Challenges Posed by Osteoporosis in Arthroscopy and Sports Injury Management.

Background: Osteoporosis, whether generalized or localized, presents significant challenges in arthroscopic procedures, particularly in surgeries such as ligament reconstructions and rotator cuff repairs, which depend on fixation through interference screws and/or anchors. These challenges are especially pronounced in women, the elderly, and individuals with chronic injuries. The literature discusses various techniques to mitigate these issues. Objective: Despite the recognition of these challenges, there is no clear consensus on the most effective methods to address them. Current literature lacks comprehensive information on the specific difficulties surgeons encounter when managing sports injuries in osteoporotic bones, particularly around the knee. This manuscript aims to outline and describe various treatment strategies to manage sports injuries in patients with osteoporotic bones. Current Knowledge: Numerous studies acknowledge the heightened risk of fixation failure in osteoporotic bones. Surgeons have described various techniques to address these fixation issues, such as alternative fixation methods, preserved insertion techniques, bone bridge techniques, larger diameter screws, and supplementary fixation strategies. Techniques such as transosseous equivalent (TOE) repair, special suture configurations, multiple fixation points, medial anchor placement in subchondral bone, and bone cement augmentation are among the methods used to improve anchor fixation in osteoporotic bone. Literature Gap: Although multiple surgical techniques are available for graft and tendon fixation in osteoporotic bones, there is no clear guideline on which method offers the best combination of biological and mechanical superiority. This article reviews the various fixation techniques and explores innovative approaches to graft fixation. In addition, the authors emphasize the importance of medical management of osteoporosis in patients undergoing surgical interventions, highlighting the role of bisphosphonate, teriparatide, denosumab. Medical therapy not only reduces the risk of fixation failure but also plays a crucial role in post-operative recovery. Conclusions: With the growing emphasis on healthy lifestyles, increasing numbers of elderly patients are participating in sports activities. As a result, more patients with low bone mineral density (BMD) are seeking treatment for sports injuries. Anticipating the issue of regional low BMD is essential, even in younger patients, to ensure that alternative fixation techniques are employed when necessary.