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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Comparative Study
Interference screw position and hamstring graft location for anterior cruciate ligament reconstruction.
Anterior cruciate ligament reconstruction with hamstring tendon graft and interference screw fixation has recently been considered. Concerns for the use of interference screws with soft tissue grafts include damage to the graft during screw insertion, decreased fixation strength, and a decrease in the bone-tendon contact area for healing within the tunnel when the screw is placed in an eccentric position. This last concern could be addressed by placing the interference screw centrally between the four limbs of the hamstring graft. ⋯ The maximum pullout force averaged 265.3 N for the screw placed in the eccentric position, and 244.7 N for the screw placed in the central position; these values were not significantly different. Placement of the interference screw in the central position did not compromise strength and it improves graft contact within the bone tunnel. Interference screw fixation, when applied against a bone plug, has been shown to consistently have a pullout force of more than 400 N.
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The case of a 14-year-old girl with osteoid osteoma of the talar neck that localized subperiostaly with a 1-year history of persistent ankle pain is presented. The diagnosis was made on the basis of clinical appearance, radiography, technetium-99m diphosphonate scintigraphy, and magnetic resonance imaging findings. ⋯ However, pathological study of the arthroscopic shavings failed to confirm the preoperative diagnosis. We concluded that the arthroscopic excision of an osteoid osteoma in an accessible location on the talar neck is an appropriate surgical intervention, but it should be done by using nonmotorized instruments for better pathological examination of the lesion.
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Randomized Controlled Trial Clinical Trial
Analgesic effects of intra-articular morphine during and after knee arthroscopy: a comparison of two methods.
The objective of this study was to compare the analgesic effects of intra-articularly administered bupivacaine with bupivacaine/morphine during and after therapeutic knee arthroscopy. In a prospective, randomized study, 50 patients with clinical signs of medial meniscal injury were allocated to two groups, A and B. The patients in group A received 40 mL of 0.25% bupivacaine while the same dose of bupivacaine combined with 1 mg of morphine sulphate was administered in group B. ⋯ However, no significant differences were found between the two groups in terms of intraoperative pain scores, supplementary analgesic requirements, or the overall rating of the procedure. This study provides evidence that arthroscopic surgery can be performed in a safe manner after intra-articularly administered bupivacaine with or without low-dose morphine. The combination of low-dose morphine and bupivacaine did, however, produce a superior postoperative analgesic effect during the 24 hours following knee arthroscopy compared with bupivacaine alone.
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The objective of this study was to arthroscopically analyse the morphology and dynamics of variants of the anterior horn of the medial meniscus of the knee (VAMM) and to then consider the pathological significance of these variants. VAMM was defined as knees in which the anterior horn of the medial meniscus is not attached to the tibia. Between April 1992 and March 1995, arthroscopy was performed on 953 knees of 903 patients. ⋯ In these cases, even detailed arthroscopic observation proved the causes of the symptoms or injury. On the basis of these findings, we surmised that the anterior portion shows hypermobility at the time of flexion/extension of the knee, regardless of the type of VAMM. In this study, we discussed the possibility that the existence of VAMM may become the cause of pain or injury to the meniscus.
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Comparative Study
The efficacy of regional anesthesia for outpatient anterior cruciate ligament reconstruction.
Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. Until recently, the majority of these procedures have been performed on an impatient basis. This retrospective study evaluated 67 consecutive patients who underwent an arthroscopically assisted, autogenous bone-patellar ligament-bone ACL reconstruction that was supervised by the same surgeon. ⋯ The use of this technique was not found to compromise operating room efficiency. Patients receiving regional anesthesia did require a slightly longer recovery room stay. ACL reconstruction performed under regional anesthesia with same-day discharge was well tolerated by our patients and it provides a cost-efficient alternative to ACL reconstructions performed as inpatient procedures.