Operative Techniques in Sports Medicine最新文献

Osteochondritis dissecans (OCD) is a pathologic condition that affects the subchondral bone and overlying articular cartilage with variable degrees of instability and detachment. The specific etiology is frequently unknown; however, it is thought to result from multifactorial contributions including acute trauma, recurrent microtrauma, inflammation, or inherited diseases involving vascular perfusion and ossification anomalies. Treatment is largely dictated by patient symptoms and their association with lesion stability, location, skeletal maturity, activity goals, and surgeon preference. Stable lesions can frequently be treated nonoperatively, but unstable lesions typically require surgical intervention that addresses lesion instability where possible. Arthroscopy is used to initially visualize and evaluate the lesion, followed by reduction and internal fixation. If the fragment is salvageable with a bony base, internal fixation with metal compression screws is a reliable strategy for enhancing patient outcomes with low rates of reoperation and failure. This review will focus on the surgical indications, techniques, and outcomes of internal fixation with metal compression screws in unstable OCD lesions of the knee.

Osteochondritis Dissecans (OCD) poses a complex treatment challenge, particularly in cases of unstable lesions or in patients who have failed conservative management. Osteochondral allograft transplantation (OCA) offers an effective solution for treating patients with large, multifocal, or complex OCD defects. This review provides an in-depth analysis of the current concepts, indications, and operative techniques for OCA in the treatment of OCD of the knee. OCA addresses both cartilage and underlying osseous injury, offering numerous advantages over other restorative techniques, including replication of native anatomy and lower graft failure rates. Postoperative outcomes for OCA reveal long-term graft durability, reduced pain, and improved functionality. Advancements in graft preparation, such as pulsed lavage, pressurized carbon dioxide, and orthobiologics, have further improved allograft viability and operative success. This review serves as an overview of the application of OCA as a versatile and effective treatment for OCD of the knee, highlighting recent advancements, graft durability, and satisfactory postoperative patient-reported outcomes.

Osteochondritis dissecans (OCD) lesions in the skeletally immature patient are rare but have the potential to become debilitating if left untreated. For skeletally immature patients with stable OCD lesions who have failed nonoperative measures, drilling is often considered the gold standard for surgical treatment. The 3 main techniques of drilling include (1) trans-articular, (2) retro-articular, and (3) notch drilling, each of which have pertinent advantages and disadvantages which must be carefully considered based on the location and characteristics of the lesion, as well as surgeon experience and technical expertise. Outcomes of all 3 techniques show excellent results in patient reported outcome measures as well as very low complication and revision rates. To date, there are no high-level studies to date which have compared outcomes of each technique in prospective fashion.

Osteochondritis dissecans most commonly affects the knee, elbow, and ankle. Due to its similarity and previous confusion with other conditions such as osteochondral fractures and osteonecrosis, and the inability to investigate the development of lesions prior to clinical presentation, the exact pathogenesis remains an enigma. The true incidence and prevalence are unknown because of the varying degree of symptomatology and the plethora of diagnostic and treatment algorithms. In this article, we provide an overview of the existing diagnostic criteria, lesion classification systems, and treatment algorithms.

Osteochondritis dissecans of the knee is a relatively common pathology presenting to sports knee surgeons with a variety of treatment options, such as drilling or drilling and internal fixation (if there is a viable fragment), or articular surface restoration techniques in the case of unsalvageable tissue. Articular surface restoration techniques include osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). OAT is typically reserved for unsalvageable grade 3 and 4 articular cartilage lesions or revision cases. OAT involves the use of 1 or multiple osteochondral plug(s) harvested from the knee in a less-weightbearing regions such as the peripheral trochlea. Recent meta-analyses have demonstrated favorable outcomes after OAT procedures, with a large number of patients returning to sport and showing substantial improvements in functional outcomes. In addition, recent studies have compared the outcomes of OAT to other techniques in prospective randomized trials, demonstrating the favorability of this technique in the correct clinical scenario. This chapter focuses on the indications, surgical technique, and clinical outcomes of OAT in young patients with knee osteochondritis dissecans.

Treatment principles of osteochondritis dissecans management are predicated upon improving the biology and stability of the subchondral bone and unossified epiphyseal cartilage to preserve the integrity of the scaffold providing support to the articular cartilage. Desirable characteristics of fixation options for these lesions include readily available implants, reasonable cost, a favorable outcome, low complication rate, ease of application, ability for use concurrent with treatment of associated pathology, and considerations for future implant removal. This manuscript provides a technical description of osteochondritis dissecans fixation using a suture bridge technique.

Osteochondritis dissecans (OCD) lesions of the knee are a common injury and may occur in up to 15% of acute or recurrent patellar dislocations. While small, stable lesions may be treated nonoperatively or with excision, large or unstable lesions generally require surgical treatment to optimize clinical outcomes. Surgical treatment often involves arthroscopy to visualize the lesion, followed by open reduction and internal fixation of the OCD lesion after debridement and preparation of the fracture bed. Various types of implants can be used for fixation of OCD lesions. Historically, metal implants were widely used due to their compression force, but the advent of bioabsorbable implants has provided additional options with promising results. Currently available bioabsorbable implants vary in size, composition, and shape, which leads to differences in their usage, benefits, and complications. Several small clinical series have reported success with the use of a wide array of bioabsorbable implants. This article will summarize bioabsorbable implant options and characteristics, surgical indications and techniques for OCD fixation, and the recent literature on clinical outcomes and complications after OCD fixation with different implants.

Despite advancements in arthroscopic and surgical techniques, successful management of large to massive rotator cuff tears remains challenging. Risk factors including advanced age, significant retraction, reduced bone mineral density, and high physical demand have previously been shown to be negative prognostic indicators of good outcomes in rotator cuff repair. In order to increase healing rates, mechanical strength, and favorable biologic conditions, multiple patch augmentation and interposition techniques using tissue scaffolds have been developed. Numerous patch grafts are commercially available, including tissue scaffolds from autogenic, allogenic, synthetic, and xenogenic sources, although the quantity of literature varies widely between grafts. This review aims to present current indications, outcomes of patch interposition and augmentation, and surgical techniques for both primary and revision rotator cuff tears.

Rotator cuff disease is one of the more common causes of shoulder pain, but there still is some dilemma with management of large or massive tears. When all other options short of a joint replacement have been explored, the reverse shoulder arthroplasty serves as a reliable and predictable treatment option. The surgeon must incorporate a detailed history, physical examination, and imaging workup when deciding how best to manage these patients with rotator cuff deficiency. Knowledge of implant specifics and options regarding the glenoid and humeral side is crucial to a successful operation. Newer implant technology and surgical techniques have additionally provided options to avoid some of the complications seen with the earliest reverse shoulder implants. When reverse shoulder arthroplasty is performed for the properly indicated patient, it can be done with predictable success and low complication rates. In this manuscript, we will provide some tips to assist in how to best manage rotator cuff deficient patients with reverse shoulder arthroplasty.