The Knee
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Randomized Controlled Trial Multicenter Study Comparative Study
A randomized, double-blind, dose-ranging study comparing wound infiltration of DepoFoam bupivacaine, an extended-release liposomal bupivacaine, to bupivacaine HCl for postsurgical analgesia in total knee arthroplasty.
DepoFoam bupivacaine is a novel liposomal formulation of bupivacaine designed to provide prolonged postsurgical analgesia. This dose-ranging study evaluated extent and duration of analgesia following administration of DepoFoam bupivacaine in patients undergoing total knee arthroplasty (TKA). ⋯ Exposure to bupivacaine increased in a dose-related manner, as reflected by mean and maximum plasma bupivacaine concentrations, and AUC(0-∞). Treatment with DepoFoam bupivacaine 532 mg was associated with statistically significantly greater analgesia while patients were at rest after surgery compared with bupivacaine HCl.
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Comparative Study
Does preoperative anxiety and depression predict satisfaction after total knee replacement?
Approximately one fifth of patients are not satisfied with the outcome of total knee arthroplasty (TKA). Preoperative variables associated with poorer outcomes are severity and chronicity of pain, psychological disease, poor coping strategies and pain catastrophisation. Psychological disease may be expressed as anxiety and depression. It is unclear whether anxiety and depression before TKA are constitutional or result from knee pain. The aim of this study was to explore the association of anxiety and depression with knee pain and function using specific outcome measures. ⋯ The difficulty in interpreting preoperative anxiety and depression and the outcome of TKA is establishing whether they are the cause or effect of pain in the knee. As anxiety and depression improve with knee pain and function, this study suggests that knee pain contributes to the psychological symptoms and that a successful TKA offers an excellent chance of improving both.
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The aim of this study was to analyze the clinical outcome obtained with arthroscopic second generation autologous chondrocyte implantation (ACI) associated with bone grafting for the treatment of knee osteochondritis dissecans (OCD) at medium term follow-up. ⋯ Second generation ACI associated with bone grafting is a valid treatment option for knee OCD and may offer a good and stable clinical outcome at mean 6 years of follow-up. Further studies are needed to confirm the results over time, and determine if there is only a symptomatic improvement, or if this procedure may also prevent or delay further knee degeneration.
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Comparative Study
Patellofemoral joint stress during running in females with and without patellofemoral pain.
Patellofemoral pain (PFP) is a common complaint among female runners. The etiology for PFP is frequently associated with increased patellofemoral joint stress (PFJS) and altered hip and knee joint kinematics during running. However, whether PFJS during running is increased among runners with PFP is unknown. ⋯ However, females with PFP demonstrated hip internal rotation that was 6° greater (P=0.04) when ground reaction forces were greatest. The extent these results are influenced by compensations for pain is unclear. However, if increased PFJS contributes to the etiology or exacerbation of PFP, interventions to minimize altered transverse plane hip kinematics may be indicated among runners who demonstrate this characteristic.
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Acute patellar dislocation is a severe injury to the knee and usually manifests with symptoms such as giving way, a sensation of lateral displacement of the patella accompanied by hemarthrosis and tenderness over the medial epicondylar region to palpation. Spontaneous reduction of the patella makes the diagnosis more difficult in initial evaluation. Radiographs often show a small bony avulsion at the medial border of the patella, which may represent an injury to the medial restraints. ⋯ The medial patellofemoral ligament (MPFL) may be avulsed distally, proximally or sustain in interstitial tear. Arthroscopic findings include hematoma and chondral or osteochondral lesions located on the central or medial facet of the patella or on the anterior lateral femoral condyle. We report a case of a patellar avulsion of medial patellofemoral ligament in a skeletally immature patient.