Biomedical subjects
Publications and source records attributed to M A Folcik.
The knee is the largest and one of the strongest joints in the body. It is used in all forms of vigorous activity and is relatively unprotected. This lends it to being one of the most injured joints in the body. In addition to being traumatized, there are several other forms of pathology that can manifest symptoms of pain, swelling, and instability. Fortunately, most of the problems can be treated with conservative methods or by arthroscopy.
In this study, 40 postarthroscopy patients were treated with either diflunisal or acetaminophen with codeine to control postoperative pain. In comparing these two drugs, better known as Dolobid and Tylenol #3, the results were comparable, though acetaminophen with codeine seemed to have a more rapid onset of action. Diflunisal provided better continuity of analgesia and less frequent dosing.
Two nonsteroidal anti-inflammatory drugs, diflunisal and naproxen, were compared for efficacy in relieving anterior knee pain of mild to moderate severity. Of 36 patients completing the study, 20 received diflunisal and 16 received naproxen. Eleven (55%) patients given diflunisal and ten (63%) given naproxen had significant relief of pain, but there were no statistically significant differences between the two treatments. Although adverse reactions were frequent in both groups, they were not severe and they abated upon discontinuation of medication.
We followed 30 patients for more than 2 years after anteromedial tibial tubercle transfer for persistent patellofemoral pain associated with patellar articular degeneration. Twelve of these patients were followed more than 5 years. We report 93% good and excellent results subjectively and 89% good and excellent results objectively. The quality of improvement was sustained in all 12 of the patients who were evaluated again after more than 5 years from surgery. When examined separately, 75% of those patients with advanced patellar arthrosis achieved a good result; none of these patients achieved an excellent result. Postoperative continuous passive motion has markedly reduced the incidence of stiffness. Serious complications such as compartment syndrome, infection, and skin slough were avoided completely in 51 consecutive cases. Patellofemoral contact pressure studies in five cadaver knees have shown that anteromedial tibial tubercle transfer can provide substantial reduction of patellofemoral contact stress while helping to balance medial and lateral facet pressures. This surgical procedure is mechanically and clinically successful for alleviating intractable pain related to patellar malalignment and articular degeneration. This procedure enables the majority of appropriately selected patients with malalignment and patellar articular degeneration to resume increased levels of activity with substantially diminished pain.
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