Update: This article was updated on September 18, 2020, because of a previous error. On page 3, the legend for Figure 2 that had read “External rotation of the hip can be measured by having the patient sit in a chair facing the camera and rotating the hip with the knee bent at 90°” now reads “Rotation of the hip can be measured by having the patient sit in a chair facing the camera and rotating the hip with the knee bent at 90°.” An erratum has been published: J Bone Joint Surg Am. 2020 Oct 21;102(20):e121. With the onset of the COVID-19 pandemic, the shifting of clinical care to telemedicine visits has been hastened. Because of current limitations in resources, many elective surgeons have been forced to venture into utilizing telemedicine, in which the standards for orthopaedic examinations have not previously been fully developed. We report our experience with protocols and methods to standardize these visits to maximize the benefit and efficiency of the virtual orthopaedic examination. At the time of scheduling, patients are asked to prepare for their virtual visit and are given a checklist. In addition to confirming audiovisual capabilities prior to the visit, patients are given specific instructions on camera positioning, body positioning, setting, and attire to improve the efficiency of the visit. During the examination, digital tools can be utilized as needed. In the setting of outpatient injury evaluations, a systematic virtual examination can aid in triaging and managing common musculoskeletal conditions. With the rapid incorporation of telehealth visits, as well as the unknown future with regard to the pandemic, the utilization and capabilities of telemedicine will continue to expand. Future directions include the development of validated, modified examination techniques and new technology that will allow for improved interactive physical examinations, as we rapidly move forward into the realm of telemedicine due to unexpected necessity.

One hundred two patients with 131 consecutive cementless total knee arthroplasties that retained the posterior cruciate ligament were followed up prospectively. The average age of the patients was 58 years (range, 32–75 years). The mean followup on the surviving knee arthroplasties was 11 years (range, 7–16 years). The patellar component was metal-backed in the first 112 (85%) knees, cementless all-polyethylene in the last 17 (13%) knees, and two knees had a prior patellectomy. Forty-four metal-backed patellar components (48%) were revised; nine were loose, and 35 had polyethylene wear through. Thirteen femoral components (12%) were revised because of femoral abrasion from a failed metal-backed patellar component. No other femoral component was revised, loose, or had osteolysis develop. Nine (8%) tibial components had failure of ingrowth; eight have been revised. Partial radiolucencies occurred in 53% of the tibias. Thirteen (12%) small osteolytic lesions developed, all around screws or screw holes in the tibial components. At an average of 11 years followup, cementless fixation yielded mixed results: cementless femoral fixation was excellent and metal-backed patellar components had a 48% patellar revision rate. Cementless tibial components had an 8% aseptic loosening rate and a 12% incidence of small osteolytic lesions. Based on these results, the authors have abandoned cementless fixation in total knee arthroplasty.

The severity of a tibial plateau fracture and the complexity of its treatment depend on the energy imparted to the limb. Low-energy injuries typically cause unilateral depression-type fractures, whereas high-energy injuries can lead to comminuted fractures with significant osseous, soft-tiss

Chondral defects of the articular surface pose a challenging problem to the orthopedic surgeon. The goal of surgery is to alleviate pain, maximize function, and prevent degenerative changes in the future. A number of techniques have been described to treat these lesions. When considering the treatment options for chondral defects, the surgeon must consider the size, depth, location, and chronicity of the lesion. In addition, the overall alignment of the joint must be evaluated. Prior to treating chondral defects, it is important to understand the indications and contraindications for the microfracture technique. When indicated, the microfracture technique has many advantages over other surgical options. This technique is relatively easy to perform, cost effective, and has low patient morbidity. In addition, the microfracture technique does not burn any long-term bridges, enabling the surgeon to choose a different procedure to revise the chondral defect if the microfracture fails. It is important to understand the mechanism of healing by microfracture, including the effects of the local environment. The postoperative protocol used after the procedure may be as important as the surgery itself. Understanding the science behind the microfracture procedure will lead to better surgical technique and improved outcomes.