Joint Reconstruction

Foot & ankle joint reconstruction: OLTs, cartilage restoration, tumor resection, and arthroplasty to avoid/delay arthrodesis.

Overview

Anatomical approaches for joint reconstruction are endorsed for their favourable short and medium-term outcomes, with the belief that these benefits will endure long-term [1]. Operative management offers the best chance of preserving long-term joint function for fractures of the posterior wall of the acetabulum, provided an anatomically reconstructed acetabulum is achieved without complication [5]. For recurrent anterior glenohumeral instability, treatment options, indications, and techniques exist to address associated bony deficiencies [4]. In patients with no significant arthritis and a deficient labrum due to previous surgical excision or irreparable tears, hip labral reconstruction is the main indication [12].

Outcomes vary by specific application and patient selection. Arthroscopic labral reconstruction reports clinically significant functional improvements with low rates of complications, revision surgery, and progression of arthritis [7], though graft types and concomitant procedures confound these results [7]. Osteochondral grafting of the metacarpophalangeal joint in rheumatoid arthritis results in stable, painless joints with acceptable outcomes despite some loss of motion [8]. Various cartilage restoration techniques for the patellofemoral joint report improvements in patient-reported outcomes with low complication rates [24]. Allografts are a viable and successful option for joint reconstruction, though their use must be balanced against risks and costs [15].

Definitive conclusions on the optimal treatment for cartilage restoration techniques for the patellofemoral joint remain elusive due to a lack of high-quality comparative studies [24]. There is no clear evidence demonstrating the superiority of one labral reconstruction method over another for restoring labral function in primary hip arthroscopy [6]. High-quality research is needed to guide the choice between anatomical and mechanical options for joint reconstruction [1]. Comparisons of reconstructive treatment in a select group that requests it will never show equal or better results when compared to routine acute treatment [17], and such studies do not provide insight into pathophysiology or the ability of surgeries to address it [17]. Longer-term follow-up is needed to fully understand labral reconstruction in patients over 40 years of age [44], and future randomized controlled trials are needed to refine indications for labral reconstruction by comparing repair versus reconstruction or segmental versus complete reconstruction [44]. Patients with no reconstruction after acetabular resection for pelvic chondrosarcoma have an acceptable functional outcome when reconstruction is not feasible [2].

Anatomy & Pathophysiology

Anatomical approaches for joint reconstruction are endorsed for their favourable short and medium-term outcomes, with the belief that these benefits will endure long-term [1]. However, high-quality research is needed to guide the choice between anatomical and mechanical options for joint reconstruction [1]. For partial defects of the proximal interphalangeal joint, osteochondral autograft from the hamate results in generally acceptable functional recovery and well-restored joint architecture [3]. In the thumb, total joint arthroplasty for the trapeziometacarpal joint is able to restore thumb function but cannot fully replicate the kinematics of the healthy TMC joint [75]. Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage osteoarthritis [81]. Metacarpal fusion for reconstruction of bone loss in the radial carpometacarpal joints maintains CMC joint kinematics and preserves digital length [72], while also avoiding the psychological burden associated with digital ray amputation [72].

Regarding the foot and ankle, a comprehensive anatomical review of the Lisfranc joint complex exists to enhance understanding of injury patterns and support accurate diagnosis and effective management [9]. The goal of treatment for injury to the tarsometatarsal joint complex is the restoration of a pain-free, functional foot [25]. Surgical treatment for foot and ankle deformities is indicated based on mechanical structure and function [10], with nonsurgical treatment always attempted for deformities associated with pain [10]. Surgical options include osteotomies, tendon transfers, or arthrodesis depending on the specific deformity and presence of arthritis [10]. The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability [76] and to achieve a painless foot for walking in patients with rheumatoid arthritis [76]. Measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity are obtainable using high-resolution cone-beam CT [74].

Osseous morphology and fixation stability are critical determinants of reconstruction success. The third toe proximal phalanx distal articular surface more closely matches the geometric characteristics of the finger proximal phalanx distal articular surface than does the toe middle phalanx distal articular surface [57]. In fixation for first tarsometatarsal joint fusion, the plantar locking plate showed the best overall stability during weight-bearing simulation compared to other fixation devices [54]. For first metatarsophalangeal joint arthrodesis, the unlocked plate plus screw and crossed screw constructs were the stiffest and most resistant to joint opening under cyclic loading [77]. Following tibiotalar arthrodesis, a significant increase in subtalar joint plantar flexion is a primary compensation during overground walking and double heel-rise activity [78].

Functional outcomes and rehabilitation protocols are influenced by specific anatomical relationships and postoperative adaptations. Hallux valgus deformity and its severity are positively associated with the magnitude of anteroposterior postural sway [60]. In modified suture suspension arthroplasty for basal joint arthritis, a relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear [36]. Current rehabilitation protocols for fresh osteochondral allograft transplantation appear to be predominantly time-based without objective criteria or functional assessment [82].

