OKOJ, Volume 11, No. 7

Surgical Approaches to the Elbow

In this article, we describe and demonstrate several surgical approaches for treatment of complex injuries about the elbow. Medial approaches to the elbow discussed in this article include the extensile medial (Hotchkiss) approach and the medial coronoid approach. Lateral approaches include the posterolateral (Kocher), anterolateral (Kaplan), and lateral column approaches. Of the posterior approaches to the elbow (olecranon osteotomy, triceps-reflecting, triceps-splitting), we describe the olecranon osteotomy approach, which has been shown to provide the best overall exposure of the articular surface of the distal humerus.

      • Subspecialty:
      • Shoulder and Elbow

      • Hand and Wrist

    Update on Cartilage Regeneration and Clinical Applications of Tissue Engineering in the Management of Cartilage Defects

    The limited repair potential of human articular cartilage results in the eventual development of osteoarthritis, and remains a significant clinical and economic challenge throughout the world. Cartilage regeneration has evolved from palliative methods, such as débridement and lavage or abrasion chondroplasty, to what has been named the two "R" paradigm: repair and replacement. Replacement aims to restore the contour of the articular surface by replacing a lesion in it with an osteochondral graft, whether autogenous, allogenous, or synthetic. Repair involves stimulating the formation of a biologic tissue that fills the defect in the articular surface. This initially involved marrow-stimulation techniques, including microfracture, which remains the most popular procedure for cartilage repair and is considered the standard of care for small cartilage defects because of its simple technique, cost-effectiveness, and single-stage nature. More recently, other cartilage repair strategies have evolved through modifications of bone marrow stimulation and the implementation of tissue-engineering strategies. The development of cartilage-regeneration strategies based on tissue engineering has progressed to provide a more functional biologic tissue for damaged cartilage. Currently, cartilage regeneration has three cornerstones. First, it requires a cell population capable of proliferation and differentiation into mature chondrocytes. Second, it requires a scaffold that is chondro-conductive and/or chondro-inductive. Third, it requires the introduction of growth factors and signaling molecules that stimulate the cellular response and subsequent production of a hyaline extracellular matrix composed predominantly of type II collagen and aggrecan. Numerous limitations hinder the translation of these applications from basic science to clinical research. The most important of these are potential contamination and disease transmission after the manipulation in vitro of cell lineages. Also important are the optimal dosage and delivery of growth factors for the initiation of chondrogenesis and maintenance of the resulting cartilage. This article summarizes the advances that have been made in cartilage regeneration, with their clinical applications and results. Specific emphasis is given to the knee and ankle joints because they remain the two most common joints for the implementation of cartilage-regeneration procedures in clinical practice.

      • Keywords:
      • cartilage repair

      • microfracture

      • osteochondral autograft transplantation

      • OAT

      • autologous chondrocyte implantation

      • ACI

      • matrix-induced autologous chondrocyte implantation

      • MACI

      • bone marrow aspirate concentrate

      • BMAC

      • autologous matrix-induced chondrogenesis

      • AMIC

      • Subspecialty:
      • Adult Reconstruction

      • Basic Science

    Arthroscopic and Open Biceps Tenodesis Distal to the Intertubercular Groove

    Tendinitis of the long head of the biceps tendon is a common and debilitating condition of the shoulder. Arthroscopic techniques of tenodesis originally secured the tendon at a location proximal to the intertubercular groove in the head of the humerus. Although this eliminates the intra-articular portion of the long head of the biceps tendon as a potential generator of pain, it does not address the portion of the tendon that lies within the intertubercular groove. Recent evidence suggests that failure to address this portion of the tendon may predispose to continued pain and clinical failure of the surgical attempt to eliminate it. We present two surgical techniques for tenodesis of the long head of the biceps tendon distal to the intertubercular groove, one for arthroscopic and the other for open tenodesis. The video presentation accompanying this paper details the relevant anatomy, surgical approaches, and technical pearls for each of these techniques.

      • Keywords:
      • long head of the biceps tendon

      • biceps tendinitis

      • arthroscopic biceps tenodesis

      • open biceps tenodesis

      • shoulder arthroscopy

      • Subspecialty:
      • Sports Medicine