performed, with an understanding that both over and under-resection can be problematic. Adequate resection should be ensured by testing range of motion, with fluoroscopic imaging, to obtain a circumferential view of the resected area. It is essential to understand how to position the lower extremity to obtain different fluoroscopic views of the femoral head-neck junction clock-face. Once complete, a thorough irrigation of the joint should be performed to remove bony debris. An ensuing capsular closure should be performed to minimize the risk of iatrogenic hip instability.

事实证明，当保守治疗无效时，关节镜股骨成形术在治疗股骨髋臼撞击症（FAI）和改善髋关节力学方面具有很高的疗效。最好以系统的方式进行术前规划和术中确认。普通X光片、核磁共振成像和/或CT有助于术前评估，确定凸轮畸形的位置和形状。在手术前了解凸轮病变的范围将有助于切除过程。然后可以通过术中透视检查和关节镜直视下动态运动评估来确认切除情况。利用波谷技术，可以将皮质-钙质边界作为深度标记来标记切除。在进行切除时，应确保轮廓平滑，因为切除过度和切除不足都会造成问题。应通过透视成像测试活动范围，以获得切除区域的周缘视图，从而确保切除充分。必须了解如何摆放下肢，以获得股骨头颈交界钟面的不同透视图。手术完成后，应对关节进行彻底冲洗，以清除骨质碎屑。随后应进行关节囊闭合，以最大限度地降低先天性髋关节不稳的风险。

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引用次数: 0

Athletic Pubalgia: A Diagnostic and Management Algorithm 运动性阴部疼痛：诊断和处理算法

IF 0.3 4区医学 Q4 SPORT SCIENCES

Operative Techniques in Sports Medicine

Pub Date : 2024-03-01 DOI: 10.1016/j.otsm.2024.151065

Nicholas Walla, Guy Ball, Brian Busconi

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

Operative Techniques in Sports Medicine

Pub Date : 2023-12-01 DOI: 10.1053/S1060-1872(23)00080-1

引用次数: 0

Tibial Tubercle Osteotomy: Anterior, Medial and Distal Corrections 胫骨结节截骨术:前、中、远端矫正

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.2023.151032

Christopher A. Schneble , Bradford S. Tucker , John P. Fulkerson

Tibial tubercle osteotomies (TTOs) are a versatile procedure that can be used to treat several conditions due to its ability to manipulate both extensor mechanism tracking and patellofemoral joint contact forces. This permits a wide array cut geometries that can be titrated to the individualized needs of each patient. Most common is the anteromedializing (AMZ) TTO, which has been a workhorse procedure for realigning extensor mechanism tracking. The patella can also be distalized, which becomes indicated when pathological patella alta is present. When treating patellar instability, a successful outcome depends on the clinician's understanding of the destabilizing factors. These risk factors are often additive, and if significant enough they can collectively breach a given stability threshold. Three-dimensional models provide a useful perspective of the joint morphology, curvature, and congruency which can be particularly helpful for developing an optimal plan for restoring balanced tracking. To decide when to perform a TTO, the decision centers on how well a TTO provides a solution to a tracking or articular loading problem, compared with the added morbidity that accompanies an osteotomy. Details regarding tubercle anteriorization, medialization and distalization are discussed, along with technical considerations and surgical technique.

胫骨结节截骨术(TTOs)是一种多用途手术，可用于治疗多种疾病，因为它能够操纵伸肌机制跟踪和髌股关节接触力。这允许广泛的阵列切割几何形状，可以滴定到每个病人的个性化需求。最常见的是前介质化(AMZ) TTO，它已经成为重新调整伸肌机制跟踪的主力程序。髌骨也可以远端化，当病理髌骨上翘存在时，这就表明了这一点。当治疗髌骨不稳定时，成功的结果取决于临床医生对不稳定因素的理解。这些风险因素通常是累加的，如果足够重要，它们可以共同突破给定的稳定性阈值。三维模型提供了关节形态、曲率和一致性的有用视角，这对于制定恢复平衡跟踪的最佳计划特别有帮助。在决定何时实施TTO时，决策的中心是与截骨术带来的额外发病率相比，TTO如何很好地解决了跟踪或关节负荷问题。详细讨论了结核的前置，中间化和远端化，以及技术考虑和手术技术。

