Current Reviews in Musculoskeletal Medicine

PURPOSE OF REVIEW: Septic arthritis of the knee following anterior cruciate ligament reconstruction is a rare but potentially deleterious complication. The main approach to the management of this potentially devastating complication in recent years has involved a more aggressive attempt at preventing graft contamination during surgery with the adoption of the pre-soaking of the graft in broad-spectrum antibiotic solution, and early and adequate treatment of established cases of knee sepsis, with or without retention of the graft...

PURPOSE OF REVIEW: The concept of meniscal extrusion has recently been recognized as a hallmark of meniscus dysfunction. This review examines contemporary literature regarding the pathophysiology, classification, diagnosis, treatment, and future directions for investigation regarding meniscus extrusion. RECENT FINDINGS: Meniscus extrusion, defined as >3 mm of radial displacement of the meniscus, leads to altered knee biomechanics and accelerated knee joint degeneration...

PURPOSE: The extent of glenohumeral bone loss seen in anterior shoulder dislocations plays a major role in guiding surgical management of these patients. The need for accurate and reliable preoperative assessment of bone loss on imaging studies is therefore of paramount importance to orthopedic surgeons. This article will focus on the tools that are available to clinicians for quantifying glenoid bone loss with a focus on emerging trends and research in order to describe current practices...

PURPOSE OF REVIEW: This article reviews the basics of 3D printing and provides an overview of current and future applications of this emerging technology in pediatric orthopedic surgery. RECENT FINDINGS: Both preoperative and intraoperative utilization of 3D printing technology have enhanced clinical care. Potential benefits include more accurate surgical planning, shortening of a surgical learning curve, decrease in intraoperative blood loss, less operative time, and fluoroscopic time...

PURPOSE OF REVIEW: The aim of this review is to interpret the existing evidence regarding the psychological aspects of sport specialization within the context of a developmental framework. RECENT FINDINGS: The growing trend toward early sport specialization is associated with increased risk for injury and burnout, both of which have significant implications for mental health. Mental health literacy programs designed to promote awareness, decrease stigma, and encourage help-seeking behaviors can be an effective way to increase resilience and early recognition of those in need...

PURPOSE OF REVIEW: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain that may potentially lead to osteoarthritis. Operative management of FAIS seeks to arthroscopically reshape the abnormal hip morphology and repair the labrum. For rehabilitation following operative management, a structured physical therapy program is unanimously recommended for the patient to return to their previous level of physical activity. Yet, despite this unanimous recommendation, significant heterogeneity exists among the current recommendations for postoperative physical therapy programs...

PURPOSE OF REVIEW: The use of hip arthroscopy has expanded substantially over the last decade, including in pediatric and adolescent populations. Indications for hip arthroscopy in the pediatric population continue to be refined and research of outcomes following hip arthroscopy has increased. The purpose of this review is to provide an overview of current indications for hip arthroscopy in the pediatric population and the outcomes for each indication. RECENT FINDINGS: Hip arthroscopy is used in the treatment of a range of pediatric hip conditions, spanning from the infant to young adult...

PURPOSE OF REVIEW: To characterize quadriceps muscle dysfunction associated with knee joint preservation surgery, with a focus on its pathophysiology and promising approaches to mitigate its impact on clinical outcomes. RECENT FINDINGS: Quadriceps dysfunction (QD) associated with knee joint preservation surgery results from a complex interplay of signaling, related to changes within the joint and from those involving the overlying muscular envelope. Despite intensive rehabilitation regimens, QD may persist for many months postoperatively and negatively impact clinical outcomes associated with various surgical procedures...

PURPOSE OF REVIEW: Periprosthetic infection after shoulder arthroplasty is relatively uncommon though associated with severe long-term morbidity when encountered. The purpose of the review is to summarize the recent literature regarding the definition, clinical evaluation, prevention, and management of prosthetic joint infection after reverse shoulder arthroplasty. RECENT FINDINGS: The landmark report generated at the 2018 International Consensus Meeting on Musculoskeletal Infection has provided a framework for diagnosis, prevention, and management of periprosthetic infections after shoulder arthroplasty...

PURPOSE OF REVIEW: Glenoid bone loss presents distinct challenges in reverse total shoulder arthroplasty (rTSA) which, if unaddressed, can cause complications including poor outcomes and early implant failure. The purpose of this review is to discuss the etiology, evaluation, and management strategies of glenoid bone loss in primary rTSA. RECENT FINDINGS: Three-dimensional computed tomography (3D CT) imaging and preoperative planning software have revolutionized the understanding of complex glenoid deformity and wear patterns from bone loss...