Classification

Anatomical vs. Mechanical Approaches: Anatomical approaches for joint reconstruction are endorsed for their favourable short and medium-term outcomes, with the belief that these outcomes will endure in the long term [1]. High-quality research is needed to guide the choice between anatomical and mechanical options for joint reconstruction [1]. Operative management for fractures of the posterior wall of the acetabulum offers the best chance of preserving long-term joint function only if an anatomically reconstructed acetabulum can be achieved without complication [5].

Glenoid Defect Morphology: The formation of clusters based on glenoid morphology indicates that patterns exist in the types of glenoid defects in failed shoulder arthroplasties [37]. There is a need to further investigate a three-dimensional classification system for glenoid defects in failed shoulder arthroplasties [37]. There is a need to potentially develop new standardized revision implant component designs based on glenoid defect patterns in failed shoulder arthroplasties [37].

Thumb Metacarpophalangeal Joint Dislocation: Palmar dislocation of the thumb metacarpophalangeal joint is classified into three types: Type A (stable joint), Type B (tendon block), and Type C (joint instability) [48].

Other Considerations: Patients with no reconstruction after acetabular resection for pelvic chondrosarcoma have an acceptable functional outcome when reconstruction is not feasible [2]. Osteochondral autograft from the hamate for treating partial defects of the proximal interphalangeal joint results in generally acceptable functional recovery and well-restored joint architecture [3]. There is no clear evidence demonstrating the superiority of one reconstruction method over another for restoration of labral function in primary hip arthroscopy [6]. All 11 studies included in a systematic review of arthroscopic labral reconstruction of the hip reported clinically significant functional improvements after the procedure [7]. Arthroscopic labral reconstruction of the hip is associated with low rates of complications, revision surgery, and progression of arthritis [7]. Graft types and concomitant procedures confound the results regarding outcomes of arthroscopic labral reconstruction of the hip [7]. The manuscript provides a comprehensive anatomical review of the Lisfranc joint complex to enhance understanding of injury patterns and support clinicians in accurate diagnosis and effective management [9]. Revision surgery for failed trapeziometacarpal joint arthritis surgery can result in satisfactory long-term outcomes, particularly when metacarpophalangeal joint pathology is addressed and complications are avoided [11]. Open reduction and internal fixation remains the standard treatment for tarsometatarsal joint injuries [27]. Primary arthrodesis has emerged as a viable option for certain types of tarsometatarsal joint injuries [27]. The use of the Sutter implant for arthroplasty of the proximal interphalangeal joint has given similar or better results than those reported from other series and should be considered when the joint has been damaged by injury [28]. Patients with reoperation after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients had significantly lower ICRS classification stages compared to patients without re-operation [46].

Clinical Presentation

Anatomical approaches for joint reconstruction are endorsed for their favourable short and medium-term outcomes, with the belief that these outcomes will endure in the long term [1]. High-quality research is needed to guide the choice between anatomical and mechanical options for joint reconstruction [1]. Operative management for fractures of the posterior wall of the acetabulum usually offers the best chance of preserving long-term joint function, provided an anatomically reconstructed acetabulum can be achieved without complication [5]. Patients with no reconstruction after acetabular resection for pelvic chondrosarcoma have an acceptable functional outcome when reconstruction is not feasible [2].

Acute Injury and Trauma

A high level of suspicion, recognition of clinical signs, and appropriate radiographic studies are needed for correct diagnosis of Lisfranc joint injury to avoid late sequelae of posttraumatic arthritis [16]. Arthroscopic excision of acetabular osteoid osteoma has been successfully performed in a 7-year-old patient [18].

Chronic Arthropathy and Deformity

Indications for reconstruction: The main indication for hip labrum reconstruction is a deficient labrum due to previous surgical excision or irreparable tears in young patients with no significant arthritis [12]. Arthroscopic labral reconstruction of the hip is associated with clinically significant functional improvements, low rates of complications, low rates of revision surgery, and low rates of progression of arthritis [7]. All studies in a systematic review on hip labral reconstruction reported improved patient-reported outcomes at minimum 5-year follow-up, suggesting durable results beyond short-term follow-up [13]. Graft types and concomitant procedures confound the results regarding outcomes of arthroscopic labral reconstruction of the hip [7]. Significant acetabular rim correction and circumferential labral reconstruction for severe pincer-type femoroacetabular impingement results in improvement in patient-reported outcomes and radiographic measurements [20].

Foot and ankle management: Nonsurgical treatment is always attempted for deformities associated with pain in the foot and ankle [10]. Surgical treatment for foot and ankle deformities is indicated based on mechanical structure and function, utilizing osteotomies, tendon transfers, or arthrodesis depending on the specific deformity and presence of arthritis [10]. Satisfactory long-term patient-reported and radiographic outcomes can be achieved after joint-preserving surgery for forefoot deformities associated with rheumatoid arthritis [42]. Osteochondral autograft from the hamate for treating partial defects of the proximal interphalangeal joint results in generally acceptable functional recovery with well-restored joint architecture [3]. Osteochondral grafting of the metacarpophalangeal joint in rheumatoid arthritis results in stable, painless joints with acceptable outcomes despite some loss of motion [8].

