Understanding Osteotomy: A narrative review

/in /by

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page: 21-30 | Domenico Alesi, Vito Gaetano Rinaldi, Amit Meena, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini

Author: Domenico Alesi [1], Vito Gaetano Rinaldi [1], Amit Meena [2], Giulio Maria Marcheggiani Muccioli [1,3], Stefano Zaffagnini [1,3]

[1] 2nd Orthopaedic and Traumatology Clinic – IRCCS – Istituto Ortopedico Rizzoli – Via G.B. Pupilli 1, 40136, Bologna, Italy.
[2] Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
[3] DIBINEM, University of Bologna, Bologna, Italy.

Address of Correspondence
Dr. Domenico Alesi,
Resident in Orthopedics and Traumatology, IRCCS – Istituto Ortopedico Rizzoli Via di Barbiano, 1/13, Bologna
E-mail: domenico.alesi@ior.it

Abstract

Osteotomy around the knee is an effective surgical procedure for active, physiologically young patients with symptomatic unicompartmental osteoarthritis (OA) and malalignment. It restores the correct lower limb mechanical alignment, redistributing weight-bearing from a damaged joint surface area to an undamaged one. Hence, it consistently provides relief in knee pain, improves knee function, and delay the need for TKA. Despite all these advantages its popularity was decreasing in the past but improved meniscal and cartilage restoration techniques renewed interest in knee osteotomies in young patients with knee pain and joint surface defects. Hence, in the last decade, the majority of osteotomies have been performed in combined with cartilage repair, meniscal transplantation, and ligament reconstruction. Understanding the rationale of an osteotomy and the possibility to combine it with other procedures allows us to obtain the most clinical benefit for the patient. This review article provides an overview of the basic osteotomy planning for knee axes malalignment, describing the different techniques based on the location of the deformity and the presence of associated lesions, thus presenting the main results of isolated and combined procedures, to provide useful updates to guide the surgeon in the choice of possible variants or associated gestures.
Keywords: Deformities around the knee, High tibial osteotomy, Clinical outcome.

References

1. Jackson J. Osteotomy for osteoarthritis of the knee. J Bone Jt Surg Br 1958:40:826.
2. Wardle EN. Osteotomy of the tibia and fibula. Surg Gynecol Obstet 1962;115:61–4.
3. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 1965;47:984–90.
4. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Distal femoral varus osteotomy. J Bone Joint Surg Am 1988;70:102–9.
5. Pape D, Adam F, Rupp S, Seil R, Kohn D. [Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis]. Orthopade 2004;33:208–17.
https://doi.org/10.1007/s00132-003-0591-2.
6. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop 1992:248–64.
7. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979;10:585–608.
8. Dejour H, Walch G, Deschamps G, Chambat P. Arthrosis of the knee in chronic anterior laxity. Orthop Traumatol Surg Res OTSR 2014;100:49–58. https://doi.org/10.1016/j.otsr.2013.12.010.
9. Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH, et al. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:1411–8. https://doi.org/10.1007/s00167-019-05502-6.
10. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 1993;75:196–201.
11. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987;69:332–54.
12. Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC, et al. Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2012;20:468–86. https://doi.org/10.1007/s00167-011-1714-7.
13. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop 1989:250–9.
14. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5 Years. Clin Orthop Relat Res 2015;473:2009–15. https://doi.org/10.1007/s11999-014-4106-8.
15. Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int Orthop 2010;34:271–81. https://doi.org/10.1007/s00264-009-0924-9.
16. Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C. Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 2006;30:403–8. https://doi.org/10.1007/s00264-006-0098-7.
17. Flecher X, Parratte S, Aubaniac J-M, Argenson J-NA. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop 2006;452:91–6. https://doi.org/10.1097/01.blo.0000229362.12244.f6.
18. Gstöttner M, Michaela G, Pedross F, Florian P, Liebensteiner M, Michael L, et al. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 2008;128:111–5. https://doi.org/10.1007/s00402-007-0438-0.
19. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 2008;90:592–6. https://doi.org/10.1302/0301-620X.90B5.20386.
20. Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, et al. Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 2011;39:64–70. https://doi.org/10.1177/0363546510377445.
21. Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2012;28:354–64. https://doi.org/10.1016/j.arthro.2011.08.310.
22. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:170–80. https://doi.org/10.1007/s00167-012-2087-2.
23. Liu JN, Agarwalla A, Garcia GH, Christian DR, Redondo ML, Yanke AB, et al. Return to sport following isolated opening wedge high tibial osteotomy. The Knee 2019;26:1306–12.
https://doi.org/10.1016/j.knee.2019.08.002.
24. Bonnin MP, Laurent J-R, Zadegan F, Badet R, Pooler Archbold HA, Servien E. Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:64–73. https://doi.org/10.1007/s00167-011-1461-9.
25. Berruto M, Maione A, Tradati D, Ferrua P, Uboldi FM, Usellini E. Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020. https://doi.org/10.1007/s00167-020-05890-0.
26. Liu JN, Agarwalla A, Gomoll AH. High Tibial Osteotomy and Medial Meniscus Transplant. Clin Sports Med 2019;38:401–16. https://doi.org/10.1016/j.csm.2019.02.006.
27. Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE. High tibial osteotomy. J Am Acad Orthop Surg 2005;13:279–89. https://doi.org/10.5435/00124635-200507000-00007.
28. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 2011;19:590–9.
https://doi.org/10.5435/00124635-201110000-00003.
29. Schuster P, Schulz M, Mayer P, Schlumberger M, Immendoerfer M, Richter J. Open-Wedge High Tibial Osteotomy and Combined Abrasion/Microfracture in Severe Medial Osteoarthritis and Varus Malalignment: 5-Year Results and Arthroscopic Findings After 2 Years. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2015;31:1279–88. https://doi.org/10.1016/j.arthro.2015.02.010.
30. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, et al. Advances in modern osteotomies around the knee : Report on the Association of Sports Traumatology, Arthroscopy, Orthopaedic surgery, Rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019;6:9. https://doi.org/10.1186/s40634-019-0177-5.
31. Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ. Analysis of Outcomes for High Tibial Osteotomies Performed With Cartilage Restoration Techniques. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2017;33:486–92. https://doi.org/10.1016/j.arthro.2016.08.010.
32. Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK. Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 2010;38:1420–4.
https://doi.org/10.1177/0363546509360403.
33. Bode G, Ogon P, Pestka J, Zwingmann J, Feucht M, Südkamp N, et al. Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 2015;39:689–96. https://doi.org/10.1007/s00264-014-2547-z.
34. Agarwalla A, Christian DR, Liu JN, Garcia GH, Redondo ML, Gowd AK, et al. Return to Work Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2020;36:808–15. https://doi.org/10.1016/j.arthro.2019.08.046.
35. Hsu AC, Tirico LEP, Lin AG, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure. Cartilage 2018;9:248–54. https://doi.org/10.1177/1947603517710307.
36. Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J. Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2014;30:1453–60. https://doi.org/10.1016/j.arthro.2014.05.036.
37. Barber-Westin SD, Noyes FR. Low-impact sports activities are feasible after meniscus transplantation: a systematic review. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2018;26:1950–8.
https://doi.org/10.1007/s00167-017-4658-8.
38. Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Surgical technique. J Bone Joint Surg Am 2006;88 Suppl 1 Pt 1:109–18.
https://doi.org/10.2106/JBJS.E.00875.
39. Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am 2005;87:715–24. https://doi.org/10.2106/JBJS.C.01344.
40. Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, Di Martino A, Di Matteo B, et al. Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:2509–17. https://doi.org/10.1007/s00167-013-2388-0.
41. Zaffagnini S, Bonanzinga T, Grassi A, Marcheggiani Muccioli GM, Musiani C, Raggi F, et al. Combined ACL reconstruction and closing-wedge HTO for varus angulated ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:934–41.
https://doi.org/10.1007/s00167-013-2400-8.
42. Bonin N, Ait Si Selmi T, Donell ST, Dejour H, Neyret P. Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. The Knee 2004;11:431–7.
https://doi.org/10.1016/j.knee.2004.02.001.
43. Trojani C, Elhor H, Carles M, Boileau P. Anterior cruciate ligament reconstruction combined with valgus high tibial osteotomy allows return to sports. Orthop Traumatol Surg Res OTSR 2014;100:209–12. https://doi.org/10.1016/j.otsr.2013.11.012.
44. Schneider A, Gaillard R, Gunst S, Batailler C, Neyret P, Lustig S, et al. Combined ACL reconstruction and opening wedge high tibial osteotomy at 10-year follow-up: excellent laxity control but uncertain return to high level sport. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:960–8. https://doi.org/10.1007/s00167-019-05592-2.
45. Mehl J, Paul J, Feucht MJ, Bode G, Imhoff AB, Südkamp NP, et al. ACL deficiency and varus osteoarthritis: high tibial osteotomy alone or combined with ACL reconstruction? Arch Orthop Trauma Surg 2017;137:233–40. https://doi.org/10.1007/s00402-016-2604-8.
46. Schuster P, Schlumberger M, Mayer P, Eichinger M, Geßlein M, Schulz-Jahrsdörfer M, et al. Excellent long-term results in combined high tibial osteotomy, anterior cruciate ligament reconstruction and chondral resurfacing in patients with severe osteoarthritis and varus alignment. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:1085–91. https://doi.org/10.1007/s00167-019-05671-4.
47. Dejour D, Saffarini M, Demey G, Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2015;23:2846–52. https://doi.org/10.1007/s00167-015-3758-6.
48. van de Pol GJ, Arnold MP, Verdonschot N, van Kampen A. Varus alignment leads to increased forces in the anterior cruciate ligament. Am J Sports Med 2009;37:481–7. https://doi.org/10.1177/0363546508326715.
49. Walker J, Hartigan D, Stuart M, Krych A. Anterior Closing Wedge Tibial Osteotomy for Failed Anterior Cruciate Ligament Reconstruction. J Knee Surg Rep 2015;1:051–6. https://doi.org/10.1055/s-0035-1551548.
50. Gupta A, Tejpal T, Shanmugaraj A, Horner NS, Simunovic N, Duong A, et al. Surgical Techniques, Outcomes, Indications, and Complications of Simultaneous High Tibial Osteotomy and Anterior Cruciate Ligament Revision Surgery: A Systematic Review. HSS J Musculoskelet J Hosp Spec Surg 2019;15:176–84. https://doi.org/10.1007/s11420-018-9630-8..

How to Cite this article: Alesi D, Rinaldi VG, Meena A, Muccioli GMM, Zaffagnini S | Understanding osteotomy: a narrative review | Journal of Clinical Orthopaedics | January-June 2020; 5(1):21-30.

