OKOJ, Volume 1, No. 10

Acute anterior cruciate ligament (ACL) tear should be suspected when a significant injury (usually a noncontact, cutting mechanism) is followed by immediate disability and the early onset of hemarthrosis, and, frequently, a slight lack of full extension and posteromedial and/or posterolateral joint line tenderness.Although several authors have speculated on the etiology of the 70% of ACL injuries that do not result from direct contact, the basic mechanism for this injury still eludes us. The basic mechanism appears to be associated with activities, such as decelerating and pivoting, awkward landings, and "out of control" play.This article reviews the pathophysiology, diagnosis, and management options for anterior cruciate ligament tears.

The hamstring autograft can be used a primary reconstruction for both the acute and chronic patient needing an ACL reconstruction. The hamstring autograft can also be used as a revision reconstruction when a patellar tendon graft has failed from the ipsilateral knee. A potential disadvantage of hamstring tendons is that achieving good initial fixation is challenging and in commonly used lengths, these grafts are structurally less stiff than the ACL. Satisfactory initial strengths can be obtained by using single or double screws and spiked washers, double staple techniques, or other devices. This article reviews the indications and contraindications; principles; and surgical technique for endoscopic hamstring graft with endobutton.

Bone-patella tendon-bone autograft has a high ultimate strength and stiffness, allows for strong aperture fixation with interference screws, and bone-to-bone healing in the femoral and tibial tunnels. This combination of a strong graft, strong aperture fixation, and early bone-to-bone healing allow for early and accelerated rehabilitation. This graft is thus ideal for the high-demand athlete. This article reviews the indications and contraindications; principles; and surgical technique for the bone-patella tendon-bone autograft (ACL) reconstruction technique.

The indications for the quadriceps tendon anterior cruciate ligament (ACL) reconstruction technique are the same for any ACL reconstruction. This procedure is indicated in patients with an ACL-deficient knee and instability, who are not willing to give up high-demand sports, with reparable meniscal tears, or with a failed prior ACL reconstruction.This article reviews the indications and contraindications; principles; and surgical technique for the quadriceps tendon anterior cruciate ligament (ACL) reconstruction technique.

Total ankle arthroplasty involves replacement of diseased articular cartilage, sclerotic subchondral bone, and associated osteophytes with a prosthetic joint. Total ankle arthroplasty remains one of the more challenging and technically demanding procedures for the orthopaedic foot and ankle surgeon. Changes in instrumentation and component design have led to renewed interest in ankle replacement as a useful treatment option for tibio-talar joint arthritis.

This article reviews the clinical presentation of tibio-talar joint arthritis and reviews the surgical technique of total ankle arthroplasty as one method of treatment. Nonsurgical management options for tibio-talar joint arthritis are also reviewed.

Adolescent ankle fractures are fractures about the mortise of the ankle that frequently involve the physis of the tibia, fibula, or both. Most fractures of the ankle in adolescents are caused by indirect violence, in which a fixed foot is forced into different position. Ankle fractures account for roughly 5 percent of pediatric fractures, and 15 percent of physeal injuries. The two major goals in the management of ankle fractures in the pediatric patient are to achieve anatomic reduction and to avoid physeal damage. Management decisions are based on restoration of acceptable alignment as well as the particular injury?s predilection toward physeal arrest.

This article addresses management options and principles for specific ankle fractures in adolescents, including Salter-Harris fractures, fractures of Tillaux, triplane fractures, isolated fibula fractures, and tibia and fibula fractures.

The combination of glenohumeral arthritis and rotator cuff deficiency presents unique problems to the treating orthopedic surgeon. Determining the etiology of the arthritic condition the patient suffers from is important for both prognostic and treatment factors. This requires a detailed history, physical examination, radiographic evaluation, and, when needed, blood work and joint aspiration. Management of this condition includes both operative and non-operative treatment. Treatment is based on the severity and duration of the patient?s symptoms.

The pathophysiology and diagnosis of glenohumeral arthritis in the rotator cuff deficient shoulder are reviewed extensively. COnsiderations in nonoperative management are reviewed. Surgical techniques, including hemiarthroplasty and arthroscopic debridement, are presented in detail.