JAAOS

JAAOS, Volume 17, No. 7


Cartilage transplantation techniques for talar cartilage lesions.

Talar articular cartilage is known to differ significantly from knee cartilage. Even so, recommendations for the treatment of talar cartilage lesions have been based on strategies for the knee. Arthroscopic management of osteochondral lesions of the talus is well documented. Results have been favorable with reparative techniques such as débridement with curettage and débridement with drilling, whether undertaken via early open techniques or more recent arthroscopic procedures. Salvage of failed reparative techniques is controversial. Early efforts to salvage failed débridement focused on osteochondral allografts and autografts that used the knee as a donor site. Results of these restorative techniques have been favorable, but concerns have been raised regarding knee donor site morbidity, the use of malleolar osteotomy, and incomplete restoration of the talar articular surface. More recent restorative techniques developed for the knee have been adapted for the ankle, such as autologous chondrocyte implantation and matrix-induced autologous chondrocyte implantation.

    • Keywords:
    • Ankle Joint|Cartilage

    • Articular|Debridement|Humans|Orthopedic Procedures|Osteochondritis|Osteotomy|Talus

    • Subspecialty:
    • Foot and Ankle

    • Sports Medicine

Locking plates for extremity fractures.

Thirty-three peer-reviewed studies met the inclusion criteria for the Overview. Criteria were framed by three key questions regarding indications for the use of locking plates, their effectiveness in comparison with traditional nonlocking plates, and their cost-effectiveness. The studies were divided into seven applications: distal radius, proximal humerus, distal femur, periprosthetic femur, tibial plateau (AO/OTA type C), proximal tibia (AO/OTA type A or C), and distal tibia. Patient enrollment criteria were recorded to determine indications for use of locking plates, but the published studies do not consistently report the same enrollment criteria. Regarding effectiveness, there were no statistically significant differences between locking plates and nonlocking plates for patient-oriented outcomes, adverse events, or complications. The literature search did not identify any peer-reviewed studies that address the cost-effectiveness or cost-utility of locking plates.

    • Keywords:
    • Arm Bones|Bone Plates|Fractures

    • Bone|Humans|Leg Bones|Orthopedic Procedures|Outcome Assessment (Health Care)

    • Subspecialty:
    • Trauma

    • Foot and Ankle

    • Shoulder and Elbow

Management of hemorrhage in life-threatening pelvic fracture.

Emergent life-saving treatment is required for high-energy pelvic fracture with associated hemorrhage and hemodynamic instability. Advances in prehospital, interventional, surgical, and critical care have led to increased survival rates. Pelvic binders have largely replaced military antishock trousers. The availability and precision of interventional angiography have expanded considerably. External pelvic fixation can be rapidly applied, often reduces the pelvic volume, and provides temporary fracture stabilization. Pelvic packing, popularized in Europe, is now used in certain centers in North America. The use of standardized treatment algorithms may improve decision making and patient survival rates. Active involvement of an experienced orthopaedic surgeon in the evaluation and care of these critically injured patients is essential.

    • Keywords:
    • Algorithms|Fractures

    • Bone|Hemorrhage|Humans|Orthopedic Procedures|Pelvic Bones|Prognosis

    • Subspecialty:
    • Trauma

Neurologic injury in the surgical treatment of idiopathic scoliosis: guidelines for assessment and management.

Iatrogenic spinal cord injury resulting from surgical treatment of spinal deformity is a relatively uncommon but devastating complication. Publications on the prevalence of spinal cord injury following surgery are numerous, but no definitive review with clinically pertinent treatment guidelines exists. Methods to reduce the risk of neurologic complications with scoliosis surgery include adequate patient evaluation and preoperative planning, intraoperative preparation, intraoperative neuromonitoring, and postoperative management. Treatment algorithms may be useful in the clinical setting to manage intraoperative or postoperative neurologic injury.

    • Keywords:
    • Algorithms|Humans|Intraoperative Care|Orthopedic Procedures|Postoperative Care|Preoperative Care|Scoliosis|Spinal Cord Injuries

    • Subspecialty:
    • Spine

Shoulder arthroplasty: prosthetic options and indications.

Glenohumeral arthropathy and failed shoulder arthroplasty can lead to debilitating pain, reduced motion and strength, and limited function. Primary osteoarthritis, posttraumatic osteoarthritis, rheumatoid arthritis, cuff tear arthropathy, and osteonecrosis are common in this patient population. Shoulder arthroplasty may fail because of problems with the prosthesis, such as wear, loosening, and dislocation of the components, or because of bone and soft-tissue problems, such as glenoid arthrosis and rotator cuff tear. The disparate pathogenesis of these processes presents unique challenges to the treating surgeon and requires diagnosis-specific treatment options, whether involving hemiarthroplasty, total shoulder arthroplasty, or reverse total shoulder arthroplasty. Until recently, prosthesis options were limited to a stemmed humeral component with or without a polyethylene glenoid component. The array of prosthetic options currently available allows individualized treatment.

    • Keywords:
    • Algorithms|Arthritis|Arthroplasty

    • Replacement|Humans|Joint Prosthesis|Osteoarthritis|Osteonecrosis|Shoulder Joint

    • Subspecialty:
    • Shoulder and Elbow

Surgical treatment of posterior cruciate ligament tears: an evolving technique.

Major advances have been made recently in the areas of posterior cruciate ligament (PCL) anatomy and biomechanics, and several basic science studies have attempted to clarify the variables relevant to the optimal methods of PCL reconstruction. The emerging science concerning the PCL relates primarily to the biomechanical benefits of the inlay technique of tibial fixation compared with traditional tunnel fixation, use of one versus two reconstructive graft bundles, location of the femoral tunnels, and the ideal degree of graft tensioning. Despite these advances, the conclusions concerning these relevant issues are often in conflict, even with well-conceived experimental designs. Although basic knowledge regarding evolving reconstructive methods is improving, many questions remain unanswered. As a result, it is difficult to advocate one particular reconstructive technique. The optimal method of PCL reconstruction can be determined only with continued advances in basic science studies and the implementation of carefully conceived clinical trials isolating one reconstructive variable.

    • Keywords:
    • Achilles Tendon|Biomechanics|Humans|Knee Joint|Orthopedic Procedures|Posterior Cruciate Ligament|Tibia|Treatment Outcome

    • Subspecialty:
    • Sports Medicine

    • Basic Science

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