Athletic Participation After Hip and Knee - Arthroplasty

Alexander Golant, M.D., Dimitrios C. Christoforou, M.D., James D. Slover, M.D., and Joseph D. Zuckerman, M.D.

The issue of athletic participation after hip and knee arthroplasty has become more relevant in recent years, with an increase in the number of young and active patients receiving joint replacements. This article reviews patient-, surgery-, implant-, and sports-related factors, and discusses currently available guidelines that should be considered by the physician when counseling patients regarding a return to athletic activity after total joint arthroplasty. Current evidence regarding appropriate athletic participation after total hip arthroplasty, resurfacing hip arthroplasty, total knee arthroplasty, and unicondylar knee arthroplasty is reviewed.

Management of Focal Cartilage Defects in the Knee - Is ACI the Answer?

Eric J. Strauss, M.D., Lauren E. Fonseca, B.A., Mehul R. Shah, M.D., and Thomas Youm, M.D.

Abstract | PDF

Injuries to the articular cartilage of the knee are common. They alter the normal distribution of weightbearing forces and predispose patients to the development of degenerative joint disease. The management of focal chondral lesions continues to be problematic for the treating orthopaedic surgeon. Although many treatment options are currently available, none fulfll the criteria for an ideal repair solution: a hyaline repair tissue that completely flls the defect and integrates well with the surrounding normal cartilage. Autologous chondrocyte implantation (ACI) is a relatively new cell-based treatment method for full-thickness cartilage injuries that in recent years has increased in popularity, with early studies showing promising results. The current article reviews the nature of cartilage lesions in the knee and the treatment modalities utilized in their management, focusing on the role ACI plays in the surgical treatment of these complex injuries.

Osteochondroses and apophyseal injuries of the foot in the young athlete.

Curr Sports Med Rep. 2010 Sep-Oct;9(5):265-8.

Gillespie H.

Division of Sports Medicine, Department of Family Medicine, University of California, Los Angeles, CA 90095-1683, USA. hgillespie@mednet.ucla.edu

Abstract

With an increase in involvement in sports activities by children and adolescents, there has been a concomitant increase in both acute and overuse injuries. The pediatric skeleton lends itself to injuries unique to the young athlete, including various apophysites and osteochondroses. It is important for primary care and sports physicians treating the athlete to be aware of normal and abnormal variations in the pediatric skeleton, as well as common sites of injury in the pediatric foot. This article provides an overview of some of the most common skeletal foot injuries in the pediatric athlete, including Freiberg's infraction, Sever's disease, Kohler's disease, os navicularis, and Iselin's disease.

The asthmatic athlete: inhaled Beta-2 agonists, sport performance, and doping.

Clin J Sport Med. 2011 Jan;21(1):46-50.

McKenzie DC, Fitch KD.

Division of Sports Medicine, School of Human Kinetics, The University of British Columbia, 3055 Wesbrook Mall, Vancouver, BC, Canada. don.mckenzie@shaw.ca

Abstract

The asthmatic athlete has a long history in competitive sport in terms of success in performance and issues related to doping. Well documented are detailed objective tests used to evaluate the athlete with symptoms of asthma or airway hyperresponsiveness and the medical management. Initiated at the 2002 Salt Lake City Games, the International Olympic Committee's Independent Asthma Panel required testing to justify the use of inhaled beta-2 agonists (IBAs) in Olympic athletes and has provided valuable guidelines to the practicing physician. This program was educational and documented the variability in prevalence of asthma and/or airway hyperresponsiveness and IBA use between different sports and different countries. It provided a standard of care for the athlete with respiratory symptoms and led to the discovery that asthmatic Olympic athletes outperformed their peers at both Summer and Winter Olympic Games from 2002 to 2010. Changes to the World Anti-Doping Agency's Prohibited List in 2010 permitted the use of 2 IBA produced by the same pharmaceutical company. All others remain prohibited. However, there is no pharmacological difference between the permitted and prohibited IBAs. As a result of these changes, asthmatic athletes are being managed differently based on a World Anti-Doping Agency directive that has no foundation in pharmacological science or in clinical practice.