Algorithms, techniques support success after failed first surgery for athletic-injured joints

GENEVA — Sports medicine specialists should be aware of re-injury prevention techniques and how to best perform any subsequent surgery when athletes injure their knee or shoulder joints after primary treatment, according to findings presented 1 June during a specialty session of European Federation of National Associations of Orthopaedic Sports Traumatology.

Gernot Felmet, MD, and Gian Luigi Canata, MD, discussed techniques for repeat ACL and PCL surgery and treatment of unstable shoulders, respectively.

New reamers, adapters and bone graft techniques are available for ACL and PCL revision, but the initial focus – before ligament replacement – should be closing the defect and restoring lost bone stock, Felmet said.

“If you would like to close the defect and restore the bone stock, you can use, for example, bone from the iliac crest. This is very common, and you also can use some bone chips,” he said.

Gian Luigi Canata

Gernot Felmet

Young age is an important factor in the risk of recurrent shoulder instability after primary treatment, Canata said. Regardless of patient age, conservative treatment can help re-establish shoulder balance in these patients. Arthroscopy can be used after the first failed surgery, as well, but completely avoiding recurrence of shoulder instability is nearly impossible, he said.

With arthroscopy, “you just have to select the proper technique,” Canata said.

Henrique Jones

“Recurrence in this surgery is multifactorial. You must take care of the hyperlaxity and the bone loss. Depending on the pathology, you can select the proper technique. If you select the proper technique, you can expect a good result,” he said.

Henrique Jones, MD, secretary general of the European Federation of National Associations of Orthopaedic Sports Traumatology, said surgeons must help athletes who undergo joint surgery due to an injury be realistic at the outset about what is possible postoperatively regarding function and return to play. Most patients need continuous neuromuscular prevention, he said, as it helps them somewhat overcome the effects of the injury, such as deformation of collagen fibers and insult to joint cartilage.

Concerning ACL re-injury, a strategy of prevention should be adopted and used before matches and in all phases of training, Jones said.

“We must always work with neuromuscular rehabilitation after our ACL reconstruction in order to correct all asymmetries and all the discrepancies between flexion and extension,” he said. – by Susan M. Rapp

Reference:

Felmet G, et al. The athletes joint—when first surgery fails. Presented at: 17th EFORT Annual Congress—A combined programme in partnership with swiss orthopaedics; 1-3 June 2016; Geneva.

Disclosures: Canata, Felmet and Jones report no relevant financial disclosures.