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1.
Clin Sports Med ; 41(1): 109-121, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782068

RESUMO

Management of the patient with multiple risk factors for recurrent patellar instability is complex. Surgeons must possess familiarity with the anatomic risk factors that are associated with first time and recurrent instability events and weigh them in the patient's individualized surgical "menu" options for surgical patellar stabilization. Addressing individual risk factors, pairing imaging findings with physical examination, and thoughts on prioritizing risk factors to determine which should be prioritized for surgical correction are discussed.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/epidemiologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Recidiva , Fatores de Risco
2.
Clin Sports Med ; 41(1): 123-136, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782069

RESUMO

Congenital dislocation of the patella is a rare condition characterized by lateral dislocation of the patella that is irreducible without surgical correction. Although there is no clear inheritance pattern, it is associated with several congenital syndromes. Patients often demonstrate flexion contracture, loss of active knee extension, increased tibial external rotation, and absent patella in the trochlea. Treatment requires surgical management and is comprised of lateral release, medial stabilization, quadriceps lengthening, and distal realignment. Results are generally favorable after treatment; persistent flexion contracture and redislocation are the most common complications. Further study is needed to define the optimal timing and treatment strategy for this uncommon condition.


Assuntos
Luxação Patelar , Humanos , Joelho , Articulação do Joelho , Patela , Luxação Patelar/diagnóstico , Luxação Patelar/cirurgia , Tíbia
3.
Clin Sports Med ; 41(1): 137-155, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782070

RESUMO

Cartilage defects of the patellofemoral joint are commonly found in association with patellar instability owing to abnormal biomechanics. Strategies to address chondral defects of the patellofemoral joint secondary to instability should first address causes of recurrent instability. Most patellofemoral chondral defects associated with instability are less than 2 cm2 and do not generally require intervention beyond chondroplasty. Larger defects of the patella and/or the trochlea can be repaired with osteochondral or surface cartilage repair.


Assuntos
Doenças das Cartilagens , Instabilidade Articular , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Patela/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia
4.
Clin Sports Med ; 41(1): 15-26, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782071

RESUMO

Coronal malalignment of the patellofemoral joint may contribute to both instability as well as pain and joint overload. The use of distal realignment procedures has evolved to include uniplanar and multiplanar osteotomies, which allows patient-specific treatment. With a careful understanding of the complex pathoanatomy, including osseous, soft tissue, and dynamic muscular factors, an appropriately designed tibial tubercle osteotomy (TTO) is an invaluable tool for the orthopedic surgeon to improve joint biomechanics and off-load articular injuries. Current techniques have improved TTO surgery to limit complications and produce reliably good results.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Osteotomia , Patela , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/cirurgia
5.
Clin Sports Med ; 41(1): 157-169, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782072

RESUMO

Patellar instability is one of the most prevalent knee disorders, with dislocations occurring in 5 to 43 cases per 10,000 annually. Traumatic patellar dislocation can result in significant morbidity and is associated with patellofemoral chondral injuries and fractures, medial soft tissue disruption, pain, and reduced function, and can lead to patellofemoral osteoarthritis. Chronic and recurrent instability can lead to deformation and incompetence of the medial soft tissue stabilizers. Despite recent gains in understanding the pathoanatomy of this disorder, the management of patients with this condition is complex and remains enigmatic.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Luxação Patelar/epidemiologia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
6.
Clin Sports Med ; 41(1): 171-183, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782073

RESUMO

The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic tightness to laxity, presenting with symptoms related to patellar instability, anterior knee pain, or arthritis. Clinical evaluation should be performed to confirm patellar dislocation, assess the integrity of the lateral and medial soft tissues, and explore other pathoanatomic factors that may need to be addressed. Lateral retinacular lengthening is recommended over lateral release owing to the potential of iatrogenic medial instability with release, and a lateral patellofemoral ligament reconstruction can be performed to effectively treat medial instability.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Patela , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
7.
Clin Sports Med ; 41(1): 27-46, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782074

RESUMO

Rotational deformity is a less common cause of patellar instability than trochlear dysplasia and patella alta. In some cases, rotational deformity is the primary bony factor producing the instability and should be corrected surgically. More research is needed on what are normal values for femoral version and tibial torsion, as well as when the axial plane alignment needs to be corrected. Many tools can be used to evaluate the axial plane and surgeons should be familiar with each of them. Understanding the advantages and disadvantages of each site for osteotomy will help the surgeon choose the most appropriate osteotomy.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Patela , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/cirurgia
8.
Clin Sports Med ; 41(1): 47-63, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782075

RESUMO

Valgus malalignment is an important risk factor in recurrent patella instability. This article explores the role of corrective osteotomy and discusses the various described methods both on the femoral and tibial sides of the joint. A detailed operative technique of medial closing wedge distal femoral osteotomy is included.


