Sports medicine and arthroscopy review
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Sports Med Arthrosc · Dec 2019
Concepts of the Distal Medial Patellar Restraints: Medial Patellotibial Ligament and Medial Patellomeniscal Ligament.
The important medial patellar ligamentous restraints to lateral dislocation are the proximal group (the medial quadriceps tendon femoral ligament and the medial patellofemoral ligament) and the distal group [medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML)]. The MPTL patellar insertion is at inferomedial border of patella and tibial insertion is in the anteromedial tibia. The MPML originates in the inferomedial patella, right proximal to the MPTL, inserting in the medial meniscus. ⋯ All were case series. Overall, good and excellent outcomes were achieved in >75% of cohorts in most studies and redislocations were <10%, with or without the association of the medial patellofemoral ligament. The MPTL is a relevant additional tool to proximal restraint reconstruction in select patient profiles; however, more definitive clinical studies are necessary to better define surgical indications.
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Sports Med Arthrosc · Sep 2019
ReviewPerioperative Pain Management and Avoidance of Long-term Opioid Use.
The opioid epidemic continues to be a problem in the United States and prescription opioid overdose fatalities continue to rise. Chronic opioid use threatens military readiness and puts service members at risk for medical separation from military service. Orthopedic surgeons commonly prescribe opioid medications for postsurgical patients. ⋯ Overprescribing may increase the risk of long-term opioid use, medication diversion and adverse outcomes. Preoperative administration of opioids dramatically increases the risk of continued use up to 1 year after surgery. Strategies to minimize opioid use include opioid-specific preoperative counseling, multimodal analgesia with opioid-sparing oral and intravenous medications, regional anesthesia, minimizing tourniquet use, and preoperative behavioral health evaluation.
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The past 3+ decades have been a period of intense interest in the anterior cruciate ligament. Graft choices, techniques, and fixation devices have all evolved. ⋯ Our follow-up and criteria for success have also expanded. Over the next several years advanced repair techniques, extra-articular augmentation, and addressing elevated tibial slope will all have to have their indications defined.
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Sports Med Arthrosc · Sep 2016
ReviewStructural Neuroimaging Findings in Mild Traumatic Brain Injury.
Common neuroimaging findings in mild traumatic brain injury (mTBI), including sport-related concussion (SRC), are reviewed based on computed tomography and magnetic resonance imaging (MRI). Common abnormalities radiologically identified on the day of injury, typically a computed tomographic scan, are in the form of contusions, small subarachnoid or intraparenchymal hemorrhages as well as subdural and epidural collections, edema, and skull fractures. ⋯ The MRI findings from a large pediatric mTBI study show low frequency of positive MRI findings at 6 months postinjury. The review concludes with an examination of some of the advanced MRI-based image analysis methods that can be performed in the patient who has sustained an mTBI.
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The elbow is the second most commonly dislocated large joint and occurs with more frequency in sports men and women than in the general population. Understanding the normal anatomy, the mechanism of injury and the pathoanatomy of the injury to the soft tissue restraints about the elbow are important for obtaining a good result. ⋯ Repair using tensionable anchors allows the surgeon to tension both medial and lateral sides sequentially in a controlled manner, and allows assessment of range and stability during the tensioning process. Once stability to the elbow has been restored, early active mobilization can be initiated, with the aim of returning to sport as soon as possible.