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引用次数: 0

Patellofemoral Imaging and Analysis 髌骨成像与分析

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.2023.151030

Galvin J. Loughran , Nicholas G. Rhodes , Monica Sri Vel , Seth L. Sherman

Imaging of the patellofemoral joint (PFJ) is essential for evaluating patellofemoral pathology and injury. In addition to a detailed history and physical examination, PFJ imaging should be used to better understand the relationship between osseous and soft tissue structures, further confirm a diagnosis, and to create an individualized treatment plan for each patient. This article reviews the relevant radiographic and advanced imaging studies utilized in the work-up and treatment of patients with patellofemoral disorders.

髌股关节(PFJ)的成像是评估髌股病理和损伤的必要条件。除了详细的病史和体格检查外，PFJ成像还应用于更好地了解骨组织和软组织结构之间的关系，进一步确认诊断，并为每位患者制定个性化的治疗计划。本章回顾了髌骨疾病患者的检查和治疗中使用的相关放射学和高级影像学研究。

引用次数: 0

Trochleoplasty: Groove-Deepening, Recession Wedge, and Entrance Grooveplasty 滑车成形术:凹槽加深，凹楔和入口凹槽成形术

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.2023.151037

Andrew Phillips , Erik Haneberg , William Harkin , Richard Danilkowicz , Mario Hevesi , Adam Yanke

Patellar instability in patients with a dysplastic trochlea can be challenging to treat without addressing the trochlea directly. Trochleoplasty allows the surgeon to target a root osseous cause of instability and is an effective treatment option in well-selected patients. This chapter explores the variations in trochleoplasty techniques and offers an overview of recently published data associated with this surgery.

滑车发育不良患者的髌骨不稳定在不直接处理滑车的情况下是具有挑战性的。滑车成形术使外科医生能够针对根骨不稳定的原因，并且在精心挑选的患者中是一种有效的治疗选择。本章探讨了滑车成形术技术的变化，并概述了最近发表的与该手术相关的数据。

引用次数: 0

Osseous Medial Patellofemoral Ligament Reconstruction 骨内侧髌股韧带重建

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.2023.151035

William E. Harkin , Erik Haneberg , Andrew Phillips , Beth E. Shubin Stein , Adam B. Yanke

Medial patellofemoral ligament (MPFL) reconstruction is the most commonly performed surgery for treatment of lateral patellar instability. It may be used in isolation or in conjunction with a variety of different procedures depending on the individual patient's specific risk factors for instability. Indicating the correct patient involves a thorough history, physical examination, and proper imaging. Careful surgical technique and a detailed understanding of both topographic and radiographic anatomy is critical to successful reconstruction. MPFL reconstruction has been shown to be a safe and effective technique for treatment for lateral patellar instability.

髌股内侧韧带(MPFL)重建是治疗外侧髌骨不稳最常用的手术。它可以单独使用，也可以与多种不同的程序结合使用，这取决于个体患者的特定不稳定风险因素。确定正确的病人包括全面的病史、体格检查和适当的影像学检查。仔细的手术技术和详细的了解地形和放射解剖学是成功重建的关键。MPFL重建已被证明是一种安全有效的治疗外侧髌骨不稳的技术。

引用次数: 0

Pediatric Medial Patellofemoral Ligament Reconstruction and Concomitant Procedures 小儿内侧髌股韧带重建及相关手术

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.2023.151034

Danielle E. Chipman , Rajul Gupta , Daniel W. Green , Shital N. Parikh

The article describes safe surgical techniques to address patellar instability in children and adolescents. Open physis presents unique technical challenges during surgical treatment in skeletally immature patients. Besides MPFL reconstruction, the article presents physeal-respecting alternatives such as MQTFL reconstruction and adductor sling technique. Concomitant procedures like guided growth and distal procedures like Roux Goldwaith procedure are also described to provide an overview of commonly used techniques in skeletally immature patients with patellar instability.

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