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 © 2009 Published by Elsevier Inc. All rights reserved. Operative Techniques in Sports Medicine1060-1872173July 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optechsportsmed.com/article/PIIS1060187209001294/abstract?rss=yesEditorial Board10.1053/S1060-1872(09)00129-4Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7iiiihttp://www.optechsportsmed.com/article/PIIS1060187209001282/abstract?rss=yesTable of Contents10.1053/S1060-1872(09)00128-2Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7iiiiiihttp://www.optechsportsmed.com/article/PIIS1060187209001191/abstract?rss=yesIt is my honor to serve as the guest editor for this issue of Operative Techniques in Sports Medicine dedicated to management of posterior cruciate ligament (PCL) injuries. The purpose of this issue is to provide practical and useful information to our readers regarding the evaluation and treatment of PCL injuries. Our goal is to have experienced PCL surgeons share their knowledge and experience on this challenging topic. Our readers can then evaluate and synthesize this information to formulate their own treatment plan for PCL injuries.IntroductionGregory C. Fanelli10.1053/j.otsm.2009.08.001Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7125125http://www.optechsportsmed.com/article/PIIS1060187209001166/abstract?rss=yesManagement of posterior cruciate ligament (PCL) injuries remains challenging, even to the most experienced orthopaedic surgeon. There is currently no uniformly accepted surgical technique that has been identified to reproducibly restore the normal anatomy and biomechanics of the knee, while protecting the articular surface from premature arthritic change. A thorough knowledge of the functional anatomy of the PCL and associated ligamentous structures is essential for the accurate diagnosis and management of these injuries. In addition, numerous biomechanical studies exist to help us sort through both the injury mechanics as well as various reconstructive techniques available for both isolated and combined PCL reconstruction.Anatomy and Biomechanics of the Posterior Cruciate Ligament and Other Ligaments of the KneeKarl F. Bowman, Jon K. Sekiya10.1053/j.otsm.2009.07.001Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7126134http://www.optechsportsmed.com/article/PIIS1060187209001221/abstract?rss=yesThis article summarizes our approach to the management of posterior cruciate ligament (PCL) injuries treated at the University of Virginia. A thoughtful methodology of treating patients with PCL injuries is essential to guarantee accurate diagnoses, appropriate triage into nonsurgical or surgical options, and optimal rehabilitation outcomes. In most patients, concomitant injuries provide a challenge and determine the selected therapeutic options. With advanced surgical techniques in PCL reconstruction, we have embraced the in-lay technique to achieve our preferred graft position. Furthermore, our rehabilitation protocols have emphasized early prone passive range of motion. Our clinical results have been promising and characterized with the help of advanced gait analyses. We encourage those involved in the treatment of ligamentous knee injuries to participate in well-designed clinical studies to enhance evidence-based knowledge regarding the therapeutic options for PCL injuries.Posterior Cruciate Ligament Injuries: The University of Virginia ExperienceErica D. Taylor, Mark D. Miller10.1053/j.otsm.2009.06.006Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7135140http://www.optechsportsmed.com/article/PIIS1060187209000914/abstract?rss=yesInjuries of the posterior cruciate ligament in the setting of the multiligament-injured knee can pose a challenge to the orthopedic surgeon. The decision to proceed with operative or nonoperative management and which surgical technique to use remain controversial. Moreover, sparse clinical data are available to support any one treatment approach for these complicated injuries. In this chapter, we describe our current management strategies for posterior cruciate ligament-based multiligament knee injuries in the context of the existing published data and our own current clinical investigations. We discuss methods of diagnosis, the importance of stress radiography, imaging, indications and timing of surgery, graft selection, and surgical techniques. In addition, we detail our approach to postoperative rehabilitation with regard to thromboprophylaxis, weight-bearing status, and return to work or sport.Management of the Posterior Cruciate Ligament-Based Multiligament-Injured KneeBruce A. Levy, Michael J. Stuart10.1053/j.otsm.2009.06.003Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7141147http://www.optechsportsmed.com/article/PIIS1060187209001154/abstract?rss=yesThis paper describes an anatomic method of reconstructing the posterior cruciate ligament (PCL) that combines the inlay and double bundle techniques using an Achilles tendon allograft. This technique is based on the rapidly improving understanding of the complex anatomy of the PCL. Current controversies are also discussed. Forty-nine knee dislocation patients with 50 anatomic PCL reconstructions have been followed with extensive outcome data. Mean length of follow-up is 56 months, with a minimum follow-up of 20 months. There were 4 failures (7%) out of 54 primary or revision