No abstract

Malalignment of the knee can cause debilitating symptoms such as pain, resulting in a decline in function and mobility. Surgical options that exist to address this problem include realignment osteotomies and joint replacements. Realignment osteotomies are the more appropriate options in certain patient populations, especially with regard to age and level of activity. Since a high tibial osteotomy (HTO) was first used to manage malalignment of the knee and osteoarthritis, different techniques involving the use of specialized implants have been developed and further refined to good effect. There has also since been much research into the field of cartilage restoration techniques, both as a standalone treatment option and as an adjunct to a realignment osteotomy. This review attempts to detail the origin and the evolution of HTO, particularly in regard to combining this tried and tested procedure with adjunct cartilage restoration techniques, and the overall patient outcomes. A literature search on PubMed was performed, and articles pertaining to the outcomes of the use of an HTO and cartilage restoration techniques were reviewed. The literature in this field indicates good outcomes in terms of objective measurements of cartilage regeneration (such as arthroscopic visualization and magnetic resonance imaging evaluation) and subjective patient outcome scoring systems (such as the International Knee Documentation Committee and Lysholm scores) with a realignment osteotomy alone, and studies have shown that patient outcomes can be further improved with the use of a cartilage restoration procedure as an adjunct.

The quadrilateral space is bounded by the teres minor superiorly, the teres major inferiorly, the long head of the triceps medially and the shaft of the humerus laterally. The axillary nerve and posterior circumflex humeral artery pass through this space to enter the posterior compartment of the upper arm. Quadrilateral space syndrome (QSS) is caused by entrapment of the axillary nerve or its main branches and/or the posterior circumflex humeral artery in the quadrilateral space by internal or external compression. QSS can often be difficult to diagnose, given that patients may present with non-specific symptoms. As such, patients may be misdiagnosed with more common disorders of the shoulder. We report a case of QSS masquerading initially as rotator cuff pathology with positive impingement signs.