Clinics in sports medicine
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PM tears most commonly occur in the young athletic male while performing weight-lifting exercises, but can result from any activity whereby the arm is maximally contracted in an extended and externally rotated position. Patients typically present with acute pain, swelling, ecchymosis, deformity, and weakness with adduction and internal rotation. Diagnosis of PM tears can usually be made by history and physical examination, but MRI can be helpful in identifying the extent and location of injury. ⋯ Nonoperative treatment is generally reserved for proximal tears, low-grade partial tears, and tears in sedentary patients. In most cases these patients will resume full activities of daily living. For all other tears, especially in the young, active athlete, acute (<6 weeks) repair is recommended to return the patient to full strength and function.
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Patella instability can cause significant pain and functional limitations. Several factors can predispose to patella instability, such as ligamentous laxity, increased anterior TT-TG distance, patella alta, and trochlear dysplasia. Acquired factors include MPFL injury or abnormal quadriceps function. ⋯ Tibial tubercle osteotomy can address bony malalignment and also unload certain articular cartilage lesions while improving stability. Trochleoplasty may be indicated in individuals with a severely dysplastic trochlea that cannot otherwise be stabilized. A combination of procedures may be necessary to fully address the multiple factors involved in causing pain, loss of function, and risk of recurrence in patients with patellar instability.
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With the recent increase in medial unicompartmental arthroplasty, this article reviews the design history, indications, results, and modern technique for the implantation of the Oxford mobile-bearing unicompartmental arthroplasty. The article also discusses how the indications for the Oxford differ from the historical indications for medial unicompartmental arthroplasty and supports this paradigm shift with review of the recent data. A detailed series of surgical pearls is also presented to help surgeons with the surgical nuances of the Oxford partial knee.
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Unicondylar knee arthroplasty (UKA) is a challenging surgical procedure for many orthopedic surgeons when compared with total knee arthroplasty (TKA). Given the proven similarities in knee biomechanics between UKA and the native knee and recent evidence showing excellent survivorship and functionality, UKA is an excellent alternative to TKA in the appropriate patient. ⋯ The concerns of complications arising from cannulating the medullary canal and excessive bleeding have not been seen. The intramedullary UKA yields high levels of success and long-term outcomes, with excellent alignment.
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The published recommendations for the nonoperative treatment of osteoarthritis (OA) of the knee include weight loss, physical therapy to strengthen lower-extremity musculature, nonsteroidal antiinflammatories, nutritional supplements, topical treatments, and steroid injections. Evidenced-based results have been mixed using these treatment modalities. The results using unloader braces and viscosupplementation have also been variable. This article reviews the use of conservative treatment of OA of the knee.