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Introduction
Jaewon Chang and Joseph Guettler
Publication Date: 2023
Imagine a multitrack train system, each track with its own train heading toward the same destination. Each train has a train engineer who has a different educational background and has a vague idea that if they follow the track they are on, they will reach their destination. Because of their different educational backgrounds, the train engineers have better knowledge of certain parts of the journey and not so much on other parts. Each train has different baggage, engines, conductors, and different kinds of resources on board all with similar qualities. However, none of the train engineers know that each train is heading toward the same location. Each train represents different background groups of people with diverse skills biology, chemistry, computer science, engineering, medicine, and public health. Translational medicine is the multistep process of bringing all these unique backgrounds into a more streamlined process in the form of diagnostics, medical procedures, devices, and behavioral changes.
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Combined Medial Patellofemoral Ligament and Medial Patellotibial Ligament Reconstruction
Robert S. Dean, Betina B. Hinckel, and Elizabeth A. Arendt
Publication Date: 2023
Lateral patellar dislocations are a common, potentially debilitating injury that occurs in young athletes. While the medial patellofemoral ligament (MPFL) is the primary ligamentous restraint to lateral patellar translation, the MPTL and medial patellomeniscal ligament (MPML) also play integral roles in patella kinematics. Biomechanical studies have shown that the MPTL is responsible for nearly 25% of restraint in extension and the combined MPTL/MPML complex provides 46% of the restraint at 90° of flexion. The indications for MPTL reconstruction are evolving, and can include patients with subluxation in extension, flexion instability, children with risk factor for recurrence, knee hyperextension and/or an increased quadriceps vector due to rotational deformities. For reconstruction of the distal medial patellotibial complex, a variety of surgical options are available and are discussed. The authors’ preferred technique is a combined MPFL, MPTL reconstruction using a tibialis anterior allograft. While the long-term outcomes are scarcely described in the literature, the available data suggests that several of these procedures are effective at preventing subsequent dislocations or instability events in select high risk situations, while also providing pain and functional relief to a young and active patient population.
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Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures
Robert S. Dean, Betina B. Hinckel, Ali Omari, Ian Hutchinson, and Andreas H. Gomell
Publication Date: 11-2023
Symptomatic cartilage lesions are a complex problem that can negatively affect quality of life, especially in young patients. The treatment of cartilage defects is multifactorial and should be formulated on a patient-specific basis based on activity level, age, lesion size, and quality in addition to the potential economic burden of available treatments. Current surgical options consist of marrow-based techniques, chondrocyte-based techniques, osteochondral scaffolds, and mature hyaline cartilage. This chapter provides a clear and contemporary description of the current cartilage lesion strategies and proposes and algorithm to guide the decision-making process of the orthopaedic surgeon in determining a successful treatment plan based upon the current literature.
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Medial Deltoid Ligament Injuries
Nacime SB Mansur, Elijah Auch, Eli Lerner Schmidt, and Cesar de Cesar Netto
Publication Date: 2022
Although still surrounded by controversy, acute deltoid ligament injuries oftentimes result in a severe and disabling ankle instability that often requires surgery. Deltoid ligament ruptures, whether associated with ankle fractures, syndesmosis injuries, or multiple-ligament lesions, are treated surgically with ligament reinsertion.
Chronic medial instability as a consequence of inadequate deltoid ligament healing after an injury or secondary to a progressive collapsing foot deformity typically demand ligament reconstruction combined with bony realignment procedures.
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Biomechanics and Implant Materials: The Anterior Column
Graysen R. Petersen-Fitts, Jad G. Khalil, and Jeffrey S. Fischgrund
Publication Date: 2022
Lumbar fusion procedures have become increasingly common in the treatment of degenerative, traumatic, neoplastic, and deforming conditions of the lumbar spine. As techniques have advanced over time to increase the success of these procedures, the adjunctive use of interbody cages to add structural stability and improve fusion rates has become more common. This chapter describes the types, biomechanical properties, and advantages and disadvantages of the various interbody fusion devices applicable to the anterior column.
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Patellofemoral Anatomy and Its Surgical Implications
Betina B. Hinckel
Publication Date: 10-4-2021
As our understanding of medial patellofemoral anatomy continues to grow, the implications for surgical reconstruction have evolved. Whereas earlier reports focused on reconstruction of the medial patellofemoral ligament (MPFL) as the primary treatment for lateral patellar instability, more recent anatomical descriptions have noted additional fibres that extend proximal to the patella, leading to the development of new reconstruction techniques.
