The American journal of sports medicine
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We performed a prospective study of 46 patients with ruptures of the anterior cruciate ligament and medial ligamentous structures. All patients had anterior cruciate ligament allograft reconstructions. Group I comprised 34 patients in whom all of the medial structures were ruptured (parallel and oblique fibers of the superficial medial collateral ligament and the posteromedial capsule) and were treated operatively. ⋯ No patient had more than 2 mm of increase on valgus stress testing at 5 degrees or 25 degrees of knee flexion. The overall ratings were as follows: Group I, 20 knees (58%) excellent or good and 14 knees (42%) fair or poor; and Group II, 11 knees (91%) excellent or good and one knee (9%) fair. Knee motion complications and patellofemoral symptoms were common in the patients rated fair or poor in Group I.
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Comparative Study
Lateral traction during shoulder arthroscopy: its effect on tissue perfusion measured by pulse oximetry.
We studied the effect of three methods of shoulder traction during arthroscopy on arterial oxygen saturation measured by a pulse oximeter applied to the fingertip of the arm in traction. Simple longitudinal traction ablated the oxygen saturation in only 1 of 30 patients. ⋯ In this series, the pulse oximeter did not demonstrate gradual gradations in arterial oxygen saturation loss. Rather, the pulse oximeter provided an all-or-none warning signal for tissue hypoxia.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intraarticular morphine and bupivacaine for pain control after outpatient knee arthroscopy. A prospective, randomized, double-blinded study.
To determine the duration of pain relief and efficacy of intraarticular morphine compared with bupivacaine after outpatient knee arthroscopy under local anesthesia, we gave patients one of three postoperative intraarticular injections: 4 mg morphine, 0.25% bupivacaine, or 0.9% saline. Visual analog scale scores and supplemental pain medication use were recorded at 0 to 30 minutes, 2, 4, 6, 8 to 12, and 24 hours after surgery. The score on the visual analog scale at 24 hours was significantly lower in the morphine group than in the bupivacaine or control groups. ⋯ The morphine group used the least supplemental pain medication during the 12 to 24 hour interval (P = 0.06). We found that the use of intraarticular morphine or bupivacaine after outpatient knee arthroscopy will decrease the amount of narcotic medication needed for pain relief during the early postoperative period. In addition, morphine provided prolonged pain relief up to 24 hours when compared with bupivacaine or placebo, and the patients in the morphine group tended to take less supplemental pain medication during the first postoperative day.
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Anterior shoulder dislocation is a common skiing injury. Several methods are available for reduction of shoulder dislocations. We evaluated a method for reduction of anterior shoulder dislocation that has not previously appeared in the literature. ⋯ The physician applies traction to the affected shoulder using downward pressure on a loop of stockinette wrapped around the patient's forearm. Our method was successful in 97% of 118 anterior dislocations with no complications. Ninety-three percent were performed without the use of narcotic analgesia.
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To describe the relationship of the pronator teres, flexor carpi radialis, flexor digitorum superficialis, and flexor carpi ulnaris muscles to the medial collateral ligament at 30 degrees, 90 degrees, and 120 degrees of elbow flexion, we dissected 11 cadaveric specimens. The flexor carpi ulnaris muscle is the predominant musculotendinous unit overlying the medial collateral ligament in the majority of cases and is the only one at 120 degrees of elbow flexion. The flexor digitorum superficialis muscle is the only other significant contributor. ⋯ The flexor carpi ulnaris muscle, because of its position directly over the medial collateral ligament, and the flexor digitorum superficialis muscle, with its near proximity and relatively large bulk, are the specific muscles best suited to provide medial elbow support. This is especially relevant to overhand throwing athletes who encounter extreme valgus force across the elbow during the cocking and acceleration phases of the throwing motion. Exercise and conditioning of the medial elbow musculature, specifically the flexor digitorum superficialis muscle and the flexor carpi ulnaris muscle, may prevent injury or assist in rehabilitation of medial elbow instability, especially in overhand throwing athletes.