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At least 595 records · Page 33Linked to original sources
PubMedDate not supplied

Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction.

BACKGROUND AND OBJECTIVES: Arthroscopic anterior cruciate ligament (ACL) reconstruction of the knee is a painful procedure requiring intensive postoperative pain management. This prospective study investigates analgesic quality after a femoral block as compared with intra-articular injection of local anesthetic. METHODS: Eighty patients scheduled for elective ACL repair under general anesthesia were included in our study. Upon completion of surgery, the patients were randomly assigned into 1 of 2 groups: femoral group (n = 40) received a femoral block with 20 mL 1% ropivacaine; intra-articular group (n = 40) received 20 mL 1% ropivacaine injected intra-articularly. During the first 24 hours after surgery, all patients received 2 g propacetamol and 100 mg ketoprofen, intravenously. Additional postoperative analgesia was available with parenteral morphine if required. Analgesic duration was defined as the time from end of surgery to the first requirement for a supplemental analgesic. Data collection included patient demographics, visual analog scale (VAS) scores, analgesic duration, and morphine use. Analysis of variance (ANOVA) test was used to compare the 2 groups. RESULTS: VAS score in the recovery room and during rehabilitation was higher in the intra-articular group than in the femoral group (P <.001). Morphine use was lower in the femoral group than in the intra-articular group (P <.001). Similarly, analgesic duration was longer in the femoral group than the intra-articular group (P <.0001). CONCLUSIONS: Compared with intra-articular injection of local anesthetic, femoral nerve block (FNB) provides better analgesia and allows a significant morphine-sparing effect after ACL repair.

Adult↗
PubMed1979

Surgery for internal derangements of the temporomandibular joint.

Three hundred and twenty-seven reconstructive arthroplasties and disk repositionings have been performed during the past 6 years at Montgomery Baptist Medical Center for patients with internal derangements of the TMJ. By our evaluation, 94% are remarkably successful, 4% are marginally successful, 1% are not improved, and less than 1% are failures. On the basis of these experiences, we believe that the surgical technique of reconstructive arthroplasty and disk repositioning has a definite place in the treatment of patients with internal derangements of the TMJ.

Arthroplasty↗
PubMed2006

Labral tears, extra-articular injuries, and hip arthroscopy in the athlete.

Labral tears in athletes can lead to disabling hip pain and affect their athletic performance. Other intra-articular lesions, including chondral injuries, capsular abnormalities, and ligamentum teres tears, commonly coexist with acetabular labral tears. Isolated athletic injury or repetitive traumatic activity can lead to labral tears; however, underlying structural (femoroacetabular impingement) and developmental abnormalities predisposing athletes to labral pathology must be addressed. Recent studies have demonstrated lesions associated with acetabular labral tears, and that labral tears rarely occur as isolated injuries. Return to sport is favorable in athletes who have labral tears if they are properly treated with arthroscopic intervention.

Adult↗
PubMed2005

Ossification of the posterior atlantoaxial membrane and the transverse atlantal ligament.

STUDY DESIGN: Case report. OBJECTIVE: To report a case of ossification of the posterior atlantoaxial membrane (PAAM) and ossification of the transverse ligament of the atlas (TAL). SUMMARY OF BACKGROUND DATA: Ossification of the PAAM and TAL are both very rare clinical entities. This is the first case involving ossification of both the PAAM and TAL with the development of cervical myelopathy. METHODS: Patient's history, physical examination, radiographic evaluation, surgical treatment, and outcome are examined. Relevant literature is also reviewed. RESULTS: The patient's neurological symptoms significantly improved after posterior decompressive surgery. CONCLUSION: Ossification of various parts of the spinal ligament have been reported previously. Among them, ossification of both the PAAM and TAL has never been reported previously and is thus extremely rare. Surgical intervention improved the neurological impairment.

Aged↗
PubMedDate not supplied

Comparison of spin echo, gradient echo and fat saturation magnetic resonance imaging sequences for imaging the canine elbow.

Two comparison studies were performed. In the first conventional spin-echo (T1- and T2-weighted) sequences and a three-dimensional (3-D Fourier transform [3DFT]) echo gradient fast-imaging sequence were compared for imaging the canine normal elbow joint. In all three sequences, there was an isointense signal of the articular cartilage and a hyposignal of the subchondral bone, as compared with the muscles. The medial coronoid process of the ulna was clearly seen on the dorsal plane images, it appeared with a homogenous low-intensity signal. Its articulation with the radius was clearly outlined. In a second study, the 3DFT echo gradient fast-imaging sequence was compared to a fat saturation sequence on normal shoulder and elbow joints. Elbows were imaged with and without injection of saline, in an attempt to show the opposing cartilaginous articular surfaces. This distinction was possible in the shoulder joint but not in the elbow because of insufficient spatial resolution. On the three MRI sequences compared, gradient echo fast imaging with steady-state precession (GE FISP) sequence was found to be the most suitable for imaging the canine elbow joint.

Animals↗
PubMedDate not supplied

Acute dislocation of the patella. A correlative pathoanatomic study.

