Annals of Joint最新文献

{"title":"Quadriceps tendon ruptures: a narrative review.","authors":"Joshua A Whitmore, Prachi Lele, Joseph G Lyons, Andrew Froehle","doi":"10.21037/aoj-24-66","DOIUrl":"10.21037/aoj-24-66","url":null,"abstract":"<p><strong>Background and objective: </strong>Quadriceps tendon ruptures can occur in both the native knee and in knees which have undergone prior total knee arthroplasty (TKA). Complete ruptures require surgical treatment to optimize patient function. Debate exists surrounding the ideal repair technique for native ruptures, and there is little consensus regarding the optimal surgical treatment option for post-TKA ruptures. The objective of this narrative review is to provide an overview of quadriceps tendon ruptures occurring in both native knees and in the setting of TKA, with a focus on contemporary treatment options and their results.</p><p><strong>Methods: </strong>A narrative review of the relevant literature was performed in November 2024. English language articles published up to November 2024 which related to quadriceps tendon ruptures, involving both the native knee and the post-TKA knee, were reviewed. All types of published articles were considered.</p><p><strong>Key content and findings: </strong>Quadriceps tendon ruptures almost always occur in patients with antecedent tendon pathology. Primary repair of acute native quadriceps ruptures is supported by a large body of literature, and most patients have reasonable outcomes. The clinical outcomes of transosseous and suture anchor repair techniques seem to be comparable in this setting. Quadriceps ruptures, which occur in the setting of TKA, are much more difficult to treat. In this setting, the complication rates of primary repair, repair with augmentation, and reconstruction are high. Even with improvements in the contemporary reconstructive options, including allograft and synthetic mesh, outcomes remain suboptimal. More work is needed to improve outcomes for patients with post-TKA quadriceps tendon ruptures.</p><p><strong>Conclusions: </strong>Generally reliable results can be achieved when treating native quadriceps tendon ruptures with contemporary techniques. Quadriceps ruptures, which occur in the setting of TKA, on the other hand, are much more challenging to treat. Various surgical techniques have been explored and developed in an effort to improve outcomes. While modest improvements have been realized, these injuries remain problematic, with very high complication and failure rates, regardless of technique.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"15"},"PeriodicalIF":0.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sports injuries during Kabaddi: a literature review.","authors":"Amit Meena, Amit Kumar Yadav, Sameer Panchal, Shahbaz Malik, Luca Farinelli, Riccardo D'Ambrosi, Darren de Sa, Sachin Tapasvi","doi":"10.21037/aoj-24-62","DOIUrl":"10.21037/aoj-24-62","url":null,"abstract":"<p><strong>Background and objective: </strong>Kabaddi is an athletic contact sport that involves power, aggression, fine mind-body balance, agility, and swift reflexes. Since Kabaddi is a contact sport, athletes face a higher risk of injuries during competition and training. There is a paucity of literature regarding sports injuries during this game. This review article lays down a plinth-stone for global recognition of this game and associated sports injuries, intending to improve awareness in the sports medicine fraternity and boost further research related to this topic.</p><p><strong>Methods: </strong>A comprehensive synthesis of the relevant literature was conducted to provide insights for clinicians, trainers, and players to enhance injury prevention and rehabilitation strategies.</p><p><strong>Key content and findings: </strong>Kabaddi, a traditional Indian sport, is gaining popularity worldwide. Its physically demanding nature poses a significant risk for sports injuries among players. Anterior cruciate ligament (ACL) ruptures with concurrent meniscal injuries are the most common soft tissue injuries in Kabaddi. However, due to the sport's aggressive and physical nature, nearly all types of injuries are possible.</p><p><strong>Conclusions: </strong>This review article highlights the mechanisms of injury and common injuries associated with Kabaddi. It also offers a comprehensive overview of the sport's origin, regulations, and etiquette. This review concludes that a multidisciplinary approach involving physiotherapists, sports orthopaedic specialists, and medical teams is crucial for conditioning players and minimizing injury risk.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"16"},"PeriodicalIF":0.