Is there a role for high tibial osteotomies in the athlete?

CONTEXT: The use of high tibial osteotomies (HTOs) in elite and professional athletes has been slow to gain acceptance by both the athlete and the surgeon because it is generally thought that return to competitive sports will be unlikely. Conversely, HTOs have been used extensively and effectively in managing degenerative knee arthrosis in the less active recreational patient with varus deformity who wishes to maintain activity and delay the need for knee arthroplasty. Unfortunately, situations arise where elite athletes develop debilitating pain secondary to malalignment that prevents them from participation, at which time corrective osteotomy may be indicated. Return to sport is not necessarily the goal of osteotomy surgery, but success with correction may allow the athlete to return to high-level activity. Return to elite competition is not the singular goal of HTO in the athlete; however, if the surgery is successful, then consideration can be given to return to play. EVIDENCE ACQUISITION: Despite an extensive literature on return to elite competition after many orthopaedic procedures, there are relatively few data following osteotomies. RESULTS: With expanded indications, osteotomies have become increasingly popular in young patients with malalignment and arthrosis. In addition to addressing malalignment and degenerative processes, HTO can be used in elite athletes in combination with knee reconstructive procedures to address articular defects, meniscal deficiency, and instability, thereby optimizing knee function. CONCLUSION: When performed with the proper indications in competitive athletes, HTO can result in unloading of joint resurfacing procedures, pain reduction, increased functional stability, and restored joint mechanics. Furthermore, as performed in select elite athletes, HTO realignment may not only result in return to play but also improve function and possibly prolong competition at a high level.

Scapular osteochondroma treated with arthroscopic excision using prone positioning.

Osteochondromas, or exostoses, are common benign bone tumors. Most commonly, osteochondromas arise in the metaphyseal regions of long bones (femur, humerus, tibia). Seldom are osteochondromas found on the undersurface of the scapula; these osteochondromas invoke mechanical irritation that leads to bursa formation, snapping, and even winging of the scapula. Many authors have reported performing open surgical excision when these osteochondromas become symptomatic. In this report, we describe the case of a woman in her mid-20s with painful scapular snapping and winging from an osteochondroma treated with arthroscopic excision using prone positioning.

Rehabilitation following high tibial osteotomy.

Tibial osteotomy is an effective surgical intervention for treating knee malalignment associated with pain or arthrosis in young and active patients. Although the techniques have evolved, the basic principle has been used for many years. The advent of improved fixation devices has allowed for earlier and more aggressive return to activity, resulting in the need for new rehabilitation guidelines that are individualized to patient pathology, expectations, and abilities.

Glenoid inclination: in vivo measures in rotator cuff tear patients and associations with superior glenohumeral joint translation.

Glenoid inclination has been associated with rotator cuff tears and superior humeral translation, but the relationship between glenoid inclination and superior humeral translation has not been assessed in vivo. This study compared glenoid inclination between repaired and contralateral shoulders in 21 unilateral rotator cuff repair patients. As a secondary analysis, we assessed the relationship between glenoid inclination and in vivo superior humeral translation. Glenoid inclination was measured from patient-specific, computed tomography-based bone models. Glenohumeral joint motion was measured from biplane radiographs collected during coronal-plane abductions. Glenoid inclination was significantly lower for the rotator cuff tear shoulders (90.7 degrees ) than the asymptomatic, contralateral shoulders (92.3 degrees , P = .04). No significant correlation existed between increased glenoid inclination and superior-inferior translation of the uninjured shoulder (P > .30). This study failed to support the theory that glenoid inclination is responsible for superior humeral translation and the development of subacromial impingement.