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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Sixty-five patients underwent magnetic resonance (MR) shoulder arthrography. Forty-eight of these patients underwent examination under anesthesia (EUA). MR images were retrospectively evaluated for signs felt to be imaging indicators of shoulder instability, including evaluation of various capsular measurements and the presence of glenoid labral tears, as well as Hill-Sachs fractures. ⋯ However, there was a statistically significant correlation between the presence of a Bankart cartilaginous deformity (p = 0.000) and Hill-Sachs fractures (p = 0.022) with EUA-documented instability. Sensitivity to labral tears was 89% and specificity was 98%, whereas Hill-Sachs fracture detection was 69% and 87%, respectively. We believe that MR saline arthrography is of benefit in the evaluation of the anterior labrum when unenhanced MR imaging is inconclusive, and we speculate on the role of MR arthrography as a primary investigative tool.
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Comparative Study
A comparison of patient-controlled analgesia and continuous lumbar plexus block after anterior cruciate ligament reconstruction.
Anterior cruciate ligament (ACL) reconstruction is often a painful operation. Fifty-eight patients who underwent ACL reconstruction using patellar tendon autograft received either a lumbar plexus block (LPB) or patient-controlled analgesia (PCA) for pain relief during the first 24 h after surgery. ⋯ The common narcotic analgesic side effects of nausea, pruritus, sedation, and urinary retention were significantly less in the LPB group. The LPB is a safe and effective alternative analgesia after ACL reconstruction.
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Review Case Reports
Recurrent atraumatic superior dislocation of the patella: case report and review of the literature.
Recurrent atraumatic superior dislocation of the patella with spontaneous reduction prevented by interlocking osteophytes has not been previously reported. Eight previous case reports were noted in the literature with single episodes of interlocking by osteophytes in a superior dislocation, none with recurrence, and all treated by closed reduction. ⋯ This case demonstrates successful arthroscopic treatment of this previously unreported condition. In light of the increasingly active aging population with coexistent patellofemoral joint osteoarthritis, this presentation may become more frequent.
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Comparative Study
Serum bupivacaine concentrations after intraarticular injection for pain relief after knee arthroscopy.
Intraarticular injection of local anesthetic drugs after arthroscopic knee surgery is used to provide postoperative analgesia. Toxic serum levels of bupivacaine have been reported after its use both in regional anesthesia and for intraarticular injection. ⋯ This study evaluates the effect of tourniquet inflation and the addition of epinephrine on serum concentrations of bupivacaine after intraarticular injection. The results shows that the peak serum bupivacaine concentrations can be reduced by adding epinephrine and injecting it after tourniquet inflation.
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Using a clear polyvinyl fluoride sheath over an arthroscope, inserted through a 1-cm stab incision, we have demonstrated the feasibility of visualizing the sciatic nerve and its branches in the feline model. The purpose of this technique is to allow visual control, without a large surgical incision, of the exact site of implantation of electrodes used for functional neuromuscular stimulation. ⋯ With the new technique, we identified nerves by their distinctive vascular markings and we followed the nerves with minimal disruption of the soft tissues. In this way, individual branches were identified and targeted for instrumentation, allowing selective stimulation of specific muscle groups.