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainable performance plan development to prevent non-contact ACL injuries in youth and adolescent athletes: a clinical practice review.","authors":"John Nyland, Deepak Sharma, Jonathon Lewis, Elliott Roman, Anna Duncan, Jarod Richards, Ryan Krupp","doi":"10.21037/aoj-24-37","DOIUrl":"10.21037/aoj-24-37","url":null,"abstract":"<p><p>Growing evidence suggests that many non-contact mechanical fatigue-related anterior cruciate ligament (ACL) injuries are related to the accumulated microtrauma that leads to sudden failure. These factors may play a critical role in enhancing both sports performance and adherence to ACL injury prevention programs among youth and adolescent athletes. This clinical practice review synthesizes existing literature on sustainable performance plan principles that integrate active rest and recovery, with an emphasis on boredom mitigation and self-control development. A comprehensive literature search was conducted using PubMed, Web of Science, and OVID MEDLINE databases to identify key themes presented in the following sub-sections: The elite training industry and rise of specialization; Lessons from sports diversity and delayed specialization; Developing more than muscles; Mitigating boredom, developing self-control; Active rest and recovery; Culture, context, and compliance; and Blending performance training and injury prevention. By fostering engagement and adherence among all stakeholders, sustainable performance plans that incorporate boredom mitigation, self-control development, and structured active rest and recovery may enhance compliance with neuromuscular training programs aimed at reducing non-contact ACL injury risk in youth and adolescent athletes. Further research is needed to assess the most effective strategies for integrating these principles into existing training models.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"14"},"PeriodicalIF":0.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of anterior shoulder instability in the contact athlete: a narrative review.","authors":"Alex M Meyer, Samuel G Lorentz, Lindsey G Droz, Julia E Ralph, Brian C Lau","doi":"10.21037/aoj-24-65","DOIUrl":"10.21037/aoj-24-65","url":null,"abstract":"<p><strong>Background and objective: </strong>Anterior shoulder instability (ASI) is a common occurrence in the athletic population with specific management challenges in contact athletes due to the high activity demand and repetitive trauma during sport. This study aims to provide a narrative review of the current literature on ASI in contact athletes, with an emphasis on pathophysiology, mechanisms of injury, clinical presentation, diagnostic strategies, treatment options, including in-season management, and outcomes.</p><p><strong>Methods: </strong>A narrative review of the current literature on ASI in contact athletes was conducted, including key studies on the management and outcomes of conservative and surgical interventions.</p><p><strong>Key content and findings: </strong>ASI typically occurs from abduction and external rotation forces. Diagnosis relies on clinical assessment and imaging (magnetic resonance imaging or computed tomography), to evaluate soft tissue and bony injuries. Non-operative management is associated with high recurrence rates in contact athletes. Surgical options include arthroscopic Bankart repair (ABR) with or without remplissage, open Bankart repair (OBR), or bone block procedure such as Latarjet procedure or distal tibia allograft. All of which have been shown to decrease risk of recurrence and have a high rate of return to sport. The choice of procedure depends on the extent of soft tissue and bony involvement and the athlete's individual demands. ABR with glenoid bone loss >13.5% have high recurrence rates, therefore, additional procedures such as remplissage or bone block procedures should be considered.</p><p><strong>Conclusions: </strong>ASI in the contact athlete is a common and challenging injury to manage. Surgical intervention provides superior outcomes in terms of stability and recurrence prevention compared to non-operative management of ASI in the contact athlete. Patient-specific considerations including level of sport, patient goals, and timing of season are considerations for treatment. Labral injury with <13.5% of glenoid bone loss and on-track Hill-Sachs lesion ABR is recommended, labral injury with 13.5-20% of glenoid bone loss with off-track Hill-Sachs lesion ABR with remplissage or OBR with capsule shift is recommended, and if >20% then bone block procedure is recommended.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"19"},"PeriodicalIF":0.