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Beliefs regarding knee pain in Indian adults: A knowledge, attitude and practice (KAP) survey

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Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page: 47-54 | Keyur B. Desai, Shruti A. Mondkar

Author: Keyur B. Desai [1], Shruti A. Mondkar [2]

[1] Department of Orthopaedics, King Edward VII Memorial Hospital, Parel, Mumbai, India.
[2] Department of Pediatrics, King Edward VII Memorial Hospital, Parel, Mumbai, India.

Address of Correspondence
Dr. Keyur B. Desai,
401, Dadarkar arcade, N.L parelkar marg, opp trimurti building, Parel village. Parel, Mumbai. Maharashtra, India.
E-mail: doctorkbd@gmail.com

Abstract

Background: Belief along with habits and personality acts as important force guiding human behaviour. Health education can modify irrational beliefs and help people adopt healthy behaviour. The aim of this study is to know the existing beliefs among individuals regarding knee pain, its aetiology, and their most effective treatment modality. The study also explores the sources of healthcare information across different age groups that can be utilized for education and creating public awareness. This study also explores the different reasons why individuals do not prefer to attend a health care facility for their knee pain.
Methods: A questionnaire based cross sectional study was designed to assess individuals beliefs and modes of treatment of knee pain, the accessibility to healthcare and the factors responsible for non attendance of healthcare facility. The likely source of health information and use of internet and smart-phones for acquiring health related information was enquired.
Results: ‘Ageing’, ‘Obesity’, ‘Overactivity’, ‘Sports and recreation’, ‘Hereditary’, were among the most commonly believed causes of knee pain. Some irrational beliefs like association with food items, fate etc were also known. Internet and smart phones remain the most accessible and used source of health information among the age group of <20 years and 20-40 years. Health professionals were more trusted for information in the age group of 40-60 and above 60 years.
Conclusions: Regulated health information through widely available medium like internet and smartphones can effectively tweak the false beliefs in the community and help to develop healthy behaviour.
Keywords: Beliefs, Traditions, Education, Aarogya Setu, Physiotherapy, Health information, Internet and health care, Smart phones and health care, Osteoarthritis, Knee pain, Indian beliefs.

References

1. Sanders C, Donovan J, Dieppe P. The significance and consequences of having painful and disabled joints in older age: Co-existing accounts of normal and disrupted biographies. Sociol Heal Illn. 2002;24(2):227–53.
2. Naderifar M, Goli H, Ghaljaie F. Snowball Sampling: A Purposeful Method of Sampling in Qualitative Research. Strides Dev Med Educ. 2017 Sep 30;14(3).
3. Hunt K. Henderson, Hamish Scott [Internet]. Oxford Dictionary of National Biography. 2011 [cited 2020 Apr 22]. Available from: https://www.oxfordreference.com/view/10.1093/oi/authority.20110803095447459
4. Rosenstock IM, Ph D. Historical Origins of the Health Belief Model. Health Educ Monogr. 1960;2(4):328–35.
5. Janz NK and Becker MH . The Health Belief Model. A decade later. 1984; 11 (1): 1-47. Health Educ Q. 1984;11(1):1–47.
6. Morden A, Jinks C, Ong BN. Understanding help seeking for chronic joint pain: Implications for providing supported self-management. Qual Health Res. 2014;24(7):957–68.
7. Hall M, Migay AM, Persad T, Smith J, Yoshida K, Kennedy D, et al. Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty. Physiother Theory Pract. 2008 May;24(3):167–81.
8. Tuckett D. Becoming a patient. In: Tuckett D, ed. An introduction to medical sociology. London: Tavistock, 1976:159–89.
9. Mechanic D. Health and illness behaviour and patient–practitioner relationships. Soc Sci Med 1992;34:1345–50.
10. Zola IK. Pathways to the doctor: from person to patient. Soc Sci Med 1973;7:677–89.
11. Shane Anderson A, Loeser RF. Why is osteoarthritis an age-related disease? Vol. 24, Best Practice and Research: Clinical Rheumatology. NIH Public Access; 2010. p. 15–26.
12. Saxon L, Finch C, Bass S. Sports participation, sports injuries and osteoarthritis implications for prevention. Vol. 28, Sports Medicine. Adis International Ltd; 1999. p. 123–35.
13. Urquhart DM, Tobing JFL, Hanna FS, Berry P, Wluka AE, Ding C, et al. What is the effect of physical activity on the knee joint? a systematic review. Vol. 43, Medicine and Science in Sports and Exercise. 2011. p. 432–42.
14. Fransen M, McConnell S, Harmer AR, Van Der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: A Cochrane systematic review. Vol. 49, British Journal of Sports Medicine. BMJ Publishing Group; 2015. p. 1554–7.
15. Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med. 1988 Jul 1;109(1):18–24.
16. Messier SP, Gutekunst DJ, Davis C, DeVita P. Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis Rheum [Internet]. 2005 Jul [cited 2020 Apr 30];52(7):2026–32. Available from: http://doi.wiley.com/10.1002/art.21139
17. Digital India: Technology to transform a connected nation | McKinsey [Internet]. [cited 2020 Apr 30]. Available from:
https://www.mckinsey.com/business-functions/mckinsey-digital/our-insights/digital-india-technology-to-transform-a-connected-nation
18. Tonsaker T, Bartlett G, Trpkov C. Health information on the Internet: gold mine or minefield? Can Fam Physician [Internet]. 2014 May [cited 2020 Apr 30];60(5):407–8. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/24828994
19. Aarogya Setu Mobile App | MyGov.in [Internet]. [cited 2020 Apr 30]. Available from: https://www.mygov.in/aarogya-setu-app/
20. 20. Govt launches “Aarogya Setu”, a coronavirus tracker app: All you need to know [Internet]. [cited 2020 Apr 30]. Available from:
https://www.livemint.com/technology/apps/govt-launches-aarogya-setu-a-coronavirus-tracker-app-all-you-need-to-know-11585821224138. html
21. Aarogya Setu App Crossed 5 Million Installs in 3 Days, Schools Help Spread Awareness | Technology News [Internet]. [cited 2020 Apr 30]. Available from: https://gadgets.ndtv.com/apps/news/aarogya-setu-tops-india-charts-on-app-stores-5-million-installs-in-three-days-of-launch-coronavirus-2206060
22. Khori V, Changizi S, Biuckians E, Keshtkar A, Alizadeh AM, Mohaghgheghi AM, et al. Relation entre la durée des consultations et la prescription rationnelle de médicaments dans la ville de gorgan (république islamique d’Iran). East Mediterr Heal J. 2012;18(5):480–6.
23. Ahmad BA, Khairatul K, Farnaza A. An assessment of patient waiting and consultation time in a primary healthcare clinic. Malaysian Fam Physician. 2017;12(1):14–21.
24. Alarcon-Ruiz CA, Heredia P, Taype-Rondan A. Association of waiting and consultation time with patient satisfaction: Secondary-data analysis of a national survey in Peruvian ambulatory care facilities. BMC Health Serv Res [Internet]. 2019 Jul 1 [cited 2020 Apr 30];19(1):439. Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4288-6.

How to Cite this article: Desai KB, Mondkar SA | Beliefs regarding knee pain in Indian adults: A knowledge, attitude and practice (KAP) survey | Journal of Clinical Orthopaedics | January-June 2020; 5(1):47- 54.

 (Abstract    Full Text HTML)   (Download PDF)

Understanding Osteotomy: A narrative review

/in /by

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page: 21-30 | Domenico Alesi, Vito Gaetano Rinaldi, Amit Meena, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini

Author: Domenico Alesi [1], Vito Gaetano Rinaldi [1], Amit Meena [2], Giulio Maria Marcheggiani Muccioli [1,3], Stefano Zaffagnini [1,3]

[1] 2nd Orthopaedic and Traumatology Clinic – IRCCS – Istituto Ortopedico Rizzoli – Via G.B. Pupilli 1, 40136, Bologna, Italy.
[2] Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, 110029, India.
[3] DIBINEM, University of Bologna, Bologna, Italy.

Address of Correspondence
Dr. Domenico Alesi,
Resident in Orthopedics and Traumatology, IRCCS – Istituto Ortopedico Rizzoli Via di Barbiano, 1/13, Bologna
E-mail: domenico.alesi@ior.it

Abstract

Osteotomy around the knee is an effective surgical procedure for active, physiologically young patients with symptomatic unicompartmental osteoarthritis (OA) and malalignment. It restores the correct lower limb mechanical alignment, redistributing weight-bearing from a damaged joint surface area to an undamaged one. Hence, it consistently provides relief in knee pain, improves knee function, and delay the need for TKA. Despite all these advantages its popularity was decreasing in the past but improved meniscal and cartilage restoration techniques renewed interest in knee osteotomies in young patients with knee pain and joint surface defects. Hence, in the last decade, the majority of osteotomies have been performed in combined with cartilage repair, meniscal transplantation, and ligament reconstruction. Understanding the rationale of an osteotomy and the possibility to combine it with other procedures allows us to obtain the most clinical benefit for the patient. This review article provides an overview of the basic osteotomy planning for knee axes malalignment, describing the different techniques based on the location of the deformity and the presence of associated lesions, thus presenting the main results of isolated and combined procedures, to provide useful updates to guide the surgeon in the choice of possible variants or associated gestures.
Keywords: Deformities around the knee, High tibial osteotomy, Clinical outcome.

