Preparing for and Executing the Ideal Posterior
Labral Repair
Instr Course Lect. 2024;73:547-557.ABSTRACTPosterior labral tears are a source of pain and instability of the shoulder. Despite being relatively uncommon (reported in approximately 10% of instability cases), the incidence of posterior labral tear is increasingly recognized as underestimated in highly active populations. Posterior labral tears can result from a traumatic posterior dislocation or repetitive microtrauma, leading to posterior chondral/labral attrition. Patients often present with vague, deep-seated shoulder discomfort rather than the sensation of instability. Unfavorable results with nonsurgical management wil...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Daniel J Stokes Jeffrey D Hassebrock Lisa A Malyak Rachel M Frank Source Type: research
Humeral Head Reconstruction of Reverse
Hill-Sachs Lesions
Instr Course Lect. 2024;73:559-571.ABSTRACTCompared with anterior instability, posterior shoulder dislocations are a rare entity and are often missed at presentation. A concomitant anteromedial impression fracture of the humeral head, or a reverse Hill-Sachs lesion, is commonly present with these dislocations and is more pronounced with a longer timeline to reduction. Treatment of these defects ranges from nonsurgical treatment to soft-tissue procedures, bony reconstruction, and arthroplasty. Management may be dictated by various factors, such as patient demands, defect size and location, concomitant injuries, and underlyi...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Jelle P van der List Brian R Waterman Source Type: research
Posterior Glenoid Bone Block Reconstruction: Indications, Techniques, and Outcomes
Instr Course Lect. 2024;73:573-586.ABSTRACTPosterior shoulder instability is of particular therapeutic interest, as it typically affects patients with high functional demands such as young athletes and active adults. Although posterior capsulolabral repair has high return-to-sport rates, it is associated with recurrent instability of up to 11%. Posterior glenoid bone loss and significant glenoid retroversion have been identified as risk factors for recurrent instability and failure after primary arthroscopic soft-tissue repair. Therefore, posterior glenoid bone block reconstruction may be indicated for glenoid bone loss 20...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Rajiv P Reddy Matthew Como Anya Singh-Varma Amin Karimi Julie Y Bishop Albert Lin Source Type: research
The Scapula: The Greater Masquerader of
Shoulder Pathologies
Instr Course Lect. 2024;73:587-607.ABSTRACTA comprehensive review of scapular pathologies and their effect on shoulder function is necessary to determine the best treatment options. The coordinated motion between the scapulothoracic and glenohumeral joints is essential for shoulder motion and depends on the balanced activity of the periscapular muscles. Disruption in these muscles can cause abnormal scapular motion and compensatory glenohumeral movements, leading to misdiagnosis or delayed diagnosis. Scapular pathologies can arise from muscle overactivity or underactivity/paralysis, resulting in a range of scapulothoracic ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Eric R Wagner Zaamin B Hussain Anthony L Karzon Jon J P Warner Bassem T Elhassan Joaquin Sanchez-Sotelo Source Type: research
Scapular Dyskinesia: How to Differentiate
Between Etiologies
Instr Course Lect. 2024;73:609-624.ABSTRACTIt is important to discuss the importance of synchronous balance between periscapular muscles for scapulothoracic motion and resultant scapulohumeral rhythm. Abnormalities in this balance can lead to scapular dyskinesia and winging, affecting shoulder motion and leading to impingement. Strategies exist to diagnose and differentiate between pathologies such as muscle paralysis (eg, trapezius or serratus anterior) or overactivity (eg, pectoralis minor). The physician should be aware of the role of diagnostic imaging, as well as the unique considerations for patients with Ehlers-Danl...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Eric R Wagner Anthony L Karzon Zaamin B Hussain Jon J P Warner Bassem T Elhassan Joaquin Sanchez-Sotelo Source Type: research
Open and Arthroscopic Elbow Contracture Release:
Tips and Pearls
Instr Course Lect. 2024;73:625-637.ABSTRACTElbow stiffness is a common consequence of trauma and can significantly limit the functionality of the affected arm. Intervention may be necessary for those with a motion arc less than 100°, but the decision to intervene should be based on individual patient needs. Restoration of joint motion in a stiff elbow can be challenging, time consuming, and costly. Nonsurgical treatment is the primary management option, and surgical intervention is considered for refractory stiffness. However, recurrent stiffness is a common issue following surgical elbow contracture release. An overview ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: H Mike Kim Mark E Morrey Scott Steinmann Raul Barco Source Type: research
Avoiding Pitfalls in Adult Spinal Deformity
Instr Course Lect. 2024;73:641-649.ABSTRACTTo avoid the high rate of complications associated with the surgical management of adult spinal deformity, it is important to recognize and avoid three major pitfalls. The first is patient selection and determining which cases are appropriately indicated. The second is optimizing modifiable medical issues that can lead to a poor outcome, such as smoking, vitamin D deficiency, nutritional status, and poor bone quality. The third is optimizing surgical factors such as defining clinically appropriate, patient-specific target alignment goals as well as using techniques to avoid proxim...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Hao-Hua Wu Michael Kelly Brian Neuman Themistocles Protopsaltis Stuart Hershman Source Type: research
C1-C2 Posterior Screw-Rod Fixation
Instr Course Lect. 2024;73:651-664.ABSTRACTMultiple approaches for instrumentation of the upper cervical spine have evolved to treat atlantoaxial instability which, until the 20th century, was largely considered to be inoperable and managed nonsurgically with immobilization. Surgeons set out to provide safe and effective approaches in a clearly dangerous and technically complex anatomic region. It is important to provide a historical analysis of the evolution of techniques that have shaped C1-C2 instrumentation, and how the diligent efforts of surgeons to improve the biomechanical stability and fusion rates of their constr...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Ali Saif R Khan Bradford L Currier Melissa M Erickson Ahmad Nassr Najib E El Tecle Charbel D Moussallem Source Type: research