Assuntos
Geno Valgo , Instabilidade Articular , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Geno Valgo/diagnóstico por imagem , Geno Valgo/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteotomia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
9.
Clin Sports Med ; 41(1): 65-76, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782076

RESUMO

Patella alta is described as abnormally high-riding patella in relation to the femur, the trochlear groove, or the tibia with decreased bony stability. Patella alta represents an important predisposing factor for patellofemoral instability. Different measurement methods are used to define patella alta. Despite the clinical importance of patella alta, there is only limited consensus on cutoff values, indications for treatment, and ideal correction. In addition, the impact of patella alta on other risk factors for lateral patellar instability is significant. This must be considered when assessing clinical complaints and choosing the best individual treatment. Combined surgical interventions may be necessary.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Humanos , Instabilidade Articular/cirurgia , Patela/diagnóstico por imagem , Patela/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Fatores de Risco
10.
Clin Sports Med ; 41(1): 77-88, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782077

RESUMO

When? Only patients with high-grade trochlear dysplasia types B and D, in which the prominence of the trochlea (supratrochlear spur) is over 5 mm, recurrent patellar dislocation, and maltracking. How? Sulcus deepening trochleoplasty: modifies the trochlear shape with a central groove and oblique medial and lateral facets; decreases the patellofemoral joint reaction force by reducing the trochlear prominence (spur); and reduces the tibial tubercle and the trochlear groove value by a proximal realignment. Pros: This procedure is highly effective in restoring patellofemoral stability and satisfying the patients. Cons: The patients must be aware of the risk of continuing residual pain and range-ofmotion limitation and that the development of patellofemoral osteoarthritis is not predictable.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Instabilidade Articular/cirurgia , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
11.
Clin Sports Med ; 41(1): 89-96, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782078

RESUMO

Medial patellofemoral ligament reconstruction is used increasingly to treat patellar instability. A number of different techniques have been described to perform this procedure. In this article, we review common pearls and pitfalls to medial patellofemoral ligament reconstruction, as well as tips for troubleshooting the procedure. A special emphasis is placed on femoral tunnel position and intraoperative adjustments that can be made to improve outcomes.


Assuntos
Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Fêmur , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho , Ligamentos Articulares/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia
12.
Clin Sports Med ; 41(1): 97-108, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782079

RESUMO

Through this article, the authors aim to summarize the techniques performed on both first time and recurrent skeletally immature patients experiencing patellar dislocation. This article focuses on several key points, such as the importance of medial patellofemoral ligament femoral insertions being distal to the growth plate and performing extensive lateral release and quadricep tendon lengthening in cases of obligatory dislocation. Although acknowledging the procedures discussed cannot be considered for all patients, as individuals with open growth plates may require additional operative time, in many cases these techniques yield high rates of success.


Assuntos
Luxação Patelar , Articulação Patelofemoral , Humanos , Articulação do Joelho , Ligamentos Articulares/cirurgia , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tendões
13.
Thorac Surg Clin ; 32(1): 57-65, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34801196

RESUMO

Esophageal cancer is a deadly cancer. Advances in multimodal treatment have improved esophageal cancer outcomes. Advancements have not benefited all races equally. Major disparities in esophageal cancer outcomes exist. Minorities undergo fewer surgical resections of esophageal cancer and have poorer outcomes.


Assuntos
Adenocarcinoma , Carcinoma de Células Escamosas , Neoplasias Esofágicas , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Disparidades em Assistência à Saúde , Humanos
14.
Clin Plast Surg ; 49(1): 1-11, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782128

RESUMO

Requiring both high-level technical skills and artistic sense, rhinoplasty continues to be one of the most challenging procedures in plastic surgery despite its popularity. A thorough preoperative consultation of the rhinoplasty patient forms the foundation of a successful case. During the consultation, the physician should obtain a detailed medical and nasal history, understand the patient's areas of concern, conduct a nasal analysis, and evaluate the patient's candidacy for surgery. This article reviews the key functional, esthetic, and psychosocial considerations that should be taken into account during a preoperative consultation for a rhinoplasty patient.


Assuntos
Rinoplastia , Cirurgia Plástica , Estética , Humanos , Nariz/cirurgia , Cuidados Pré-Operatórios
15.
Clin Plast Surg ; 49(1): 111-121, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782129

RESUMO

The crooked nose is a challenging esthetic and functional problem. The surgeon must carefully evaluate baseline facial asymmetry as well as whether deviation stems from the upper third, middle third, or lower third of the nose. Surgical intervention should be tailored accordingly, with techniques geared toward addressing each deviated section. Modified dorsal preservation techniques represent a newer means to address deviations. Operative results must be measured, ideally through patient-reported outcomes measures, to quantify overall success.


