J Am Acad Orthop Sur
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Chronic musculoskeletal pain results from a complex interplay of mechanical, biochemical, psychological, and social factors. Effective management is markedly different from that of acute musculoskeletal pain. Understanding the physiology of pain transmission, modulation, and perception is crucial for effective management. ⋯ Extended-release tramadol; select tricyclic antidepressants, serotonin reuptake inhibitors, and anticonvulsants; and topical medications such as lidocaine, diclofenac, and capsaicin are among the most effective treatments. However, drug efficacy varies significantly by indication. Orthopaedic surgeons should be familiar with the widely available safe and effective nonnarcotic options for chronic musculoskeletal pain.
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J Am Acad Orthop Sur · Feb 2014
ReviewFresh osteochondral allograft transplantation for the knee: current concepts.
Fresh osteochondral allograft (OCA) transplantation has been used to manage a wide spectrum of chondral and osteochondral knee disorders. Basic science and clinical studies support the safety and efficacy of the procedure. Transplantation of viable, mature hyaline cartilage into the affected area is an advantage of the procedure, which can be used to restore bone stock in complex or salvage scenarios. ⋯ The procedure also can be used for complex biologic knee reconstruction in the setting of osteonecrosis, fracture malunion, or posttraumatic arthritis. Challenges associated with OCA transplantation include allograft storage and size matching, tissue availability, chondrocyte viability, the possibility of immunologic graft response, and a demanding surgical technique. Future research should focus on optimizing allograft viability and healing and refining current surgical indications and techniques.
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J Am Acad Orthop Sur · Jan 2014
ReviewPathogenesis and prevention of posttraumatic osteoarthritis after intra-articular fracture.
Posttraumatic osteoarthritis (PTOA) occurs after traumatic injury to the joint. It is most common following injuries that disrupt the articular surface or lead to joint instability. ⋯ Pathogenesis of PTOA after intra-articular fracture is likely multifactorial and may be associated with acute cartilage injury as well as chronic joint overload secondary to instability, incongruity, and malalignment. Additional studies are needed to better elucidate how these factors contribute to the development of PTOA and to develop advanced treatment algorithms that consist of both acute biologic interventions targeted to decrease inflammation and cellular death in response to injury and improved surgical methods to restore stability, congruity, and alignment.
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J Am Acad Orthop Sur · Dec 2013
ReviewPlatelet-rich plasma in orthopaedic applications: evidence-based recommendations for treatment.
Autologous platelet-rich plasma (PRP) therapies have seen a dramatic increase in breadth and frequency of use for orthopaedic conditions in the past 5 years. Rich in many growth factors that have important implications in healing, PRP can potentially regenerate tissue via multiple mechanisms. ⋯ However, for many conditions, there is limited reliable clinical evidence to guide the use of PRP. Furthermore, classification systems and identification of differences among products are needed to understand the implications of variability.
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The range of open and arthroscopic shoulder procedures continues to evolve and expand. Despite advances in instrumentation and technology, complications still exist and neurologic injury remains an inherent part of these procedures. ⋯ Various surgical procedures about the shoulder are known to place the brachial plexus and peripheral motor nerves at risk. Peripheral nerve monitoring has been helpful in identifying specific surgical steps and key anatomic regions that are susceptible to iatrogenic nerve injury.