Updates in the Management of Metastatic Spine Disease
Instr Course Lect. 2024;73:665-673.ABSTRACTThe number of cancer diagnoses continues to increase each year in the United States, and given the propensity for bone metastases from solid organ malignancies, orthopaedic spine surgeons will inevitably encounter patients with metastatic spine disease and need to have a framework for approaching the evaluation and treatment of these complex patients. Many patients seeking care for spinal metastases already have a history of disseminated malignancy, but metastatic spine disease itself will be the presenting symptom of cancer in approximately 20% of patients. Because the first pres...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: S Mohammed Karim Andrew J Schoenfeld Maksim Vaynrub Source Type: research
Treatment of Spinal Infections
Instr Course Lect. 2024;73:675-687.ABSTRACTThe treatment of spinal infections is not well defined, and a cursory review of the literature can lead to conflicting treatment strategies. To add to the complexity, infections can include primary infection of the spine, infection secondary to another primary source, and postoperative infections including epidural abscesses, discitis, osteomyelitis, paraspinal soft-tissue infections, or any combination. Furthermore, differing opinions often exist within the medical and surgical communities regarding the outcomes and effectiveness of varying treatment strategies. Given the paucity...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Christopher C J Kleck Laura Damioli David Ou-Yang Source Type: research
Management of Glenoid Bone Loss in Shoulder Instability: Where We Are in 2023
Instr Course Lect. 2024;73:691-707.ABSTRACTThe management of glenoid bone loss in shoulder instability can be challenging. Although shoulder instability can often be managed with arthroscopic soft-tissue procedures alone, the extent of glenoid bone loss and bipolar bone defects may require bone augmentation procedures for restoration of stability. In this setting, patient evaluation, examination, treatment options, and surgical pearls are vital. Furthermore, a treatment algorithm is established to guide both indications and the technical application of procedures including Bankart repair with remplissage, Latarjet procedur...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Michael T Kody Jack Anavian Ronald A Navarro Evan S Lederman Phob Ganokroj Ryan J Whalen John M Apostolakos Capt Matthew T Provencher Source Type: research
Case-Based Understanding of the Role of the Scapula in Common Shoulder Pathologies
Instr Course Lect. 2024;73:709-724.ABSTRACTScapular dyskinesis is an extremely common component of shoulder pathology, especially in the overhead athlete; despite its prevalence, proper diagnosis and management of scapular disorders remains an enigma for many clinicians. An understanding of the contribution of the scapula to pathomechanics and clinical symptoms is necessary to optimize both surgical and nonsurgical treatment of shoulder disorders. Without correction of scapular dysfunction, even effective management of the pathoanatomy is unlikely to produce optimal results. It is important to examine the role of the scapu...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Austin V Stone Jeffrey Grantham Aaron Sciascia William B Kibler Source Type: research
Elbow Ulnar Collateral Ligament Tears in 2023: Evaluation and Management
Instr Course Lect. 2024;73:725-736.ABSTRACTThe ulnar collateral ligament, also called the medial collateral ligament of the elbow, is the primary stabilizer against valgus loads. This ligament can be traumatically torn, such as in an elbow dislocation, or can tear through attritional damage with overhead sports. Although baseball pitching is the most common contributor, these injuries also occur with volleyball, gymnastics, and javelin throwing. Patients most commonly report a history of medial elbow pain with associated loss of command, control, and throw velocity. The ulnar nerve lies directly superficial to the posterio...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Peter N Chalmers Eric Bowman Brandon J Erickson Matthew V Smith Christopher L Camp Michael T Freehill Source Type: research
Evaluation and Management of the Athlete's Hip
Instr Course Lect. 2024;73:737-748.ABSTRACTHip and groin pain is common in athletes, and there are many possible underlying pathologies. It is important to describe athletic hip pathology in the context of sport-specific physiologic loads and biomechanical demands. Three distinct types of athletes with this pathology are collision athletes, hypermobility athletes, and endurance athletes. Although there is considerable overlap between sports, athletes with hip pain should always be evaluated in the context of their sport. Understanding the effect of sport-specific biomechanical demands may help with both diagnosis and treat...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Caitlin A Orner Madison Sakheim Robert W Westermann Joshua D Harris Thomas H Wuerz Michael Banffy Source Type: research
Measure Twice, Cut Once: The Future of Digitally Planned Knee Osteotomies
Instr Course Lect. 2024;73:749-763.ABSTRACTIt is important to highlight the use of patient-specific cutting guides for knee joint osteotomies. Rationale, pitfalls, and planning of conventional osteotomy techniques are examined. The benefits of using patient-specific guides focusing on the potential for improved accuracy, efficiency, and safety are reviewed. The versatility of guides to manipulate the slope in both the coronal and sagittal planes, as well as its ability to accommodate concomitant procedures, is discussed. The time and cost differentials between standard cutting guides and three-dimensional-guided templating...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Michael Buldo-Licciardi Ariana Lott Ian Savage-Elliott Andreas H Gomoll Anil S Ranawat Michael J Alaia Laith M Jazrawi Source Type: research
