Clinics in sports medicine
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The lateral approach provides an easy and safe access to the hip joint. The line from skin to the joint itself is a straight, downward drop (Fig. 18). The vital arteries and nerves are a safe distance from the portal sites. ⋯ For hip arthroscopy, the slats do not have to be removed. The lateral approach provides a safe and simple way of performing hip arthroscopy. The instruments can be manipulated easily so that the entire confines of the joint can be visualized with the arthroscope and reached with operative instruments.
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The treatment of osteochondral fractures and OCD lesions in the knee is controversial. Many new procedures and techniques have been developed recently to address osteochondral lesions, indicating that no single procedure is accepted universally. Our treatment algorithm is based on the age of the patient, skeletal maturity, and the presence of adequate subchondral bone attached to the chondral lesion. ⋯ Although the results of many reconstructive procedures are quite encouraging with early follow up, the ultimate goal is to prevent long-term degenerative arthritis. Only well-designed prospective studies with long-term follow up will determine the adequacy of these procedures in reaching the ultimate goal. This treatment algorithm is based on the senior author's (WGC) experience with the complex dilemma of osteochondral lesions of the knee.
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A review of the literature shows that 3% to 9% of all athletic injuries occur to the hand or wrist. Also, hand and wrist injuries are more common in pubescent and adolescent athletes than adults. Although knee and shoulder injuries are more common athletic injuries, an injury to the hand or wrist significantly can impair the athlete's ability to throw or catch a ball, or swing a bat or racquet. ⋯ Displaced fractures of the hook of the hamate, trapezial ridge fractures, and comminuted pisiform fractures are managed best by early excision to promote uncomplicated recovery and early return to sport. For most athletes, return to competition can be expedited safely with the use of padded gloves and custom playing splints or casts. The sports medicine physician always must put the athlete's safety first when deciding the appropriate time for return to competition.
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Elbow dislocations can result in extensive injury to the supporting structures of the elbow joint. Principles of treatment include prompt reduction of the dislocation and treatment of associated fractures. ⋯ When stability is compromised, as with many complex dislocations, further stabilization with ligament repair, reconstruction, and fracture fixation also can lead to satisfactory results. The prognosis following complex dislocations is more guarded in the athlete, and depends on anatomic restoration and initiation of early motion.
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Valgus instability of the elbow in athletes is uncommon among athletes in general, but has a higher incidence in individuals who throw repetitively. When valgus overload injury results in disabling symptoms for the athlete, surgical reconstruction of the anterior band of the ulnar collateral ligament may be indicated. This procedure has been successful in getting athletes back to premorbid levels of competition. The authors provide a comprehensive review of valgus instability of the elbow and offer their preferred method of treatment.