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Biologics and injection therapy for the management of osteoarthritis
OVERVIEW Chapter synopsis Osteoarthritis (OA) is a progressive degenerative joint disease that leads to considerable disability and plagues our aging population with pain and impaired function. There are currently no treatments that reverse or halt the progression of osteoarthritis. Various…
Management of proximal tibiofibular joint instability
OVERVIEW Chapter synopsis Proximal tibiofibular joint instability is an uncommon injury that can often be difficult to diagnose. Anterior instability is the most common pattern of instability involving disruption or attenuation of the posterior ligaments. If conservative treatment fails, anatomic…
Management of arthrofibrosis of the knee
OVERVIEW Chapter synopsis Arthrofibrosis of the knee is a preventable complication that presents many challenges to the treating physician. Effective treatment involves working closely with rehabilitation staff, with the overall objective being to regain symmetrical knee extension, knee flexion, and…
Complex decision-making in patellofemoral surgery and anteromedial tibial tubercle transfer
OVERVIEW Chapter synopsis In patellofemoral surgery, complex decision-making is common, given the variability of anatomic, structural, psychosocial, and functional factors pertaining to patellofemoral disorders. History and physical examination are always important. Listening closely to the patient is essential regarding the…
Distal realignment for patellofemoral disease
OVERVIEW Chapter synopsis Tibial tuberosity osteotomy (TTO), often performed in conjunction with other proximal realignment procedures, is an effective treatment to address patellofemoral instability, patellar and trochlear focal chondral defects, and patellofemoral arthritis. TTO is a powerful tool that can…
Sulcus deepening trochleoplasty: Open and arthroscopic techniques
OVERVIEW Chapter synopsis Trochlear dysplasia has been recognized as the most common anatomical anomaly associated with recurrent lateral patellar dislocation. A thorough physical exam and imaging evaluation is important to identify the small percentage of patients with high-grade trochlear dysplasia…
Lateral patellofemoral ligament reconstruction for medial patellar iatrogenic instability
OVERVIEW Chapter synopsis Important points Indications Patients with medial patellar subluxation or dislocations Patients with excessive lateral patellar laxity undergoing medial patellofemoral ligament reconstruction Relative contraindications Unaddressed symptomatic patellofemoral chondral damage Surgical technique Soft tissue-based reconstruction with a semi-tendinosis allograft…
Medial patellofemoral ligament reconstruction and repair for lateral patellar instability
OVERVIEW Chapter synopsis The medial patellofemoral ligament (MPFL) is the primary soft tissue restraint to lateral patellar translation. The MPFL is often injured with a first-time lateral patellar dislocation. Rehabilitation is the mainstay of treatment for first-time patellar dislocation; however…
Managing the lateral side of the patellofemoral joint
OVERVIEW Chapter synopsis Pathologic tightness of the lateral retinaculum can result in maltracking and hypercompression. After clinical assessment of overall bony alignment and integrity of chondral surfaces, the patient may benefit from a procedure addressing the lateral side of the…