JAAOS, Volume 21, No. 11

Management of Septic Arthritis Following Anterior Cruciate Ligament Reconstruction: A Review of Current Practices and Recommendations

Septic arthritis following anterior cruciate ligament reconstruction is a rare and potentially devastating complication that often leads to articular destruction and adverse clinical outcomes. Because of its rare occurrence, best practices for diagnosis and management have yet to be established. However, graft retention and favorable outcomes are possible with early diagnosis, surgical intervention, and appropriate antibiotic management. Clinicians must be familiar with the diagnostic criteria and management options for septic arthritis. Most patients require multiple procedures to effectively eradicate infection. When the original reconstructed graft cannot be salvaged, a staged anterior cruciate ligament reconstruction revision is required.

      • Subspecialty:
      • Sports Medicine

    Foot Compartment Syndrome: Diagnosis and Management

    Although uncommon, foot compartment syndrome (FCS) is a distinct clinical entity that typically results from high-energy fractures and crush injuries. In the literature, the reported number of anatomic compartments in the foot has ranged from 3 to 10, and the clinical relevance of these compartments has recently been investigated. Diagnosis of FCS can be challenging because the signs and symptoms are less reliable indicators than those of compartment syndrome in other areas of the body. This may lead to a delay in diagnosis. The role of fasciotomy in management of FCS has been debated, but no high-level evidence exists to guide decision making. Nevertheless, emergent fasciotomy is commonly recommended with the goal of preventing chronic pain and deformity. Surgical intervention may also be necessary for the correction of secondary deformity.

        • Subspecialty:
        • Foot and Ankle

      Hip Pathology in the Adolescent Athlete

      Hip injuries in young athletes are being diagnosed with increasing frequency. Improvements in diagnostic imaging and surgical technologies have helped facilitate the diagnosis of intra- and extra-articular derangements that were previously untreated in this age group. Athletic injuries of the hip in the young athlete encompass both osseous and soft-tissue etiologies, which can be the result of a single traumatic event or repetitive microtrauma or may be associated with an underlying pediatric hip disorder. Without accurate diagnosis and management, these injuries may result in debilitating consequences. This article will review the more common causes of hip and groin pain in the adolescent athlete, as well as advances in diagnostic and therapeutic interventions.

          • Subspecialty:
          • Pediatric Orthopaedics

        Tendon Transfers for Radial, Median, and Ulnar Nerve Palsy

        Tendon transfers are used to restore balance and function to a paralyzed, injured, or absent neuromuscular-motor unit. In general, tendon transfer is indicated for restoration of muscle function after peripheral nerve injury, injury to the brachial plexus or spinal cord, or irreparable injury to tendon or muscle. The goal is to improve the balance of a neurologically impaired hand. In the upper extremity, tendon transfers are most commonly used to restore function following injury to the radial, median, and ulnar nerves. An understanding of the general principles of tendon transfer is important to maximize the outcome.

            • Subspecialty:
            • Hand and Wrist

          Management of Metastatic Bone Disease of the Acetabulum

          Metastatic acetabular disease can be severely painful and may result in loss of mobility. Initial management may consist of diphosphonates, narcotic analgesics, radiation therapy, protected weight bearing, cementoplasty, and radiofrequency ablation. Patients with disease affecting large weight-bearing regions of the acetabulum and with impending failure of the hip joint are unlikely to gain much relief from nonsurgical treatment and interventional procedures. The profound osteopenia of the acetabulum, limited healing potential of the fracture, and projected patient life span and function necessitate surgical techniques that provide immediate stable fixation to reduce pain and restore ambulatory function. Current reconstructive procedures, including cemented total hip arthroplasty, the saddle or periacetabular endoprosthesis, and porous tantalum implants, are based on the quality of remaining acetabular bone as well as the patient's level of function and general health. Well-executed acetabular reconstructions can provide durable hip joints with good pain relief and function.

              • Subspecialty:
              • Musculoskeletal Oncology

            Driving After Orthopaedic Surgery

            The decision to drive after orthopaedic injury or surgery is fraught with legal and safety issues. Although driving is an important part of most patients' lives, there are no well-established guidelines for determining when it is safe to drive after injury or treatment. Typically, impairment in driving ability is measured by changes in the time needed to perform an emergency stop. Braking function returns to normal 4 weeks after knee arthroscopy, 9 weeks after surgical management of ankle fracture, and 6 weeks after the initiation of weight bearing following major lower extremity fracture. Patients may safely drive 4 to 6 weeks after right total hip arthroplasty or total knee arthroplasty. Patients should not drive with a cast or brace on the right leg. Upper extremity immobilization may cause significant impairment if the elbow is immobilized; however, simple forearm casts may be permissible.

                • Subspecialty:
                • General Orthopaedics

                • Spine

                • Adult Reconstruction