References

1. Jackson J. Osteotomy for osteoarthritis of the knee. J Bone Jt Surg Br 1958:40:826.
2. Wardle EN. Osteotomy of the tibia and fibula. Surg Gynecol Obstet 1962;115:61–4.
3. Coventry MB. Osteotomy of the upper portion of the tibia for degenerative arthritis of the knee. A preliminary report. J Bone Joint Surg Am 1965;47:984–90.
4. Healy WL, Anglen JO, Wasilewski SA, Krackow KA. Distal femoral varus osteotomy. J Bone Joint Surg Am 1988;70:102–9.
5. Pape D, Adam F, Rupp S, Seil R, Kohn D. [Stability, bone healing and loss of correction after valgus realignment of the tibial head. A roentgen stereometry analysis]. Orthopade 2004;33:208–17.
https://doi.org/10.1007/s00132-003-0591-2.
6. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop 1992:248–64.
7. Fujisawa Y, Masuhara K, Shiomi S. The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 1979;10:585–608.
8. Dejour H, Walch G, Deschamps G, Chambat P. Arthrosis of the knee in chronic anterior laxity. Orthop Traumatol Surg Res OTSR 2014;100:49–58. https://doi.org/10.1016/j.otsr.2013.12.010.
9. Lee DK, Wang JH, Won Y, Min YK, Jaiswal S, Lee BH, et al. Preoperative latent medial laxity and correction angle are crucial factors for overcorrection in medial open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:1411–8. https://doi.org/10.1007/s00167-019-05502-6.
10. Coventry MB, Ilstrup DM, Wallrichs SL. Proximal tibial osteotomy. A critical long-term study of eighty-seven cases. J Bone Joint Surg Am 1993;75:196–201.
11. Hernigou P, Medevielle D, Debeyre J, Goutallier D. Proximal tibial osteotomy for osteoarthritis with varus deformity. A ten to thirteen-year follow-up study. J Bone Joint Surg Am 1987;69:332–54.
12. Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC, et al. Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2012;20:468–86. https://doi.org/10.1007/s00167-011-1714-7.
13. Miniaci A, Ballmer FT, Ballmer PM, Jakob RP. Proximal tibial osteotomy. A new fixation device. Clin Orthop 1989:250–9.
14. Cameron JI, McCauley JC, Kermanshahi AY, Bugbee WD. Lateral Opening-wedge Distal Femoral Osteotomy: Pain Relief, Functional Improvement, and Survivorship at 5 Years. Clin Orthop Relat Res 2015;473:2009–15. https://doi.org/10.1007/s11999-014-4106-8.
15. Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int Orthop 2010;34:271–81. https://doi.org/10.1007/s00264-009-0924-9.
16. Papachristou G, Plessas S, Sourlas J, Levidiotis C, Chronopoulos E, Papachristou C. Deterioration of long-term results following high tibial osteotomy in patients under 60 years of age. Int Orthop 2006;30:403–8. https://doi.org/10.1007/s00264-006-0098-7.
17. Flecher X, Parratte S, Aubaniac J-M, Argenson J-NA. A 12-28-year followup study of closing wedge high tibial osteotomy. Clin Orthop 2006;452:91–6. https://doi.org/10.1097/01.blo.0000229362.12244.f6.
18. Gstöttner M, Michaela G, Pedross F, Florian P, Liebensteiner M, Michael L, et al. Long-term outcome after high tibial osteotomy. Arch Orthop Trauma Surg 2008;128:111–5. https://doi.org/10.1007/s00402-007-0438-0.
19. Akizuki S, Shibakawa A, Takizawa T, Yamazaki I, Horiuchi H. The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up. J Bone Joint Surg Br 2008;90:592–6. https://doi.org/10.1302/0301-620X.90B5.20386.
20. Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, et al. Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 2011;39:64–70. https://doi.org/10.1177/0363546510377445.
21. Laprade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2012;28:354–64. https://doi.org/10.1016/j.arthro.2011.08.310.
22. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: a retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:170–80. https://doi.org/10.1007/s00167-012-2087-2.
23. Liu JN, Agarwalla A, Garcia GH, Christian DR, Redondo ML, Yanke AB, et al. Return to sport following isolated opening wedge high tibial osteotomy. The Knee 2019;26:1306–12.
https://doi.org/10.1016/j.knee.2019.08.002.
24. Bonnin MP, Laurent J-R, Zadegan F, Badet R, Pooler Archbold HA, Servien E. Can patients really participate in sport after high tibial osteotomy? Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:64–73. https://doi.org/10.1007/s00167-011-1461-9.
25. Berruto M, Maione A, Tradati D, Ferrua P, Uboldi FM, Usellini E. Closing-wedge high tibial osteotomy, a reliable procedure for osteoarthritic varus knee. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020. https://doi.org/10.1007/s00167-020-05890-0.
26. Liu JN, Agarwalla A, Gomoll AH. High Tibial Osteotomy and Medial Meniscus Transplant. Clin Sports Med 2019;38:401–16. https://doi.org/10.1016/j.csm.2019.02.006.
27. Wright JM, Crockett HC, Slawski DP, Madsen MW, Windsor RE. High tibial osteotomy. J Am Acad Orthop Surg 2005;13:279–89. https://doi.org/10.5435/00124635-200507000-00007.
28. Rossi R, Bonasia DE, Amendola A. The role of high tibial osteotomy in the varus knee. J Am Acad Orthop Surg 2011;19:590–9.
https://doi.org/10.5435/00124635-201110000-00003.
29. Schuster P, Schulz M, Mayer P, Schlumberger M, Immendoerfer M, Richter J. Open-Wedge High Tibial Osteotomy and Combined Abrasion/Microfracture in Severe Medial Osteoarthritis and Varus Malalignment: 5-Year Results and Arthroscopic Findings After 2 Years. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2015;31:1279–88. https://doi.org/10.1016/j.arthro.2015.02.010.
30. Gao L, Madry H, Chugaev DV, Denti M, Frolov A, Burtsev M, et al. Advances in modern osteotomies around the knee : Report on the Association of Sports Traumatology, Arthroscopy, Orthopaedic surgery, Rehabilitation (ASTAOR) Moscow International Osteotomy Congress 2017. J Exp Orthop 2019;6:9. https://doi.org/10.1186/s40634-019-0177-5.
31. Kahlenberg CA, Nwachukwu BU, Hamid KS, Steinhaus ME, Williams RJ. Analysis of Outcomes for High Tibial Osteotomies Performed With Cartilage Restoration Techniques. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2017;33:486–92. https://doi.org/10.1016/j.arthro.2016.08.010.
32. Sterett WI, Steadman JR, Huang MJ, Matheny LM, Briggs KK. Chondral resurfacing and high tibial osteotomy in the varus knee: survivorship analysis. Am J Sports Med 2010;38:1420–4.
https://doi.org/10.1177/0363546509360403.
33. Bode G, Ogon P, Pestka J, Zwingmann J, Feucht M, Südkamp N, et al. Clinical outcome and return to work following single-stage combined autologous chondrocyte implantation and high tibial osteotomy. Int Orthop 2015;39:689–96. https://doi.org/10.1007/s00264-014-2547-z.
34. Agarwalla A, Christian DR, Liu JN, Garcia GH, Redondo ML, Gowd AK, et al. Return to Work Following High Tibial Osteotomy With Concomitant Osteochondral Allograft Transplantation. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2020;36:808–15. https://doi.org/10.1016/j.arthro.2019.08.046.
35. Hsu AC, Tirico LEP, Lin AG, Pulido PA, Bugbee WD. Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure. Cartilage 2018;9:248–54. https://doi.org/10.1177/1947603517710307.
36. Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J. Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 2014;30:1453–60. https://doi.org/10.1016/j.arthro.2014.05.036.
37. Barber-Westin SD, Noyes FR. Low-impact sports activities are feasible after meniscus transplantation: a systematic review. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2018;26:1950–8.
https://doi.org/10.1007/s00167-017-4658-8.
38. Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Surgical technique. J Bone Joint Surg Am 2006;88 Suppl 1 Pt 1:109–18.
https://doi.org/10.2106/JBJS.E.00875.
39. Verdonk PCM, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg Am 2005;87:715–24. https://doi.org/10.2106/JBJS.C.01344.
40. Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, Di Martino A, Di Matteo B, et al. Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:2509–17. https://doi.org/10.1007/s00167-013-2388-0.
41. Zaffagnini S, Bonanzinga T, Grassi A, Marcheggiani Muccioli GM, Musiani C, Raggi F, et al. Combined ACL reconstruction and closing-wedge HTO for varus angulated ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2013;21:934–41.
https://doi.org/10.1007/s00167-013-2400-8.
42. Bonin N, Ait Si Selmi T, Donell ST, Dejour H, Neyret P. Anterior cruciate reconstruction combined with valgus upper tibial osteotomy: 12 years follow-up. The Knee 2004;11:431–7.
https://doi.org/10.1016/j.knee.2004.02.001.
43. Trojani C, Elhor H, Carles M, Boileau P. Anterior cruciate ligament reconstruction combined with valgus high tibial osteotomy allows return to sports. Orthop Traumatol Surg Res OTSR 2014;100:209–12. https://doi.org/10.1016/j.otsr.2013.11.012.
44. Schneider A, Gaillard R, Gunst S, Batailler C, Neyret P, Lustig S, et al. Combined ACL reconstruction and opening wedge high tibial osteotomy at 10-year follow-up: excellent laxity control but uncertain return to high level sport. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:960–8. https://doi.org/10.1007/s00167-019-05592-2.
45. Mehl J, Paul J, Feucht MJ, Bode G, Imhoff AB, Südkamp NP, et al. ACL deficiency and varus osteoarthritis: high tibial osteotomy alone or combined with ACL reconstruction? Arch Orthop Trauma Surg 2017;137:233–40. https://doi.org/10.1007/s00402-016-2604-8.
46. Schuster P, Schlumberger M, Mayer P, Eichinger M, Geßlein M, Schulz-Jahrsdörfer M, et al. Excellent long-term results in combined high tibial osteotomy, anterior cruciate ligament reconstruction and chondral resurfacing in patients with severe osteoarthritis and varus alignment. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2020;28:1085–91. https://doi.org/10.1007/s00167-019-05671-4.
47. Dejour D, Saffarini M, Demey G, Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 2015;23:2846–52. https://doi.org/10.1007/s00167-015-3758-6.
48. van de Pol GJ, Arnold MP, Verdonschot N, van Kampen A. Varus alignment leads to increased forces in the anterior cruciate ligament. Am J Sports Med 2009;37:481–7. https://doi.org/10.1177/0363546508326715.
49. Walker J, Hartigan D, Stuart M, Krych A. Anterior Closing Wedge Tibial Osteotomy for Failed Anterior Cruciate Ligament Reconstruction. J Knee Surg Rep 2015;1:051–6. https://doi.org/10.1055/s-0035-1551548.
50. Gupta A, Tejpal T, Shanmugaraj A, Horner NS, Simunovic N, Duong A, et al. Surgical Techniques, Outcomes, Indications, and Complications of Simultaneous High Tibial Osteotomy and Anterior Cruciate Ligament Revision Surgery: A Systematic Review. HSS J Musculoskelet J Hosp Spec Surg 2019;15:176–84. https://doi.org/10.1007/s11420-018-9630-8..

How to Cite this article: Alesi D, Rinaldi VG, Meena A, Muccioli GMM, Zaffagnini S | Understanding osteotomy: a narrative review | Journal of Clinical Orthopaedics | January-June 2020; 5(1):21-30.

