Empleo de laser terapéutico versus corrientes TENS para manejo de dolor en pacientes posoperados de artroscopia de rodilla en etapa posoperatoria / Use of therapeutic laser vs TENS currents for pain management in postoperative knee arthroscopy patients in the postoperative stage

Resumen Objetivo: Comprar el dolor en pacientes posoperados de artroscopia de rodilla después de ser sometidos a tratamiento con láser terapéutico versus corrientes TENS. Materiales y método: Se realizó un estudio de tipo experimental, longitudinal, prospectivo, y comparativo que incluyó a 14 pacientes que acudieron al área de Medicina Física y Rehabilitación del Hospital Central Militar, identificados con el diagnóstico de posoperados de artroscopia de rodilla, mediante aleatorización simple, por sorteo, para incluir a los pacientes en los grupos de trabajo: tratamiento con láser terapéutico versus tratamiento con corrientes TENS. Se aplicó la escala visual análoga en la evaluación, y se realizó la medición de ambas rodillas por circometria, pre y postratamiento para medir el edema. El análisis se realizó con el programa estadístico SPSS versión 26 y se utilizó la prueba T de student. Nivel de significancia p<0.05. Resultados: Ingresaron al estudio un total de 14 pacientes, a 7 se les dio en tratamiento con láser terapéutico y a 7 con corrientes TENS. El 50% (7 pacientes) fueron mujeres y el 50% (7 pacientes) fueron hombres. La edad promedio fue de 44.85 años. Al analizar la escala visual análoga, en la evaluación pre y postratamiento ambos grupos disminuyeron su intensidad de dolor con diferencias estadísticamente significativas, (con una desviación típica de 1.15 para TENS y una desviación típica de 1.35) al comparar ambos resultados, se observó una diferencia estadisticamente significativa a favor de las corrientes TENS sobre el láser terapeutico p<0.0001. Conclusiones: En ambos tratamientos, se observaron mejorías en el dolor percibido por los pacientes. Teniendo mayor disminución del dolor con las corrientes TENS. Por lo tanto, en este estudio se llega a la conclusión que este tratamiento es más efectivo que el láser terapéutico en el manejo del dolor en pacientes posoperados de artroscopia de rodilla. No se observó mejoría en el edema en ninguno de los tratamientos.

Abstract Objective: To measure pain in postoperative knee arthroscopy patients after undergoing treatment with therapeutic laser vs. TENS currents. Materials and method: An experimental, longitudinal, prospective, and comparative study was carried out that included 14 patients who attended the Physical Medicine and Rehabilitation area of the Hospital Central Militar, identified with the diagnosis of postoperative knee arthroscopy, through randomization. simple, by lottery, to include patients in the work groups: treatment with therapeutic laser vs treatment with TENS currents. The visual analogue scale was applied in the evaluation, and measurement of both knees was carried out by circometry, pre- and post-treatment to measure edema. The analysis was carried out with the statistical program SPSS version 26 and the student's T test was used. Significance level p<0.05. Results: A total of 14 patients entered the study, 7 were treated with therapeutic laser and 7 with TENS currents. 50% (7 patients) were women and 50% (7 patients) were men. The average age was 44.85 years. When analyzing the visual analog scale, in the pre- and post-treatment evaluation, both groups decreased their pain intensity with statistically significant differences (with a standard deviation of 1.15 for TENS and a standard deviation of 1.35). When comparing both results, a difference was observed. statistically significant difference in favor of TENS Currents over therapeutic laser p<0.0001. Conclusions: In both treatments, both the therapeutic laser and the TENS currents, improvements were observed in the pain perceived by the patients. Having a greater reduction in pain with TENS currents. Therefore, in this study we conclude that treatment with TENS currents is more effective than therapeutic laser in pain management in post-knee arthroscopy patients. No improvement in edema was observed in any of the treatments.

Clinical application of thromboelastography in the prevention of lower extremity intermuscular venous thrombosis after knee arthroscopy / 中国输血杂志

【Objective】 To explore the guiding value of thromboelastography (TEG) in the formulation of personalized anticoagulation regimen after knee arthroscopy. 【Methods】 A total of 50 patients who underwent knee arthroscopy in our hospital from April to August 2023 were randomly divided into two groups. Twenty-seven patients with routine anticoagulation were selected as the control group, and 23 patients with personalized anticoagulation were selected as the experimental group. Conventional anticoagulation was a prophylactic dose of low molecular weight heparin calcium (LMWHC) selected according to body weight, once a day to 7 days after surgery. Personalized anticoagulation was performed according to the prophylactic dose of LMWHC until postoperative day 3. On postoperative day 3, LMWHC was changed to aspirin according to the TEG return index (MA>70 mm, α Angle >72°, K value <1 min), and the initial prophylactic dose was 100 mg/d. LMWHC was changed to rivaroxaban when R<5 min, and the prophylactic dose was 10 mg/d until postoperative day 7. Patients with hypocoagulation or subcutaneous ecchymosis stopped the drug first, and if it was further aggravated, component blood transfusion was performed according to the TEG results. The difference of Caprini score in perioperative period, the correlation between TEG and CCT on postoperative day 1, and the accuracy of predicting thrombosis on postoperative day 7 were compared between the two groups using the receiver operating characteristic curve (ROC). 【Results】 There was a significant difference in Caprini score between the two groups at 7 days after operation (P<0.05), suggesting that the adjustment of anticoagulant drugs in the experimental group was effective at 3 days after operation. Pearson correlation evaluation showed that there was a strong positive correlation between maximum coagulation intensity (MA) in TEG and platelet (Plt) in CCT at day 1 after surgery (P<0.05). Thrombosis was found in the control group at 7 days after operation, all of which were CMVT and disappeared after therapeutic antithrombotic therapy. MA was included in the ROC curve for model analysis. The area under the ROC curve (AUC) of the control group was 0.819, and the AUC of the experimental group was 0.508. It was found that the control group model had higher accuracy in predicting the formation of CMVT. 【Conclusion】 Individualized anticoagulation under TEG monitoring can effectively reduce the occurrence of CMVT after knee arthroscopy, which has guiding value for anticoagulation and thrombosis prevention.