Revision and salvage: Revision surgery for failed trapeziometacarpal joint arthritis surgery can result in satisfactory long-term outcomes, particularly when metacarpophalangeal joint pathology is addressed and complications are avoided [11]. Revision ligament reconstruction tendon interposition for trapeziometacarpal arthritis can be offered in the setting of persistent or recurrent symptoms, but improvement of symptoms is unpredictable [21].

Rheumatoid elbow: Synovectomy may provide relief of symptoms for patients with rheumatoid elbow who are unresponsive to nonsurgical management [19]. Arthroplasty is a reasonable alternative for patients with rheumatoid elbow who have more advanced disease [19].

Shoulder stability: Excellent clinical and sports outcomes with low recurrence rates have been observed in both classic and congruent-arc Latarjet procedures [22].

Investigations

Plain radiography: Appropriate radiographic studies are essential for the correct diagnosis of Lisfranc joint injury to avoid late sequelae of posttraumatic arthritis [16].

MRI: Radially reconstructed MERGE MRI may serve as an alternative to magnetic resonance arthrography for evaluating acetabular labrum tears [51]. Magnetic resonance imaging indicates that the donor site after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint is resurfaced with fibrous tissue [70].

CT: Differences between 3D CT and 3D MRI regarding surface area and glenoid apposition are small and likely not clinically significant [62].

Other Considerations: High-quality research is needed to guide the choice between anatomical and mechanical joint reconstruction options [1]. Patients with no reconstruction after acetabular resection for pelvic chondrosarcoma have an acceptable functional outcome when reconstruction is not feasible [2]. Osteochondral autograft from the hamate for partial defects of the proximal interphalangeal joint results in generally acceptable functional recovery and well-restored joint architecture [3]. Arthroscopic excision of acetabular osteoid osteoma has been successfully performed in a 7-year-old patient [18].

Treatment

Non-Operative

Nonsurgical treatment is always attempted for deformities associated with pain in the foot and ankle [10]. For patients with rheumatoid elbow unresponsive to nonsurgical management, synovectomy may provide relief of symptoms [19]. Treatment options for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint range from non-operative measures to various surgical procedures [49].

Operative

Indications: Surgical management is indicated for coxa vara in childhood when there is progressive, painful, unilateral deformity or leg-length discrepancy, whereas moderate nonprogressive coxa vara often does not require surgery [61]. The main indication for hip labrum reconstruction is a deficient labrum due to previous surgical excision or irreparable tears in young patients with no significant arthritis [12]. Surgical treatment for foot and ankle deformities is indicated based on mechanical structure and function, utilizing osteotomies, tendon transfers, or arthrodesis depending on the specific deformity and presence of arthritis [10]. If reduction of chronic locked anterior shoulder dislocation is not possible, other surgical reconstruction should be considered [38]. Operative management offers the best chance of preserving long-term joint function for fractures of the posterior wall of the acetabulum, provided an anatomically reconstructed acetabulum can be achieved without complication [5]. Patients with no reconstruction after acetabular resection for pelvic chondrosarcoma have an acceptable functional outcome when reconstruction is not feasible [2].

Surgical Approach / Technique: Anatomical approaches for joint reconstruction are endorsed for their favorable short and medium-term outcomes, with the belief that these outcomes will endure in the long term [1]. Treatment options for bony deficiencies in recurrent anterior glenohumeral instability include various indications and techniques to address these deficiencies [4]. Both capsular management strategies (unrepaired capsulotomy and capsular repair) resulted in statistically significant improvements in all patient-reported outcomes at a minimum of 2 years after arthroscopic hip preservation surgery [55]. Open reduction and internal fixation remains the standard treatment for tarsometatarsal joint injuries, though primary arthrodesis has emerged as a viable option for certain types of these injuries [27]. Arthroscopic interpositional arthroplasty for Freiberg's disease is easy to perform, can be performed on an outpatient basis, and helps preserve joint space [41]. All patients undergoing minimally invasive thumb carpometacarpal joint arthrodesis with headless screws and arthroscopic assistance achieved complete union at the fusion site at a mean of 9 weeks and reported pain relief [66].

Implant Selection: Allografts are a viable and successful option for joint reconstruction, though their use must be balanced against risks and costs [15]. The use of the Sutter implant for arthroplasty of the proximal interphalangeal joint has given similar or better results than those reported from other series and should be considered when the joint has been damaged by injury [28]. Arthroplasty is a reasonable alternative for patients with more advanced rheumatoid elbow disease [19]. The use of a 3D-printed prosthesis with an articular interface for pelvic reconstruction demonstrated stable prosthetic fixation, anatomical acetabular reconstruction, and acceptable early functional outcomes [56]. Volar plate interposition arthroplasty provided satisfactory results in terms of pain relief and functional preservation for finger joints with posttraumatic arthritis at the minimum 2-year follow-up [65]. The technique for little finger carpometacarpal arthroplasty provided satisfactory pain relief and motion preservation for posttraumatic arthritis of the little finger CMC joint [71].