The objective of our study was to elucidate the characteristic pathoanatomy associated with patellar dislocation and report the preliminary results of early surgical repair. Twenty-three patients with documented patellar dislocation had standard radiographs and a magnetic resonance imaging scan. Intraarticular lesions were evaluated and treated arthroscopically followed by an open exploration of the medial aspect of the knee in 16 patients. Twelve patients were observed for a minimum of 2 years after surgical repair (average, 34 months). Eleven patients returned for a follow-up examination. Magnetic resonance imaging revealed effusion (100%), tears of the femoral insertion of the medial patellofemoral ligament (87%), increased signal in the vastus medialis muscle (78%), and lateral femoral condyle (87%) and medial patellar (30%) bone bruises. Arthroscopic examination revealed osteochondral lesions involving the patella and the lateral femoral condyle in 68% of cases. Open surgical exploration revealed tears of the medial patellofemoral ligament off the femur in 15 of 16 patients (94%). After medial patellofemoral ligament repair, none of the patients experienced recurrent dislocation. Overall 58% of the results were considered to be good or excellent and 42% were fair. Fifty-eight percent of the group returned to their previous sport with no or minor limitations.

Acute Disease↗
PubMed2005

Palsy of the common peroneal nerve after traumatic dislocation of the knee.

Injury to the common peroneal nerve was present in 14 of 55 patients (25%) with dislocation of the knee. All underwent ligament reconstruction. The most common presenting direction of the dislocation was anterior or anteromedial with associated disruption of both cruciate ligaments and the posterolateral structures of the knee. Palsy of the common peroneal nerve was present in 14 of 34 (41%) of these patients. Complete rupture of the nerve was seen in four patients and a lesion in continuity in ten. Three patients with lesions in continuity, but with less than 7 cm of the nerve involved, had complete recovery within six to 18 months. In the remaining seven with more extensive lesions, two regained no motor function, and one had only MRC grade-2 function. Four patients regained some weak dorsiflexion or eversion (MRC grade 3 or 4). Some sensory recovery occurred in all seven of these patients, but was incomplete. In summary, complete recovery occurred in three (21%) and partial recovery of useful motor function in four (29%). In the other seven (50%) no useful motor or sensory function returned.

Adult↗
PubMed1978

Underside lesions of the meniscus.

A total of 180 menisectomies were performed with special attention to lesions located only on the underside of the menisci. Thirty-six lesions (20 per cent) were found with this location, all in the posterior part of the menisci. Half of these were atypical horizontal cleavage lesions. The clinical features of these lesions were compared with normal meniscal lesions and no differences could be demonstrated. The subjective results after meniscectomy for 35 underside lesions were 94 per cent good or excellent after an average follow-up period of 22.3 months. Meniscectomy is the treatment of choice for these lesions. It is emphasized that careful examination of the underside of the meniscus is necessary if a patient presents a clinical picture of meniscal lesion and no other lesions can be found.

Adult↗
PubMedDate not supplied

Wrist arthroscopy: principles and clinical applications.

With the development of better and smaller equipment, arthroscopy of the wrist offers the same benefits achievable with arthroscopy of the knee, shoulder, or elbow - not only diagnostic information but also a therapeutic option. Standardized techniques of performing wrist arthroscopy have been developed to evaluate the treat various wrist disorders, such as lesions of the triangular fibrocartilage complex, intra-articular distal radius fractures, and scaphoid fractures. Arthroscopy is now performed in the treatment of dorsal-wrist ganglion cysts and interosseous ligament disruptions, as well as for bone incisions, such as radial styloidectomy, distal ulnar excision (wafer procedure), and proximal-row carpectomy. Compared with other techniques, arthroscopic procedures, such as repair of the triangular fibrocartilage complex, demonstrate better results and improved localization of the injury with a low complication rate. In addition, arthroscopic procedures involve lesssurgical dissection, less postoperative pain, a shorter recovery time, and an earlier return to work for the patient.

Arthroscopy↗
PubMed1995

[Diagnosis of changes in the knee joint of high performance athletes].

Sport-associated knee-joint alterations are frequent. A correct and rapid differentiation between traumatic lesions, chronic degenerative changes, and adaptive processes is important with regard to therapy as well as training and competitive planning for athletes. After the case history and physical examination, X-ray images are an absolute necessity for more in-depth diagnostic procedures. Depending on the clinical symptoms, partial aspects of the knee-joint can be visualized by sonography as well as by conventional tomography and computed tomography. If, however, a comprehensive evaluation of all knee-joint structures is needed, magnetic resonance imaging of the knee-joint should be performed. As a rapid, noninvasive procedure with high diagnostic reliability for all essential knee-joint structures only magnetic resonance imaging presently fulfills the specific demands placed on a modern diagnostic procedure by doctors working in sports-medicine.

Athletic Injuries↗
PubMed1983

Arthrography of the shoulder.

Arthrography of the shoulder is a simple, safe, and relatively painless diagnostic procedure that is used to demonstrate the integrity, shape, and capacity of the glenohumeral joint space.

Arthrography↗
PubMed2005

Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions.

PURPOSE: To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. METHOD: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). RESULTS: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. CONCLUSION: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly identify articular cartilage lesions.

Anterior Cruciate Ligament Injuries↗