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Sports Medicine and Arthroscopy Reviews: Shoulder Instability
No abstract available (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - August 9, 2017 Category: Sports Medicine Tags: Editorial Source Type: research

Rehabilitation After Medial Patellofemoral Ligament Reconstruction
Patellar instability resulting from subluxation or dislocation is a painful and commonly recurring condition. Retinacular restraints control patellar tracking, limiting the movement of the patella in the trochlear groove. The medial patellofemoral ligament (MPFL) is considered the main soft tissue stabilizer against lateral displacement. Few studies of patellar instability discuss rehabilitation after MPFL reconstruction. In this review, we discuss the phases of rehabilitation after MPFL reconstruction, typical interventions by rehabilitation specialists, and patient-specific guidelines for return to prior level of functio...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Surgical Options for Patellar Stabilization in the Skeletally Immature Patient
The surgical management of children and youth with patellar instability can be a challenging exercise. It is possible to identify the various pathoanatomies that coexist with and predispose to patellar instability and in so doing, it is possible to address some, but not all, of these pathoanatomies as part of the surgical management. Although reconstruction of the medial patellofemoral ligament has become a mainstay of treatment, it is not without potential complications. Understanding the importance of surgical technique as it relates to the unique anatomies involved is crucial. Despite the presence of open growth plates,...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Patellar Instability: When is Trochleoplasty Necessary?
Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy and biomechanics of the anterior distal femur, a wider array of surgical techniques may be applied to address specific conditions. Patients must be carefully selected to undergo trochleoplasty by use of a thorough history and physical examination as well as basic and advanced imaging. The presence of a “J sign” on physical examination, a history of recurrent instability, patella alta, trochlear dysplasia, and elevated tibial tubercle to trochlear groov...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Complications of Tibial Tuberosity Osteotomy
It is important to understand potential complications of tibial tuberosity osteotomies (TTOs) and how to avoid them. TTO is associated with a 1% to 3% rate of tibial fracture and 1% rate of nonunion. Early weight-bearing and complete detachment of the distal tuberosity may increase these risks. Painful screws requiring removal occur in 3% to 77% of cases. Use of small (3.5- mm diameter), countersunk screws reduces this risk. Recurrent instability occurs in ∼5% of cases at 5 years. The risk of deep-vein thrombosis (4%) after TTO is higher than that associated with other sports surgeries (1% to 2%). The risk of wound compl...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

When and How Far to Move the Tibial Tuberosity in Patients With Patellar Instability
The many factors contributing to patellar instability have led to various surgical techniques that are used commonly today. When surgery is deemed necessary, the operation should be tailored to the patient’s specific pathoanatomy. Patients with malalignment can often be stabilized by moving the tibial tuberosity to a more medial, anteromedial, or distal position. Subsequent changes in the forces acting on the patellofemoral joint will depend on the direction and distance of the tuberosity repositioning. When planning tuberosity osteotomies, it is crucial to understand how to use clinical and imaging modalities to measure...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Nonoperative Treatment of Patellar Instability
The treatment of patellar instability is challenging and typically begins with nonoperative methods. Clinical decisions are made on an individual basis and may vary according to a number of factors. First-time patellar dislocations most commonly occur during sports participation. Initial evaluation, including patient history, physical examination, and appropriate imaging, determines care. Although nonoperative treatment consists primarily of regressive immobilization and physical therapy, there is little evidence to support particular protocols for either. Factors that may contraindicate nonoperative treatment include oste...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Diagnosis and Characterization of Patellofemoral Instability: Review of Available Imaging Modalities
Patellofemoral instability (PI) is defined as single or multiple episodes of patellar dislocation. Imaging modalities are useful for characterization of patellar malalignment, maltracking, underlying morphologic abnormalities, and stabilizing soft-tissue injuries. Using these findings, orthopedic surgeons can decide when to operate, determine the best operation, and measure degree of correction postoperatively in PI patients. Also, these methods assist with PI diagnosis in some suspicious cases. Magnetic resonance imaging is the preferred method especially in the setting of acute dislocations. Multidetector computed tomogr...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction
Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking. Decreased lateral patellofemoral contact pressures have also been not...
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

The Anatomy of the Medial Patellofemoral Complex
The term “medial patellofemoral complex” (MPFC) was proposed to describe the static medial stabilizer of the patella, typically referred to as the medial patellofemoral ligament. In light of our increasing understanding of the attachment of its fibers to the quadriceps tendon in addition to the patella, the term MPFC is used in this article. The purpose of this article is to describe and discuss the anatomy of the MPFC. (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

SMAR Patellofemoral Instability Editorial Volume 25, Issue 2
No abstract available (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - May 4, 2017 Category: Sports Medicine Tags: Editorial Source Type: research

Surgical Treatment for Failure of Repair of Patellar and Quadriceps Tendon Rupture With Ipsilateral Hamstring Tendon Graft
Tears of the patellar and quadriceps tendon are common in the active population, especially in athletes. At present, several techniques for surgical repair and reconstruction are available. When reruptures occur, a reconstruction is mandatory. In the present paper, we describe a surgical technique for patellar and quadriceps tendon reconstruction using ipsilateral hamstring autograft. After routine hamstring tendon harvesting, the tendon ends are prepared using a whip stitch. A transverse tunnel is drilled in the midportion of the patella, the hamstring graft is passed through the patella, and firmly secured to the patella...
Source: Sports Medicine and Arthroscopy Review - January 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

The Management of Extensor Mechanism Disruption After Total Knee Arthroplasty: A Systematic Review
We performed a literature search on PubMed, Web of Science, Science Direct/Scopus, Google Scholar, and Google to evaluate results of several techniques to manage disruption of the extensor mechanism after total knee arthroplasty. Different methods to manage extensor mechanism disruption are available at present, with no level I studies informing surgeons in an evidence-based fashion. Primary repair is not indicated. Allograft reconstruction could be effective, providing that appropriate surgical technique and allograft tensioning are implemented. (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - January 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Revision Surgery for Failed Patellar Tendinopathy Exploration
We describe our surgical approach in the management of recalcitrant patellar tendinopathy. (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - January 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research

Revision Posterior Cruciate Ligament Surgery
Successful posterior cruciate ligament (PCL) reconstruction surgery results from identification and treatment of associated pathology such as posterolateral instability, posteromedial instability, and lower extremity malalignment. The use of strong graft material, properly placed tunnels to as closely as possible approximate the PCL insertion sites, and minimization of graft bending also enhance the probability of PCL reconstruction success. In addition, mechanical graft tensioning, primary and back-up PCL graft fixation, and the appropriate postoperative rehabilitation program are also necessary ingredients for PCL recons...
Source: Sports Medicine and Arthroscopy Review - January 4, 2017 Category: Sports Medicine Tags: Review Articles Source Type: research