ABSTRACT
Neurogenic thoracic outlet syndrome and superior labrum anterior posterior tears are usually treated in a staged manner due to different post-operative therapy needs. This case describes successful combined surgery with expedited physical therapy.
Subject(s)
Lacerations , Shoulder Injuries , Thoracic Outlet Syndrome , Humans , Treatment Outcome , Arthroscopy , Thoracic Outlet Syndrome/diagnostic imaging , Thoracic Outlet Syndrome/etiology , Thoracic Outlet Syndrome/surgeryABSTRACT
PURPOSE OF REVIEW: Anterior glenohumeral instability is a common injury in contact and collision athletes, and in-season management remains a controversial topic. RECENT FINDINGS: Several recent studies have examined non-operative and operative management of in-season athletes after instability events. Non-operative treatment is associated with faster return to play and higher rates of recurrent instability. Dislocations and subluxations have similar rates of recurrent instability but non-operatively treated subluxations have a quicker return to play than dislocations. Operative treatment is often a season ending decision but is associated with high rates of return to sport and significantly lower rates of recurrent instability. Indications for in-season operative intervention may include critical glenoid bone loss (>15%), an off-track Hill-Sachs lesion, an acutely reparable bony Bankart lesion, high-risk soft tissue injures such as a humeral avulsion of the glenohumeral ligament or displaced anterior labral periosteal sleeve avulsion, recurrent instability, insufficient time remaining in season to rehabilitate from injury, and inability to successfully return to sport with rehabilitation. It is the role of the team physician to appropriately educate athletes on risks and benefits of operative and non-operative treatment strategies and guide athletes through the shared decision-making process that balances these risks against their long-term health and athletic career goals.
ABSTRACT
PURPOSE: Injury to the anterior cruciate ligament (ACL) is common in alpine skiing in the form of either an intra-substance ACL tear or anterior tibial spine fracture (ATSF). Anterior tibial spine fractures are typically reported in children. However, several case reports describe these injuries in adults while skiing. The purpose of this study is to describe the sport specific incidence of ATSF in alpine skiing. METHODS: The study was conducted over a 22-year period. Skiers who suffered an ATSF were identified and radiographs were reviewed to confirm the diagnosis. Additionally, control data from intra-substance ACL injury groups were collected. The incidence of these injuries in children, adolescents, and adults (grouped as ages 0-10, 11-16, and 17 + years old, respectively) was evaluated and the risk factors for ATSF versus ACL tear were determined. RESULTS: There were 1688 intra-substance ACL and 51 ATSF injuries. The incidence of intra-substance ACL injury was greater in adults (40.0 per 100,000 skier days) compared to the adolescent (15.4 per 100,000) and child (1.1 per 100,000) age groups. In contrast, the incidence of ATSF was similar in the adult (0.9 per 100,000), adolescent (1.9 per 100,000), and child (1.9 per 100,000) age groups. Loose ski boot fit was identified as a risk factor for ATSF. CONCLUSION: The incidence of ATSF in alpine skiers is similar among all age groups. However, the incidence of intra-substance ACL injuries is far greater in adult skiers compared to adolescents and children. Risk factors for ATSF relate to compliance between the foot/ankle and the ski boot. LEVEL OF EVIDENCE: III.
Subject(s)
Anterior Cruciate Ligament Injuries , Skiing , Spinal Fractures , Tibial Fractures , Adolescent , Adult , Anterior Cruciate Ligament Injuries/epidemiology , Anterior Cruciate Ligament Injuries/etiology , Child , Humans , Incidence , Infant, Newborn , Skiing/injuries , Spinal Fractures/complications , Tibial Fractures/complications , Tibial Fractures/epidemiologyABSTRACT
Polyethylene (PE) is the key component of total knee replacement (TKR). The wear of polyethylene, a common cause of revision surgeries, depends on multiple factors. The mechanical properties, wear characteristics, and oxidative resistance of PE can be manipulated by the techniques of processing, sterilization, and packaging methods. This article describes the making of conventional and cross-linked poly, packaging, sterilization, processing techniques, and a summary of commercially available plastics and their rationale in TKR including the latest advances.
