OKOJ, Volume 6, No. 11

Patellar Instability After Total Knee Arthroplasty

Common patellofemoral complications after total knee arthroplasty (TKA) include instability, patellar fracture, implant loosening, component breakage, osteonecrosis, and accelerated polyethylene wear. Nonsurgical management of these complications after TKA is almost always indicated initially but has been associated with mixed results. Because femoral or tibial component malposition is often the etiology of patellar complications, revision of the malpositioned TKA components is usually required. Proximal realignment for patellar maltracking in the setting of properly positioned and sized components is associated with good results. Isolated patellar component revision has been reported to have a high rate of complications.

    • Keywords:
    • resurfaced patella

    • unresurfaced patella

    • onlay patella

    • inset patella

    • metal-backed patella

    • congruent articulation

    • incongruent articulation

    • lateral release

    • vastus medialis advancement

    • tibial tubercle transfer

    • Subspecialty:
    • Adult Reconstruction

The Thrower's Shoulder

Athletes who participate in repetitive overhead throwing activities experience distinct injuries of the shoulder that create significant clinical challenges for the sports medicine physician. This article explores how scapular "issues" in the overhead thrower may potentiate the development of tissue breakdown in the shoulder. Diagnostic procedures for rotator cuff and labral injuries are discussed, recent advances in both nonsurgical and surgical intervention are elaborated, and preventive strategies are described.

    • Keywords:
    • overhead throwing athlete

    • scapular dyskinesis

    • rotator cuff injury

    • rotator cuff impingement

    • rotator cuff tear

    • shoulder impingement syndrome

    • internal impingement

    • SLAP tear

    • humeral retroversion

    • posterior capsular contracture

    • anterior capsular laxity

    • GIRD

    • kinetic chain breakdown

    • shoulder arthroscopy

    • Subspecialty:
    • Shoulder and Elbow

    • Sports Medicine

Fractures of the Scapula

Traumatic injuries to the scapula are uncommon and therefore have received little attention in the orthopaedic literature. Scapula fractures often result from significant high-energy trauma, such as motor vehicle accidents or falls from a height. Direct blows over the anterior, posterior, or superior aspect of the shoulder are most common, although indirect mechanisms can also occur, such as a fall on the arm that causes the humeral head to impact against the glenoid. The indications for surgical management of scapula fractures are still evolving. Most isolated fractures of the scapular body without involvement of the glenoid or scapular neck can be managed nonsurgically. However, fractures that are significantly displaced can result in adverse healing and long-term functional consequences and should be considered for open reconstruction.

    • Keywords:
    • scapular fractures

    • glenoid fracture

    • glenoid rim fracture

    • scapular neck fracture

    • acromion fracture

    • coracoid fracture

    • scapulothoracic dissociation

    • shoulder girdle injury

    • Subspecialty:
    • Trauma

    • Shoulder and Elbow