Indications
- grade 3 or 4 ICRS lesions
Niemeyer et al Arthroscopy 2011
- lesions < 4cm2 microfracture
- lesions > 4cm2 or failed microfracture ACI
Cole et al JBJS 2009
Labral tear
Cam / pincer impingement
Loose bodies / trauma / synovial proliferation
Operative v Nonoperative
Levy et al Arthroscopy 2009
- systematic Review
- improved outcomes with operative management
https://pubmed.ncbi.nlm.nih.gov/19341932/
Vicenti et al. Injury 2019
- systematic review
- two studies compare operative v nonoperative
Metaphyseal
Extra-articular
Congenital
Acquired
- trauma
- post ACL reconstruction / TKR
- chronic quadriceps rupture
Decreases ROM
Associated with early OA of the PFJ
Blackburne-Peel ratio at 30 degrees flexion
Facet joint dislocations secondary flexion distraction injury
10%
1. Unifacet subluxation - interspinous process widening
2. Unifacet dislocation - 25% anterolisthesis
3. Bifacet dislocation - 50% anterolisthesis
4. Complete vertebral translation - 100% anterolisthesis
1. Direct lateral blow to patella
- usually with knee partly flexed and quadriceps relaxed
2. Indirect low energy injury
Femur
- removal of femoral head cartilage
- resurfacing with metal
- cemented / uncemented
Acetabulum
- standard technique
Bearing surface
- metal on metal
Relatively young man (40 - 50)
OA
Age 0 - 5
- Salter Harris I
Age 5 - 11
- Salter Harris II
III / IV rare
Great remodelling potential
- 80% growth of humerus from proximal physis
Shoulder ROM compensatory
Age
- even older adolescents do well
Schwannoma
- benign tumour of nerve sheath
Less common than neurofibroma
- occurs in adults
- can occur along any peripheral nerve
- also can occur along a nerve root
Usually a large nerve
More common in forearm
Seen in NF 2
- acoustic Schwannoma