Alignment / Balancing Strategy: The acetabular distraction technique for treatment of chronic pelvic discontinuity permits biological fixation and intraoperative customization of the construct based on the pattern of bone loss identified following component removal [50]. Surgical reconstruction using a bone-ingrowth component for glenoid bone loss can offer initial secure fixation, pain relief, and improved motion [40]. Osteochondral grafting of the metacarpophalangeal joint in rheumatoid arthritis resulted in stable, painless joints with acceptable outcomes despite some loss of motion [8].

Pain Management: Arthrodesis and ligament reconstruction with tendon interposition for thumb carpometacarpal osteoarthritis had similar results with regard to pain, function, and satisfaction [35]. Minimal differences in strength and motion exist between arthrodesis and ligament reconstruction with tendon interposition for thumb carpometacarpal osteoarthritis [35]. The "Pillow" technique for thumb carpometacarpal joint arthritis provides pain relief and satisfactory function at an average of 12.5 years after surgery [45].

Adjuncts: Acromioclavicular fusion is difficult to achieve, and the use of locking plates and biological supplementation is recommended [63]. Potential advantages of suture suspension arthroplasty for thumb carpometacarpal arthritis reconstruction include short operative time, a single incision, minimal cost, and no need for tendon harvesting, pin fixation, or implantable hardware [58].

Other Considerations: High-quality research is needed to guide the choice between anatomical and mechanical options for joint reconstruction [1]. There is no clear evidence demonstrating the superiority of one labral reconstruction method over another for restoring labral function in primary hip arthroscopy [6]. Current literature on the management of glenohumeral chondral defects assigns grades of treatment recommendations based on available evidence [14]. Comparisons of reconstructive treatment in a select group that requests it will never show equal or better results when compared to routine acute treatment [17]. Such studies comparing selective reconstructive treatment do not provide insight into pathophysiology or the ability of surgeries to address it [17]. Despite the fast pace of progress in the treatment and repair of articular cartilage injury in the ankle, a clear gold standard in management has yet to emerge [31]. A good, validated outcomes measure to adequately assess active patients with a painful nonarthritic hip is needed to determine the efficacy of labral repair and aid in managing patient expectations [64]. Outcomes for structural autografts used in reconstruction of the shoulder joint vary, with some studies showing good stability and pain relief while others note unpredictable results or donor site morbidity [67]. The one-step bone marrow-derived cell transplantation technique is an alternative for cartilage repair in talar osteochondral lesions, permitting improved functional scores and overcoming the drawbacks of previous techniques [39]. Selection of treatment for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint depends on disease stage and patient factors [49].

Complications

Infection (PJI): Deep infection represents the most common complication and primary driver for further surgery following limb-salvage reconstruction after acetabular resection for pelvic bone sarcomas [101]. Reported superficial infection rates are relatively high following thumb metacarpal extension osteotomy for symptomatic carpometacarpal laxity and early basal joint arthritis [105]. Potential postoperative complications following modified Mitchell's osteotomy and shortening oblique osteotomy for forefoot deformities include infection [106].

Aseptic loosening: Hemiarthroplasty for trapeziometacarpal arthritis demonstrates a high rate of loosening and is therefore reserved for low-demand patients [90].

Other Considerations: Patients with no reconstruction after acetabular resection for pelvic chondrosarcoma have an acceptable functional outcome when reconstruction is not feasible [2]. Arthroscopic labral reconstruction of the hip is associated with low rates of complications, revision surgery, and progression of arthritis [7]. Revision surgery for failed trapeziometacarpal joint arthritis surgery can result in satisfactory long-term outcomes when metacarpophalangeal joint pathology is addressed and complications are avoided [11]. Cartilage restoration techniques for the patellofemoral joint report low complication rates [24]. Anatomic proximal tibiofibular joint reconstruction for isolated instability provides a low risk of complications or need for additional procedures [30]. Humeral head reconstruction with osteochondral allograft transplantation has substantial complication and reoperation rates [32]. Osteochondral allograft transfer for treatment of osteochondral lesions of the talus has a high incidence of clinical failure (13%) and need for reoperation (25%) [33]. Primary hip labral reconstruction achieves superior outcomes compared with revision reconstruction after primary repair at minimum 2-year follow-up [34]. Revision at a minimum of two years after excision of the radial head and synovectomy in patients with rheumatoid arthritis yields inferior results compared to primary capitellocondylar total elbow arthroplasty [80]. Reported complication and revision rates for matrix-associated autologous chondrocyte implantation for osteochondral lesions of the talus range from 0% to 59% and 0% to 45%, respectively [87]. Combined revision and failure rates for large single-surface, multisurface, or bipolar osteochondral allograft transplantation in the knee using shell grafts are 10% [88]. Complications are common after distal tibial allograft glenoid reconstruction for recurrent shoulder instability, occurring in 31% of patients [97]. Pyrocarbon proximal interphalangeal joint arthroplasty has a fairly high incidence of complications, though most are minor and often do not need further treatment [103]. The use of Denosumab for joint salvage in patients with giant cell tumour of bone is associated with a higher than expected rate of local recurrence at 44% [100]. Potential postoperative complications following modified Mitchell's osteotomy and shortening oblique osteotomy for forefoot deformities include the appearance of hallux valgus deformity [106].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity across the provided studies; however, patients treated with arthroscopic-assisted coronoid fracture repair returned to preoperative avocations and occupations [53], and those undergoing single-stage acute osseous correction for neglected congenital knee dislocations returned to work following deformity correction [84].

