183. LIVE (REBOOT) from AOSSM: Challenging Cartilage Injuries (Dr. Sabrina Strickland & Dr. Seth Sherman)

Dr. Sabrina Strickland is an associate professor of orthopaedic surgery and an attending surgeon at Hospital for Special Surgery . She is active member of many societies and research groups, including the International Cartilage Repair Society and the International Patellofemoral Study Group.Dr. Seth Sherman is the Director of the Sports Medicine Fellowship at Stanford University Orthopaedics and is a Stanford University Football team physician. He is Chairman of the AAOS Sports Medicine/Arthroscopy committee and is also a member of the International Patellofemoral Study Group.Both Dr. Strickland and Dr. Sherman publish and lecture extensively on the topic of knee joint preservation, cartilage restoration and specifically patellofemoral cartilage disease - so we’re excited to hear them speak more this topic!We are narrowing the focus of our conversation today to osteotomies. We just did a two-part episode with Dr. Cassandra Lee that tackles all the different cartilage restoration options for the patellofemoral joint. So go check that out if you want to hear more about when to choose OATS vs. OCA vs. MACI. But for today: let’s chat about osteotomies.In this episode, we discuss:What are some key findings to look for on exam and imaging to determine if a realignment osteotomy is needed?We are familiar with the tibial tubercle trochlear groove (TT-TG) measurement, but what is the Sagittal TT-TG (sTT-TG) distance and what does it tell us?How should a tibial tubercle osteotomy (TTO) be customized to address different areas of cartilage pathology? (Check out our Instagram - @thesportsdocspod - to see different types of TTOs based on location of cartilage lesion and/or presence of instability in the setting of malalignment.)How can the TTO surgical technique be modified to minimize risk of complications when performing a complete tubercle detachment? Image 3 shows four surgical tips for lessening complication risk.There are other osteotomies besides TTO to address patellofemoral pathology — including a derotational distal femoral osteotomy. What are the indications for this procedure?