Although there is no consensus on the absolute chronologic definition of “middle age,” the period in adult life between young adult and old age, in its broadest definition, encompasses ages 35 to 65 years. The “baby boomers” (born between the end of World War II and 1964) have swelled their ranks. This group, and I count myself among them, has been exceedingly active athletically and wants to maintain that activity even though the toll of that activity on their joints has led to significant osteoarthritis (OA) of the knee.
We all work with the premise that joint replacement, as it has a finite life span, should be delayed for as long as possible and, when performed, requires a major alteration in lifestyle to prevent premature failure. Therefore, we continually seek treatments that may prolong the function of an osteoarthritic knee and allow that patient to maintain an active, athletic lifestyle. To that end this edition of Sports Medicine and Arthroscopy Review has been organized to allow the reader to understand the science behind our nonoperative treatment modalities (physical therapy, bracing, and viscosupplementation). These 3 articles are superb summaries of where we are today, evidence based, in terms of the use of these modalities in the treatment of OA of the knee in this younger, more active population. Drs Penney, Briem, Axe, and their coauthors have given the practitioner treating this group the data to make appropriate treatment decisions.
We then move to the surgical treatment of OA in this patient group. In this realm, there is a dearth of level I and II studies to support our treatments, and those studies that do exist often suffer from significant selection bias issues. As orthopedic surgeons we are required to make the best choice for our individual patients. We are somewhat limited by this lack of information, but the options of arthroscopic surgery, complex cartilage treatment, and periarticular osteotomies should be in our armamentarium; these methodologies clearly have a role in prolonging function in the active middle-aged athlete. Although the world of evidence-based medicine might frown on their use, that is not because there do not exist many patients who have truly benefited from these techniques but because of the relatively poor quality of orthopedic surgery literature when it comes to randomized control trials. We have to rely on poorer quality data to aid our decision making. Drs Levy, Mithoefer, Gardiner, and their coauthors perform an excellent review of the indications and techniques needed to address this challenging group of patients with appropriate surgery.
Finally, we end this edition of Sports Medicine and Arthroscopy Review with 2 articles that highlight the rapidly evolving field of orthopedic surgery. Both illustrate exciting new techniques that are minimally invasive and promise to improve on our current armamentarium of surgical procedures. These are truly cutting edge and utilize the most up-to-date technology and materials. Drs DeBeradino, McKeon, and their coauthors provide excellent details on the newest, high-tech procedures in the realm of periarticular osteotomy and unicompartmental knee arthroplasty.