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Micro-core Decompression combined with Intralesional Zoledronic Acid as a treatment of Osteonecrosis of femoral Head: A Novel Technique

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Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page: 41-46 | Muhammed Ashraf, Jyothis George, Ibad Sha I

Author: Muhammed Ashraf [1], Jyothis George [1], Ibad Sha I [1]

[1] Department of Orthopedics, Government Medical College, Alappuzha.

Address of Correspondence
Dr. Muhammed Ashraf,
Professor and HOD
Department of Orthopedics
Government Medical College, Alappuzha
E-mail: dr.ashraf.hod@gmail.com

Abstract

Background: Avascular Necrosis / Osteonecrosis of the femoral head is a debilitating condition affecting the hip joint especially in the younger population and is one of the most common causes of total hip replacement in this age group. The available treatments include pharmacological and surgical options with Total hip arthroplasty (THA) being the main stay of treatment. Because of the disadvantages like implant loosening and need for revision surgery especially in young patients. We here is studying a novel technique of combining micro core decompression with intra-lesional bisphosphonate as treatment for osteonecrosis of hip.
Materials and Methods: A prospective study of 19 hips in 15 patients was done. There were 11 males and 4 females with an average age of 54.3 years ranging between 42 – 63 years. Four hips were stage I , ten hips were stage IIA, three hips were stage IIb and two hips were stage III. 16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The minimum period of follow up was 24 months. All patients were assessed clinically during pre- and post-operative period according to the Harris Hip Score (HHS) and radiologically by X-rays. The operative procedure include decompressing the avascular area with drilling then injecting the zolendronic acid locally through drill holes
Results: The mean preoperative modified Harris Hip Score in stage I(n=4), stage IIa(n=10), stage IIb(n=3) and Stage III(n=2) were 81.9, 72.7, 68.8 and 59.2 respectively. The mean postoperative modified Harris Hip Score at two years in stage I, stage IIa, stage IIb and Stage III were 97.3, 91.1, 88.4 and 82.5 respectively.
Conclusion: We found that the use of micro core-decompression with intra-lesional bisphosphonate will provide higher chances towards hip preservation especially in late cases or cases with larger lesions where core decompression may not be successful.
Keywords: Intra-lesional bisphosphonate, Avascular necrosis hip, Hip preservation surgery, Micro core-decompression.

References

1. Baig SA, Baig MN. Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management. Cureus. 2018;10(8):e3171. Published 2018 Aug 21.
2. Kakaria HL, Sharma AK, Sebastian B. Total Hip Replacement in Avascular Necrosis of Femoral Head. Med J Armed Forces India. 2005;61(1):33‐35.
3. Vardhan H, Tripathy SK, Sen RK, Aggarwal S, Goyal T. Epidemiological Profile of Femoral Head Osteonecrosis in the North Indian Population. Indian J Orthop. 2018;52(2):140‐146. doi:10.4103/ortho.IJOrtho_292_16
4. Boskey AL, Raggio CL, Bullough PG, Kinnett JG. Changes in the bone tissue lipids in persons with steroid- and alcohol-induced osteonecrosis. Clin Orthop Relat Res. 1983;172:289–95.
5. Matsuo K, Hirohata T, Sugioka Y, Ikeda M, Fukuda A. Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res. 1988;234:115–23.
6. Koo KH, Kim R, Kim YS, Ahn IO, Cho SH, Song HR, et al. Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment. Clin Rheumatol. 2002;21:299–303
7. Moya-Angeler J, Gianakos A, Villa J, Ni A, Lane J (2015) Current concepts on osteonecrosis of the femoral head. World J Orthop 6:590–601
8. Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: Management in the 21st century. Instr Course Lect. 2003;52:337–55.
9. Sen RK. Management of avascular necrosis of femoral head at pre-collapse stage. Indian J Orthop. 2009;43:6–16.
10. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459–74.
11. Assouline-Dayan, Y., Chang, C., Greenspan, A., Shoenfeld, Y., & Gershwin, M. E. (2002). Pathogenesis and natural history of osteonecrosis. Seminars in Arthritis and Rheumatism, 32(2), 94–124.
12. Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ. Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: a two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2012;64:1572–1578.
13. Peled E, Bejar J, Barak M, Orion E, Norman D. Core decompression and alendronate treatment of the osteonecrotic rat femoral head: computer-assisted analysis. Int J Exp Pathol. 2013;94:212–216.
14. Ficat P, Arlet J, Vidal R, Ricci A, Fournial JC. Therapeutic results of drill biopsy in primary osteonecrosis of the femoral head (100 cases) Rev Rhum Mal Osteoartic. 1971;38:269–276.
15. Polkowski, G. G., Callaghan, J. J., Mont, M. A., & Clohisy, J. C. (2012). Total Hip Arthroplasty in the Very Young Patient. Journal of the American Academy of Orthopaedic Surgeons, 20(8), 487–497.
16. Arlet J, Ficat RP (1964) Forage-biopsie de la tete femorale dans 1’osteonecrose primative. Observations histopathologiques portant sur huit foranes. Rev Rhum Ed Fr 31: 257-264.
17. Marker DR, Seyler TM, Ulrich SD, Srivastava S, Mont MA. Do modern techniques improve core decompression outcomes for hip osteonecrosis? Clin Orthop Relat Res. 2008;466(5):1093.
18. Rajagopal M, Balch Samora J, Ellis TJ. Efficacy of core decompression as treatment for osteonecrosis of the hip: a systematic review. Hip Int J Clin Exp Res Hip pathol Ther. 2012;22(5):489. [
19. Mohanty SP, Singh KA, Kundangar R, Shankar V. Management of non-traumatic avascular necrosis of the femoral head—a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. Musculoskelet Surg. 2017;101:59–66. doi: 10.1007/s12306-016-0431-2.
20. Kim SY, Kim DH, Park IH. Multiple drilling compared with core decompression for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Br. 2004;86:149.
21. Song, W. S., Yoo, J. J., Kim, Y.-M., & Kim, H. J. (2007). Results of Multiple Drilling Compared with Those of Conventional Methods of Core Decompression. Clinical Orthopaedics and Related Research, 454, 139–146
22. Li, J., Li, Z.-L., Zhang, H., Su, X.-Z., Wang, K.-T., & Yang, Y.-M. (2017). Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head. Chinese Medical Journal, 130(12), 1435–1440.
23. Müller I, Vaegler M, Holzwarth C, Tzaribatchev N, Pfister SM, Schütt B, et al. Secretion of angiogenic proteins by human multipotent mesenchymal stromal cells and their clinical potential in the treatment of avascular osteonecrosis. Leukemia. 2008;22:2054–61.
24. Kawate K, Yajima H, Ohgushi H, Kotobuki N, Sugimoto K, Ohmura T, et al. Tissue-engineered approach for the treatment of steroid-induced osteonecrosis of the femoral head: Transplantation of autologous mesenchymal stem cells cultured with beta-tricalcium phosphate ceramics and free vascularized fibula. Artif Organs. 2006;30:960–2.
25. Zhang C, Zeng B, Xu Z, Song W, Shao L, Jing D, et al. Treatment of femoral head necrosis with free vascularized fibula grafting: A preliminary report. Microsurgery. 2005;25:305–9.
26. Fang T, Zhang EW, Sailes FC, McGuire RA, Lineaweaver WC, Zhang F. Vascularized fibular grafts in patients with avascular necrosis of femoral head: A systematic review and meta-analysis. Arch Orthop Trauma Surg. 2013;133:1–10.
27. Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology (Oxford) 2005;44:352–9.
28. Agarwala S, Shah SB. Ten-year followup of avascular necrosis of femoral head treated with alendronate for 3 years. J Arthroplasty. 2011;26:1128–34.
29. Nishii T, Sugano N, Miki H, Hashimoto J, Yoshikawa H. Does alendronate prevent collapse in osteonecrosis of the femoral head? Clin Orthop Relat Res. 2006;443:273–9.
30. Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ. Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: A two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2012;64:1572–8.
31. Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am. 2005;87:2155–9.
32. Wang, J.-A. (2014). Evidence for Using Alendronate to Treat Adult Avascular Necrosis of the Femoral Head: A Systematic Review. Medical Science Monitor, 20, 2439–2447.
33. Kumar V, Shahi AK. Nitrogen containing bisphosphonates associated osteonecrosis of the jaws: A review for past 10 year literature. Dent Res J (Isfahan). 2014;11(2):147‐153.

How to Cite this article: Ashraf N, George J, Sha II. Micro-core Decompression combined with Intralesional Zoledronic Acid as a treatment of Osteonecrosis of femoral Head: A Novel Technique. Journal of Clinical Orthopaedics Jan-Jun 2020;5(1):  41-46.

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The Role of Serum Procalcitonin in Establishing Diagnosis of Bone and Joint Infections

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Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 3-7 | John Nolan, Putu Feryawan Meregawa

Author: John Nolan [1], Putu Feryawan Meregawa [2]

[1] Faculty of Medicine, Udayana University, Denpasar.
[2] Departement of Orthopaedic and Traumatology, Medical Faculty, Udayana University-Sanglah General Hospital Denpasar, Indonesia.

Address of Correspondence
John Nolan,
Faculty of Medicine, Udayana University, Denpasar
E-mail: johnnolan@student.unud.ac.id

Abstract

Background: Acute bone and joint infection such as septic arthritis and osteomyelitis diagnostic are still considered as a pitfall especially in the emergency department. Some laboratory markers, such as total Count (TC), Erythrocyte Sedimentation Rate (ESR) and C – Reactive Protein (CRP) assessed regularly whereas those are not specific. Serum PCT has a role as a sensitive and specific marker in supporting the diagnosis of bone and joint infections.
Method: Literature review is done by searching journals with “serum procalcitonin”, “bone infections”, “diagnosis”, and “joint infections” on the search engines. From 37 journals that were reviewed, 34 were found suitable as reference for this paper.
Outcome: High level of serum PCT indicate the activation of immune system, specifically the innate immune system due to microbial infections. One of the most different aspect with CRP is serum PCT infrequently elevates in response to viral infection, which means PCT is useful in differentiating bacterial and viral infections Serum PCT concentration elevates following the endotoxin or cytokines release such as interleukin (IL)- 6, tumor necrosis factor (TNF)-alpha, and IL-1b which usually appears in bone and joint infections. Although its benefits, there are some limitation interfering the usage and levels of serum PCT.
Conclusion: Serum PCT has a role as a sensitive and specific marker in supporting the diagnosis of bone and joint infections due to its sensitivity following endotoxins release. Further researches and studies are required to identify the appropriate usage, interfering factors, and clinical application of serum PCT in establishing the diagnosis of bone and joint infections.
Keywords: Procalcitonin, Bone infections, joint infections, Diagnosis.