PURPOSE OF REVIEW: Anterior glenohumeral instability is a common injury in contact and collision athletes, and in-season management remains a controversial topic. RECENT FINDINGS: Several recent studies have examined non-operative and operative management of in-season athletes after instability events. Non-operative treatment is associated with faster return to play and higher rates of recurrent instability. Dislocations and subluxations have similar rates of recurrent instability but non-operatively treated subluxations have a quicker return to play than dislocations...

PURPOSE OF REVIEW: This review provides a historical perspective on the approach to radial tears and collates the currently available evidence on repair techniques, rehabilitation, and outcomes following the treatment of meniscus radial tears. RECENT FINDINGS: Recent literature shows that the repair of meniscus radial tears reports improved patient-reported outcome scores with high return to function and activity. However, no single technique nor construct was proven better than the other...

PURPOSE OF REVIEW: To provide an overview of the recent scientific literature about ramp lesions of the medial meniscus and to summarise the current evidence on their prevalence, classification, biomechanics, surgical techniques and clinical outcomes. RECENT FINDINGS: Ramp lesions may be present in more than 1 patient undergoing ACL reconstruction out of 5 and almost half of the medial meniscal tears observed in this population. Due to the risk of persistent anterior and rotational laxity after ACL reconstruction, their repair has been advocated...

PURPOSE OF REVIEW: Lumbar disc herniation (LDH) is a common injury experienced by athletes and has important clinical considerations for athletes including the timing of return to sport. Lumbar disc herniation may result in loss of individual training and playing time for athletes. Current literature is inconclusive on whether surgical or conservative treatment of LDH is superior in athletes. Our aim was to review the literature to identify return-to-play (RTP) rates and performance outcomes following operative and nonoperative treatment of LDH in the athletic population...

PURPOSE OF REVIEW: The lateral meniscus oblique radial tear (LMORT) of the posterior horn is a relatively new term for one of the more common types of lateral meniscal tears found in patients with acute anterior cruciate ligament (ACL) injuries. Given the importance of anatomical reduction and preservation of the lateral meniscus to maintain normal knee stability and slow the progression of early-onset osteoarthritis, LMORT classification and treatment guidelines have been formulated...

PURPOSE OF REVIEW: This review focuses on the etiology, diagnosis, and management of patellar instability in pediatric patients. RECENT FINDINGS: Radiological outcomes such as tibial-tubercle to trochlear groove (TT-TG) distance used in diagnosis are subject to factors of influence such as femoral anteversion and knee flexion angle, and new measure such as tibial-tubercle to posterior cruciate ligament distance as well as TT-TG/trochlear width (TT-TG/TW) are under investigation...

PURPOSE OF REVIEW: Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review assesses the current literature pertaining to management of both anterior instability and MDI in the pediatric and adolescent populations. RECENT FINDINGS: Current research suggests that pediatric and adolescent patients with shoulder instability have excellent outcomes following arthroscopic Bankart repair; however, higher rates of recurrent instability requiring revision surgical management have been identified in patients with more than one dislocation episode pre-operatively, those with Hill-Sachs lesions and those under age 16...

PURPOSE OF REVIEW: Patients with seizure disorders commonly suffer shoulder dislocations and subsequent instability. Due to high rates of recurrence and bone loss, management of this instability and associated pathology has proven to be more complex than that of patients without seizure disorders. The ultimate goal of this review is to outline the various treatment modalities and their respective outcomes in this complex patient population. RECENT FINDINGS: Optimization of medical management of seizure disorders is imperative...

PURPOSE OF REVIEW: The psychological aspects of musculoskeletal injury are often overlooked in the rehabilitation process. This review examines the effects of musculoskeletal injury on mental health in adult athletes and identifies themes to guide further research. RECENT FINDINGS: Athletes are at risk for mental health struggles due to high athletic identity and identity foreclosure. Injured athletes have specifically been shown to have higher rates of anxiety and depression when compared to the general population...

PURPOSE OF REVIEW: Meniscal allograft transplantation is intended to address painful knees with symptoms that can be attributed to meniscal deficiency through injury or meniscectomy. Initially viewed as an experimental procedure, refinements in patient selection and surgical technique have led to improved clinical outcomes with wider acceptance. Our intention with this paper is to provide a review of meniscal allograft transplantation, with the focus on the different surgical techniques employed and their influence on outcomes...