Operative Techniques in Sports Medicine RSS feed: Current Issue. Operative Techniques in Sports Medicine combines the authority of a textbook, the usefulness of a color atlas and the timeliness of a journal. Each issue focuses on a single clinical condition, offering several different management approaches. It's the easiest way for practitioners to stay informed of the latest surgical advancements and developments. http://www.optechsportsmed.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Operative Techniques in Sports Medicine1060-1872201March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optechsportsmed.com/article/PIIS106018721200024X/abstract?rss=yesEditorial Board10.1053/S1060-1872(12)00024-XOperative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-9iihttp://www.optechsportsmed.com/article/PIIS1060187212000238/abstract?rss=yesTable of Contents10.1053/S1060-1872(12)00023-8Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-9iiiivhttp://www.optechsportsmed.com/article/PIIS1060187212000147/abstract?rss=yesOn January 1, 2012, I assumed the responsibility as Editor for Operative Techniques in Sports Medicine. This is nothing less than a humbling opportunity that is truly an honor and privilege. I remember as a resident how this journal was the nightly read to prepare me for the next day's cases. It, as it does today, provided a compact, timely and “need to know” synopsis of the very same cases that I would not only be quizzed on through traditional Socratic teaching, but also allowed me to assist in a way that contributed to the accuracy and efficiency of getting the case done. As an aside, it made my attending happy too. The historic content of this journal has thus benefitted thousands of patients and eased the burden of many to improve the management of nearly every pathology a sports medicine physician is likely to see and treat. The contemporary value of this journal has not accrued by accident, but rather through the significant efforts and commitment of the founding editors, Drs. David Drez, Jr and Jesse C. DeLee.The Changing of the GuardsBrian J. Cole10.1053/j.otsm.2012.03.013Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-911http://www.optechsportsmed.com/article/PIIS1060187212000020/abstract?rss=yes The hamstrings group is made up of three two-joint muscles whose unique anatomy and functional properties during movement make this group particularly susceptible to muscle stain injury along the extensive muscle-tendon junctions, particularly during high-speed activities like sprinting. Proximal strains injury to the hamstring can also occur from unopposed stretch that can lead to a possible avulsion injury. An office examination will identify numerous clinical signs and symptoms of strain injury, but an MR image is helpful for defining the extent of a proximal injury. The common strain injury is treated with RICE while the choice of treatment for a proximal injury is dependent upon the number of tendons involved and the amount of tissue retraction. Early surgical intervention is advocated to avoid complications from a chronic injury. Proximal Hamstring Avulsion Injuries: Injury Mechanism, Diagnosis and Disease CourseErmias S. Abebe, Claude T. Moorman, William E. Garrett10.1053/j.otsm.2012.03.001Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-926http://www.optechsportsmed.com/article/PIIS1060187212000032/abstract?rss=yes Growing interest in double-bundle anterior cruciate ligament (ACL) reconstruction has sparked tremendous research, yielding a better understanding of normal ACL anatomy, kinematics, and function. Recent studies have more accurately defined the size and orientation of the femoral and tibial insertion sites of the anteromedial and posterolateral bundles. At our institution, we have identified specific osseous landmarks to better guide tunnel placement. The goal of anatomic ACL is to use these discoveries, refine technique, and reconstruct the ACL in a manner that most closely mimics normal anatomy. Logically, we believe that anatomic ACL reconstruction will lead to more favorable kinematics and, in turn, improved patient outcomes. This article summarizes our experiences and details our systematic approach to anatomic ACL reconstruction. Finally, we highlight multiple issues with conventional ACL reconstruction to better illustrate the concept of anatomic ACL reconstruction. The Concept of Anatomic Anterior Cruciate Ligament ReconstructionCesar A.Q. Martins, Eric J. Kropf, Wei Shen, Carola F. van Eck, Freddie H. Fu10.1053/j.otsm.2012.03.002Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-9718http://www.optechsportsmed.com/article/PIIS1060187212000044/abstract?rss=yes The goals of anterior cruciate ligament (ACL) reconstruction are to restore knee stability and function and to preserve joint health. Static tests for anteroposterior laxity (eg, Lachman test or KT-1000 arthrometer) have typically shown restoration of normal or near-normal laxity with a variety of modern ACL reconstruction techniques. However, ACL reconstruction has failed to prevent the early onset of osteoarthritis, and there is growing evidence that traditional single-bundle ACL reconstruction does not restore normal knee mechanics under functional loading conditions. ACL reconstruction may fail to restore normal rotational stability during the pivot shift. Abnormal internal-external rotation and ab/adduction have been reported after ACL reconstruction during normal daily activities like walking and running. Recently, cadaveric studies have shown the potential superiority of ACL double-bundle (DB) reconstruction for restoring anatomy and mechanical function. However, clinical data demonstrating the clear superiority of DB reconstruction is lacking because of the absence of well-controlled clinical studies. Additionally, dynamic knee function after anatomic DB ACL has yet to be assessed comprehensively. The Kinematic Basis of