Etiology and Pathomechanics of Femoroacetabular Impingement Abstract Purpose of review Femoroacetabular impingement is a common cause of hip pain in young patients and has been shown to progress to osteoarthritis. The purpose of this review is to better understand the development of femoroacetabular impingement. Recent findings Recent literature shows little genetic transmission of FAI. However, molecular studies show strong similarities with the cartilage in osteoarthritis. The development of cam lesions has a strong association with sports participation, particularly at the time of physeal closure suggesting abnormal development. Lumbar, pelvis, and femoral biomechanics may also play an important role in dynamic impingement. Summary In summary, femoroacetabular impingement is a dynamic process with many influences. Further research is needed to clarify the pathophysiology of FAI development in hopes of finding preventative options to reduce symptoms and progression to osteoarthritis.

The Current State of Minimally Invasive Approaches to Adult Spinal Deformity Abstract Purpose of Review Minimally invasive approaches to adult spinal deformity (ASD) surgery have seen a large increase in popularity over the last decade, largely because these techniques are viewed as a potential improvement to the lengthy recovery and high complication rates observed after traditional open surgery for this pathology. The purpose of this review is to present a summary of the latest minimally invasive techniques used in adult spinal deformity surgery, examine whether MIS surgery can accomplish the goals of ASD surgery, and investigate whether MIS surgery is safer than traditional approaches. Recent Findings While minimally invasive approaches have been able to achieve similar patient-reported outcomes as open approaches, they are associated with their own unique complications. Furthermore, they are limited in their ability to correct severe sagittal imbalance. Emerging techniques, such as anterior column realignment and mini-open posterior column osteotomy, have been developed to address these limitations. The minimally invasive spinal deformity surgery algorithm (MISDEF) can help guide surgeons on which approaches may be appropriate for a particular case. Summary To maximize the benefits of a minimally invasive approach without compromising the goals of ASD surgery, surgeons must be selective in choosing which cases are amenable to an MIS approach. Leading experts continue to develop algorithms to guide surgical decision-making. As we learn to better define our indications, understand treatment goals, and refine our techniques, MIS approaches will likely play an even larger role in a comprehensive ASD treatment strategy.

Management of Congenital Pseudoarthrosis of the Tibia and Fibula Abstract Purpose of Review Congenital pseudoarthrosis of the tibia and fibula are rare conditions that share common treatment strategies. The purpose of this review is to provide an overview of the recent developments in treatments for both conditions. Recent Findings Recent literature has focused on the use of BMP and on gait analysis as a tool for measuring long-term functional outcomes. Recent study has indicated rhBMP-2 may shorten the time to initial healing of pseudoarthroses, but not guarantee bony union. Children with initial fractures before the age of four have been shown to have long-term gait outcomes that may be ultimately comparable to children with prostheses. Summary Both congenital pseudoarthrosis of the tibia and fibula are challenging conditions to treat, which require comprehensive approaches to account for both the biological and mechanical components of the conditions.

The Clinical Use of Biologics in the Knee Lesions: Does the Patient Benefit? Abstract Purpose of Review Overview the outcomes of the latest use of platelet-rich plasma (PRP) for the treatment of knee lesions in the clinics and discuss the challenges and limitations. Recent Findings Recent clinical studies mainly indicate there may be benefit of PRP usage for the treatment of knee lesions. As an autologous source of bioactive components, PRP has been shown to be typically safe, free of major adverse outcomes. The use of PRP has been continuously increasing, and some well-designed, double-blinded, placebo-controlled clinical trials have been published. Summary Clinical outcomes relating to PRP usage are multifactorial and depend on the severity of the lesion and patient characteristics. Although PRP is safe to use and it can be easily applied in the clinics, case-specific considerations are needed to determine whether PRP could be beneficial or not. If the use of PRP is favored, then, the configuration/optimization of the preparation and administration/delivery strategy with or without a concomitant treatment may further enhance the clinical outcomes and patients’ experience.

Current Concepts in the Evaluation of the Pediatric Patient with Concussion Abstract Purpose of the Review A concussion is a mild traumatic brain injury (mTBI) that results in a change in how a person feels or functions after a force transmitted to the head. Nearly 10% of all sports-related injuries are mild traumatic brain injuries. Concussion/mTBIs have accounted for more than 3 million emergency department visits between 2005 and 2009 and present as an important public health concern. Recent Findings Physical, cognitive, and psychological functioning are known to be affected by concussion/mTBI, and various tools are readily available to guide clinicians through the initial evaluation. Summary Evaluation of patients with concussion/mTBI should include symptom report and balance, vestibular-ocular, and neurocognitive testing. Awareness of past medical history and pre-injury history of social, behavioral, and emotional functioning is essential to better understand the injury and to predict the expected course of recovery. No tool available can be used alone to diagnose concussion/mTBI or evaluate for recovery.