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent advances in the application of nanotechnology in joint arthroplasty: a narrative review.","authors":"Whisper Grayson, Nicholas M Brown","doi":"10.21037/aoj-24-50","DOIUrl":"10.21037/aoj-24-50","url":null,"abstract":"<p><strong>Background and objective: </strong>Osteoarthritis (OA) is a multifactorial disease, involving biomechanical, inflammatory, and metabolic processes that ultimately impact the structure and function of a joint. Current therapeutic options can improve symptoms and prolong the time to surgery, yet they are not curative and are limited by their systemic side-effects and their inability to provide site-specific delivery. Nanomedicine takes advantage of the unique properties held by technology on the nanoscale (1-100 nm), including surface effects and quantum effects, that allow for novel mechanical, thermal, and magnetic functions. The primary aim of this narrative review is to summarize the recent advances made in nanotechnology and their uses in joint arthroplasty.</p><p><strong>Methods: </strong>This narrative review was performed following a computerized search of the electronic database on PubMed in September 2024. Papers related to the use of nanotechnology in orthopaedic arthroplasty surgery were included for review.</p><p><strong>Key context and findings: </strong>Nanotechnology holds the promise of optimizing OA treatment, refining the implants used during joint arthroplasty, and aiding in the diagnosis and treatment of post-operative joint infections. With the increasingly aging population and growing demand for joint replacement, this review aims to cover the novel applications of nanoparticles (NPs) within the realm of joint replacement surgery.</p><p><strong>Conclusions: </strong>Future studies are needed to further investigate the clinical translation of NPs in joint arthroplasty. Additionally, the potential of NPs needs to be considered within their limitations and their safety profile that is still being defined.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"13"},"PeriodicalIF":0.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating retrieval augmented generation and ChatGPT's accuracy on orthopaedic examination assessment questions.","authors":"Jordan Eskenazi, Varun Krishnan, Maximilian Konarzewski, David Constantinescu, Gilberto Lobaton, Seth D Dodds","doi":"10.21037/aoj-24-49","DOIUrl":"10.21037/aoj-24-49","url":null,"abstract":"<p><strong>Background: </strong>Since the introduction of large language models (LLMs) such as ChatGPT, there has been a race to test its capability in medical problem solving across specialties to varying degrees of success. Retrieval augmented generation (RAG) allows LLMs to leverage subject specific knowledge to provide context, a greater number of sources, and the ability to cite medical literature to increase the accuracy and credibility of its answers. The use of LLM + RAG has not yet been used in the appraisal of artificial intelligence's capability of orthopedic problem solving. The purpose of this study is to assess the performance of ChatGPT + RAG against the performance of ChatGPT without RAG as well as against humans on orthopedic examination assessment questions.</p><p><strong>Methods: </strong>The American Academy of Orthopaedic Surgeons (AAOS) OrthoWizard question bank was used as the source of questions. After 13 textbooks and 28 clinical guidelines were made available for RAG, text-only multiple-choice questions were presented in a zero-shot learning fashion to ChatGPT-4 + RAG, ChatGPT-4, and ChatGPT-3.5.</p><p><strong>Results: </strong>On 1,023 questions tested, ChatGPT-3.5, ChatGPT-4, ChatGPT-4+RAG, and humans scored 52.98%, 64.91%, 73.80%, and 73.97%, respectively. There was no statistical difference between orthopedic surgeons and ChatGPT-4 + RAG on overall accuracy (P>0.99). Both orthopedic surgeons and ChatGPT4 + RAG scored better than ChatGPT-4 (P<0.001) and ChatGPT-3.5 (P<0.001). Of the 13 textbooks available to RAG, RAG used AAOS Comprehensive Review 3 Volume 3 for 39.6% of questions, more often than any other resource available to it.</p><p><strong>Conclusions: </strong>ChatGPT-4 + RAG was able to answer 1,023 questions from the OrthoWizard question bank at the same accuracy as Orthopedic surgeons. Both ChatGPT-4 + RAG and orthopedic surgeons had superior accuracy on these specialty exam questions compared to ChatGPT-4 and ChatGPT-3.5. Artificial intelligence is becoming increasingly accurate in its ability to answer orthopaedic surgery test questions with the guidance of orthopaedic surgery textbooks. RAG enables an LLM to effectively cite its sources after providing an answer to a question, which is an important tool for the integration of LLMs to orthopaedic surgery education and can function as a valuable tool for anyone studying for an orthopedic examination.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"12"},"PeriodicalIF":0.