The American journal of knee surgery
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Comparative Study
A comparison of crushed ice and continuous flow cold therapy.
Crushed ice was compared to continuous flow cold therapy for control of postoperative pain after arthroscopic patellar tendon autograft anterior cruciate ligament (ACL) reconstruction. With all other variables held constant, cold was administered by either continuous flow (group 1) or crushed ice (group 2). The cold therapy was constant for 3 days, then as needed in days 4 through 7. ⋯ During postoperative days 4 through 6, group 1 patients applied their cold modality for 47.9 hours but group 2 patients applied their cold modality for 29.5 hours (P<.01). Compared to crushed ice, continuous flow cold therapy lowered VAS and Likert pain scores more, reduced hydrocodone bitartrate with acetaminophen use, was used more often, increased continuous passive motion, increased 1-week knee flexion, and was given significantly higher performance ratings by patients. Continuous flow cold is superior to crushed ice for outpatient ACL reconstruction pain and should not be considered an equivalent modality.
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This biomechanical study evaluated the static response of a new opening-wedge osteotomy plate to compression and torsion loads in a human cadaver model. This plate incorporates a metal block that distracts the medial tibial cortices to ensure precise correction and prevent bone collapse. The 15-mm plate was inserted into 23 fresh cadaver specimens using a standard surgical technique. ⋯ This opening-wedge osteotomy plate construct appears marginally strong enough to withstand the estimated axial load on the proximal tibia during gait. Estimated torsional load on the knee during level walking slightly exceeds the failure load prior to osteotomy healing. This information can be used to guide further experimental protocols for static and dynamic testing of this device to determine the appropriate rehabilitation guidelines following opening-wedge proximal tibial osteotomy.
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This article outlines the indications and technique of selective denervation for chronic knee pain secondary to neuromata from prior surgery or trauma and describes the results obtained in a series of patients who underwent selective denervation for neuromatous knee. Of the 13 patients in this series, 3 (23%) rated their outcome as excellent, 7 (54%) rated the outcome as good, and 3 (23%) rated the outcome as poor; no patient rated the outcome as worse. Several case reports are included to illustrate the procedure. This technique should be considered an option in select patients with neuromatous knee pain.