How to Recognize, Correct, and Avoid Intraoperative Complications During Anterior Cruciate Ligament Reconstructions
Instr Course Lect. 2024;73:765-777.ABSTRACTTechnical complications are a leading cause of graft failure following anterior cruciate ligament reconstructions. Complications can occur during any phase of the procedure, from graft harvesting to tunnel preparation to graft fixation. Predicting potential causes of technical difficulty and developing strategies to avoid potential pitfalls can limit the number of intraoperative complications. If adverse events do occur intraoperatively, prompt recognition and treatment can lead to favorable outcomes. It is important to discuss strategies to understand potential complications and ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Andrew Kim J Brett Goodloe Edgar Garcia-Lopez Jeffrey D Klott Kelly M Dopke Brian Feeley Mark D Miller Frederick M Azar Robert A Gallo Source Type: research

Meniscus Extrusion, Radial Tears, and Root Tears
Instr Course Lect. 2024;73:779-793.ABSTRACTManagement of meniscal radial and root tears and extrusion is complex and has changed significantly over recent years. It is important to provide a comprehensive overview of the management of radial and root tears and meniscal extrusion and be aware of the currently available evidence on repair techniques, rehabilitation, and outcomes following radial and root repairs.PMID:38090940 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Garrett R Jackson Enzo S Mameri Lika Dzidzishvili Michael J Alaia Scott A Rodeo Jorge Chahla J Lee Pace Source Type: research

Treatment of Patellofemoral Instability and 
Chondral Lesions
Instr Course Lect. 2024;73:795-811.ABSTRACTLateral patellar instability is one of the most common knee disorders among adolescents. Numerous anthropometric features, including trochlear dysplasia, patella alta, high tibial tubercle-to-trochlear groove distance, and coronal and rotational plane malalignment, are considered primary risk factors for patellar dislocation, and the understanding of their complex interplay is continuously evolving. Because of the multifactorial nature of patellar instability, there is a lack of consensus regarding many aspects of surgical intervention. Medial patellofemoral ligament reconstructio...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Sharif Garra Zachary I Li Thomas R Carter Abigail R Hamilton J Lee Pace Laith M Jazrawi Source Type: research

Axial Plane Deformity: How to Avoid It and How to Correct It
Instr Course Lect. 2024;73:815-830.ABSTRACTMalreductions in the axial plane (ie, length and rotation) are common when managing long bone fractures. Careful attention to detail during the initial treatment can prevent these malreductions. Various fluoroscopy-based techniques exist for the prevention of malrotation and limb-length discrepancy during surgery for fracture. If malreductions do occur, a systematic clinical and radiographic evaluation can provide the necessary information to correct rotational malreduction and limb-length discrepancy.PMID:38090942 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Mary Kate Erdman Patrick Schottel Milton Little Geoffrey S Marecek Source Type: research

Reducing the Burden of Disease Associated With Periprosthetic Fractures: Prevention and the Need for Improved Perioperative Care
Instr Course Lect. 2024;73:831-841.ABSTRACTThe management of periprosthetic fractures remains challenging and controversial. There continues to be a significant burden of disease and substantial resource implications associated with fractures following total joint arthroplasty. Achieving consensus opinions regarding the prevention and treatment of this problem has important implications given the profound effect on patient outcomes. Multidisciplinary care in the preoperative and postoperative settings is critical, with a specific focus on bone health.PMID:38090943 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Geoffrey W Schemitsch Adam Sassoon Aaron Nauth Emil H Schemitsch David Laniado Diana K Lee Andrew Schmidt Source Type: research

Fixation Strategies for Periprosthetic Fractures With Stable Implants
Instr Course Lect. 2024;73:843-860.ABSTRACTThe fixation of periprosthetic fractures remains challenging and controversial. It is important to achieve consensus opinions regarding the management of stable periprosthetic fractures with internal fixation. Key strategies to optimize surgical decision making and fixation and manage complications following these difficult injuries are addressed.PMID:38090944 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Aaron Nauth Andrew Schmidt Geoffrey W Schemitsch Jhase Sniderman Jeremy Alan Hall Ryan D Stancil Adam Sassoon Emil H Schemitsch Source Type: research

The Role of Revision Total Joint Arthroplasty for Periprosthetic Fractures With Unstable Implants
Instr Course Lect. 2024;73:861-878.ABSTRACTThe management of periprosthetic fractures with unstable prosthetic implants is a challenging and commonly encountered problem. It is important to address the many current issues and controversies regarding the treatment of periprosthetic fractures with revision total joint arthroplasty. Key strategies to optimize surgical decision making around the use of arthroplasty and management of complications following these complex injuries will be addressed.PMID:38090945 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Adam Sassoon Andrew Schmidt Aaron Nauth Geoffrey W Schemitsch Rafi Husain Jeremy Alan Hall Emil H Schemitsch Source Type: research

Tibial Plateau Fractures: Addressing Commonly Encountered Challenges in Reduction and Fixation
Instr Course Lect. 2024;73:879-900.ABSTRACTTibial plateau fractures encompass a broad array of injuries. The mechanism of injury ranges from low to high energy. Devastating complications and associated injuries can occur in both low-energy and high-energy mechanisms; therefore, a careful and detailed physical examination and review of imaging must be performed. Furthermore, a mechanistic approach to fracture classification and morphology enhances the surgeon's understanding of the injury and the ability to predict associated injuries and develop effective strategies for management.PMID:38090946 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: John Morellato Matthew Graves Allan Liew Matthew Hogue Christopher K Folau Source Type: research