Full activity (months): Return to competitive sports was observed in approximately half of elite athletes treated arthroscopically for femoroacetabular impingement syndrome at 5-year follow-up, with 77% decreasing their sports level [83]. Patients treated with the Elmslie–Trillat procedure for recurrent patellar instability demonstrated functional improvement at an average of 98 months post-surgery [47]. Anatomic proximal tibiofibular joint reconstruction for isolated instability facilitated a return to activities at an average follow-up of 43.2 months [30].

Complete recovery / outcome plateau (months): Durable results for hip labral reconstruction were observed at minimum 5-year follow-up [13]. Primary repair of the acetabular labrum showed favorable outcomes and evidence of good healing at 2-year follow-up, even among patients requiring repeat arthroscopy [91]. Primary hip labral reconstruction achieved superior outcomes compared with revision reconstruction at minimum 2-year follow-up [34]. Posttraumatic osteoarthritis was evident on radiographs 2 to 24 years after surgical treatment of tarsometatarsal joint complex injuries, though symptomatic occurrence was lower [29].

Rehabilitation protocol: The evidence does not detail specific rehabilitation protocols, immobilization durations, or weight-bearing progression schedules for the procedures described.

Functional milestones: Improved patient-reported outcomes were observed in all studies of hip labral reconstruction at minimum 5-year follow-up [13]. Primary MOPS-preserved osteochondral allograft transplantation with meniscal allograft transplantation for femoral condyle and tibial plateau defects was associated with statistically significant and clinically meaningful improvements in patient-reported measures of pain and function [79]. MRI demonstrated complete regeneration of subchondral bone and cartilage with significant improvement in functional scores following management of Hepple stage V osteochondral lesions of the talus with a platelet-rich plasma scaffold [26]. Functional recovery following osteochondral autograft from the hamate for partial defect of the proximal interphalangeal joint was generally acceptable with well-restored joint architecture [3].

Other Considerations: Anatomical approaches for joint reconstruction are endorsed for favorable short and medium-term outcomes, with the belief that these outcomes will endure in the long term [1]. Revision surgery for trapeziometacarpal arthritis can be offered for persistent or recurrent symptoms, but improvement of symptoms is unpredictable [21]. Excellent clinical and sports outcomes with low recurrence rates have been observed in both classic and congruent-arc Latarjet procedures [22]. Hemihamate reconstruction is favored for dorsal fracture-dislocations of the proximal interphalangeal joint in patients with greater than 50% of the articular surface involvement [23]. The goal of treatment for injury to the tarsometatarsal joint complex is the restoration of a pain-free, functional foot [25]. A clear gold standard in the management of articular cartilage injury has yet to emerge despite the fast pace of progress in treatment and repair [31]. Complication and reoperation rates for humeral head reconstruction with osteochondral allograft transplantation are substantial, although use of fresh allograft tissue may result in less resorption and necrosis [32]. Patients undergoing osteochondral allograft transfer for osteochondral lesions of the talus must be carefully selected and counseled on the morbidity of the procedure, the high incidence of clinical failure (13%), and the need for reoperation (25%) and revision surgery (8.8%) [33]. There was a substantial occurrence of posttraumatic osteoarthritis evident on radiographs 2 to 24 years after surgical treatment of tarsometatarsal joint complex injuries, although the occurrence of symptomatic osteoarthritis was lower [29]. A relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear in modified suture suspension arthroplasty for basal joint arthritis [36]. Closed capsule arthroscopic treatment of femoroacetabular impingement and labral tears can provide greater improvement in sports-specific outcomes at early follow-up compared with open capsule [86].

