Biomedical subjects
Publications and source records attributed to D Drez.
We report the case of a patient who developed hypesthesia in the distribution of the saphenous nerve after an arthroscopic debridement of a medial meniscal cyst. Dermatitis developed in the area of the hypesthesia 3 months later, Both complications responded to symptomatic treatment. A review of the literature confirms the unusual nature of these complications.
Pain dysfunction syndrome is a descriptive term recommended by Amadio to describe patients whose pain is excessive, nonanatomic, and out of proportion to their injury. This retrospective review reports the effectiveness of a differential epidural block in the evaluation of these patients. Four patterns of response were identified with the block: 1) reflex sympathetic dystrophy (RSD) (14%), 2) somatic (9%), 3) mixed sympathetic and somatic (27%), and 4) central (50%). The inciting injury in 70% of the patients was a minor strain, sprain, or contusion. Despite accurate diagnosis, the results in compensation cases with pain dysfunction syndrome are exceedingly poor.
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The posterior cruciate ligament (PCL) was dissected in 12 frozen human cadaver knees. The tibial attachment was radiographically mapped and guide wires placed on the distal-lateral bulk of the ligament's tibial attachment. Radiographic landmarks were then described on the anteroposterior and lateral radiographs to assist in tibial tunnel guide wire placement in PCL reconstruction. The radiographic site corresponding to the posterior ridge of the tibial plateau approximately 1 cm below the joint line and a few millimeters lateral to the center of the lateral tibial tubercle will reliably confirm tibial tunnels in PCL reconstruction.
This article reviews the subjective, objective, functional, and radiographic results of five patients with symptomatic anterior cruciate instability, genu varum, and varus rotational instability treated by sequential high tibial osteotomy and anterior cruciate ligament reconstruction at one operative procedure. The average patient age was 27 years (range: 21 to 35), and the average follow up was 2.5 years (range: 2 to 3). All patients had symptomatic instability with anterior tibia subluxation, which was documented by KT-1000 testing. All patients also had a varus alignment clinically and radiographically with medial compartment pain. Postoperatively, the medial compartment pain was improved, and instability episodes were eliminated. Side to side differences (KT-1000--manual maximum) were reduced to 3.1 mm. There were no complications. The instability episodes were eliminated, and functional levels were improved in all patients. We concluded that, for this select group of patients, simultaneous extremity realignment and ligament stabilization will effectively manage both conditions without compromising the results of either procedure.
The anatomic relationship between the anterior humeral circumflex vessels and the axillary nerve was studied in 24 fresh-frozen cadaveric four-quarter shoulder specimens. Each shoulder was exposed through a standard deltopectoral incision, and the axillary nerve, anterior humeral circumflex vessels, and bicipital groove were identified. The perpendicular distance from the medial border of the bicipital groove to a point where the vessels crossed anterior to the nerve measured 2.6 +/- 0.4 cm (range, 2.1-3.6 cm). The perpendicular distance from the medial aspect of the bicipital groove to the point where the axillary nerve crossed the inferior border of the subscapularis and thus entered the quadrangular space was 3.0 +/- 0.5 cm (range, 2.1-4.4 cm). The anterior humeral circumflex vessels were easily located in all specimens, and the axillary nerve could be identified by its relationship to the vessels as described above, thus providing the operating surgeon with a consistent and reliable method of recognizing this nerve during anterior shoulder procedures. In addition, the axillary nerve was palpable in all specimens by sweeping the index finger in a medial-to-lateral direction along the inferior border of the subscapularis.
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We reviewed the cases of 3468 patients who had had arthroscopy of the knee between January 1976 and December 1988. Twenty-six patients (0.8 per cent) had a partial or a complete discoid lateral meniscus, and seven (0.2 per cent) had the Wrisberg-variant-type lateral meniscus. Of the seven patients, six had operative stabilization of the meniscus and one had a partial lateral meniscectomy because of an irreparable complex tear. Subjective, objective, and radiographic evaluations were performed on the patients who had had stabilization of the meniscus. According to the scale of Tegner and Lysholm, the result was excellent in four patients, good in one, and fair in one. None of the six patients had a tear of the sutured meniscus after an average follow-up of thirty-two months (range, twenty-four to forty months). Two patients had progressive symptoms attributable to osteoarthrosis, but the changes in the articular cartilage had been present at the time of the index procedure. None of the seven Wrisberg-variant-type menisci demonstrated a true discoid shape of the meniscus. We therefore classified this lesion as a lateral meniscal variant with absence of the posterior coronary ligament.
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The occurrence of a synovial fistula after knee arthroscopy is uncommon. In a retrospective review of 976 arthroscopies of the knee over 3 years, six patients developed synovial fistulae (incidence 6.1/1,000). All patients were treated with short-term immobilization and oral prophylactic antibiotics. All fistulae closed after an average of 9 days of immobilization, and none required further treatment. Risk factors that may predispose a patient to fistula formation are posterior compartment portals and the presence of significant degenerative joint disease. A treatment protocol is presented.
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We measured anterior tibial displacements in 21 anterior cruciate ligament deficient patients using two instrumented testing devices, the KT-1000 and the KSS. A comparison of values obtained from testing was done using statistical analysis. The two tests common to both devices were the 20 lb pull and the manual maximum. The involved normal (I-N) values showed that there was no significant difference between the two devices for both the manual maximum and the 20 lb force level. There was also no significant difference between devices for the manual maximum absolute values. The significant difference between the absolute values for the 20 lb force level is probably due to the different testing techniques for both devices. When testing with the KSS, the patella remains free; testing with the KT-1000 requires that the examiner maintain pressure to hold the patella down. The manual maximum absolute values showed no significant difference because the testing techniques for both devices were identical. Comparable data for both devices are the I-N values for the 20 lb and manual maximum values.
In knee ligament reconstruction procedures, soft tissue grafts are often secured to bone with sutures tied around screws used as tie-down posts. The technique of utilizing screw angulation to preserve the tension in the graft is demonstrated. Angulation of the fixation screw can enhance the attachment of the graft to bone by maintaining or increasing the tension applied to the graft as the screw is advanced to its final position in the bone.
We compared naproxen sodium (550 mg) and propoxyphene napsylate with acetaminophen (PN/A, 100 mg with 650 mg) for pain relief after arthroscopy or arthroscopic meniscectomy. Fifty-two patients entered this multicenter, double-blind, randomized, parallel trial. In each drug group, pain intensity values dropped consistently throughout this six-hour study from mean baseline levels of approximately 55 on a scale of 0 to 100. Pain intensity values were lower at each hour in the naproxen sodium than in the PN/A group and significantly lower at hour 1 (P = .008). Pain intensity differences (PID, reflecting change from baseline) mirrored this trend: greater mean PIDs were seen in the naproxen sodium group at each hour, and this difference between drug groups was statistically significant at hour 1 (P = .017). One patient in the naproxen sodium group and seven patients using PN/A took a second dose within the six hours. Patients in each drug group reported five complaints.