Limb Rotation in Lower Extremity Fractures
Instr Course Lect. 2024;73:901-918.ABSTRACTFractures of the tibia and femur are common. Rotation of the limb can affect the outcome of the injury, both in the immediate term and the long term. Because plain radiographs are two dimensional, rotation is hard to assess radiographically. As a result, rotational malalignment is common. It is important to provide technical tips on the assessment of rotation preoperatively, intraoperatively, and postoperatively. The goal is to better assess rotation so that deformity can be minimized. This applies to fractures of the tibia and femur. Even after careful treatment, rotational defor...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Michael Blankstein Patrick Schottel Mark Brinker James Krieg Source Type: research

Current Trends in Orthopaedics and Trauma in 
Germany
Instr Course Lect. 2024;73:919-928.ABSTRACTDuring the Guest Nation Symposium (cobranded with the Deutsche Gesellschaft für Orthopädie und Unfallchirurgie, Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie, and Deutsche Gesellschaft für Unfallchirurgie) at the 2023 American Academy of Orthopaedic Surgeons Congress in Las Vegas, the goal was to compile nationally important content from German orthopaedics and trauma surgery. This resulted in a mix of content on the latest developments in trauma care, knee arthroplasty, spinopelvic importance for hip arthroplasty, stemless shoulder endoprostheses, joint p...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Maximilian Rudert Steffen Ruchholtz Bertil Bouillon Andreas Halder Matthias Pumberger Markus Scheibel Christina Stukenborg-Colsman Matthias M ünzberg Benedikt Friemert Source Type: research

Ankle Malunion: When and How to Perform Supramalleolar Osteotomy
Instr Course Lect. 2024;73:209-219.ABSTRACTAnkle osteoarthritis is usually posttraumatic, creating asymmetric damage on the ankle joint in approximately 80% of cases. The talus is susceptible to tilt to the damaged cartilage area, producing a supramalleolar deformity with localized ankle arthritis. Supramalleolar osteotomy is joint-preserving surgical treatment for patients with localized ankle arthritis. This procedure's objectives include improving intra-articular load distribution by overcorrecting the axis, slowing down or stopping the degeneration of the tibiotalar joint, and improving function. Preoperative planning ...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Cristian Ortiz Mateluna Ximena Ahumada Pavez Source Type: research

Management of the Hindfoot and Ankle in 
Charcot Arthropathy
Instr Course Lect. 2024;73:221-230.ABSTRACTNeuropathic destabilization of the hindfoot and/or ankle is a significant complication for the patient with diabetes/neuropathy. The loss of ligamentous integrity and bony destruction results in a limb that is not stable for weight bearing. This loss of independence adds significant health risks to the patient. Management of this disease process is both time consuming and technically demanding for both the practitioner and the patient. Attention to detail and aggressive decision making is often necessary to salvage the limb. The goal for treatment is to produce a stable, weight-be...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: John S Early Source Type: research

Midfoot Fusion Using Superconstructs for the Charcot Foot: Current Techniques and Complications
Instr Course Lect. 2024;73:231-245.ABSTRACTNeuroarthropathy of the foot and ankle presents a series of challenges. The treating physician faces a perfect storm of pathomechanics, deformity, and medical comorbidities. Successful treatment requires a systematic approach in diagnosis, nonsurgical management, surgical management, and long-term maintenance of the affected extremity. Nonsurgical care of the Charcot foot remains the mainstay of treatment and is successful in most cases. Surgery has become more accepted for patients with severe deformity. The concept of a superconstruct has been introduced to describe modern surgi...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Vincent James Sammarco Josika A Sammarco Mark E Baratz G James Sammarco Source Type: research

Managing the Severe Cavus Foot Deformity in Global Humanitarian Programs
Instr Course Lect. 2024;73:247-261.ABSTRACTThe cavus foot represents a complex spectrum of deformity ranging from the subtle idiopathic to the severe sensorimotor neuropathy and other neuromuscular deformities. The successful surgical treatment of the cavus foot depends on a fundamental understanding of the underlying multiplanar deformity, inherent muscle balance, and the rigidity of the hindfoot. The location of the deformity is described and understood according to its multiple apices. These deformities are addressed with osteotomies or arthrodesis directed at the apices of deformity. Simultaneously, correction of muscu...
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Brady T Williams Shuyuan Li Mark S Myerson Source Type: research

Management of Infections and Osteomyelitis in 
Patients With Charcot Foot Arthropathy
Instr Course Lect. 2024;73:263-267.ABSTRACTThere is growing interest in performing reconstruction of deformities associated with Charcot foot arthropathy. At least half of the patients undergoing this reconstruction will have chronic wounds and osteomyelitis overlying the deformity. It is important to provide orthopaedic surgeons with tools for making the diagnosis of osteomyelitis in this patient population and creating a strategy for treatment.PMID:38090903 (Source: Instructional Course Lectures)
Source: Instructional Course Lectures - December 13, 2023 Category: Orthopaedics Authors: Michael S Pinzur Source Type: research