{"title":"Osteochondral allograft transplantation of the knee: a review of indications, techniques, outcome and how to promote biology","authors":"Mohammad Haikal, Renjit Thomas Issac, Martyn Snow","doi":"10.1016/j.mporth.2023.03.004","DOIUrl":"10.1016/j.mporth.2023.03.004","url":null,"abstract":"<div><p><span>Articular cartilage<span> lesions of the knee in young and active patients can result in significant disability. Osteochondral allografts (OCAs) can be used to treat challenging articular lesions of the knee ≥2 cm</span></span><sup>2</sup><span><span><span><span>, either as a primary or revision procedure. They have the advantage of restoring the articular surface with mature </span>hyaline cartilage without any size limitations or donor site morbidity. </span>Chondrocyte viability above 70% at the time of implantation is thought to be desirable, and consequently OCA implantation within the 28-day graft expiration date can result in logistical challenges. No randomized trials exist; however, excellent clinical outcomes have been reported, along with good long-term </span>survivorship up to 20 years. Several factors can influence the outcome after OCA use, including patient selection, anatomical location, associated pathologies and several biological considerations. The purpose of this article is to review the latest evidence on treatment indications, graft storage and surgical techniques, biological considerations, patient outcomes and rehabilitation after surgery.</span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 3","pages":"Pages 161-169"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43841351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Recurrent patellofemoral instability: diagnosis and treatment algorithm","authors":"Matthew Hampton, Andrew Barnett","doi":"10.1016/j.mporth.2023.03.012","DOIUrl":"10.1016/j.mporth.2023.03.012","url":null,"abstract":"<div><p><span>The aetiology of recurrent patellofemoral instability (PFI) is multifactorial. These factors include both demographic and anatomic risk factors. Demographic risk factors for recurrent instability include young age, female sex, family history and most importantly, a history of previous ipsilateral or contralateral<span><span> patellar dislocations. Anatomic factors include generalized ligamentous laxity, neuromuscular imbalance, coronal or axial malalignment, trochlear </span>dysplasia, </span></span>patella<span> alta and an elevated tibial tuberosity to trochlea groove (TT-TG) distance. Understanding and recognizing these different risk factors for each individual patient who presents with recurrent PFI is fundamental to achieving good outcomes when treating this often-complex patient group.</span></p><p>The main focus of this review is to explore the clinical assessment, radiological investigations and different surgical treatment options available for patients who present with recurrent PFI.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 3","pages":"Pages 207-211"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42260683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anterior cruciate ligament reconstruction: current concepts and latest thinking","authors":"Ian Douglas McDermott","doi":"10.1016/j.mporth.2023.03.008","DOIUrl":"10.1016/j.mporth.2023.03.008","url":null,"abstract":"<div><p><span>Never has there been such focus on just one small ribbon-like ligament in the human body: the anterior cruciate ligament<span> (ACL) is the most highly studied and highly written about ligament in the knee, and yet still, there seem to be many ongoing unknowns. Despite this, there seem to be even more so-called experts than papers, all with their own firm and didactic opinions. This review article provides a contemporary opinion on the subject of ACL tears<span> and ACL reconstruction, with a focus on the diagnosis of ACL tears and the decision-making process, with respect to conservative </span></span></span><em>versus</em><span> surgical management. The review also discusses the topics of tunnel placement, graft options, internal bracing, the anterolateral ligament and, importantly, outcomes. This paper highlights that there are a number of different approaches and options, and emphasizes the importance of discussing the pros and cons of these options with your patients, thoroughly, with shared decision-making leading to fully informed consent.</span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 3","pages":"Pages 195-206"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43836281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The benefits of focal resurfacing implants over articular cartilage grafting in the knee","authors":"Paul Jermin, Jill Mulrain, Nikhil Sharma","doi":"10.1016/j.mporth.2023.03.003","DOIUrl":"https://doi.org/10.1016/j.mporth.2023.03.003","url":null,"abstract":"<div><p><span>The surgical treatment of chondral and osteochondral defects within the knee is becoming increasingly more complex and challenging, with an ever-increasing selection of options available to the orthopaedic surgeon. Technological and innovative advancements often move at a greater pace than the associated clinical outcomes and research-based