Background Osteoporosis, whether generalized or localized, presents significant challenges in arthroscopic procedures, particularly in surgeries such as ligament reconstructions and rotator cuff repairs, which depend on fixation through interference screws and/or anchors. These challenges are especially pronounced in women, the elderly, and individuals with chronic injuries. The literature discusses various techniques to mitigate these issues. Objective Despite the recognition of these challenges, there is no clear consensus on the most effective methods to address them. Current literature lacks comprehensive information on the specific difficulties surgeons encounter when managing sports injuries in osteoporotic bones, particularly around the knee. This manuscript aims to outline and describe various treatment strategies to manage sports injuries in patients with osteoporotic bones. Current Knowledge Numerous studies acknowledge the heightened risk of fixation failure in osteoporotic bones. Surgeons have described various techniques to address these fixation issues, such as alternative fixation methods, preserved insertion techniques, bone bridge techniques, larger diameter screws, and supplementary fixation strategies. Techniques such as transosseous equivalent (TOE) repair, special suture configurations, multiple fixation points, medial anchor placement in subchondral bone, and bone cement augmentation are among the methods used to improve anchor fixation in osteoporotic bone. Literature Gap Although multiple surgical techniques are available for graft and tendon fixation in osteoporotic bones, there is no clear guideline on which method offers the best combination of biological and mechanical superiority. This article reviews the various fixation techniques and explores innovative approaches to graft fixation. In addition, the authors emphasize the importance of medical management of osteoporosis in patients undergoing surgical interventions, highlighting the role of bisphosphonate, teriparatide, denosumab. Medical therapy not only reduces the risk of fixation failure but also plays a crucial role in post-operative recovery. Conclusions With the growing emphasis on healthy lifestyles, increasing numbers of elderly patients are participating in sports activities. As a result, more patients with low bone mineral density (BMD) are seeking treatment for sports injuries. Anticipating the issue of regional low BMD is essential, even in younger patients, to ensure that alternative fixation techniques are employed when necessary.

Challenges Posed by Osteoporosis in Arthroscopy and Sports Injury Management

期刊论文
发表日期：

2025年1月13日

查看全文

Ravi Gupta,
Anil Kapoor

摘要

Background

Osteoporosis, whether generalized or localized, presents significant challenges in arthroscopic procedures, particularly in surgeries such as ligament reconstructions and rotator cuff repairs, which depend on fixation through interference screws and/or anchors. These challenges are especially pronounced in women, the elderly, and individuals with chronic injuries. The literature discusses various techniques to mitigate these issues.

Objective

Despite the recognition of these challenges, there is no clear consensus on the most effective methods to address them. Current literature lacks comprehensive information on the specific difficulties surgeons encounter when managing sports injuries in osteoporotic bones, particularly around the knee. This manuscript aims to outline and describe various treatment strategies to manage sports injuries in patients with osteoporotic bones.

Current Knowledge

Numerous studies acknowledge the heightened risk of fixation failure in osteoporotic bones. Surgeons have described various techniques to address these fixation issues, such as alternative fixation methods, preserved insertion techniques, bone bridge techniques, larger diameter screws, and supplementary fixation strategies. Techniques such as transosseous equivalent (TOE) repair, special suture configurations, multiple fixation points, medial anchor placement in subchondral bone, and bone cement augmentation are among the methods used to improve anchor fixation in osteoporotic bone.

Literature Gap

Although multiple surgical techniques are available for graft and tendon fixation in osteoporotic bones, there is no clear guideline on which method offers the best combination of biological and mechanical superiority. This article reviews the various fixation techniques and explores innovative approaches to graft fixation. In addition, the authors emphasize the importance of medical management of osteoporosis in patients undergoing surgical interventions, highlighting the role of bisphosphonate, teriparatide, denosumab. Medical therapy not only reduces the risk of fixation failure but also plays a crucial role in post-operative recovery.

Conclusions

With the growing emphasis on healthy lifestyles, increasing numbers of elderly patients are participating in sports activities. As a result, more patients with low bone mineral density (BMD) are seeking treatment for sports injuries. Anticipating the issue of regional low BMD is essential, even in younger patients, to ensure that alternative fixation techniques are employed when necessary.