Anterior Cruciate Ligament ReconstructionScott Tashman, Sebastian Kopf, Freddie H. Fu10.1053/j.otsm.2012.03.003Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-91922http://www.optechsportsmed.com/article/PIIS1060187212000056/abstract?rss=yes In our original technique, semitendinosus/gracilis tendons are harvested without detaching their tibial insertion, and sutures are tightened at their free proximal extremities. The tibial tunnel is performed in the medial-posterior portion of the native anterior cruciate ligament tibial insertion. For the femoral tunnel, the knee is flexed at 130° and the guide pin is advanced in the 9:30 clockwise position until it passes the lateral femoral condyle cortex. The exit point in the lateral aspect of the femur has to be immediately above the end of the lateral femoral condyle. After the lateral incision, the tendons are passed over the top. The correct placement is found by palpating the posterior tubercle of the lateral femoral condyle. The stitches on the free proximal end of the tendons are tied onto the passing suture that is pulled through the joint to the over the top position. A suture loop is introduced into the joint through the anteromedial portal using a suture passer and then pulled into the femoral tunnel under the arthroscopic view. The stitches on the free end of the tendons are looped again onto the passing suture, which is pulled through the femoral tunnel, the knee joint, and the tibial tunnel to retrieve back the graft from the tibial incision. The combined gracilis and semitendinosus graft are then tensioned and fixed with a transosseous suture or a staple. This technique reproduces the kinematic effect of posterolateral and anteromedial anterior cruciate ligament bundles with a 4-stranded graft, although achieving a better anatomic and functional result. Double-Bundle Anterior Cruciate Ligament Reconstruction: The Italian ExperienceStefano Zaffagnini, Danilo Bruni, Russo Alessandro, Giulio Maria Marcheggiani Muccioli, Giovanni Giordano, Maurilio Marcacci10.1053/j.otsm.2012.03.004Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-92332http://www.optechsportsmed.com/article/PIIS1060187212000068/abstract?rss=yes Recent publicity and some scientific reports suggest increasing success in treating an entity called “sports hernia,” more accurately named athletic pubalgia. The primary purpose of this article is to portray what we believe to be the key concepts for understanding this wide variety of abdominal and groin injuries that afflict high-performance athletes. These injuries have been plaguing athletes for a long time, and past treatments, based on concepts of occult hernia or simple strains, have generally failed. The former concepts do not take into account the likely mechanisms of injury or various patterns of pain that these athletes exhibit. The authors believe that the concept of a “pubic joint” or “pubic dynamic complex” is fundamental to understanding the anatomy and pertinent pathophysiology in these patients. Many injuries can now be treated successfully. Some of the injuries require surgery, and others do not. In most cases, decisions regarding treatment and timing for return to full play require proper identification of the problems and consideration of a wide variety of medical, social, and business factors. Understanding “Sports Hernia” (Athletic Pubalgia): The Anatomic and Pathophysiologic Basis for Abdominal and Groin Pain in AthletesWilliam C. Meyers, Edward Yoo, Octavia N. Devon, Nikhil Jain, Marcia Horner, Cato Lauencin, Adam Zoga10.1053/j.otsm.2012.03.005Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-93345http://www.optechsportsmed.com/article/PIIS106018721200007X/abstract?rss=yes SLAP (superior labrum, anterior and posterior) lesions have been identified as a cause of instability and pain in the shoulder. This review describes clinical features, mechanism of injury, physical examination, classification and associated lesions, normal and pathologic anatomy, as well as a treatment algorithm for SLAP lesions. The Diagnosis, Classification, and Treatment of SLAP LesionsScott E. Powell, Keith D. Nord, Richard K.N. Ryu10.1053/j.otsm.2012.03.006Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-94656http://www.optechsportsmed.com/article/PIIS1060187212000081/abstract?rss=yes The Latarjet coracoid transfer procedure provides a “triple blocking” effect in the treatment of anterior shoulder instability. First, the coracoid bone block increases the anterior posterior diameter of the inferior portion of the glenoid fossa, making it more difficult for the humeral head to subluxate or dislocate. Second, the conjoined tendon acts as a sling reinforcing the inferior capsular ligamentous complex and the inferior portion of the subscapularis. Finally, repair of the inferior capsular ligamentous complex to the stump of the coracoacromial ligament reconstructs the capsulolabral anatomy. We describe our preferred technique for this procedure. With proper patient selection and systematic surgical technique, instability can be eliminated without loss of external rotation in more than 98% of cases. The Latarjet Procedure for Recurrent Anterior Shoulder Instability: Rationale and TechniqueT. Bradley Edwards, Gilles Walch10.1053/j.otsm.2012.03.007Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-95764http://www.optechsportsmed.com/article/PIIS1060187212000093/abstract?rss=yes Injuries to the lateral and posterolateral aspects of the knee are likely more common than appreciated. If these injuries are not recognized and treated, they may result in suboptimal results when treating injuries to the anterior cruciate ligament and posterior cruciate ligament. The treatment options for injuries to the lateral and posterolateral structures include primary repairs, primary repairs with augmentation, tightening of existing structures, and the creation of structural restraints from the lateral