Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized, double-blind trial of pre-emptive local anesthesia in day-case knee arthroscopy.
The study goal was to assess the efficacy of pre-emptive analgesia in a clinical setting. ⋯ Prophylactic local anesthesia confers no statistically significant reduction in pain scores or perioperative general anesthetic requirements as compared with postoperative administration. The pre-emptive effect in clinical practice may be less dramatic than that observed in more controlled animal models. Further studies are required to investigate the magnitude of the pre-emptive effect in clinical practice.
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Comparative Study
Proprioception of the knee before and after anterior cruciate ligament reconstruction.
The purpose of this study was to determine, first, if there is measurable deficit in proprioception in an anterior cruciate ligament (ACL)-deficient knee, either compared to the contralateral knee or external controls; second, if this deficit, if present, improves after ACL reconstruction; and third, if improvement occurs, what the time course of improvement is. ⋯ TDPM was a more reliable method than JPS for testing proprioception before and after ACL reconstruction in this study. Bilateral deficits in knee joint proprioception (TDPM) were documented after unilateral ACL injury. Reconstruction of a mechanical restraint (ACL graft) was believed to have a significantly positive impact on early and progressive improvement in proprioception.
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Two cases are presented that demonstrate the utility of arthroscopic intervention for the management of gunshot wounds to the shoulder. The first report involves a 24-year-old man with a retained bullet in his glenohumeral joint after a drive-by shooting The intra-articular bullet was retrieved arthroscopically avoiding chondral injury from the mechanical effects of a loose body as well as the potential local and systemic effects of lead toxicity. ⋯ The other case describes a 19-year-old man who sustained a gunshot wound to the lateral portion of his upper arm resulting in a proximal humerus fracture along with a retained bullet in his subacromial space. The bullet was successfully removed arthroscopically avoiding a traditional exposure, which would have complicated his fracture care.
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Fractures of the tibial eminence can be treated arthroscopically. Fixation of the fracture is usually followed by temporary immobilization. The literature suggests that only anterograde fixation with cannulated screws and washer is considered stable enough to allow for immediate mobilization and weight bearing. The goal of this study was to evaluate the 5-year results of arthroscopic reductions and anterograde fixations of the tibial eminence fracture with cannulated screws. ⋯ Arthroscopic fixation of the fracture of the intercondylar eminence of the tibia with a cannulated screw or screw and washer is a simple, safe, reproducible, and effective procedure. The fixation is stable even in type IV fractures, so that immobilization is unnecessary.
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The etiology, pathogenesis, time course, and response to treatment of stiff shoulder pathology is still under investigation and debate. This prospective study evaluated arthroscopic capsular release to treat stiff shoulder pathology that was resistant to conservative management. The etiology of the shoulder stiffness was categorized and analyzed for effect on outcomes. ⋯ Stiff shoulder pathology can result from a variety of differing etiologic factors. Arthroscopic capsular release was equally effective across the 5 identified etiologic groups, and provided significant pain relief, restoration of motion, and function within an average of 3 months.