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Tibial Tuberosity Osteotomies
Betina B. Hinckel
Publication Date: 10-1-2021
Normal patellar tracking is mediated statically by the bone structures, passively by the soft tissue stabilisers and actively by the musculature about the knee. Patellofemoral tracking relates to contact because the patella is physiologically intended to be centred within the trochlear groove (TG) throughout a range of motion (ROM) with a physiological pressure distribution
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Patellar Instability
Seth L. Sherman, Joseph M. Rund, Betina B. Hinckel, and Jack Farr
Publication Date: 2021
The evaluation and management of patellofemoral instability is complex and multifactorial. Variability in patient symptoms and the pathology of the underlying bony and soft tissue make it difficult to form precise treatment guidelines and recommendations for individual patients. Risk stratification through recognition of key anatomic and biomechanical factors, functional ability, and patient-specific goals is critical for selection of nonoperative versus operative treatment. This chapter presents a comprehensive approach to the work-up and treatment of patellofemoral instability. Our goal is to integrate anatomy, biomechanics, clinical examination, and imaging studies to guide physicians toward evidence-based recommendations.
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Revision surgery of the foot and ankle:surgical strategies and techniques
Mark J. Berkowitz, Michael P. Clare, Paul T. Fortin, Lew C. Schon, and Roy W. Sanders
Publication Date: 2020
This unique text utilizes a bulleted, case-based approach to present a variety of surgical strategies and techniques for tackling the many challenges posed by revision foot and ankle surgery.The book is organized thematically into sections on the forefoot, trauma, sports injuries, and arthritis and reconstruction, with each chapter including key takeaway points, discussions of evaluation, surgical planning, and the cases themselves. Specific revision topics presented include first MTP joint fusion, failed bunion and hammertoe, failed Lisfranc and fifth metatarsal fracture, failed flatfoot and subtalar fusion, and nonunion of ankle fusion and failed total ankle replacement, among others.
The challenge of revision foot and ankle surgery is that there are countless ways for a surgery to fail. Therefore, presenting as many different scenarios as possible and techniques to address them is the main advantage of the book. Practical and user-friendly, Revision Surgery of the Foot and Ankle will prove indispensable to both the young and veteran orthopedic surgeon preparing for these challenging surgical interventions.
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Revision of nonunion and malunion: Ankle arthrodesis
Paul T Fortin and D N. Beaman
Publication Date: 2020
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Diagnosis, Management, and Prevention of the Unstable Shoulder Arthroplasty
Alexander Martusiewicz
Publication Date: 1-1-2019
Instability after anatomic and reverse shoulder arthroplasty is one of the most common and challenging complications to manage. Understanding the risk factors for instability, its etiology, and management options is key to treating instability after arthroplasty. In this chapter we will discuss how to accurately diagnose and manage instability after anatomic and reverse total shoulder arthroplasty. Intraoperative assessments and techniques to prevent instability from occurring will also be reviewed.
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Introduction, Demographics, and Epidemiology of Diabetes
Paul T. Fortin
Publication Date: 4-15-2016
Diabetes mellitus, a leading cause of mortality, is a complex condition caused by uncontrolled hyperglycemia. A diabetes diagnosis increases the risk of developing additional comorbidities, including cardiovascular disease, nephropathy, retinopathy, mental health disorders, and neuropathies. The rate of new diabetes diagnoses in the United States has not significantly changed since 2006, according to the Centers for Disease Control and Prevention; however, the International Diabetes Federation (IDF) estimates that prevalence of diabetes will increase by 53 % worldwide between 2014 and 2035, growing from approximately 387 million people to 592 million affected. Africa, Middle East/North Africa, and South East Asia will be most impacted by 2035, with estimated increases of 93 %, 85 %, and 64 % people affected by diabetes in each region, respectively. While the international cost of diabetes was $612 billion of all healthcare expenses by health systems and patients in 2014, the IDF expects this figure to increase to approximately $627 billion by 2035. Epidemiological studies have analyzed the diabetic population demographically, to assess factors such as age, sex, race/ethnicity, socioeconomic status, and environment in diabetes development. Although the polymorphisms of the disease, Type I diabetes and Type II diabetes, are commonly known, many variants of diabetes exist. Numerous etiologies of diabetes, such as infection, chemical exposure, and genetic defects, have been identified, although some causes remain unknown. Epigenetic-, gene-, and genome-wide association-based studies have continued to investigate multifactorial linkages between the human genome and development of diabetes.
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