Assuntos
Deformidades Adquiridas Nasais , Rinoplastia , Estética , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Resultado do Tratamento
16.
Clin Plast Surg ; 49(1): 123-136, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782130

RESUMO

An understanding of anatomy and pathophysiology of the cleft nasal deformity is crucial to its management, including selection of correct surgical techniques for repair. Timing of intermediate and definitive rhinoplasty should be considered carefully, with definitive rhinoplasty occurring after management of facial skeletal deformities. At the time of definitive rhinoplasty, the septum, external and internal nasal valves, alar base malposition (and corresponding bony deficiency), and position and shape of the lower lateral cartilage and the columella all must be individually considered. Thorough knowledge of rhinoplasty techniques is crucial to address the cleft nasal deformity with optimal functional and aesthetic outcomes.


Assuntos
Fenda Labial , Rinoplastia , Cartilagem , Fenda Labial/cirurgia , Estética , Humanos , Septo Nasal/cirurgia , Nariz/cirurgia
17.
Clin Plast Surg ; 49(1): 137-148, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782132

RESUMO

To manage the deficient nasal dorsum, a thorough knowledge of dorsal augmentation techniques should be mastered by the rhinoplasty specialist. Indications for dorsal augmentation may arise in both primary and revision rhinoplasty presentations. To direct operative planning, a complete facial analysis, noting the importance of maintaining overall nasofacial balance, is essential. An array of techniques, including autologous and nonautologous (ie, allogeneic and synthetic) sources, have been used globally-each carrying its own advantages and disadvantages. The authors believe autologous grafts to be the optimal source for dorsal augmentation because of their biocompatibility and ability to produce natural and long-lasting outcomes.


Assuntos
Fáscia , Rinoplastia , Fáscia/transplante , Humanos , Nariz/cirurgia , Coleta de Tecidos e Órgãos , Transplante Autólogo
18.
Clin Plast Surg ; 49(1): 149-160, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782133

RESUMO

Today non-Caucasian patients comprise an important group of patients seeking rhinoplasty. The term non-Caucasian is used interchangeably to speak about patients of ethnic origin. It becomes important to understand the interplay of culture, race, and ethnicity when evaluating patients and defining what their aesthetic ideals are and what will be needed for surgery. An integrated approach and management of the non-Caucasian patient is presented in which medical and surgical options are explored. The final goal when treating non-Caucasian patients should be trying to help patients achieve their aesthetic ideal in the best possible fashion.


Assuntos
Rinoplastia , Estética , Grupos Étnicos , Humanos , Nariz/cirurgia
19.
Clin Plast Surg ; 49(1): 161-178, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782134

RESUMO

Treatment of nasal base deformities is critical for a successful rhinoplasty. Several anatomic variations are seen on nasal base. Alar base deformities can be horizontal excess or deficiency, vertical excess or deficiency, cephalic malposition or caudal malposition of alar base, wide or narrow nostril sills, and columellar base deformities. Columellar base should be addressed before alar base resections. Correction of columellar base deformities and positioning of medial crural footplates should be the primary step of nasal base surgery to attain aesthetic ideals of the columellar base and improve external nasal valve function. The most common deformities requiring alar base modification include wide nasal base, alar flaring, large nostril size, and asymmetries of nostrils or alae. There are 3 basic types of excision on alar base surgery. (1) Alar wedge excision, (2) nostril sill excision, and (3) combined alar wedge and nostril sill excision. The alar wedge excision is an elliptical excision placed in the alar crease that is used to reduce the size and shorten the vertical length of alar lobule and correct the excessive flaring on the frontal view. Nostril sill excision is the technique which is used to decrease interalar distance and nostril sill length, and reduce the size of nostril. The combined alar wedge and nostril sill excision is used in cases with wide alar base and additionally, there is excessive flaring and large alar lobule.


Assuntos
Procedimentos Ortopédicos , Rinoplastia , Estética , Humanos , Cavidade Nasal , Septo Nasal/cirurgia , Nariz/cirurgia
20.
Clin Plast Surg ; 49(1): 191-195, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782136

RESUMO

Nonsurgical rhinoplasty is increasing in popularity, and when used appropriately, can be less costly and have less downtime than surgical rhinoplasty. It can offer patients a means of seeing how they would feel about a surgical rhinoplasty later. Injection can be safe but patients should still be counseled regarding the rare, possible risks of tissue loss and potentially irreversible tissue ischemia and irreversible blindness. Treatment with hyaluronidase can be partially effective when signs and symptoms are caught early; however, avoidance is still the best medicine along with seeking an experienced, qualified rhinoplasty plastic surgeon.


Assuntos
Rinoplastia , Humanos , Isquemia , Nariz/cirurgia
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