O'Donoghue, J Chronic Dis 1961 - Late Results--Good and Bad--In the Treatment of Injuries to Athletes

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Late Results--Good and Bad--In the Treatment of Injuries to Athletes

O'Donoghue·J Chronic Dis·1961·0 citations·Review article

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O'Donoghue reviews the late chronic sequelae of common athletic injuries across the knee, ankle, wrist, elbow, and shoulder. The paper asks how to decide when definitive, often surgical, treatment of a degenerated joint is justified. It frames a philosophy: identify the initiating lesion and treat it before irreversible arthritis develops.

Key Findings

Chronic joint disability in aging athletes usually reflects the mismanaged initial injury rather than the injury itself. The cause frequently lies in management by the doctor or patient. This is the paper's central thesis and why early definitive treatment matters.
A neglected medial meniscus tear drives a predictable cascade: diffuse synovitis, fat pad redundancy, chondromalacia patellae, and chondral marginal osteophytes. Early meniscectomy can prevent this progression, which is why the tear should be addressed whenever it is identified as the driver.
Ligamentous instability sets up a vicious circle. The laxity thins cartilage, flattens the menisci, and enlarges osteophytes, which further irritate the remaining ligament. Pure joint debridement can worsen this by adding to the instability that caused the problem.
The ankle is the most frequently injured athletic joint but far less likely than the knee to cause chronic sequelae. Its bony stability from the talus mortised between the malleoli allows most injuries to heal spontaneously.
Carpal navicular (scaphoid) fracture is the most common cause of chronic wrist disability in athletes and is frequently overlooked. It masquerades as recurrent sprains until nonunion is established, so any wrist sprain warranting imaging demands oblique views.
Posterior shoulder dislocation is commonly unrecognized for years and causes serious chronic disability. Careful analysis of the original injury usually reveals the unreduced dislocation, but late treatment is unsatisfactory.
Chronic acromioclavicular arthritis is reliably relieved by resecting only the distal 3/4 inch of the clavicle, eliminating direct joint apposition. This is a simple, highly successful procedure that should not be withheld.

Board PearlChronic athletic joint disability usually stems from the mismanaged initial injury, not the injury itself, so treat the specific lesion early to interrupt progressive degeneration.

Late Results--Good and Bad--In the Treatment of Injuries to Athletes.

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Late Results--Good and Bad--In the Treatment of Injuries to Athletes

O'Donoghue·J Chronic Dis·1961·0 citations·Review article

|

O'Donoghue reviews the late chronic sequelae of common athletic injuries across the knee, ankle, wrist, elbow, and shoulder. The paper asks how to decide when definitive, often surgical, treatment of a degenerated joint is justified. It frames a philosophy: identify the initiating lesion and treat it before irreversible arthritis develops.

Key Findings

Chronic joint disability in aging athletes usually reflects the mismanaged initial injury rather than the injury itself. The cause frequently lies in management by the doctor or patient. This is the paper's central thesis and why early definitive treatment matters.
A neglected medial meniscus tear drives a predictable cascade: diffuse synovitis, fat pad redundancy, chondromalacia patellae, and chondral marginal osteophytes. Early meniscectomy can prevent this progression, which is why the tear should be addressed whenever it is identified as the driver.
Ligamentous instability sets up a vicious circle. The laxity thins cartilage, flattens the menisci, and enlarges osteophytes, which further irritate the remaining ligament. Pure joint debridement can worsen this by adding to the instability that caused the problem.
The ankle is the most frequently injured athletic joint but far less likely than the knee to cause chronic sequelae. Its bony stability from the talus mortised between the malleoli allows most injuries to heal spontaneously.
Carpal navicular (scaphoid) fracture is the most common cause of chronic wrist disability in athletes and is frequently overlooked. It masquerades as recurrent sprains until nonunion is established, so any wrist sprain warranting imaging demands oblique views.
Posterior shoulder dislocation is commonly unrecognized for years and causes serious chronic disability. Careful analysis of the original injury usually reveals the unreduced dislocation, but late treatment is unsatisfactory.
Chronic acromioclavicular arthritis is reliably relieved by resecting only the distal 3/4 inch of the clavicle, eliminating direct joint apposition. This is a simple, highly successful procedure that should not be withheld.

Board PearlChronic athletic joint disability usually stems from the mismanaged initial injury, not the injury itself, so treat the specific lesion early to interrupt progressive degeneration.

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