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of open, percutaneous, or mini-open repair in the treatment of Achilles tendon ruptures: a systematic review and meta-analysis based on comparison studies.","authors":"Thomas Cho, Ajay Nair, Elisabeth Sohn, Rayanne Mustapha, Shradha Shendge, Jiayong Liu","doi":"10.21037/aoj-24-53","DOIUrl":"10.21037/aoj-24-53","url":null,"abstract":"<p><strong>Background: </strong>The Achilles tendon rupture is a common injury of the lower extremity, inducing pain and physical impairment. Surgical treatment methods include open, percutaneous, and mini-open repair techniques. This study aims to compare the outcomes of these three techniques.</p><p><strong>Methods: </strong>PubMed, Google Scholar, and EMBASE were searched until November 2023. Randomized controlled trials (RCT) and retrospective comparative studies (RCS) comparing either open versus percutaneous repair, open versus mini-open repair, or percutaneous <i>vs.</i> mini-open repair of the Achilles tendon rupture were included with at least one of the following outcomes: American Orthopedic Foot & Ankle Society (AOFAS) score, Achilles Tendon Total Rupture Score (ATRS) score, re-ruptures, sural nerve injuries, infections, wound dehiscence, deep vein thrombosis (DVT), and average operating time. Meta-analysis was mostly processed by RevMan 5. A P value of ≤0.05 was considered statistically significant. Risk of bias was assessed with RevMan 5 and the Newcastle-Ottawa scale.</p><p><strong>Results: </strong>Twenty-six studies, including 1,898 patients, were included. The percutaneous group had significantly more sural nerve injuries [risk ratio (RR) =0.28; 95% confidence interval (CI): 0.14 to 0.57; P<0.001], fewer infections (RR =2.99; 95% CI: 1.37 to 6.49; P=0.006), higher AOFAS score [standardized mean difference (SMD) =-0.32; 95% CI: -0.61 to -0.03; P=0.03], higher ATRS (SMD =-0.24; 95% CI: -0.47 to -0.02; P=0.03), and a shorter average operating period (SMD =2.29; 95% CI: 1.63 to 2.96; P<0.001) than the open repair group. The mini-open group had a significantly higher AOFAS score (SMD =-0.58; 95% CI: -1.06 to -0.09; P=0.02), higher ATRS (SMD =-0.65; 95% CI: -1.05 to -0.26; P=0.001), longer average operating time (SMD =-0.95; 95% CI: -1.46 to -0.45; P<0.001), and lower rates of re-ruptures and sural nerve injuries than the percutaneous group. The open group had significantly more infections than the mini-open group (RR =2.99; 95% CI: 1.07 to 8.37; P=0.04).</p><p><strong>Conclusions: </strong>The mini-open repair technique demonstrated superior function scores and lower complication rates than percutaneous repair and open repair. It should be the first choice when treating Achilles tendon ruptures, with percutaneous repair being a reliable alternative.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"11"},"PeriodicalIF":0.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brachial plexus injuries in the contact athlete: a narrative review.","authors":"Rachel A Windmueller, Oluwafemi O Gbayisomore, Reagan L Mead, Mihir J Desai, Eric N Bowman","doi":"10.21037/aoj-24-67","DOIUrl":"10.21037/aoj-24-67","url":null,"abstract":"<p><strong>Background and objective: </strong>Brachial plexus injuries (BPIs) are a rare but potentially devastating injury among contact athletes. More common injuries, such as \"burners\" or \"stingers\", indicate a temporary and less severe insult to either the nerve roots or plexus. The aim of this review is to discuss this spectrum of injuries in their epidemiology, mechanism in contact sports, diagnosis, and treatment.</p><p><strong>Methods: </strong>This literature review utilized key terms to search manuscripts available in English from inception to October 2024 within three research databases.</p><p><strong>Key content and findings: </strong>BPIs among contact athletes occur on a spectrum from neuropraxia to neurotmesis. Neuropraxia is very common among contact athletes with approximately a 49-65% incidence among career football players with the most common mechanism being a traction injury. Most of these resolve within minutes to hours. Axonotmesis and neurotmesis can be far more severe injuries and require further investigation if not resolved by 2-3 weeks. The majority of athletes who suffer neuropraxic injuries will return to sport with minimal to no time missed, however, more severe injuries portend variable outcomes.</p><p><strong>Conclusions: </strong>BPIs are common among contact athletes and involve a spectrum of nerve damage, of which most are self-limiting. However, further evaluation is warranted when symptoms last beyond 2-3 weeks. Future studies should focus on treatment algorithms and long-term outcomes, including return to sport.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"18"},"PeriodicalIF":0.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteochondral autograft from the second toe for complex proximal interphalangeal joint fracture-dislocations: a case report and literature review.","authors":"Yi Xie, Ishith Seth, Namal Munasinghe","doi":"10.21037/aoj-24-25","DOIUrl":"10.21037/aoj-24-25","url":null,"abstract":"<p><strong>Background: </strong>Managing complex fracture-dislocations of the proximal interphalangeal (PIP) joint poses significant clinical challenges, necessitating innovative treatment strategies.