Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
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Knee Surg Sports Traumatol Arthrosc · Jan 1996
Proprioception in the nearly extended knee. Measurements of position and movement in healthy individuals and in symptomatic anterior cruciate ligament injured patients.
Proprioception of the knee was measured in 19 healthy individuals to evaluate whether there were any differences between extension and flexion movements from two different starting positions. The threshold before detecting a passive movement, visual estimation on a protractor of a passive change in position (30 degrees angular change) and active reproduction of the same angular change were registered. The reference population was tested twice to study normal variation and reproducibility, followed by the evaluation of 20 patients with chronic, symptomatic and unilateral anterior cruciate ligament (ACL)-deficient knees. ⋯ Thus, information of passive movements in the nearly extended knee position was more sensitive towards extension than towards flexion in threshold tests and the sensitivity improved closer to full extension, which implies a logical joint protective purpose. In this nearly extended knee position, which is the basis for most weight-bearing activities, patients with symptomatic ACL-deficient knees had an impaired awareness in detecting a passive movement. There were no differences in the more flexed position or in the reproduction tests between the patients and the normal group, and reproduction tests in the present form seem less appropriate to use in the evaluation of ACL injuries.
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Knee Surg Sports Traumatol Arthrosc · Jan 1996
Randomized Controlled Trial Clinical TrialPostoperative analgesic effects of an external cooling system and intra-articular bupivacaine/morphine after arthroscopic cruciate ligament surgery.
The aim of this study was to evaluate the analgesic effect of an external cooling system with or without the combined effect of intra-articularly administered bupivacaine/morphine after arthroscopic anterior cruciate ligament (ACL) reconstruction. Fifty patients with isolated ACL insufficiency operated on under general anaesthesia were randomized to three different postoperative treatment groups. Group I was treated with the cooling system during the first 24 h after surgery and an intra-articular injection of 20 ml of physiological saline given at the completion of surgery; in group II, the cooling system was combined with an intra-articular injection of 20 ml bupivacaine 3.75 mg/ml and 1 mg of morphine at the end of the operation; while group III (placebo group) received an intra-articular injection of 20 ml of physiological saline at the completion of surgery. ⋯ No complications due to the use of the cooling system or the intra-articular injections of bupivacaine/morphine were observed. The external cooling system used in this study provides an effective method of obtaining pain relief after arthroscopic surgery. The combination with an intra-articular injection of morphine and bupivacaine results in a slightly greater analgesic effect than the cooling system alone.
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Knee Surg Sports Traumatol Arthrosc · Jan 1996
Case ReportsTraumatic prepatellar neuroma: an unusual cause of anterior knee pain.
Although the patellar (infrapatellar) branch of the saphenous nerve is vulnerable to direct trauma, traumatic prepatellar neuroma has rarely been reported in the literature. It should be considered in the differential diagnosis of disorders causing anterior knee pain. Point tenderness, a palpable fusiform nodule and a positive Tinel's sign are the diagnostic features. Simple excision is curative.
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Knee Surg Sports Traumatol Arthrosc · Jan 1996
Management of anterior cruciate ligament injuries in skeletally immature adolescents.
Anterior cruciate ligament (ACL) injuries in skeletally immature adolescents are being diagnosed and reported with increasing frequency. Nonoperative management of mid-substance ACL injuries in adolescent athletes frequently results in a high incidence of giving-way episodes, recurrent meniscal tears, and early onset of osteoarthritis. An intraarticular ACL reconstruction (using the central 10-mm patellar tendon graft) in young athletes approaching skeletal maturity provides predictable excellent knee stability, and the athletes are able to return to competitive sports with a decreased risk of recurrent meniscal and/or chondral injury. Guidelines for the management of ACL injuries in skeletally immature adolescents are presented.