Key Evidence

• [L5] The authors endorse the wide adoption of anatomic approaches for joint reconstruction, believing their favourable short and medium-term outcomes will endure in the long term, while noting that high-quality research is needed to guide the choice between anatomical and mechanical options. (10.1007/s00167-022-07013-3)
• [L3] When reconstruction is not feasible, patients with no reconstruction have an acceptable functional outcome. (10.1302/0301-620x.103b2.bjj-2020-1012.r1)
• [L4] The functional recovery is generally acceptable, with a well-restored joint architecture. (10.1016/j.jhsa.2021.11.007)
• [L5] The purpose of this summary is to review treatment options as well as indications and techniques to address bony deficiencies. (10.1177/0363546505277074)
• [L4] Operative management usually offers the best chance of preserving long-term joint function, but only if an anatomically reconstructed acetabulum can be achieved without complication. (10.5435/00124635-199901000-00006)
• [L5] There is no clear evidence demonstrating the superiority of one reconstruction method over the other. (10.1016/j.arthro.2021.08.003)
• [L1] All 11 studies included in this systematic review reported clinically significant functional improvements after arthroscopic labral reconstruction and low rates of complications, revision surgery, and progression of arthritis, although graft types and concomitant procedures confound the results. (10.1016/j.arthro.2019.02.031)
• [L4] The procedure resulted in stable, painless joints with acceptable outcomes despite some loss of motion. (10.1054/jhsb.2002.0839)
• [L5] The manuscript provides a comprehensive anatomical review of the Lisfranc joint complex to enhance understanding of injury patterns and support clinicians in accurate diagnosis and effective management to achieve optimal clinical outcomes. (10.1002/ksa.70260)
• [L4] Revision surgery, however, can result in satisfactory long-term outcomes particularly when metacarpophalangeal joint pathology is addressed and complications are avoided. (10.1016/j.jhsa.2018.10.025)
• [L2] The main indication for reconstruction was a deficient labrum due to previous surgical excision or irreparable tears in young patients with no significant arthritis. (10.1007/s00167-013-2804-5)
• [L1] Improved patient-reported outcomes were observed in all studies at minimum 5-year follow-up, suggesting that labral reconstruction can offer durable results beyond short-term follow-up. (10.1016/j.arthro.2023.02.015)
• [L5] This review summarizes current literature on the management of glenohumeral chondral defects and assigns grades of treatment recommendations based on the available evidence. (10.5435/jaaos-d-17-00057)
• [L5] Allografts are a viable and successful option for joint reconstruction, though their use must be balanced against risks and costs. (10.1007/s00167-019-05514-2)
• [L5] A high level of suspicion, recognition of clinical signs, and appropriate radiographic studies are needed for correct diagnosis to avoid late sequelae of posttraumatic arthritis. (10.5435/00124635-201012000-00002)
• [Letter] Comparisons of reconstructive treatment in a select group that requests it will never show equal or better results when compared to routine acute treatment, and such studies do not provide insight into pathophysiology or the ability of surgeries to address it. (10.1016/j.jse.2013.01.013)
• [L5] This case report presents the youngest patient treated arthroscopically for this condition with successful outcomes. (10.1007/s00167-014-2978-5)
• [L5] Synovectomy may provide relief of symptoms for patients unresponsive to nonsurgical management, while arthroplasty is a reasonable alternative for those with more advanced disease. (10.5435/00124635-200303000-00004)
• [L4] This, in addition to concomitant circumferential allograft labral reconstruction, resulted in improvement in patient-reported outcomes and radiographic measurements. (10.1016/j.arthro.2022.05.014)
• [L3] Revision surgery can be offered in the setting of persistent or recurrent symptoms, but patients should be counseled that improvement of symptoms is unpredictable. (10.1016/j.jhsa.2016.09.005)
• [L5] Excellent clinical and sports outcomes with low recurrence rates have been observed in both techniques. (10.1016/j.arthro.2022.08.016)
• [L5] The authors favor hemihamate reconstruction in patients with greater than 50% of the articular surface involvement. (10.1016/j.jhsa.2015.08.023)
• [L4] Overall, the various cartilage restoration techniques reported improvements in patient reported outcomes with low complication rates, though definitive conclusions on the optimal treatment remain elusive due to a lack of high-quality comparative studies. (10.1007/s00167-018-5139-4)
• [L5] The goal of treatment is the restoration of a pain-free, functional foot. (10.5435/00124635-200307000-00005)
• [L4] MRI demonstrated complete regeneration of subchondral bone and cartilage in all patients with significant improvement in functional scores. (10.1155/2017/6525373)
• [L5] Open reduction and internal fixation remains the standard treatment for tarsometatarsal joint injuries, although primary arthrodesis has emerged as a viable option for certain types of injuries. (10.5435/jaaos-d-15-00556)
• [L4] The use of the Sutter implant has given similar or better results than those reported from other series, and its use should be considered when the joint has been damaged by injury. (10.1054/jhsb.1999.0257)
