Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
-
Comparative Study
A comparison of outpatient and inpatient anterior cruciate ligament reconstruction surgery.
The feasibility of outpatient anterior cruciate ligament (ACL) surgery has not been reported in the literature. We evaluated outpatient ACL surgery by comparing outpatient versus inpatient pain control, narcotic consumption, postoperative complications, recovery time, and cost analysis. Thirty-seven ACL reconstructions were performed in 37 patients over a 16-month period. ⋯ The average inpatient cost was $9,220 (2.4 hospital days) compared with the average outpatient cost of $3,905. This reflected a savings of 58%. These results show that outpatient ACL reconstruction surgery is possible in the appropriate patient without harm to the patient and with a significant cost savings.
-
A 13-year-old boy with the diagnosis of osteochondritis dissecans underwent arthroscopic examination of his knee joint. At surgery a cartilaginous mass in the medial femoral condyle was identified. ⋯ Clinical and radiographic follow-up of the affected joint 5 years after surgery was satisfactory. Arthroscopic removal of an intra-articular tumor is an attractive treatment alternative, provided the lesion is accessible and there is no suggestion of a malignancy.
-
The neural histology of the human shoulder ligaments, glenoid labrum, and subacromial bursae were studied using a modified gold chloride stain. Two morphological types of mechanoreceptors and free nerve endings were found in the ligaments. Slow adapting Ruffini end organs and rapidly adapting Pacinian corpuscles were identified in the superior, middle, inferior, and the posterior glenohumeral ligaments. ⋯ This is the first histological evidence of neural receptors in the human shoulder ligaments, glenoid labrum, and the subacromial bursae. Any disruption of the labrum or these ligaments by trauma or surgery can deprive the shoulder of mechanical stability, and may cause a decrease in proprioception because of the loss of these afferent neural receptors. Removal of symptomatic, inflamed bursae may decrease pain signals from this area of the shoulder.
-
Outcome is presented for 465 knee arthroscopies performed under general anesthesia in a public teaching hospital day surgery unit. The unanticipated hospital admission rate on the day of surgery was 1.07%. There were 11 (2.37%) major complications in the combined perioperative and postdischarge periods (up to 4 weeks postdischarge). ⋯ At early follow-up, 4.7% and 2.5% of patients had presented to hospital accident and emergency departments and local family doctors, respectively, usually for minor problems. Ninety-nine percent of all patients were happy with the ambulatory surgery service. With careful patient assessment and selection, day-case knee arthroscopy in a teaching hospital can provide satisfactory outcome.
-
Randomized Controlled Trial Clinical Trial
Analgesic effects of intraarticular bupivacaine after day-case arthroscopy.
A blind, prospective, randomized, controlled trial was conducted to assess the analgesic properties of intraarticular bupivacaine after day-case arthroscopy. Forty-eight patients undergoing routine arthroscopy were randomly allocated to receive 10 ml of 0.5% bupivacaine or 0.9% saline into the joint at the end of the procedure. The analgesic effects were assessed by visual analogue scales at discharge, on going to bed, and the following morning. Significant reduction in reported pain was found in the treatment groups on leaving the hospital and later the same evening, although no benefit was found the following day.