okoj, Volume 6, No. 6

Minimally Invasive Total Knee Arthroplasty

Minimally invasive total knee arthroplasty is a controversial topic in orthopaedics. Across all surgical specialties, more than 300 articles on minimally invasive surgery have been published within the past 5 years. Among these, we identified 69 peer-reviewed articles that analyzed the outcomes of minimally invasive total knee arthroplasty. Although"minimally invasive"is a commonly used term in all surgical specialites and a term patients seem to understand, some orthopaedic surgeons argue that total knee arthroplasty is an extremely invasive procedure by nature, and therefore the term"minimally invasive"is used inappropriately. Our experience with minimally invasive total knee arthroplasty began in 1999, and the first national presentation of our outcome data was in October 2001. Since that time, surgeons and device manufacturers have developed approaches, techniques, instrumentation, and even implants to facilitate total knee arthroplasty with reduced exposure. Several controversial issues have arisen concerning the value of minimally invasive surgery, one viewpoint being that minimally invasive surgery, although useful for marketing and/or promotional purposes, primarly has a cosmetic value and typically leads to short-term gains and an increased risk of complications.

    • Keywords:
    • MIS

    • TKA

    • soft-tissue sparing retractor

    • quad-saving approach

    • quadriceps saving approach

    • mini-midvastus approach

    • mini mid-vastus approach

    • mini-subvastus approach

    • mini sub-vastus approach

    • mini-median parapatellar approach

    • computer-assisted navigation

    • arthroscopic-assisted mini-subvastus approach

    • Effingham modification

    • arthroscopic-assisted mini sub-vastus approach

    • Subspecialty:
    • Adult Reconstruction

Tibial Shaft Fractures

Tibial shaft fractures are among the most common pediatric injuries and account for 4% to 5% of all pediatric fractures. Tibial shaft fractures may result from low-energy trauma, such as a fall from a standing height (more common in younger children), or high-energy trauma, such as that occurs when a bicyclist is struck by a car. Treatment is individualized based on patient age, concomitant injuries, fracture pattern, and associated soft-tissue and neurovascular injuries. The goal of management of a tibial shaft fracture is complete union with satisfactory alignment in the coronal, sagittal, and axial planes, and acceptable shortening. Most tibial shaft fractures in children can be treated conservatively with closed reduction and casting. Surgical management options include percutaneous pinning with Kirschner wires, external fixation, intramedullary nailing, and plate-and-screw fixation.

    • Keywords:
    • broken leg

    • broken shinbone

    • leg fracture

    • fractured leg

    • fractured tibia

    • broken tibia

    • compartment syndrome

    • Subspecialty:
    • Pediatric Orthopaedics

    • Trauma

Autologous Osteochondral Transplantation

Osteochondral autograft transplantation is a viable treatment option for symptomatic high-grade articular cartilage lesions of the distal femur in young, active patients. The advantages of this technique include graft availability, the absence of disease transmission, and the low cost of a single surgical procedure. Disadvantages include graft availability and donor-site morbidity. Osteochondral autograft transplantation is a technically demanding procedure, and particular attention must be given to choosing the location of the donor site and harvesting appropriately sized osteochondral grafts. In addition, the method of graft harvest and delivery affects both chondrocyte viability and recipient graft stability. The future of articular cartilage restoration is promising. New advances in technology, bioengineering, and gene-modified tissue engineering will provide surgeons the tools to more accurately restore articular defects to normal hyaline cartilage, thus allowing patients to maintain a high level of activity.

    • Keywords:
    • osteochondral pathology

    • articular cartilage injury

    • articular cartilage lesions

    • hyaline cartilage defects

    • osteochondral grafts

    • OATS

    • osteoarticular transfer surgery

    • osteoarticular allograft transplantation

    • osteochondral autograft transplantation

    • mosaicplasty

    • chondral osseous replacement

    • COR

    • autologous chondrocyte implantation

    • ACI

    • Subspecialty:
    • Sports Medicine

    • Basic Science