Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesic effect of intraarticular morphine, bupivacaine, and morphine/bupivacaine after arthroscopic knee surgery.
In a double-blind randomized fashion, 38 patients were divided into four groups according to the intraarticular injection received after arthroscopic surgery. Patients in group I (n = 7) received saline, group II (n = 10) morphine, group III bupivacaine, and group IV (n = 11) morphine and bupivacaine. Before surgery and at 0.5, 1, 1.5, 2, 6, and 24 h postoperatively, pain levels were recorded. ⋯ Although there was a statistically significant difference in pain scores between the saline group and the other three groups during the early postoperative period, there was no significant difference in pain scores between the morphine, bupivacaine, and morphine/bupivacaine groups. We conclude that postoperative, intraarticular injection of analgesics is beneficial in reducing pain levels. The combination of morphine/bupivacaine appears to be the most beneficial analgesic due to its low supplemental analgesic requirements postoperatively.
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Recent reports indicate that combined anterior cruciate ligament/medial collateral ligament (ACL/MCL) knee injuries are usually associated with a lateral meniscus tear. In our center, snow skiing is the athletic activity most frequently associated with this double-ligament injury complex. A sports-specific analysis was undertaken to evaluate the hypothesis that the snow skiing ligament injury is different from similar injuries caused by other athletic activities. ⋯ Skiers were older (average age 35 years) than the nonskiers (average age 28 years). The right knee was injured almost twice as frequently as the left. These data suggest that the double (ACL/MCL) ligament injury in skiers might be distinctly different from that in nonskiers.
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Comparative Study
Comparison of ketorolac and opioid analgesics in postoperative ACL reconstruction outpatient pain control.
Pain control is an important postoperative consideration with any surgical procedure. Technological and procedural improvements have contributed to the reduction in both the degree of surgical difficulty and the postsurgical complications associated with intricate surgeries. As a result, certain surgeries have potential for being performed on an outpatient basis, dependent upon appropriate pain-management regimens and the degree of potential for postoperative complications. ⋯ The purpose of this study was to determine the efficacy of a ketorolac tromethamine used for the management of the postoperative pain produced as a result of outpatient ACL reconstruction. When the ketorolac pain management regimen is compared in this setting with meperidine or morphine, pain control is as good as, or in some cases better than, either of the opioid drugs. Additionally, the adverse side effects associated with opioid drugs are significantly reduced at a substantially lower direct cost to the patient.
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Irreducible knee dislocation is a rare effection of the knee joint; only 23 cases have been reported in the literature. This is a case report of a 35-year-old man who injured his left knee in a motorcycle accident. Dislocation was documented on radiograph. ⋯ Eventually, the patient had open reduction of the dislocation. An arthroscopy view of the dislocation showed that the medial femoral condyle was buttonholed through the anteromedial capsule and retinaculum. Arthroscopy was an excellent tool for partial lateral meniscectomy and planning the open surgical procedure.
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Sixty-five patients underwent magnetic resonance (MR) shoulder arthrography. Forty-eight of these patients underwent examination under anesthesia (EUA). MR images were retrospectively evaluated for signs felt to be imaging indicators of shoulder instability, including evaluation of various capsular measurements and the presence of glenoid labral tears, as well as Hill-Sachs fractures. ⋯ However, there was a statistically significant correlation between the presence of a Bankart cartilaginous deformity (p = 0.000) and Hill-Sachs fractures (p = 0.022) with EUA-documented instability. Sensitivity to labral tears was 89% and specificity was 98%, whereas Hill-Sachs fracture detection was 69% and 87%, respectively. We believe that MR saline arthrography is of benefit in the evaluation of the anterior labrum when unenhanced MR imaging is inconclusive, and we speculate on the role of MR arthrography as a primary investigative tool.