References

1. Calhoun J, Manring M, Shirtliff M. Osteomyelitis of the Long Bones. Seminars in Plastic Surgery. 2009;23(02):059-072.
2. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. Journal of paediatrics and child health. 2005 Jan;41(1‐2):59-62.
3. Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. The Lancet. 2010 Mar 6;375(9717):846-55.
4. Timsit S, Pannier S, Glorion C, Chéron G. Acute osteomyelitis and septic arthritis in children: one year experience. Archives de pediatrie: organe officiel de la Societe francaise de pediatrie. 2005 Jan;12(1):16-22.
5. Bonhoeffer J, Haeberle B, Schaad UB, Heininger U. Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children’s Hospital Basel. Swiss medical weekly. 2001 Oct 6;131(39-40):575-81.
6. Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton III LJ, Huddleston III PM. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. The Journal of bone and joint surgery. American volume. 2015 May 20;97(10):837.
7. Perron AD, Brady WJ, Miller MD. Orthopedic pitfalls in the ED: osteomyelitis. The American journal of emergency medicine. 2003 Jan 1;21(1):61-7.
8. Kolinsky DC, Liang SY. Musculoskeletal Infections in the Emergency Department. Emergency Medicine Clinics. 2018 Nov 1;36(4):751-66.
9. Shen CJ, Wu MS, Lin KH, Lin WL, Chen HC, Wu JY, Lee MH, Lee CC. The use of procalcitonin in the diagnosis of bone and joint infection: a systemic review and meta-analysis. European journal of clinical microbiology & infectious diseases. 2013 Jun 1;32(6):807-14.
10. Maharajan K, Patro DK, Menon J, Hariharan AP, Parija SC, Poduval M, Thimmaiah S. Serum Procalcitonin is a sensitive and specific marker in the diagnosis of septic arthritis and acute osteomyelitis. Journal of orthopaedic surgery and research. 2013 Dec 1;8(1):19.
11. Casado JF, Blanco AQ. Procalcitonin. A new marker for bacterial infection. Anales espanoles de pediatria. 2001 Jan;54(1):69-73.
12. Alkholi UM, Al-Monem NA, El-Azim AA, Sultan MH. Serum procalcitonin in viral and bacterial meningitis. Journal of global infectious diseases. 2011 Jan;3(1):14.
13. Wang C, Zhong DA, Liao Q, Kong L, Liu A, Xiao H. Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis. Experimental and therapeutic medicine. 2014 Oct 1;8(4):1075-80.
14. Saeed K, Dryden M, Sitjar A, White G. Measuring synovial fluid procalcitonin levels in distinguishing cases of septic arthritis, including prosthetic joints, from other causes of arthritis and aseptic loosening. Infection. 2013 Aug 1;41(4):845-9.
15. Sigmund IK, McNally MA. Diagnosis of bone and joint infections. Orthopaedics and Trauma. 2019 Jun 1;33(3):144-52.\
16. Tsaras G, Maduka-Ezeh A, Inwards CY, Mabry T, Erwin PJ, Murad MH, Montori VM, West CP, Osmon DR, Berbari EF. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. JBJS. 2012 Sep 19;94(18):1700-11.
17. Unkila-Kallio L, Kallio MJ, Peltola H, Eskola J. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics. 1994 Jan 1;93(1):59-62.
18. Gaigneux E, Cormier G, Varin S, Mérot O, Maugars Y, Le Goff B. Ultrasound abnormalities in septic arthritis are associated with functional outcomes. Joint Bone Spine. 2017 Oct 1;84(5):599-604.
19. Merlini L, Anooshiravani M, Ceroni D. Concomitant septic arthritis and osteomyelitis of the hip in young children; a new pathophysiological hypothesis suggested by MRI enhancement pattern. BMC medical imaging. 2015 Dec 1;15(1):17.
20. Fritz JM, McDonald JR. Osteomyelitis: approach to diagnosis and treatment. The Physician and sportsmedicine. 2008 Jan 1;36(1):50-4.
21. Wang S, Yin P, Quan C, Khan K, Wang G, Wang L, Cui L, Zhang L, Zhang L, Tang P. Evaluating the use of serum inflammatory markers for preoperative diagnosis of infection in patients with nonunions. BioMed research international. 2017;2017.
22. Colston J, Atkins B. Bone and joint infection. Clinical Medicine. 2018 Apr;18(2):150.
23. Assicot M, Bohuon C, Gendrel D, Raymond J, Carsin H, Guilbaud J. High serum procalcitonin concentrations in patients with sepsis and infection. The Lancet. 1993 Feb 27;341(8844):515-8.
24. Koramutla HK, Koyagura B, Ravindran B. Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study. International Journal of Research in Orthopaedics. 2018 Jul;4(4):601.
25. Ibrahim KA, Abdel-Wahab AA, Ibrahim AS. Diagnostic value of serum procalcitonin levels in children with meningitis: a comparison with blood leukocyte count and C-reactive protein. JPMA-Journal of the Pakistan Medical Association. 2011 Apr 1;61(4):346.
26. Chan T, Gu F. Early diagnosis of sepsis using serum biomarkers. Expert review of molecular diagnostics. 2011 Jun 1;11(5):487-96.
27. Agency for Healthcare Research and Quality. Effective Health Care Program. EPC Project. Project Title: Procalcitonin for diagnosis and Management of Sepsis. Research protocol. 2011. Apr, Available at:http://www.effectivehealthcare.ahrq.gov
28. Schuetz P, Christ-Crain M, Muller B. Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections–hope for hype?. Swiss medical weekly. 2009 Jun 13;139(23):318.
29. Mehanic S, Baljic R. The importance of serum procalcitonin in diagnosis and treatment of serious bacterial infections and sepsis. Materia socio-medica. 2013 Dec;25(4):277.
30. Christ-Crain M, Muller B. Procalictonin–you only find what you look for, and you only look for what you know. J Am Geriatr Soc. 2006 Mar 1;54(3):546.
31. Limper M, De Kruif MD, Duits AJ, Brandjes DP, van Gorp EC. The diagnostic role of procalcitonin and other biomarkers in discriminating infectious from non-infectious fever. Journal of Infection. 2010 Jun 1;60(6):409-16.
32. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, Ritz R. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Critical care medicine. 2000 Apr 1;28(4):977-83.
33. Koramutla HK, Koyagura B, Ravindran B. Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study. International Journal of Research in Orthopaedics. 2018 Jul;4(4):601.
34. Reinhart K, Bauer M, Riedemann NC, Hartog CS. New approaches to sepsis: molecular diagnostics and biomarkers. Clinical microbiology reviews. 2012 Oct 1;25(4):609-34..

How to Cite this article: Nolan J, Meregawa P.F. The Role of Serum Procalcitonin in Establishing Diagnosis of Bone and Joint Infections. Journal of Clinical Orthopaedics Jan-Jun 2020;5(1): 3-7.

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Thoughts on Anterior Cruciate Ligament Surgery over the Past 40 Years: Back to the Future

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Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020 | page:15-20 | Chad Lasceski, Chris Nacca, Sarav S. Shah, John C. Richmond

Author: Chad Lasceski [1], Chris Nacca [1], Sarav S. Shah [1], John C. Richmond [2]

[1] Department of Orthopedics 4th Floor 125 Parker Hill Avenue, Boston, MA 02120
[2] Department of Orthopedics Surgery 4th Floor 125 Parker Hill Avenue, Boston, MA 02120

Address of Correspondence
Dr. John C. Richmond,
Department of Orthopedics Surgery 4th Floor 125 Parker Hill Avenue, Boston, MA 02120
E-mail: jrichmon@nebh.org

Abstract

Surgical treatment of anterior cruciate injury (ACL) has evolved over the last 40 years. Both patient as well as surgeon considerations must be made to optimize the successful treatment of an ACL injured patient. The focus of this paper is to discuss several of the many important issues that continue as topics of discussion in the literature and on the podium. These include graft selection and preparation, the role of anterior cruciate ligament repair, extra-articular tenodesis, and posterior tibial slope (PTS). We will present the current data as it pertains to these topics and include the senior author’s preferences derived from 40 years of personal experience.
Keywords: ACL reconstruction, ACL repair, extra-articular tenodesis, ACL graft choice, posterior tibial slope.

