The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Jun 2011
Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair.
The biomechanical effects of radial split tears and vertical tears of the medial meniscus are not well characterized. The goal of the present study was to determine the effects of these meniscal tears and meniscal repair on tibiofemoral joint contact pressure and area. ⋯ Radial split tears of the medial meniscus that extend from the inner rim to the peripheral third of the meniscus do not cause significant changes in joint contact area and pressure. Vertical tears of the medial meniscus cause nonsignificant increases in joint contact pressure and reductions in contact area in the medial and lateral compartments.Repair of the vertical tear reverses these contact changes, resulting in contact pressure and area similar to the intact state.
-
J Bone Joint Surg Am · Jun 2011
ReviewEvidence summary: systematic review of surgical treatments for geriatric hip fractures.
There is a growing body of literature on surgical treatments for elderly patients with a hip fracture and the effects of various surgical procedures on complications and postoperative outcomes. No single review has previously summarized the literature on the effects of surgical procedures on outcomes after treatment across all types of hip fractures. We conducted a comprehensive systematic literature review to organize the clinical evidence for patient-centered outcomes across all types of geriatric hip fractures. ⋯ The broader questions about the relationship of patient factors, fracture type, and specific treatments to the outcomes of mortality, functional status, and quality of life cannot be addressed with the existing literature. Research should include comprehensive conceptual models that capture complete sets of important independent variables. Studies of musculoskeletal outcomes, including hip fracture, require well-defined patient groups and consistent use of validated outcome measures.
-
Adequate postoperative pain control in patients who have undergone total joint arthroplasty allows faster rehabilitation and reduces the rate of postoperative complications. Multimodal pain management involves the introduction of adjunctive pain control methods in an attempt to control pain with less reliance on opioids and fewer side effects. ⋯ Nearly all multimodal pain management modalities have a safe side-effect profile when they are added to existing methods. The exception is the administration of DepoDur (extended-release epidural morphine) to elderly or respiratory-compromised patients because of a potential for hypoxia and cardiopulmonary events.
-
J Bone Joint Surg Am · Jun 2011
Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006.
This study was proposed to investigate the changes in the utilization of knee arthroscopy in an ambulatory setting over the past decade in the United States as well as its implications. ⋯ This study revealed that the knee arthroscopy rate in the United States was more than twofold higher than in England or Ontario, Canada, in 2006. Our study found that nearly half of the knee arthroscopic procedures were performed for meniscal tears. Meniscal damage, detected by magnetic resonance imaging, is commonly assumed to be the source of pain and symptoms. Further study is imperative to better define the symptoms, physical findings, and radiographic findings that are predictive of successful arthroscopic treatment.