evidence. The treatment for these conditions is continually evolving and developing before it is possible to critically appraise the data on their success. These surgical treatments are either biological, where an attempt is made to regenerate the lost tissue, or non-biological, such as focal resurfacing, partial or </span>total arthroplasty. Each of these treatment modalities has their own merits and drawbacks. Focal resurfacings have been around for a few decades, and their aim is to be the best of both options. While still not part of mainstream practice within the UK, their evidence base is growing, and the National Institute for Health and Care Excellence has issued a review on their use. This review aims to assess the options available for treating cartilage defects in the knee, with a focus on these novel focal resurfacing implants.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 3","pages":"Pages 154-160"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50185856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Answers to the CME questions on The Hand","authors":"","doi":"10.1016/j.mporth.2023.03.010","DOIUrl":"https://doi.org/10.1016/j.mporth.2023.03.010","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 3","pages":"Page 214"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50186090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Osteoarthritis of the fingers","authors":"Malek Racy, Lindsay Muir","doi":"10.1016/j.mporth.2023.01.002","DOIUrl":"10.1016/j.mporth.2023.01.002","url":null,"abstract":"<div><p><span><span><span>Hand osteoarthritis is the commonest form of arthritis and can result in significant morbidity. Gender, ethnicity and occupation are recognized risk factors and result in different patterns of disease, though radiographic features do not consistently correlate with clinical symptoms. A range of non-operative and operative </span>treatment options are available. Non-operative measures include analgesia, intra-articular injections and hand therapy, whereas operative measures include </span>joint fusion and joint replacement. A range of fusion and </span>arthroplasty techniques are available with varying levels of evidence and efficacy. A patient-centred approach is required, combining a range of different treatment techniques to create a treatment strategy tailored to each patient's individual symptomatic and functional needs.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 2","pages":"Pages 92-97"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47992154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of acute open flexor tendon injuries of the hand and wrist: basic sciences, surgical factors and rehabilitation pertinent to optimizing outcome","authors":"Matthew Weston, Sarah Henning, Michael David","doi":"10.1016/j.mporth.2023.01.006","DOIUrl":"10.1016/j.mporth.2023.01.006","url":null,"abstract":"<div><p>Flexor tendon injuries to the hand and wrist represent a significant resource burden to the UK NHS. A good understanding of tendon basic science and repair techniques is crucial for the surgeon undertaking their repair and rehabilitation. Furthermore, this is a common topic assessed in the FRCS(Orth) examination. This article will summarize the basic science relating to tendon structure, physiology and injury. Additionally, it will present key surgical and rehabilitation factors relevant to clinical outcomes.</p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 2","pages":"Pages 125-133"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47986652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The benefits of focal resurfacing implants over articular cartilage grafting in the knee","authors":"P. Jermin, J. Mulrain, Nitasha Sharma","doi":"10.1016/j.mporth.2023.03.003","DOIUrl":"https://doi.org/10.1016/j.mporth.2023.03.003","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"55098808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical examination of the hand","authors":"Madeleine Corkery-Hayward, Robert J. MacFarlane","doi":"10.1016/j.mporth.2023.02.001","DOIUrl":"10.1016/j.mporth.2023.02.001","url":null,"abstract":"<div><p><span>Clinical examination of the hand requires a structured approach allowing the clinician the formulate an appropriate differential diagnosis for the purposes of further investigation and timely diagnosis and management. Eliciting a careful history and subsequently employing the examination principles of inspection, palpation, and movement, followed by targeted special tests, are key to assessing the various pathologies affecting the hand. This article discusses the key elements of history-taking and examination structure when assessing hand pathology, and reviews in detail the special tests involved in common pathology seen in the hand, including osteoarthritis<span><span>, rheumatoid arthritis, </span>carpal tunnel syndrome<span>, cubital tunnel syndrome, </span></span></span>Dupuytren's disease<span>, and de Quervain's tenosynovitis.</span></p></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"37 2","pages":"Pages 98-103"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47100311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}