Introduction Hyaline articular cartilage is an avascular and insensate tissue that allows low-friction transmission of physiologic loads in diarthrodial joints. Its functional structure ideally is maintained in homeostasis over the lifetime of an individual but remains incapable of mounting an…
Indications Critical Points Indications and Contraindications Indications Symptomatic full-thickness chondral defect Symptoms such as direct tenderness at lesion, activity-related weight-bearing pain, effusion, and response to injection Treat concomitant pathology (meniscus, alignment, ligament) Patient selection and addressing expectations are critical Contraindications…
The senior author (Frank R. Noyes) has no conflict of interest directly or indirectly with the implant or robotic system mentioned in this chapter. Indications Tibiofemoral unicompartmental knee arthroplasty (UKA) is a viable option for patients in whom severe joint…
Introduction and Diagnosis Critical Points Introduction and Diagnosis Patients with chronic insufficiency of the lateral and posterolateral structures may develop a gait abnormality characterized by excessive knee hyperextension during the stance phase of the gait cycle. Gait abnormality is easily…
Clinical Concepts The protocol described in this chapter was designed for opening-wedge high tibial osteotomy (HTO) and distal femoral osteotomy (DFO). The operative techniques, detailed in Chapter 26 , prevent delayed union or nonunion and collapse at the osteotomy site…
Introduction The use of osteotomies has decreased, particularly in North America, caused by the advent of more reliable and predictable arthroplasty solutions for younger and middle-aged patients with knee arthrosis. However, interest in osteotomy has recently undergone resurgence with the…
Indications Critical Points Indications Varus osseous malalignment: weight-bearing line <50% of tibial width Mild to moderate symptomatic arthrosis medial tibiofemoral compartment Articular cartilage retained in medial tibiofemoral compartment To achieve normal limb alignment before: Medial meniscus transplant Articular cartilage restorative…
Clinical Concepts Critical Points Clinical Concepts Initial rehabilitation goal: prevent excessive compressive and shear forces through limited weight bearing General Postoperative Healing Expectations Rapid healing of peripheral meniscus repairs Delayed healing of complex meniscus repairs in middle third region Further…
Indications Critical Points Indications Prior meniscectomy Age ≤50 years Pain in the meniscectomized tibiofemoral compartment No radiographic evidence of advanced joint deterioration; ≥2 mm of tibiofemoral joint space on 45-degree weight-bearing PA radiographs No or only minimal bone exposed on tibiofemoral…
Introduction The crucial roles of the menisci in the human knee are well understood and include load bearing, load transmission, shock absorption, knee joint stability, and lubrication and nutrition of articular cartilage. Meniscectomy frequently leads to irreparable joint damage, including…