JAAOS

JAAOS, Volume 9, No. 1


Cartilage substitutes: overview of basic science and treatment options.

Articular cartilage defects that are symptomatic and refractory to nonoperative treatment represent a clinical management challenge. Although there have been important advances in stimulating intrinsic repair mechanisms, cartilage regeneration, and other substitution techniques, to date none has unlocked the understanding necessary to duplicate normal articular cartilage. The objectives of treatment of cartilage lesions are to obtain pain relief, reduce effusions and inflammation, restore function, reduce disability, and postpone or alleviate the need for prosthetic replacement. As the field of articular cartilage repair continues to evolve rapidly, the most appropriate treatment option for an individual patient should be based on the pathologic characteristics of the lesion and the patient's symptoms and expectations. The orthopaedic surgeon needs to be familiar with both the existing and the newly emerging cartilage treatment techniques in order to best educate patients and meet their expectations for long-term benefits.

    • Keywords:
    • Animals|Anti-Inflammatory Agents

    • Non-Steroidal|Bone Morphogenetic Proteins|Cartilage

    • Articular|Chondrocytes|Humans|Osteoarthritis|Polymers|Transplantation

    • Homologous|Wound Healing

    • Subspecialty:
    • Sports Medicine

    • Basic Science

Displaced acetabular fractures: indications for operative and nonoperative management.

Displaced acetabular fractures are a challenging problem. In contradistinction to most conditions in which surgery is based on specific operative indications, displaced acetabular fractures should be considered an operative problem unless specific criteria for nonoperative management are met. These include a congruent hip joint on the anteroposterior and oblique (Judet) radiographs, an intact weight-bearing surface (as defined by roof arc and subchondral arc measurements on computed tomographic scans), and a stable joint. The final decision about the treatment method must also consider the patients functional demands, expectations, and physical condition and the physicians experience and institutional support for dealing with this type of injury. Displaced both-column fractures with secondary congruence may have better results than other displaced fractures. In older patients, nonoperative management may be effectively utilized. Understanding the current criteria for effective use of nonoperative treatment will help the surgeon make these difficult decisions.

    • Keywords:
    • Acetabulum|Algorithms|Fractures

    • Bone|Humans|Ossification

    • Heterotopic|Postoperative Complications|Prognosis|Risk Factors|Tomography

    • X-Ray Computed|Treatment Outcome

    • Subspecialty:
    • Trauma

Magnetic resonance imaging of articular cartilage of the knee.

Recently developed magnetic resonance (MR) imaging techniques allow accurate detection of moderate- and high-grade articular cartilage defects. There has been increased interest in MR imaging of articular cartilage in part because it is useful in identifying patients who may benefit from new articular cartilage replacement therapies, including chondrocyte transplantation, improved techniques for osteochondral transplantation, chondroprotective agents, and cartilage growth stimulation factors. The modality also has the potential to play an important role in the follow-up of patients during and after treatment. Detection of articular cartilage defects is beneficial for patients undergoing arthroscopy for other injuries, such as meniscal tears, because the presence of articular cartilage injury worsens prognosis and may modify therapy options.

    • Keywords:
    • Cartilage

    • Articular|Chondrocytes|Humans|Knee Joint|Magnetic Resonance Imaging|Osteoarthritis

    • Subspecialty:
    • Sports Medicine

Strength training for children and adolescents.

Strength, or resistance, training for young athletes has become one of the most popular and rapidly evolving modes of enhancing athletic performance. Early studies questioned both the safety and the effectiveness of strength training for young athletes, but current evidence indicates that both children and adolescents can increase muscular strength as a consequence of strength training. This increase in strength is largely related to the intensity and volume of loading and appears to be the result of increased neuromuscular activation and coordination, rather than muscle hypertrophy. Training-induced strength gains are largely reversible when the training is discontinued. There is no current evidence to support the misconceptions that children need androgens for strength gain or lose flexibility with training. Given proper supervision and appropriate program design, young athletes participating in resistance training can increase muscular strength and do not appear to be at any greater risk of injury than young athletes who have not undergone such training.