PCL reconstructions. Patients achieved an average of a 122° arc of motion with excellent posterior stability, based on both physical examination and KT-2000 ligament arthrometer examinations. Good to excellent outcomes were achieved by most patients when evaluated using the Lysholm knee score and International Knee Documentation Committee (IKDC) score. Most patients were able to return to full-time work but only half were able to resume their prior level of recreation activities. The anatomic PCL reconstruction functions well in the medium to long-term follow-up. We recommend allograft reconstruction that uses an Achilles tendon allograft as a good strategy to treat knee dislocation patients who have sustained a PCL tear.Anatomic PCL Reconstruction: The Double Bundle Inlay TechniqueJames P. Stannard, Richard M. McKean10.1053/j.otsm.2009.06.005Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7148155http://www.optechsportsmed.com/article/PIIS106018720900121X/abstract?rss=yesThe experience of two Canadian surgeons at separate university centers is discussed. The majority of posterior cruciate ligament (PCL) injuries encountered are associated with multiligament knee injuries and knee dislocations. Although not optimal, it is not unusual to have these injuries referred for orthopaedic assessment on a chronic basis. In the setting of multiligament injury we prefer to proceed with timely reconstruction of the PCL with a tendo-Achilles allograft in a single bundle construct. Other high-grade ligament injuries are repaired and/or reconstructed simultaneously as appropriate. Double bundle reconstructions are reserved for isolated PCL injury or in revision situations.Technical Considerations in Posterior Cruciate Ligament Reconstruction. A Canadian PerspectivePeter MacDonald, Daniel Whelan10.1053/j.otsm.2009.08.004Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7156161http://www.optechsportsmed.com/article/PIIS1060187209001208/abstract?rss=yesDiagnosis and management of posterior cruciate ligament tears has advanced over the past 2 decades due to improved understanding of the natural history of injury and basic science principles. Despite the current advances, our understanding of posterior cruciate ligament injury and treatment continues to lag behind that of the anterior cruciate ligament. In addition, there is still controversy regarding indications for surgical intervention, use of 1 vs 2 reconstructive graft bundles, location of the femoral tunnels, and the ideal degree of graft tensioning. The purpose of this article is to present our diagnostic and surgical preferences.Management of Posterior Cruciate Ligament InjuriesRobert G. Marx, Michael K. Shindle, Russell F. Warren10.1053/j.otsm.2009.08.003Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7162166http://www.optechsportsmed.com/article/PIIS1060187209000926/abstract?rss=yesThe injury to the posterior cruciate ligament in sports is uncommon, but can be devastating, and potentially career ending. The diagnosis of the injury may be missed entirely, or mistaken for an anterior cruciate ligament injury. The diagnosis is primarily made by physical examination. The hallmark clinical test is the posterior drawer test performed with the knee at 90°. The clinical staging is easily made in this position. When the tibia is subluxed behind the femoral condyle, this is a grade 3 injury and is usually associated with injury to the posterolateral or posteromedial corner of the knee. An MRI may be helpful to assess other injuries in the knee. The grade 3 injury is generally considered for surgical intervention. My technique of reconstruction is transtibial with inside-out drilling of the femur and an Achilles tendon allograft. In most cases, the posterolateral corner is reconstruction with an allograft fibular head sling. If there is severe external rotation and hyperextension then an anatomic reconstruction of the posterolateral corner is considered. The grade 2 posteromedial laxity is treated with plication of the ligament. In the grade 3 medial collateral ligament laxity associated with a posteromedial spin, an allograft is used to reconstruct the medial collateral ligament. To eliminate the posteromedial rotation, one limb of the graft is pulled under the semimembranosus to prevent the spin. The rehabilitation is slow with immobilization and non-weight-bearing for the first 3-4 weeks. Gradually, range of motion and strengthening exercises are instituted according to the individual patient response.Posterior Cruciate Ligament Injuries: My ApproachDon Johnson10.1053/j.otsm.2009.06.004Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7167174http://www.optechsportsmed.com/article/PIIS106018720900118X/abstract?rss=yesThe keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft tensioning device, use primary and back-up graft fixation, and employ the appropriate postoperative rehabilitation program. Adherence to these technical points results in successful single and double bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction documented with stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.How I Manage Posterior Cruciate Ligament InjuriesGregory C. Fanelli, Joel L. Boyd, Matthew W. Heckler10.1053/j.otsm.2009.08.002Operative Techniques in Sports Medicine 17, 3 (2009)2009-07-01Operative Techniques in Sports Medicine2009-07-01173S1060-1872(09)X0006-7175193