The journal of knee surgery
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The aim of the article is to identify demographic and intraoperative factors that predict patient-oriented outcomes as measured by knee-specific and general quality of life (QoL) questionnaires for chronic, unilateral primary anterior cruciate ligament (ACL) tears following surgical reconstruction. A total of 69 patients were prospectively evaluated using the Medical Outcomes Study 36-item Short Form (SF-36), modified Lysholm, Tegner activity level, and subjective portion of the International Knee Documentation Committee (IKDC) questionnaires. The surveys were administered preoperatively and postoperatively with a minimum 2-year follow up. ⋯ QoL and knee function were improved following ACL reconstruction for chronic ACL tears. Independent predictors of poorer outcome were identified in the PF, bodily pain, and physical component score (PCS) of the SF-36. Increasingly, severe articular cartilage injury to the medial and patellofemoral compartments, as well as the presence of a lateral meniscal tear were predictive of poorer outcomes.
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Patellofemoral instability can be a disabling problem. Numerous techniques are employed for its treatment. Medial patellofemoral ligament (MPFL) reconstruction in combination with other procedures has been explored by many orthopedic surgeons. ⋯ The series mean IKDC scores at follow-up was 76.3 ± 19.2 (range, 30-99), and Tegner activity scores were 5.6 ± 2.5. MPFL reconstruction is an option for treating the symptoms of patellar instability, preventing recurrent dislocation, and returning patients near to their preinjury level of activity. The level of evidence is IV.
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Methods of tibial plateau fracture fixation have evolved over the last decades; however the techniques used to reduce these fractures have remained relatively unchanged. Balloon tibioplasty, a minimally invasive novel technique used in the reduction of depressed tibial plateau fractures, has been gaining popularity. ⋯ Although an attractive option, as with all novel techniques there is a learning curve. The purpose of this article is to briefly describe our technique of balloon tibioplasty, potential contraindications, and to illustrate some possible complications, and provide some tips and tricks we have found useful to avoid them.
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Primary or revision total knee arthroplasties (TKAs) may be associated with a marked amount of intraoperative or postoperative blood loss that potentially may lead to the need for blood transfusions. However, Jehovah's Witnesses usually refuse blood transfusions because of their religious beliefs. ⋯ In this report, we provide an overview of various potential preoperative, intraoperative, and postoperative blood management measures that may be used for the care of Jehovah's Witnesses who undergo knee arthroplasty procedures. In addition, we review reported outcomes of primary and revision TKAs in these patients.
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Elective total knee arthroplasty is frequently associated with considerable blood loss and a concomitant decline in hemoglobin postoperatively. This often leads to high rates of allogeneic transfusions, with reports of up to 69%, to treat postoperative anemia. Allogeneic blood transfusions have been shown to be an independent risk factor for increased adverse outcomes, such as prolonged length of hospital stay and postoperative infections. ⋯ Specifically, we evaluated preoperative autologous blood donation, iron therapy, and intravenous erythropoietin. Current evidence suggests that these techniques independently may be effective at reducing the incidence of allogeneic blood transfusions, correcting preoperative, and preventing postoperative anemia. However, more studies are necessary to evaluate combination protocols, as well as the cost-effectiveness and safety of these practices as part of routine preoperative blood management for total knee arthroplasty.