femoral epicondyle to either the posterolateral tibia or the fibular head. Reconstructive procedures to the fibular head offer advantages over those to the posterolateral tibia in that they are more optimally positioned to resist varus and posterolateral rotations, and tissue from the epicondyle to the posterior aspect to the fibular head maintains near isometry through a functional range of knee motion. A free semintendinosus tendon graft can be used to reconstruct the lateral collateral ligament and popliteofibular ligaments with minimal morbidity. This procedure can be used as an isolated procedure or in combination with other reconstructive procedures or primary repairs. Isometry of the Lateral Collateral and Popliteofibular Ligaments and Techniques for Reconstruction Using a Free Semitendinosus Tendon GraftRoger V. Larson10.1053/j.otsm.2012.03.008Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-96571http://www.optechsportsmed.com/article/PIIS106018721200010X/abstract?rss=yes Since its introduction in 1987, autologous chondrocyte transplantation (ACT) for the management of full-thickness chondral defects of the knee has gained considerable attention and has renewed interest in cartilage repair. At this time there are patients with 10 to 13 years of follow-up who have continued to benefit from ACT. ACT is indicated for the management of full-thickness femoral articular Outerbridge grade III and IV lesions. Treatment of other surfaces such as the patella and tibia have also been successful. A thorough knowledge of patient selection and indications, good laboratory practices (GLP), standards of cell culturing, meticulous surgical technique, understanding of the normal time course of healing, the appropriate functional postoperative rehabilitation, and the management of specific ACT-related complications are all essential to good clinical outcomes. The success of this procedure with its excellent clinical outcomes and durability of the articular repair have made it a cost-effective procedure comparable to other technologies. Autologous Chondrocyte TransplantationTom Minas, Lars Peterson10.1053/j.otsm.2012.03.009Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-97286http://www.optechsportsmed.com/article/PIIS1060187212000111/abstract?rss=yes Opening wedge high tibial osteotomy allows correction of alignment deformities in all planes, particularly in planned alterations to the tibial slope in the sagittal direction. In addition, corrections of 5° or less are easier to achieve than with closing wedge osteotomy. This technique has been previously described with favorable results. Throughout the procedure, attention to detail is essential for minimizing the potential for complications. Medial Opening Wedge High Tibial Osteotomy: How I Do ItPeter J. Fowler, Jee Lim Tan, Greg A. Brown10.1053/j.otsm.2012.03.010Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-98792http://www.optechsportsmed.com/article/PIIS1060187212000123/abstract?rss=yes A standard set of preoperative plain radiographs includes the following: bilateral weight-bearing anteroposterior views in full extension, bilateral weight-bearing posteroanterior tunnel views at 30° flexion, lateral views, skyline views of the patellofemoral joint, and a standing single leg hip-to-ankle anteroposterior view. Using these radiographs, 3 preoperative planning methods for a valgus-producing high tibial osteotomy are presented. These methods can be based on the anatomic axis, the mechanical axis, or the weight-bearing line. Sagittal plane alignment is also considered. Both anterior and posterior cruciate ligament instability may be taken into account in the preoperative planning process through alterations in the posterior tibial slope. Radiographic Evaluation and Preoperative Planning for High Tibial OsteotomiesGreg A. Brown, Annunziato Amendola10.1053/j.otsm.2012.03.011Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-993102http://www.optechsportsmed.com/article/PIIS1060187212000135/abstract?rss=yes Shoulder rehabilitation can best be understood and implemented as the practical application of biomechanical and muscle activation guidelines to the repaired anatomic structures in order to allow the most complete return to function. The shoulder works as a link in the kinetic chain of joint motions and muscle activations to produce optimum athletic function. Functional shoulder rehabilitation should start with establishment of a stable base of support and muscle facilitation in the trunk and legs, and then proceeds to the scapula and shoulder as healing is achieved and proximal control is gained. The pace of this “flow” of exercises is determined by achievement of the functional goals of each segment in the kinetic chain. In the early rehabilitation stages, the incompletely healed shoulder structures are protected by exercises that are directed towards the proximal segments. As healing proceeds, the weak scapular and shoulder muscles are facilitated in their re-activation by the use of the proximal leg and trunk muscles to re-establish normal coupled activations. Closed chain axial loading exercises form the basis for scapular and glenohumeral functional rehabilitation, as they more closely simulate normal scapula and shoulder positions, proprioceptive input, and muscle activation patterns. In the later rehabilitation stages, glenohumeral control and power production complete the return of function to the shoulder and the kinetic chain. In this integrated approach, glenohumeral emphasis is part of the entire program and is towards the end of rehabilitation, rather than being the entire program and being at the beginning of the program. Shoulder Rehabilitation Strategies, Guidelines, and PracticeW. Ben Kibler, John McMullen, Tim Uhl10.1053/j.otsm.2012.03.012Operative Techniques in Sports Medicine 20, 1 (2012)2012-03-01Operative Techniques in Sports Medicine2012-03-01201S1060-1872(12)X0002-9103112