• [L4] However, there was a substantial occurrence of posttraumatic OA, as evident on radiographs, albeit the occurrence of symptomatic OA was lower. (10.2106/jbjs.15.00623)
• [L4] At an average follow-up of 43.2 months, anatomic PTFJ reconstruction for isolated PTFJ instability provided improvement in clinical outcomes, a return to activities, and a low risk of complications or need for additional procedures. (10.1016/j.arthro.2020.01.056)
• [L4] Despite the fast pace of progress in the treatment and repair of articular cartilage injury, a clear gold standard in management has yet to emerge. (10.1136/jisakos-2017-000163)
• [L1] Complication and reoperation rates are substantial, although use of fresh allograft tissue may result in less resorption and necrosis. (10.1016/j.arthro.2015.03.021)
• [L1] However, patients must be carefully selected and counseled on the morbidity of the procedure as well as the high incidence of clinical failure (13%) and need for reoperation (25%) and revision surgery (8.8%). (10.1016/j.arthro.2016.06.011)
• [L3] However, primary reconstruction achieves superior outcomes, with a higher percentage of patients reaching clinically meaningful thresholds. (10.1016/j.arthro.2025.06.022)
• [L3] The two procedures had similar results with regard to pain, function, and satisfaction despite minimal differences in strength and motion. (10.2106/00004623-200110000-00002)
• [L4] A relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear. (10.1177/1558944719886669)
• [L4] The formation of clusters based on glenoid morphology indicates that patterns exist in the types of glenoid defects, highlighting a need to further investigate a three-dimensional classification system and potentially new standardized revision implant component designs. (10.1016/j.jse.2026.04.002)
• [L4] If this reduction is not possible, then other surgical reconstruction should be considered. (10.2106/jbjs.15.00832)
• [L4] The one-step technique is an alternative for cartilage repair, permitting improved functional scores and overcoming the drawbacks of previous techniques. (10.1007/s11999-009-0885-8)
• [L4] This method of surgical reconstruction can offer initial secure fixation, pain relief, and improved motion. (10.1016/j.jse.2011.12.013)
• [L4] The technique is easy, can be performed on an outpatient basis, and helps preserve joint space. (10.1007/s00167-006-0189-4)
• [L4] Satisfactory long-term patient-reported and radiographic outcomes after joint-preserving surgery for forefoot deformities associated with RA can be achieved. (10.2106/jbjs.20.01144)
• [L5] Longer-term follow-up is needed to fully understand labral reconstruction in patients over 40, and future randomized controlled trials comparing repair versus reconstruction or segmental versus complete reconstruction are needed to refine indications. (10.1016/j.arthro.2020.06.013)
• [L4] This technique provides pain relief and satisfactory function at an average of 12.5 years after surgery. (10.1016/j.jhsa.2016.04.018)
• [L4] Patients with reoperation had significantly lower ICRS classification stages compared to patients without re-operation. (10.1186/s13018-021-02282-z)
• [L4] Functionally, all patients were improved at an average of 98 months after surgery. (10.1016/j.arthro.2007.07.028)
• [L4] Palmar dislocation of the thumb metacarpophalangeal joint is classified into three types: Type A (stable joint), Type B (tendon block), and Type C (joint instability). (10.1177/1753193413499291)
• [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
• [L4] This surgical technique permits biological fixation and intraoperative customization of the construct to be implanted based on the pattern of the bone loss identified following component removal. (10.1302/0301-620x.100b7.bjj-2017-1551.r1)
• [L2] The noninvasive imaging modality of radially reconstructed MERGE MRI may be an alternative to magnetic resonance arthrography for evaluating labrum tears. (10.1016/j.arthro.2019.05.006)
• [L4] All patients returned to preoperative avocations and occupations. (10.1016/j.arthro.2007.05.017)
• [L5] The plantar locking plate showed the best overall stability during weight-bearing simulation. (10.1186/s13018-018-0876-0)
• [L3] Both capsular management strategies (unrepaired capsulotomy and capsular repair) resulted in statistically significant improvements in all patient-reported outcomes at a minimum of 2 years. (10.1016/j.arthro.2014.10.014)
• [L3] The use of a 3D-printed prosthesis with an articular interface for pelvic reconstruction demonstrated stable prosthetic fixation, anatomical acetabular reconstruction, and acceptable early functional outcomes. (10.2106/jbjs.23.01462)
• [L4] The third toe proximal phalanx distal articular surface more closely matched the geometric characteristics of the finger proximal phalanx distal articular surface than did the toe middle phalanx distal articular surface. (10.1016/j.jhsa.2011.01.047)
• [L4] Potential advantages include short operative time, a single incision, minimal cost, and no need for tendon harvesting, pin fixation, or implantable hardware. (10.1177/15589447211003176)
• [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
• [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
• [L4] Differences between 3D CT and 3D MRI were small and likely not clinically significant. (10.1177/03635465231157430)