References

1. Gordon MD, Steiner ME. Anterior cruciate ligament injuries. In: Orthopaedic Knowledge Update Sports Medicine III, Garrick JG (Ed), American Academy of Orthopaedic Surgeons, Rosemont 2004. p.169
2. Albright JC, Carpenter JE, Graf BK, et al. Knee and leg: soft tissue trauma. In: Orthopaedic Knowledge Update 6, Beaty JH (Ed), American Academy of Orthopaedic Surgeons, Rosemont 1999. p.533
3. Miyasaka KC, Daniel DM, Stone ML. The incidence of knee ligament injuries in the general population. Am J Knee Surg. 1991; 4:43.
4. Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee–the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am. 1976;58(5):583-94.
5. Daniel DM, Stone ML, Dobson BE, et al. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994;22(5):632–644.
6. Georgoulis AD, Ristanis S, Moraiti CO, et al. ACL injury and reconstruction: Clinical related in vivo biomechanics. Orthop Traumatol Surg Res. 2010;96(8 Suppl):S119–S128.
7. Loh JC, Fukuda Y, Tsuda E, et al. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy. 2003;19(3):297–304
8. Ajuied A, Wong F, Smith C, et al. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2014;42(9):2242–2252.
9. Øiestad BE, Holm I, Risberg MA. Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up. Br J Sports Med. 2018;52(18):1199–1204.
10. Goldblatt J.P., Fitzsimmons S.E., Balk E., Richmond J.C. Reconstruction of the anterior cruciate ligament: Meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy. 2005;21:791–803.
11. Biau DJ, Katsahian S, Kartus J, et al. Patellar tendon versus hamstring tendon autografts for reconstructing the anterior cruciate ligament: a meta-analysis based on individual patient data. Am J Sports Med. 2009;37(12):2470–2478.
12. Gifstad T, Foss OA, Engebretsen L, et al. Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med. 2014;42(10):2319–2328.
13. Rahardja R, Zhu M, Love H, Clatworthy MG, Monk AP, Young SW. Effect of graft choice on revision and contralateral anterior cruciate ligament reconstruction: Results from the New Zealand ACL Registry. Am J Sports Med. 2020;48(1):63–69.
14. MOON Knee Group, Spindler KP, Huston LJ, et al. Anterior cruciate ligament reconstruction in high school and college-aged athletes: Does autograft choice influence anterior cruciate ligament revision rates? Am J Sports Med. 2020;48(2):298–309.
15. Chee MY, Chen Y, Pearce CJ, et al. Outcome of patellar tendon versus 4-strand hamstring tendon autografts for anterior cruciate ligament reconstruction: A systematic review and meta-analysis of prospective randomized trials. Arthroscopy. 2017;33(2):450–463.
16. Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT, Parker RD, Kaeding CC, Magnussen RA. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy. 2013 Dec;29(12):1948-53.
17. Figueroa F, Figueroa, Espregueira-Mendes J. Hamstring autograft size importance in anterior cruciate ligament repair surgery. EFORT Open Rev 2018;3:93-97.
18. Kaeding CC, Pedroza AD, Reinke EK, et al. Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: Prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med. 2015;43(7):1583-1590.
19. Vertullo CJ, Quick M, Jones A, Grayson JE. A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy. 2012;28(3):337-342.
20. Baron JE, Shamrock AG, Cates WT, Cates RA, An Q, Wolf BR, et al. Graft preparation with intraoperative vancomycin decreases infection after ACL reconstruction. J Bone Joint Surg Am. 2019;101(24):2187-2193.
21. Nakayama H, Yagi M, Yoshiya S, Takesue Y. Micro-organism colonization and intra-operative contamination in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 2012;28(5):667–671.
22. Feagin JA, Abbott HG, Rokous JA. The isolated tear of the anterior cruciate ligament. J Bone Joint Surg Am. 1972;54(6):1340-1341.
23. Feagin JA, Curl WW. Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 1976;4(3):95-100.
24. Taylor DC, Posner M, Curl WW, Feagin JA. Isolated tears of the anterior cruciate ligament. Over 30-year follow-up of patients treated with arthrotomy and primary repair. Am J Sports Med. 2009;37(1):65-71.
25. Kaplan N, Wickiewicz TL, Warren RF. Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study. Am J Sports Med. 1990;18(4):354-358.
26. Jonkergouw A, Van der List JP, DiFelice GS. Arthoroscopic primary repair of proximal anterior cruciate ligament tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthros 2019 Jan; 27(1):21-28.
27. Van der List JP, Jonkergouw A, van Noort A, Kerkhoffs GMMJ, DiFelice GS. Identifying candidates for arthroscopic primary repair of the anterior cruciate ligament: A case-control study. Knee. 2019 Jun;26(3):619-627
28. Nwachukwu BU, Patel BH, Allen AA, Williams RJ. Anterior cruciate ligament repair outcomes: An updated systematic review of recent literature. Arthroscopy. 2019 July;35(7)2233-2247.
29. Waryasz GR, Marcaccio S, Gil JA, Owens BD, Fadale PD. Anterior cruciate ligament repair and biologic innovations. JBJS Rev. 2017;5(5): http://dx.doi.org/10.2106/JBJS.RVW.16.00050
30. Dunn MG, Liesch JB, Tiku ML, Zawadsky JP. Development of fibroblast-seeded ligament analogs for ACL reconstruction. J Biomed Mater Res. 1995;29(11):1363-1371.
31. Murray MM, Kalish LA, Fleming BC, et al. Bridge-enhanced anterior cruciate ligament repair: Two-year results of a first-in-human study. Ortho J Sports Med. 2019;7(3):1-13.
32. Segond P. Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Progrès Médical 1879; 16: 297–299, 319–321, 340–341
33. Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am. 1976;58(2):173–179.
34. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;223(4):321–328. doi:10.1111/joa.12087
35. Song GY, Hong L, Zhang H, Zhang J, et al. Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon. Arthroscopy. 2016;32(5):898–905.
36. Sonnery-Cottet B, Barbosa NC, Vieira TD, Saithna A. Clinical outcomes of extra-articular tenodesis/anterolateral reconstruction in the ACL injured knee. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):596–604.
37. Sonnery-Cottet B, Saithna A, Frois Temponi E, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: A prospective comparative study of 502 patients from the SANTI study group. Am J Sports Med. 2017;45(7):1547-1557.
38. Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY study randomized clinical trial. Am J Sports Med. 2020;48(2):285–297.
39. Ferreira Mde C, Zidan FF, Miduati FB, et al. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings – technical note. Rev Bras Ortop. 2016;51(4):466–470.
40. Todd MS, Laliss S, Garcia E, et al. The relationship between posterior tibial slope and anterior cruciate ligament injuries. Am J Sports Med. 2010;38(1):63-67.
41. Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, et al. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient. Am J Sports Med. 2013;41(12):2800-2804.
42. Dejour D, Saffarini M, Demey G, Baverel L. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):2846-2852.

How to Cite this article: Lasceski C, Nacca C, Shah SS, Richmond JC. Thoughts on Anterior Cruciate Ligament Surgery over the Past 40 Years: Back to the Future . Journal of Clinical Orthopaedics Jan-Jun 2020;5(1): 15-20.

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Peri prosthetic fractures after total knee arthroplasty

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Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 36-40 | Shubhranshu S. Mohanty, Swapnil A. Keny, Ashwin Sathe

Author: Shubhranshu S. Mohanty [1], Swapnil A. Keny [1], Ashwin Sathe [1]

[1] Department of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.

Address of Correspondence
Dr. Shubhranshu S. Mohanty,
Department of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.
E-mail: drssmohanty@hotmail.com

Abstract

Background: The risk of periprosthetic fracture following TKA is particularly high because most of the TKA patients are elderly and also have osteoporosis. The management remains challenging as a result of poor bone stock, pre-existing implant and bone cement that may impede fracture reduction and fixation, predisposing to non-union or malunion . This article is a comprehensive review of Periprosthetic fractures following total knee replacement surgery along with their management algorithms.
Keywords: Total knee arthroplasty, Preprosthetic fracture, Review.

References

1. Yoo JD, Kim NK. Periprosthetic Fractures Following Total Knee Arthroplasty. Knee Surg Relat Res [Internet]. 2015 [cited 2019 Aug 21];27(1):1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349639/
2. Lindahl H, Garellick G, Regnér H, Herberts P, Malchau H. Three Hundred and Twenty-one Periprosthetic Femoral Fractures. J Bone Jt Surg [Internet]. 2006 Jun [cited 2019 Aug 21];88(6):1215–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16757753
3. Agarwal S, Sharma RK, Jain JK. Periprosthetic Fractures after Total Knee Arthroplasty. J Orthop Surg [Internet]. 2014 Apr [cited 2019 Aug 26];22(1):24–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24781608
4. Herrera DA, Kregor PJ, Cole PA, Levy BA, Jönsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: Systematic review of 415 cases (1981–2006). Acta Orthop [Internet]. 2008 Jan 8 [cited 2019 Aug 24];79(1):22–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18283568
5. Lindahl H, Malchau H, Herberts P, Garellick G. Periprosthetic Femoral Fractures. J Arthroplasty [Internet]. 2005 Oct [cited 2019 Aug 22];20(7):857–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16230235
6. McGraw P, Kumar A. Periprosthetic fractures of the femur after total knee arthroplasty. J Orthop Traumatol [Internet]. 2010 Sep [cited 2019 Aug 25];11(3):135–41. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20661762
7. LESH ML, SCHNEIDER DJ, DEOL G, DAVIS B, JACOBS CR, PELLEGRINI VD. The Consequences of Anterior Femoral Notching in Total Knee Arthroplasty. J Bone Jt Surgery-American Vol [Internet]. 2000 Aug [cited 2019 Aug 25];82(8):1096–101. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10954098
8. Marsland D, Mears SC. A Review of Periprosthetic Femoral Fractures Associated With Total Hip Arthroplasty. Geriatr Orthop Surg Rehabil [Internet]. 2012 Sep [cited 2019 Aug 21];3(3):107. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23569704
9. Rorabeck CH, Taylor JW. Classification of periprosthetic fractures complicating total knee arthroplasty. Orthop Clin North Am [Internet]. 1999 Apr [cited 2019 Aug 25];30(2):209–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10196422
10. Chimutengwende-Gordon M, Khan W, Johnstone D. Recent Advances and Developments in Knee Surgery: Principles of Periprosthetic Knee Fracture Management. Open Orthop J [Internet]. 2012 Jul 27 [cited 2019 Aug 26];6(1):301–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22888380
11. Felix NA, Stuart MJ, Hanssen AD. Periprosthetic fractures of the tibia associated with total knee arthroplasty. Clin Orthop Relat Res [Internet]. 1997 Dec [cited 2019 Aug 26];(345):113–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9418628
12. Schreiner AJ, Schmidutz F, Ateschrang A, Ihle C, Stöckle U, Ochs BG, et al. Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue. BMC Musculoskelet Disord [Internet]. 2018 Dec 11 [cited 2019 Aug 26];19(1):323. Available from: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2250-0
13. ORTIGUERA CJ, BERRY DJ. PATELLAR FRACTURE AFTER TOTAL KNEE ARTHROPLASTY. J Bone Jt Surgery-American Vol [Internet]. 2002 Apr [cited 2019 Aug 26];84(4):532–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11940611
14. Chalidis BE, Tsiridis E, Tragas AA, Stavrou Z, Giannoudis P V. Management of periprosthetic patellar fractures. A systematic review of literature. Injury. 2007 Jun;38(6):714–24.

How to Cite this article: Mohanty SS, Keny SA, Sathe A| Peri prosthetic fractures after total knee arthroplasty | Journal of Clinical Orthopaedics | January-June 2020; 5(1):36-40.

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Is Telemedicine here to stay?

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Journal of Clinical Orthopaedics | Vol Vol 5 | Issue 1 |  Jan-Jun 2020 | page:1-2 | Dr. Nicholas Antao, Dr. Ashok Shyam

Author: Dr. Nicholas Antao [1], Dr. Ashok Shyam [2, 3]

[1] Hill Way Clinic, Hill N Dale Building, 4th Floor, Hill Road, Bandra West, Mumbai – 400050
[2] Sancheti Institute for Orthopaedics and Rehablitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence
Dr. Nicholas Antao
Head of Dept. of Orthopaedics, Holy Spirit Hospital, Mahakali Road, Andheri (E), Mumbai – 400093 India.
Email: narantao@gmail.com

Is Telemedicine here to stay?

