Effect of a Sleep Aid in Analgesia after Arthroscopic Rotator Cuff Repair

PURPOSE: The aim of this study was to evaluate the effects and safety of a sleep aid for postoperative analgesia in patients undergoing arthroscopic rotator cuff repair. MATERIALS AND METHODS: Seventy-eight patients were prospectively assigned to either the zolpidem group (multimodal analgesia+zolpidem; 39 patients) or the control group (multimodal analgesia; 39 patients). Self-rated pain levels were assessed twice a day using a visual analog scale (VAS). The need for additional rescue analgesic, duration of functional recovery, and adverse effects were assessed for the first 5 days after surgery. RESULTS: The mean number of times that additional rescue analgesic was required during 5 days after surgery was 2.1+/-2.0 in the zolpidem group and 3.3+/-2.8 in the control group, a significant difference. There were no significant differences between the two groups in mean VAS pain scores during the first 5 days after surgery, although the zolpidem group had lower VAS pain scores than the control group. Additionally, there were no significant differences in duration of functional recovery and adverse effects between the two groups. CONCLUSION: The use of zolpidem for analgesia after arthroscopic rotator cuff repair provided a significant reduction in the need for rescue analgesic without increasing adverse effects. Nevertheless, mean VAS pain scores during the first 5 days after surgery did not differ between the zolpidem group and the control group.

Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results

BACKGROUND: The aim of this study was to describe the mini-open suture bridge technique with porcine dermal patch augmentation for massive rotator cuff tear and to assess preliminary clinical and radiological results. METHODS: Five patients with massive rotator cuff tear for which it was not possible to restore the anatomical footprint underwent mini-open suture bridge repair using a porcine dermal patch. The patients' average age was 53.4 years (range, 45 to 57 years), and the average duration of follow-up was 20.6 months (range, 14 to 26 months). Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was assessed by magnetic resonance imaging 6 months postoperatively. RESULTS: The average VAS pain score, UCLA score, and ASES score improved from 6.8, 15.4, and 39.4 preoperatively to 0.8, 31.2, and 86.4 postoperatively (p = 0.041, 0.042, and 0.043, respectively). Magnetic resonance images obtained at an average of 8 months after surgery showed that four patients had intact repair integrity with graft incorporation. One patient had a re-tear with partial healing but still had a satisfactory clinical outcome. There was no intraoperative or postoperative complication in any patient. CONCLUSIONS: Mini-open suture bridge repair with porcine dermal patch augmentation can be an option in young patients with high physical demands and massive rotator cuff tears for which it is not possible to restore the anatomical footprint.

Results of Total Knee Arthroplasty with NexGen LPS-flex Implant Using Navigation System (Brain Lab): Results with a 5-year Follow-up

PURPOSE: To evaluate the clinical and radiological results of patients that underwent total knee arthroplasty (TKA) with a NexGen LPS-Flex implant using a Navigation system (Brain Lab). MATERIALS AND METHODS: Between January 2001 and December 2005, 55 knees in 46 patients which used the NexGen LPS-Flex implant with a Navigation system (Brain Lab) for primary TKA were clinically and radiologically evaluated after a minimum follow-up of 5 years. Evaluation included preoperative and postoperative range of motion (ROM), Knee Society Score (KSS), tibio-femoral angle and postoperative complications. RESULTS: Knee ROM was increased from 118.9degrees preoperatively to 126.9degrees at the last follow up. In addition, the preoperative flexion contracture improved from 6.5degrees to 1.8degrees postoperatively. The mean KSS and functional score were improved from 59.8 and 51.2 to postoperative scores of 86.4 and 85.2 respectively. The rate of appearance of radiolucency in X-ray was 21.8%. One case of superficial skin infection and one case of aseptic loosening were noted as complications but, did not require a revision surgery. CONCLUSIONS: TKA with NexGen LPS-Flex implant using Navigation system (Brain Lab) showed satisfactory improvement in pain and function, but more long term follow up will be needed to complete verification.

Myelopathy due to Spinal Dural Arteriovenous Fistula: A Case Report / 대한척추외과학회지

Spinal dural arteriovenous fistulas are rare abnormal connections of arteries and veins on the surface of the dura. A male presenting with myelopathy, which had a slowly progressive course for about 28 months, was diagnosed by magnetic resonance imaging and selective angiography. After surgical coagulation and excision, his symptoms were mildly improved. We report here on a man who underwent a surgical procedure for his myelopathy that was due to spinal arteriovenous fistula. Although it is unusual, spinal arteriovenous fistula should be considered when making a differential diagnosis of myelopathy.