• [L4] Fusion is difficult to achieve, and the use of locking plates and biological supplementation is recommended. (10.1111/sae.12004)
• [L5] However, a good, validated outcomes measure to adequately assess active patients with a painful nonarthritic hip is needed to determine the efficacy of such repair and aid in managing patient expectations. (10.5435/00124635-201006000-00006)
• [L4] At the minimum 2-year follow-up, volar plate interposition arthroplasty provided satisfactory results in terms of pain relief and functional preservation for finger joints with posttraumatic arthritis. (10.1016/j.jhsa.2007.10.020)
• [L4] All patients achieved complete union at the fusion site at a mean of 9 weeks and reported pain relief. (10.1016/j.jhsa.2014.10.020)
• [L4] Outcomes vary, with some studies showing good stability and pain relief, while others note unpredictable results or donor site morbidity. (10.1111/j.1758-5740.2012.00215.x)
• [L4] However, magnetic resonance imaging indicates that the donor site is resurfaced with fibrous tissue. (10.1177/0363546507306465)
• [L4] Our technique provided satisfactory pain relief and motion preservation for posttraumatic arthritis of the little finger CMC joint. (10.1016/j.jhsa.2014.06.014)
• [L4] Metacarpal fusion is a relatively simple reconstructive option that maintains CMC joint kinematics, preserves digital length, and avoids the psychological burden associated with digital ray amputation. (10.1016/j.jhsg.2021.06.009)
• [L2] Measurements analogous to traditional radiographic parameters of adult acquired flatfoot deformity are obtainable using high-resolution cone-beam CT. (10.2106/jbjs.16.01366)
• [L4] We also showed that, whereas total joint arthroplasty is able to restore thumb function, it cannot fully replicate the kinematics of the healthy TMC joint. (10.1016/j.jhsa.2017.10.011)
• [L4] The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. (10.1186/1471-2474-13-148)
• [L5] The unlocked plate plus screw and crossed screw constructs were the stiffest and most resistant to joint opening under cyclic loading. (10.1186/s13018-017-0525-z)
• [L4] A significant increase in subtalar joint plantar flexion was found to be a primary compensation during overground walking and a double heel-rise activity following tibiotalar arthrodesis. (10.2106/jbjs.19.01132)
• [L4] Primary MOPS-preserved OCAT with MAT for treatment of femoral condyle and tibial plateau articular cartilage defects with concurrent meniscal deficiency was associated with statistically significant and clinically meaningful improvements in patient-reported measures of pain and function. (10.1177/03635465221144003)
• [L3] The results of revision at a minimum of two years were inferior to those of primary capitellocondylar total elbow arthroplasty. (10.2106/00004623-199610000-00012)
• [L5] Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage OA. (10.1016/j.jhsa.2007.02.009)
• [L4] Current protocols appear to be predominantly time-based without objective criteria or functional assessment. (10.1177/23259671211017135)
• [L4] Approximately half of the cohort was still in competitive sports at follow-up, yet 77% had decreased their level of sports, and nine of ten patients were satisfied with their surgery. (10.1177/0363546520908840)
• [L4] Single-stage acute osseous correction with femoral shortening allowed correction of the osseous deformity without the need for soft-tissue lengthening, enabling the patient to return to work and dramatically improving his functional and psychological state. (10.2106/jbjs.i.00128)
• [L3] Closed capsule can provide greater improvement in the sports-specific outcomes at early follow-up. (10.1007/s00167-022-07266-y)
• [L5] Reported complication and revision rates ranged from 0% to 59% and 0% to 45%, respectively. (10.1016/j.arthro.2025.07.045)
• [L4] Combined revision and failure rates were 10%, with 90% of patients considered to have successful 2- to 4-year outcomes. (10.1177/2325967120967928)
• [L4] Due to the high rate of loosening, this implant should only be used in low-demand patients. (10.1054/jhsb.2002.0861)
• [L4] This study showed good clinical results of primary repair with favorable outcomes and evidence of good healing, even among the 11% of patients who required repeat arthroscopy. (10.1016/j.arthro.2014.02.007)
• [L4] However, complications are common after this procedure, occurring in 31% of patients. (10.1177/2325967118s00097)
• [L3] The use of Denosumab for joint salvage was associated with a higher than expected rate of local recurrence at 44%. (10.1302/0301-620x.103b1.bjj-2020-0274.r1)
• [L3] Deep infection was the most common complication and the major cause of further surgery. (10.1302/0301-620x.103b4.bjj-2020-0665.r1)
• [L4] Although the incidence of complications is fairly high, most are minor, often do not need further treatment, and are associated with a successful outcome. (10.1177/1753193411434053)
• [L4] Although reoperation rates and superficial infections with the described method of fixation were relatively high, thumb metacarpal osteotomy provides some degree of pain relief and improvement of function. (10.1016/j.jhsa.2018.01.005)
• [L4] The procedure provides clear benefits, though careful attention should be paid to potential postoperative complications such as the appearance of HV deformity and infection. (10.1186/s13018-025-05965-z)

See Also

• Surgical Management

References

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