Clinical medicine has evolved over the years and time. It involves listening to the patient complaints, analysing them, and then correlating them with the symptoms and signs to arrive at a suitable diagnosis. Our teachers were so clinically astute, and were thorough in the examination and elicitation of the signs of the clinical disorder of the patient, which always left a vivid lasting impression on the student. They hammered these principles in our minds during our training. As exam going students, we would be expected to perfect this clinical judgement and have both a diagnosis and thoughts of differential diagnosis at hand.
In a busy orthopaedic OPD in a public hospital, there were patients who would come over and over again, so much so, their thick OPD papers with standard (ctall) continue all, one wondered at the motivation of these patients to keep coming to see the doctor, and to take the same tablets over and over again. Were they there to experience the care and compassion of the doctor’s touch? or the value of being healed in their pain. Surprisingly this feel good factor seemed to mitigate the discomfort of waiting for hours in endless queues. There were certainly an equal number with genuine complaints to be attended to, who were given suitable and sufficient time for proper assessment to arrive at a diagnosis.
In the Covid19 pandemic that we are experiencing, telemedicine has radically and quickly altered how medical practitioners can provide care to their patients, within approved guidelines. Technology is being made use of to deliver health care services. Some research studies provide theoretical and practical evidence on the significance of using telemedicine and virtual care for remote treatment of patients during this pandemic. It is felt that it reduces face to face contact among physicians and patients, social distancing and protect both the patient and the doctor from the infection.
In a vast country like India with its diverse culture and different level of educational and social backgrounds, people may not be accustomed to using this technology. In some of the smaller cities and towns, challenges like network connectivity disturbances in the bandwidth and even absence of smart phones and devices hinder the use of telemedicine.
Starting telemedicine services in government and semi government and charitable hospitals will entail not just a financial outlay but also call for sound technical support. Many hospitals do not have the resources and infrastructure to change their mind set and some institutions are even reluctant to upgrade their old systems to digital technology. The government needs to support the health system by infusing more funds to facilitate the availability of this technology.
Another great challenge with the introduction of telemedicine will be the inability to do the various clinical tests on the patients and solely rely on patients’ movements and imaging studies reports. The clinician will soon lose the clinical touch, and this will result an attempt to treat the imaging diagnosis, rather than tailor the treatment to the patient needs and symptomatology and signs.
Telemedicine is necessary and it is a powerful tool in the hands of medicine and it is the field which is emerging and futuristic. However there are issues of not having proper legislation in place, challenges of upgrading the infrastructure, training of the staff, financial constraints, irregularity of the band width which can be a major constraint in the further application of the digital technology and widespread usage, and for the individual patient not having the proper technology backup to avail of telemedicine facilities may be an area of concern. Issues relating to payment for services rendered will have to be analysed, as in some cases and most especially for senior citizens, transfer of funds and payments via portals, may be a challenge.
Although telemedicine will give the medical professional an opportunity to social distancing and work during a pandemic, it will contradict and oppose our clinical acumen that is our hallmark of our profession. With telemedicine, we run the risk of challenging our professional joy of using our professional expertise to arrive at a diagnosis and treat the patient with a holistic approach.

Dr Nicholas Antao
Dr Ashok Shyam.

How to Cite this article: Antao N, Shyam AK. Is Telemedicine here to stay?. Journal of Clinical Orthopaedics Jan-Jun 2020;5(1):1-2.

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Cartilage Repair: What Works in Young Arthritic Knees

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Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 8-14 | Gonzalo Samitier, Gustavo Vinagre, Patricia Laiz Boada, Montserrat Cugat Balletbó, Maria Sava, Eduard Alentorn-Geli, Ramón Cugat Bertomeu

Author:Gonzalo Samitier [1], Gustavo Vinagre [3], Patricia Laiz Boada [1,2], Montserrat Cugat Balletbó [1,2], Maria Sava [4], Eduard Alentorn-Geli [5], Ramón Cugat Bertomeu [5].

[1] Department of Orthopaedic and Traumatology Surgery at Instituto Cugat, Barcelona.
[2] Fundación García Cugat, Barcelona.
[3] Department of Orthopaedic Surgery, Aspetar Orthopaedic & Sports Medicine Hospital, Doha, Qatar.
[4] Western University oh Health Sciences, Pomona, California, United States.
[5] Mutualidad de Futbolistas Españoles, Delegación Catalana, Federación Española de Fútbol, Barcelona, Spain.

Address of Correspondence
Dr. Gonzalo Samitier,
Department of Orthopaedic and Traumatology Surgery at Instituto Cugat, Barcelona.
E-mail: gsamitier@sportrauma.com

Abstract

Cartilage repair is one of the most challenging treatments due to the specificity, complex structure and biomechanical behavior of the cartilage tissue. Chondral injuries and damage have several clinical implications and can lead to patients’ daily and sports limitations or restrictions, along with future degeneration.There are various cartilage surgical techniques described for cartilage repair and further research has been made to improve orthobiological assessment for those conditions. In this review article we aim for an updated overview of what can works in young arthritic knees..
Keywords: Cartilage, Chondral, orthobiological, arthritic knees.

References

1. Cole BJ, Pascual-Garrido C, Grumet RC. Surgical management of articular cartilage defects in the knee. J Bone Joint Surg Am. 2009;91(7):1778-90.
2. Gudas R, Simonaityte R, Cekanauskas E, Tamosiunas R. A prospective, randomized clinical study of osteochondral autologous transplantation versus microfracture for the treatment of osteochondritis dissecans in the knee joint in children. J Pediatr Orthop. 2009;29(7):741-8.
3. Knutsen G, Drogset JO, Engebretsen L, Grontvedt T, Ludvigsen TC, Loken S, et al. A Randomized Multicenter Trial Comparing Autologous Chondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years. J Bone Joint Surg Am. 2016;98(16):1332-9.
4. Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19(5):477-84.
5. De Windt TS, Bekkers JE, Creemers LB, Dhert WJ, Saris DB. Patient profiling in cartilage regeneration: prognostic factors determining success of treatment for cartilage defects. Am J Sports Med. 2009;37 Suppl 1:58S-62S.
6. Kreuz PC, Muller S, Ossendorf C, Kaps C, Erggelet C. Treatment of focal degenerative cartilage defects with polymer-based autologous chondrocyte grafts: four-year clinical results. Arthritis Res Ther. 2009;11(2):R33.7. Noyes FR, Stabler CL. A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med. 1989;17(4):505-13.
7. Noyes FR, Stabler CL. A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med. 1989;17(4):505-13.
8. Goyal D, Keyhani S, Lee EH, Hui JH. Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy. 2013;29(9):1579-88.
9. Williams RJ, 3rd, Harnly HW. Microfracture: indications, technique, and results. Instr Course Lect. 2007;56:419-28.
10. Eldracher M, Orth P, Cucchiarini M, Pape D, Madry H. Small subchondral drill holes improve marrow stimulation of articular cartilage defects. Am J Sports Med. 2014;42(11):2741-50.
11. Chung JY, Lee DH, Kim TH, Kwack KS, Yoon KH, Min BH. Cartilage extra-cellular matrix biomembrane for the enhancement of microfractured defects. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1249-59.
12. Shive MS, Stanish WD, McCormack R, Forriol F, Mohtadi N, Pelet S, et al. BST-CarGel(R) Treatment Maintains Cartilage Repair Superiority over Microfracture at 5 Years in a Multicenter Randomized Controlled Trial. Cartilage. 2015;6(2):62-72.
13. Kordas G, Szabo JS, Hangody L. Primary stability of osteochondral grafts used in mosaicplasty. Arthroscopy. 2006;22(4):414-21.
14. Solheim E, Hegna J, Inderhaug E. Long-term clinical follow-up of microfracture versus mosaicplasty in articular cartilage defects of medial femoral condyle. Knee. 2017;24(6):1402-7.
15. Nakagawa Y, Mukai S, Setoguchi Y, Goto T, Furukawa T, Nakamura T. Clinical Outcomes of Donor Sites After Osteochondral Graft Harvest From Healthy Knees. Orthop J Sports Med. 2017;5(10):2325967117732525.
16. Pearce SG, Hurtig MB, Clarnette R, Kalra M, Cowan B, Miniaci A. An investigation of 2 techniques for optimizing joint surface congruency using multiple cylindrical osteochondral autografts. Arthroscopy. 2001;17(1):50-5.
17. Solheim E, Oyen J, Hegna J, Austgulen OK, Harlem T, Strand T. Microfracture treatment of single or multiple articular cartilage defects of the knee: a 5-year median follow-up of 110 patients. Knee Surg Sports Traumatol Arthrosc. 2010;18(4):504-8.
18. Lopez-Alcorocho JM, Aboli L, Guillen-Vicente I, Rodriguez-Inigo E, Guillen-Vicente M, Fernandez-Jaen TF, et al. Cartilage Defect Treatment Using High-Density Autologous Chondrocyte Implantation: Two-Year Follow-up. Cartilage. 2018;9(4):363-9.
19. Brittberg M. Autologous chondrocyte implantation–technique and long-term follow-up. Injury. 2008;39 Suppl 1:S40-9.
20. Kraeutler MJ, Belk JW, Carver TJ, McCarty EC. Is Delayed Weightbearing After Matrix-Associated Autologous Chondrocyte Implantation in the Knee Associated With Better Outcomes? A Systematic Review of Randomized Controlled Trials. Orthop J Sports Med. 2018;6(5):2325967118770986.
21. Cinque ME, Kennedy NI, Moatshe G, Vinagre G, Chahla J, Hussain ZB, et al. Osteochondral Allograft Transplants for Large Trochlear Defects. Arthrosc Tech. 2017;6(5):e1703-e7.
22. Sherman SL, Garrity J, Bauer K, Cook J, Stannard J, Bugbee W. Fresh osteochondral allograft transplantation for the knee: current concepts. The Journal of the American Academy of Orthopaedic Surgeons. 2014;22(2):121-33.
23. Chahal J, Gross AE, Gross C, Mall N, Dwyer T, Chahal A, et al. Outcomes of osteochondral allograft transplantation in the knee. Arthroscopy. 2013;29(3):575-88.
24. Cugat R, Alentorn-Geli E, Steinbacher G, Alvarez-Diaz P, Cusco X, Seijas R, et al. Treatment of Knee Osteochondral Lesions Using a Novel Clot of Autologous Plasma Rich in Growth Factors Mixed with Healthy Hyaline Cartilage Chips and Intra-Articular Injection of PRGF. Case Rep Orthop. 2017;2017:8284548.
25. Cugat R, Alentorn-Geli E, Navarro J, Cusco X, Steinbacher G, Seijas R, et al. A novel autologous-made matrix using hyaline cartilage chips and platelet-rich growth factors for the treatment of full-thickness cartilage or osteochondral defects: Preliminary results. J Orthop Surg (Hong Kong). 2020;28(1):2309499019887547.
26. Themistocleous GS, Chloros GD, Kyrantzoulis IM, Georgokostas IA, Themistocleous MS, Papagelopoulos PJ, et al. Effectiveness of a single intra-articular bone marrow aspirate concentrate (BMAC) injection in patients with grade 3 and 4 knee osteoarthritis. Heliyon. 2018;4(10):e00871.
27. Otsuru S, Gordon PL, Shimono K, Jethva R, Marino R, Phillips CL, et al. Transplanted bone marrow mononuclear cells and MSCs impart clinical benefit to children with osteogenesis imperfecta through different mechanisms. Blood. 2012;120(9):1933-41.
28. Gupta PK, Thej C. Mesenchymal stromal cells for the treatment of osteoarthritis of knee joint: context and perspective. Ann Transl Med. 2019;7(Suppl 6):S179.
29. Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014;42(3):648-57.
30. Rodriguez L. SR, Codinach M., Torrents S., Cusco X., Garcia J., Cugat R. . Processing volumes and therapeutic cellular doses of point of care bone marrow concentrates. . Int J of Orth 2016(August 23; 3(4): 621-626. ).
31. Centeno C, Sheinkop M, Dodson E, Stemper I, Williams C, Hyzy M, et al. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med. 2018;16(1):355.
32. Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-Step Cartilage Repair with Bone Marrow Aspirate Concentrated Cells and Collagen Matrix in Full-Thickness Knee Cartilage Lesions: Results at 2-Year Follow-up. Cartilage. 2011;2(3):286-99.26. Themistocleous GS, Chloros GD, Kyrantzoulis IM, Georgokostas IA, Themistocleous MS, Papagelopoulos PJ, et al. Effectiveness of a single intra-articular bone marrow aspirate concentrate (BMAC) injection in patients with grade 3 and 4 knee osteoarthritis. Heliyon. 2018;4(10):e00871.
27. Otsuru S, Gordon PL, Shimono K, Jethva R, Marino R, Phillips CL, et al. Transplanted bone marrow mononuclear cells and MSCs impart clinical benefit to children with osteogenesis imperfecta through different mechanisms. Blood. 2012;120(9):1933-41.
28. Gupta PK, Thej C. Mesenchymal stromal cells for the treatment of osteoarthritis of knee joint: context and perspective. Ann Transl Med. 2019;7(Suppl 6):S179.
29. Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014;42(3):648-57.
30. Rodriguez L. SR, Codinach M., Torrents S., Cusco X., Garcia J., Cugat R. . Processing volumes and therapeutic cellular doses of point of care bone marrow concentrates. . Int J of Orth 2016(August 23; 3(4): 621-626. ).
31. Centeno C, Sheinkop M, Dodson E, Stemper I, Williams C, Hyzy M, et al. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med. 2018;16(1):355.
32. Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-Step Cartilage Repair with Bone Marrow Aspirate Concentrated Cells and Collagen Matrix in Full-Thickness Knee Cartilage Lesions: Results at 2-Year Follow-up. Cartilage. 2011;2(3):286-99.
33. Gobbi A, Whyte GP. Long-term Clinical Outcomes of One-Stage Cartilage Repair in the Knee With Hyaluronic Acid-Based Scaffold Embedded With Mesenchymal Stem Cells Sourced From Bone Marrow Aspirate Concentrate. Am J Sports Med. 2019;47(7):1621-8.

