Platelet-rich plasma: Clarifying the issues

Recently, AAOS Now convened a panel of experts to discuss what may be the hottest topic in orthopaedics this year—platelet-rich plasma (PRP). Joining moderator Jo A. Hannafin, MD, PhD, were Steven P. Arnoczky, DVM; Freddie H. Fu, MD; and Allan K. Mishra, MD. Dr. Hannafin: I did a Google search and found more than 400,000 citations for PRP treatment, including YouTube videos on how the procedure is performed. Clearly, patients, physicians, and scientists are interested in the use of PRP.

Unlocking the mechanisms of ACL injury

Jennie McKee

JAAOS article highlights recent research advances Barry P. Boden, MD AAOS Now: What mechanisms have traditionally been believed to cause ACL injuries? Dr. Boden: One popular but unproven theory was that ACL impingement against the intercondylar notch caused the injury. Another popular theory is that the quadriceps causes an anterior vector on the knee, stressing and potentially disrupting the ACL, whereas the hamstring causes a posterior vector, thereby protecting the ACL.

Allograft or autograft for ACL reconstruction?

Peter Pollack

Outcomes similar, but autografts may be better for the most active patients Patellar tendon allograft and autograft offer similar clinical outcome potential for reconstruction of the anterior cruciate ligament (ACL), although autografts may be a better option for patients who wish to return to the most strenuous levels of activity, said Randy Mascarenhas, MD, who presented a paper on the topic at the 2010 annual meeting of the Arthroscopy Association of North America.

AAHKS seeks expert panelists

The American Association of Hip and Knee Surgeons (AAHKS) is looking for AAOS members who perform hip or knee procedures, are willing to learn about the details of Relative Value code development, and will consider becoming part of an expert panel. General orthopaedic surgeons are invited to attend the American Medical Association/Relative Value Scale Update Committee (AMA/RUC) Physicians Work Survey Training Course presented by Roseanne Fischoff, MMP, on Friday, Nov. 5, 2010, from 2:00 p.m.

Meetings and Course Listings

Listed below are upcoming continuing medical education (CME) courses and orthopaedic meetings (mid October through December). For more information about AAOS-sponsored courses, contact the AAOS customer service department at (800) 626-6726 or visit the CME course section of the AAOS Web. For more information about other CME courses or orthopaedic meetings listed, contact the source provided.

Treating tendinopathy with PRP

Letha Y. Griffin, MD, leads a focused roundtable Chronic overuse conditions such as Achilles tendinopathy (tendinosis) are not uncommon, but are extremely difficult sports injuries to treat. The pathophysiology of tendinopathy—the term used to refer to chronic inflammation of the tendon (as distinguished from tendinitis, which refers to the acute inflammatory state)—continues to elude physicians studying the issue.

Practical guidelines for using PRP in the orthopaedic office

Santos F. Martinez, MD

The use of biologics such as platelet-rich plasma (PRP), mesenchymal stem cells, or growth factors in the orthopaedic office setting is becoming more common, fueled, in part, by a growing body of research and increasing market demand for alternative methods of nonsurgical management of soft-tissue and musculoskeletal conditions. The use of biologics has been facilitated by advances in imaging technology such as musculoskeletal ultrasound.

PRP shows potential for treating Achilles tendinosis

Terry Stanton

Study examines treatment effects in insertional and noninsertional cases Pain of the Achilles tendon is among the most frequent causes of pain among patients seen at foot and ankle practices. The common cause, chronic Achilles tendinosis, is the result of poor vascularization and of microtears in the collagen fibers due to repetitive overuse. At the 2010 annual meeting of the American Orthopaedic Foot & Ankle Society (AOFAS), Martin J.

What’s your Diagnosis?

In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted. The images for this month’s challenge were submitted by resident member Ben Grear, MD. He provides the following patient information: “The patient is a 4-year-old girl who has been limping for 3 weeks. The patient’s mother denies any trauma. Examination of the left foot reveals tenderness over the dorsomedial and plantomedial midfoot. Otherwise, the exam is unremarkable.”

Making the case for ankle distraction

Terry Stanton

Award-winning paper outlines “a promising procedure” The most commonly performed surgical procedures for ankle osteoarthritis (OA) are ankle fusion and joint replacement, but distraction, although controversial, has many advocates. Distraction—the mechanical separation of the opposing articular cartilage surfaces—has been demonstrated in some studies to achieve significant improvement in pain, function, and clinical condition in as many as 73 percent of patients.

Prepare for sports-related foot, ankle injuries

Terry Stanton

JAAOS article reviews management techniques Robert B. Anderson, MD AAOS Now: Can you identify specific distribution patterns in sports-related foot and ankle injuries? Dr. Anderson: The overall incidence of foot and ankle injuries in any given sport is difficult to obtain; they often occur in unorganized play, and many minor injuries may go unreported.

Second Look—Clinical News and Views

If you missed these Headline News Now items the first time around, AAOS Now gives you a second chance to review them. Headline News Now—the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons—brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

Shoulder dislocation in the young patient

Peter Pollack

Arthroscopic treatment may be better treatment for first-time dislocations Arthroscopic treatment of traumatic anterior-inferior shoulder dislocation offers greater patient satisfaction than conservative treatment in younger patients, according to data presented by Rico Listringhaus, MD, at the annual meeting of the Arthroscopy Association of North America. Dr. Listringhaus and his coauthors are associated with the Center for Orthopedics and Traumatology, St Anna Hospital, in Herne, Germany.