Contemporary Management of the Hip Capsule During Arthroscopic Hip Preservation Surgery Abstract Purpose of Review The importance of the hip capsule and its effect on hip biomechanics, functional outcomes, and hip arthroscopy success rates has been demonstrated in recent studies. These results have led to a shift in management of the hip capsule, where an increasing number of surgeons routinely perform complete capsular closure. The purpose of this review is to highlight recent studies evaluating the hip capsule and describe contemporary capsular management and repair. Recent Findings Biomechanical studies using cadaveric models have demonstrated that complete capsular closure restores hip distraction, rotation, and extension forces back to the native, intact state. Additionally, capsular closure by plication results in quantifiable intraarticular volume reduction, which increases hip stability, particularly in cases of patulous capsule and hypermobility. Clinical studies have demonstrated superior patient-reported functional outcomes and decreased failure rates when undergoing hip arthroscopy with comprehensive capsular management for femoroacetabular impingement surgery. Summary Complete capsular management, including appropriate capsulotomy and subsequent closure, is critical for restoring biomechanical properties of the hip, ensuring high survivorship and improving functional outcomes. This review provides an update on the effects of contemporary capsular management as well as a detailed description of efficient T-capsulotomy and comprehensive capsule closure via plication.

Innovative Approaches in the Management of Shoulder Instability: Current Concept Review Abstract Purpose of Review This article summarises the latest innovations and concepts in the management of shoulder instability associated with glenoid bone loss. Recent Findings The management of shoulder instability has undergone significant evolution in the last century with rapid strides being made in the last few decades due to the transition from open to arthroscopic techniques allowing management of pathological entities which were previously untreatable. However, there is no consensus on treatment methods, especially in the presence of glenoid bone loss. The complication profile associated with non-anatomic glenoid bony reconstruction procedures has triggered research for alternate techniques using free bone grafts. Open Latarjet procedure continues to be the gold standard in the face of glenoid bone loss; however, arthroscopic anatomic glenoid reconstruction with bone block grafts is gaining in popularity and is associated with excellent short-term clinico-radiologic outcomes. Summary Arthroscopic anatomic glenoid reconstruction using bone grafts has been proposed as an alternative to the complex all-arthroscopic Latarjet procedure with excellent short-term results, minimal complications and a relatively easier learning curve. Capsular reconstruction has emerged as option for the management of instability with poor quality or absent capsular tissue. Future long-term outcome studies and randomised comparative trials will determine if these innovations stand the test of time.

Outcome After Anterior Cruciate Ligament Revision Abstract Purpose of Review To describe the current literature related to anterior cruciate ligament (ACL) revision in terms of surgical aspects, graft choices, concomitant injuries, patient-reported outcome, return to sport, and objective measurement outcome. Recent Findings An ACL rupture is a common knee injury, and the number of primary ACL reconstructions is increasing, implying a subsequent increase of ACL revisions in the future. It is widely accepted that an ACL revision is surgically challenging with a myriad of graft options to choose from. In many cases, simultaneous injuries to the index limb including meniscal and chondral lesions, respectively, are observed in the setting of a secondary ACL injury. Furthermore, the general understanding is that an ACL revision results in inferior outcome compared with a primary ACL reconstruction. Summary Surgical treatment of an ACL revision can be performed as one-stage or two-stage procedure depending on, for example, the presence of limb malalignments, concomitant injuries, and tunnel widening. Nonirradiated allografts and autologous patella tendon, hamstring tendon, and quadriceps tendon are feasible options for ACL revision. Concomitant injuries to the affected knee such as intraarticular chondral lesions are more common in the setting of an ACL revision compared with primary ACL reconstruction while a lower presence of concomitant meniscal pathology is reported at ACL revision. Patients undergoing ACL revision have lower clinical and patient-reported outcome and lower rates of return to sport when compared with primary ACL surgery cases. However, long-term follow-ups with large study cohorts evaluating outcome of ACL revision are limited. Further research is needed to confirm the present findings of this review.

Outcomes for Surgical Treatment of Femoroacetabular Impingement in Adults Abstract Purpose of review To assess the outcomes of modern techniques for arthroscopic surgery in the treatment of femoroacetabular impingement. Recent findings While initially approached by means of open surgical hip dislocation, recent literature has shown generally good outcomes of arthroscopic treatment for femoroacetabular impingement. Modern advances in hip arthroscopy technique and implants now allow for labral repair or reconstruction when indicated. Summary Arthroscopic treatment of femoroacetabular impingement results in significant improvements in patient pain and function, with low complication rates and high patient satisfaction. A majority of improvements in these patients occur within 1 to 2 years post-operatively. Hip arthroscopy for femoroacetabular impingement yields the best results in patients without significant arthritis or hip dysplasia.

Management of High Energy Distal Radius Injuries Abstract Purpose of Review High energy distal radius are commonly multi-fragmentary with significant comminution and/or bone loss. They can also be associated with ligamentous and soft tissue injury and neurovascular compromise. As such, reconstruction of these injuries can be challenging. This paper will review the relevant anatomy, different methods of fixation, and present techniques for difficult fractures. Recent Findings Volar locked plating is a successful, very common method of treatment for distal radius fractures, but dorsal plating, fragment specific fixation, spanning bridge plating, and external fixation are sometimes necessary, particularly in higher energy injuries characterized by metaphyseal comminution, small volar fragments, intra-articular free fragments or lunate facet subsidence. Extended flexor carpi radialis (FCR), dorsal, and flexor carpi ulnaris (FCU) exposures can assist in visualizing the fracture site. Summary There are many different modes of fixation for distal radius fractures, and successful outcome depends on selection of appropriate fixation based on the fracture pattern and status of the soft tissues.