    • Keywords:
    • Adolescent|Anabolic Agents|Child|Humans|Muscle

    • Skeletal|Weight Lifting

    • Subspecialty:
    • Sports Medicine

    • Pediatric Orthopaedics

The musculoskeletal effects of smoking.

Currently, there are more than 50 million smokers in this country, and approximately 800 billion cigarettes are smoked each year. Smoking is now the leading avoidable cause of morbidity and mortality in the United States. According to one report, over 500,000 deaths per year in the United States alone can be attributed to smoking. For years, orthopaedic surgeons have known about the relationships that putatively exist between smoking and an array of orthopaedic conditions and complications. It has been shown to adversely affect bone mineral density, lumbar disk disease, the rate of hip fractures, and the dynamics of bone and wound healing. Although scientific and clinical information on smoking and its consequences suggests differing degrees of correlation between smoking and orthopaedic conditions, most available data do suggest a real and reproducible relationship. In the past, there have been many individual reports that deal with these relationships separately but very few published comprehensive reviews. This summary of the current literature regarding the relationship between smoking and musculoskeletal diseases and their treatment provides information that can be used clinically by both the practitioner and the patient.

    • Keywords:
    • Causality|Fracture Healing|Humans|Intervertebral Disk Displacement|Low Back Pain|Musculoskeletal Diseases|Osteoporosis|Regional Blood Flow|Smoking|Wound Healing

    • Subspecialty:
    • General Orthopaedics

Use of ergogenic aids by athletes.

"Ergogenic aid" is defined as any means of enhancing energy utilization, including energy production, control, and efficiency. Athletes frequently use ergogenic aids to improve their performance and increase their chances of winning in competition. It is estimated that between 1 and 3 million male and female athletes in the United States alone have used anabolic steroids. In response to the problem of drug use, many athletic organizations have established policies prohibiting the use of certain pharmacologic, physiologic, and nutritional aids by athletes and have implemented drug testing programs to monitor compliance. Therefore, it is important for physicians to be knowledgeable about the available ergogenic aids so they can appropriately treat and counsel the athletic patient.

    • Keywords:
    • Anabolic Agents|Creatine|Dietary Supplements|Female|Growth Hormone|Humans|Male|Sports|Vitamins

    • Subspecialty:
    • Sports Medicine

Wrist arthrodesis: review of current technique.

Wrist arthrodesis is a well-established procedure that predictably relieves pain and provides a stable wrist for power grip. Although a variety of techniques for achieving a solid fusion have been described, the combination of rigid stabilization with a dorsal plate and autogenous cancellous bone grafting results in a high fusion rate and obviates the need for prolonged postoperative cast immobilization. Successful results with dorsal plating with or without local bone graft have recently been reported for patients with posttraumatic conditions. Rod or pin fixation is an established procedure for patients with inflammatory arthritis or a connective tissue disorder; however, plate fixation for these conditions is becoming a more acceptable alternative. Complications are relatively common and range from minor transient problems to major problems, such as wound dehiscence, infection, extensor tendon adhesions, and plate tenderness, which may require implant removal. Preoperatively, patients should be assessed for the presence of carpal tunnel syndrome, distal radioulnar joint arthritis, or ulnocarpal impaction syndrome, which may become or remain symptomatic after arthrodesis. Wrist arthrodesis results in a high degree of patient satisfaction with respect to pain relief and correction of deformity. Patients are able to accomplish most daily tasks and activities by learning to adapt to, and compensate for, the loss of wrist motion.

    • Keywords:
    • Arthrodesis|Bone Plates|Bone Screws|Bone Transplantation|Humans|Treatment Outcome|Wrist Joint

    • Subspecialty:
    • Trauma

    • Hand and Wrist

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