How to Cite this article: Samitier G, Vinagre G, Laiz P, García M, Sava M, Alentorn-Geli E, Cugat R.| Cartilage Repair: What Works in Young Arthritic Knee | Journal of Clinical Orthopaedics | January-June 2020; 5(1):8-14.

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Posterior shoulder instability

/in /by

Journal of Clinical Orthopaedics | Vol 5 | Issue 1 |  Jan-Jun 2020   | page: 31-35 | E. Taverna, A.Spreafico, C. Perfetti, V. Guarrella

Author: E. Taverna [1], A.Spreafico [1,2], C. Perfetti [1], V. Guarrella [1]

[1] IRCCS Istituto ortopedico Galeazzi, Milan, Italy
[2] Università degli studi di Milano, Scuola di specializzazione in Ortopedia e Traumatologia

Address of Correspondence
Dr. E. Taverna,
IRCCS Istituto ortopedico Galeazzi, Milan, Italy
E-mail: vguarrella@hotmail.com

Abstract

Normally, shoulder movements are well balanced through an interplay between static structures (bone and soft tissues as capsule, ligaments and labrum) and muscular dynamic stabilizers (muscles and tendons). Dysfunction of one or more of these components due to an injury, degeneration or congenital abnormalities may lead to shoulder instability with concomitant pain and dysfunction. This article provides an overview of the soft tissue and bony anatomy of the shoulder joint and pathopysiology of shoulder instability. It also covers the important aspects of clinical examination and special test for diagnosis of shoulder instability. A brief over view of conservative and surgical management protocols for shoulder instability are also covered in view of recent literature and authors experience.
Keywords: Posterior shoulder instability, conservative treament, Surgical management, arthroscopy.

References

1. Robinson CM, Dobson RJ. Anterior instability of the shoulder after trauma. J Bone Joint Surg [Br] 2004;86-B(4):469–479.
2. Rowe CR, Yee LB. A posterior approach to the shoulder. J Bone Joint Surg. 1944;26:580.
3. Steinmann SP. Posterior shoulder instability. Arthroscopy 2003; 19 Suppl 1: 102
4. Owens BD, Duffey ML, Nelson BJ, et al. The incidence and characteristics of shoulder instability at the United Statesmilitary academy. Am J Sports Med. 2007;35:1168–1173.
5. Robinson CM, Aderinto J. Current concepts review: recurrent posterior shoulder instability. J Bone Joint Surg Am. 2005;87: 883–892.
6. Tannenbaum EP, Sekiya JK. Posterior shoulder instability in the contact athlete. Clin Sports Med. 2013;32:781–796.
7. Brewer BJ, Wubben RC, Carrera GF. Excessive retroversion of the glenoid cavity. A cause of non- traumaticposterior instability of the shoulder. J Bone Joint Surg Am. 1986;68:724–31.
8. Dekker TJ, Peebles LA, Goldenberg BT, Millett PJ, Bradley JP, Provencher MT. Location of the Glenoid Defect in Shoulders With Recurrent Posterior Glenohumeral Instability. Am J Sports Med. 2019 Oct 16:363546519876282
9. Meyer DC, Ernstbrunner L, Boyce G, Imam MA, El Nashar R, Gerber C. Posterior Acromial Morphology Is Significantly Associated with Posterior Shoulder Instability.J Bone Joint Surg Am. 2019 Jul 17;101(14):1253-1260.
10. Blasier RB, Soslowsky LJ, Malicky DM, Palmer ML. Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. J Bone Joint Surg Am 1997; 79: 433-440.
11. Kim S, Ha K, Park J, Kim Y, Lee Y, Lee J, Yoo J. Arthroscopic posterior labral repair and capsular shift for traumatic unidirectional recurrent posterior subluxation of the shoulder. J Bone Joint Surg Am. 2003;85:1479–87.
12. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32:413–418.
13. Saliken DJ, Bornes TD, Bouliane MJ, Sheps DM, Beaupre LA. Imaging methods for quantifying glenoid and Hill-Sachs bone loss in traumatic instability of the shoulder: a scoping review. BMC Musculoskelet Disord. 2015 Jul 18;16:164.
14. Burkhead Jr WZ, Rockwood Jr CA. Treatment of instability of the shoulder with an exercise program. J Bone Joint Surg Am. 1992;74:890–6.
15. McIntyre K, Be´langer A, Dhir J, et al. Evidence-based conservative rehabilitation for posterior glenohumeral instability: a systematic review. Phys Ther Sport. 2016;22:94–100.
16. Schwartz E, Warren RF, O’Brien SJ, Fronek J. Posterior shoulder instability. Orthop Clin N Am. 1987;18:409–19.
17. Woodmass JM, Lee J, Johnson NR, Wu IT, Camp CL, Dahm DL, Krych AJ. Nonoperative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 10 Years After Diagnosis. Arthroscopy. 2019 Jul;35(7):1964-1970.
18. Saupe N, White LM, Bleakney R, Schweitzer ME, Recht MP, Jost B, Zanetti M. Acute traumatic posterior shoulder dislocation: MR findings. Radiology 2008; 248: 185-193.
19. Peat M. Functional anatomy of the shoulder complex. Phys Ther 1986; 66: 1855-1865.
20. Barbier O, Ollat D, Marchland JP, Versier G. Iliac bone-block autograft for posterior shoulder instability. Rev Chir Orthop Traumatol. 2009;95:100–7.
21. Métais P, Grimberg J, Clavert P, Kouvalchouk JF, Sirveaux F, Nourissat G, Garret J, Mansat P, Godenèche A; French Arthroscopy Society. Posterior shoulder instability managed by arthroscopic acromial pediculated bone-block. Technique. Orthop Traumatol Surg Res. 2017 Dec;103(8S):S203-S206
22. D’Ambrosi R, Perfetti C, Garavaglia G, Taverna E. One step arthroscopically assisted Latarjet and posterior bone-block, for recurrent posterior instability and anterior traumatic dislocation. Int J Shoulder Surg. 2015 Jul-Sep;9(3):94-8
23. Cerciello S, Enrico V, Morris BJ, Corona K. Bone block procedures in posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):604–11.
24. Inui H, Nobuhara K.Glenoid osteotomy for atraumatic posteroinferior shoulder instability associated with glenoid dysplasia. Bone Joint J 2018;100-B:331-7.
25. Mc LH. Posterior dislocation of the shoulder. J Bone Joint Surg Am. 1952;24 a:584–590.
26. Dueya RE, Burkhart SS. Arthroscopic treatment of a reverse Hill-Sachs lesion. Arthrosc Tech. 2013;2:e155–9.
27. Meuffels DE, Schuit H, van Biezen FC, Reijman M, Verhaar JA. The posterior bone block procedure in posterior shoulder instability: a long-term follow-up study. J Bone Joint Surg Br 2010; 92: 651-655
28. Bradley JP, McClincy MP, Arner JW, Tejwani SG. Arthroscopic capsulolabral reconstruction for posterior instability of the shoulder: a prospective study of 200 shoulders. Am J Sports Med 2013; 41: 2005-2014
29. Seppel G, Braun S, Imhoff AB. Surgical Management of Posterior Shoulder Instability. ISAKOS: Brockmeier SF, 2013.

How to Cite this article: Taverna E, Spreafico A, Perfetti C, Guarrella V. Posterior shoulder instability. Journal of Clinical Orthopaedics Jan-June 2020;5(1):31-35.

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