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ACI for talar cartilage repairOsteochondral lesions of the talus occur in up to 70% of ankle fractures; defects measuring 2cm² or larger typically undergo autologous chondrocyte implantation, which uses cultured cells rather than bone plugs to restore cartilage but requires medial malleolar osteotomy to access the joint.Osteochondral lesions of the talus occur in up to 70% of ankle fractures; defects measuring 2cm² or larger typically undergo autologous chondrocyte implantation, which uses cultured cells rather than bone plugs to restore cartilage but requires medial malleolar osteotomy to access the joint.
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When knee replacement pain needs specialist reviewOnce bacteria establish themselves on a knee implant, antibiotics cannot penetrate the protective layer they form, making surgery almost always necessary — catching infection early prevents this escalation.Once bacteria establish themselves on a knee implant, antibiotics cannot penetrate the protective layer they form, making surgery almost always necessary — catching infection early prevents this escalation.
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When cartilage repair is the right choiceCartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.Cartilage repair succeeds for a focal defect in otherwise healthy joint tissue in younger patients, but fails in diffuse arthritis. Lesion size, depth, patient age, and activity level determine the appropriate technique.
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Who to see first for tennis elbowTennis elbow develops when a forearm tendon accumulates microscopic tears faster than it can self-repair; progressive loading through physiotherapy rebuilds the damaged structure, whereas anti-inflammatory treatments only mask pain.Tennis elbow develops when a forearm tendon accumulates microscopic tears faster than it can self-repair; progressive loading through physiotherapy rebuilds the damaged structure, whereas anti-inflammatory treatments only mask pain.
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When OATS mosaicplasty beats other ankle cartilage repairsLesions exceeding 150 mm² require OATS mosaicplasty: marrow stimulation produces fibrocartilage that breaks down within two to three years, whilst transplanted hyaline cartilage lasts decades.Lesions exceeding 150 mm² require OATS mosaicplasty: marrow stimulation produces fibrocartilage that breaks down within two to three years, whilst transplanted hyaline cartilage lasts decades.
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Physio or Surgery for Supraspinatus TendinopathySupraspinatus tendinopathy is cellular degeneration, not inflammation: the tendon needs progressive loading to remodel, not rest. Physiotherapy succeeds for most; night pain disrupting sleep or arm weakness indicate when surgical assessment becomes necessary.Supraspinatus tendinopathy is cellular degeneration, not inflammation: the tendon needs progressive loading to remodel, not rest. Physiotherapy succeeds for most; night pain disrupting sleep or arm weakness indicate when surgical assessment becomes necessary.
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When a grade 1 hamstring strain needs specialist careEccentric strength training halves the reinjury rate in grade 1 hamstring strains—7.4% versus 18.5%—and returns athletes to sport roughly a week sooner than conventional physiotherapy.Eccentric strength training halves the reinjury rate in grade 1 hamstring strains—7.4% versus 18.5%—and returns athletes to sport roughly a week sooner than conventional physiotherapy.
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OATS or microfracture for active knee patientsMicrofracture improves early but deteriorates progressively beyond two years because it deposits fibrocartilage, whilst OATS transplants intact cartilage that remains stable long-term.Microfracture improves early but deteriorates progressively beyond two years because it deposits fibrocartilage, whilst OATS transplants intact cartilage that remains stable long-term.
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Osteochondral Allograft for Ankle Cartilage DefectsLesions on the talus larger than 15mm fail with microfracture repair; osteochondral allograft instead restores the cartilage and bone using donor tissue, achieving 85% survivorship at ten years.Lesions on the talus larger than 15mm fail with microfracture repair; osteochondral allograft instead restores the cartilage and bone using donor tissue, achieving 85% survivorship at ten years.
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Gluteal tendinopathy beyond self-managementGluteal tendinopathy — a condition in which hip tendons lose capacity to handle everyday load — self-perpetuates through geometry: compressive positions reload the sensitised structure, whilst rest removes stimulus and generic stretches worsen compression.Gluteal tendinopathy — a condition in which hip tendons lose capacity to handle everyday load — self-perpetuates through geometry: compressive positions reload the sensitised structure, whilst rest removes stimulus and generic stretches worsen compression.
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TFL Strain and Choosing the Right SpecialistTFL strain ranges from acute tears to chronic overuse; clinical markers—weight-bearing ability, bruising extent, and palpable gap—grade the injury, and the grade determines whether physiotherapy or physician assessment is required first.TFL strain ranges from acute tears to chronic overuse; clinical markers—weight-bearing ability, bruising extent, and palpable gap—grade the injury, and the grade determines whether physiotherapy or physician assessment is required first.
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Allograft vs autograft for large knee cartilage defectsAutograft for knee cartilage defects larger than roughly 2–4 cm² risks replacing one area of cartilage loss with another at the harvest site. Osteochondral allografts from cadaveric donors eliminate this trade-off and achieve 5-year survival of 79–87.8%.Autograft for knee cartilage defects larger than roughly 2–4 cm² risks replacing one area of cartilage loss with another at the harvest site. Osteochondral allografts from cadaveric donors eliminate this trade-off and achieve 5-year survival of 79–87.8%.