</p><p><strong>Case description: </strong>This case report highlights the successful treatment of a severe PIP joint fracture-dislocation in a 49-year-old male carpenter who sustained a traumatic laceration to the right index finger. The injury's complexity led to the pioneering use of an osteochondral autograft from the patient's second toe proximal phalanx, marking a novel approach in autologous tissue utilization for joint reconstruction. This method effectively achieved fracture resolution and joint stabilization. A comprehensive literature search was conducted up to May 2024 across multiple databases, including PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The search strategy employed a combination of Medical Subject Headings (MeSH) terms and keywords related to PIP joint fracture-dislocations and osteochondral autografts. Inclusion criteria were articles in English involving human subjects, focusing on osteochondral autografts for PIP joint fracture-dislocations. Exclusion criteria included studies involving animals or cadaveric models and those not focused on osteochondral grafts. Postoperative assessments of the patient revealed successful graft integration and notable recovery in finger mobility, alongside positive functional hand outcomes as confirmed by patient-reported measures.</p><p><strong>Conclusions: </strong>The significant enhancements in structural and functional aspects highlight the potential of this technique. Despite its sparse representation in the literature, the favourable outcomes of this case strongly support further exploration of using second toe proximal phalanx osteochondral autografts. This report underscores the need for extensive, prospective research to comprehensively ascertain the method's effectiveness and safety in addressing intricate PIP joint fracture dislocations.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"20"},"PeriodicalIF":0.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint preservation procedures: osteotomies about the knee.","authors":"Michael S Rocca, Karina Dias, Jonathan D Hughes","doi":"10.21037/aoj-24-68","DOIUrl":"10.21037/aoj-24-68","url":null,"abstract":"<p><p>Osteotomies around the knee are an effective method for preserving the knee joint by correcting overall alignment. Although osteotomies have historically been used in treatment of knee pathology, they have recently regained a renewed interest as a treatment strategy for alignment correction, ligamentous stability, and cartilage preservation. Osteotomies are a powerful way to correct alignment in both the sagittal and coronal plane to preserve and/or protect the cartilage in the medial, lateral, and patellofemoral compartments of the knee and improve the ligamentous stability of the knee. Medial opening wedge high tibial osteotomy (MOW-HTO) and lateral closing wedge high tibial osteotomy (LCW-HTO) are commonly performed osteotomies for correcting varus malalignment, each with distinct indications, surgical techniques, and associated complications. Similarly, distal femoral osteotomy (DFO) plays a critical role in the correction of both varus and valgus malalignment, and may be particularly important in cases where a tibial osteotomy alone would lead to excessive joint line obliquity (JLO). In complex cases where single-level osteotomy does not provide optimal correction, double-level osteotomy may be necessary to achieve appropriate mechanical axis restoration while maintaining joint congruence. Beyond coronal plane corrections, increasing attention has been given to sagittal plane osteotomies for managing ligamentous instability, particularly anterior and posterior cruciate ligament (PCL) deficiencies. Modifying the posterior tibial slope (PTS) through anterior closing wedge or anterior opening wedge high tibial osteotomy can improve knee biomechanics and stability in both anterior cruciate ligament (ACL) and PCL-deficient patients. Additionally, tibial tubercle osteotomies (TTO) have emerged as an important surgical adjunct in the treatment of patellofemoral malalignment and cartilage preservation strategies. The goal of knee osteotomies is to offload the affected compartment, preserve and protect cartilage and menisci, and enhance ligamentous stability, thereby delaying the need for arthroplasty. Therefore, osteotomies represent an intriguing procedure for young and active patients. Recently, with the renewed interest in osteotomy procedures about the knee, studies have demonstrated that osteotomies continue to play a critical role in treatments for limb alignment and cartilage protection.</p>","PeriodicalId":44459,"journal":{"name":"Annals of Joint","volume":"10 ","pages":"17"},"PeriodicalIF":0.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}