Retrospective analysis and comparison of total internal disability preservation technique and standardized reconstruction technique / 中国骨伤

OBJECTIVE@#To investigate the efficacy and clinical results of total internal protection technique in anterior cruciate ligament reconstruction.@*METHODS@#A total of 56 patients undergoing anterior cruciate ligament reconstruction treated from January 2018 to December 2019 were selected. According to the different surgical methods, they were divided into total internal reconstruction group and standard bone tunnel group. There were 21 patients in the total internal reconstruction group, including 15 males and 6 females, aged from 20 to 48 with an average of (35.6±6.7) years old, and 35 patients in the standard tibial tunnel group, including 26 males and 9 females, aged 22 to 51 years old with an average of (33.7±9.6) years old. Preoperative examination of Lachman test was positive, magnetic resonance indicated anterior cruciate ligament rupture. There were no significant differences between the two groups in age, sex, body mass index, time from injury to ACL reconstruction, combined meniscus injury and operation method, operation time, ligament diameter, ligament length and other general information. Postoperative evaluation included operation duration, length and diameter of transplanted tendon after braid. International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner score and perioperative complications 2 years after surgery.@*RESULTS@#Both groups were followed up, ranging from 24 to 30 months with an average of (26.9±3.4) months. Postoperative incision healing was good, and no failure or joint infection occurred at the last follow-up. There was no statistically significant difference between the two groups in IKDC score, Lysholm score and Tegner score before, 1 year and 2 years after surgery. However, IKDC score, Lysholm score and Tegner score at 1 year and 2 years after surgery.@*CONCLUSION@#The same postoperative function and stability of knee joint can be obtained by both the residual whole technique and the standardized reconstruction technique. In the residual whole group, only the semitendinosus muscle is taken, and the femoral thin muscle is retained, with greater tibial bone mass preserved, which is safe and effective in clinical practice.

Effects of Modified Sanhuang Powder （加味三黄散） Combined with Cold Compression on Swelling and Pain after Knee Arthroscopy： A Retrospective Cohort Study / 中医杂志

ObjectiveTo compare the effects of topical application of Modified Sanhuang Powder （加味三黄散， MSP） combined with cold compression versus cold compression alone on swelling and pain after knee arthroscopy through a retrospective cohort study. MethodsMedical records of 134 patients with knee arthroscopy-induced knee swelling and pain were divided into non-exposure group （51 cases） and exposure group （83 cases） based on whether they used MSP for external application after surgery. The non-exposure group received simple cold compression therapy in addition to functional exercise and routine treatment after surgery， while the exposure group received topical MSP on the basis of what were given in the non-exposure group. The Visual Analog Scale （VAS） scores were compared between the two groups before and 7 days after treatment， and knee swelling measurements were taken before and 3， 5， and 7 days after treatment. The clinical effective rate was compared between the two groups. ResultsThe VAS scores in both groups were lower after treatment （P＜0.05）， and the exposure group had lower scores than the non-exposure group （P＜0.05）. On the 3rd， 5th， and 7th days of treatment， the scores on swelling at 2 cm above the superior pole of the patella， at the midline of the patella， and 5 cm below the inferior pole of the patella significantly decreased after treatment in both groups （P＜0.05）， and the exposure group had lower scores than the non-exposure group （P＜0.05）. The total clinical effective rate in the exposure group was 91.56% （76/83）， which was higher than 78.43% （40/51） in the non-exposure group （P＜0.05）. ConclusionTopical application of MSP combined with cold compression is effective in relieving postoperative swelling and pain after knee arthroscopy and is superior to cold compress alone.

Tratamiento artroscópico de pacientes con cuerpos libres articulares en la rodilla

Introducción: Existe escasa información en la literatura nacional sobre los cuerpos libres articulares en la articulación de la rodilla. Estos ocurren como consecuencia de lesiones traumáticas, degenerativas, inflamatorias e isquémicas. Objetivo: Actualizar los conocimientos en los aspectos más generales de los cuerpos libres articulares en la rodilla y de su tratamiento mediante la vía artroscópica. Método: La búsqueda y análisis de la información se realizó en un periodo de 59 días (1 de enero al 28 de febrero de 2023) y se emplearon las siguientes palabras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 211 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline. Se empleó el gestor de búsqueda y administrador de referencias EndNote. Del total se utilizaron 33 contribuciones seleccionadas para realizar la revisión, 32 fueron de los últimos cinco años. Desarrollo: Se hace referencia al diagnóstico positivo basado en los antecedentes, cuadro clínico e imagenología. En relación al diagnóstico diferencial de esta entidad se hace especial énfasis con todas las afecciones que producen bloqueo articular. En específico, se revisan las lesiones de menisco, así como las clasificaciones más empleadas según tamaño, origen, cantidad y movilidad. En relación al tratamiento artroscópico se describen las cuatro etapas que consisten en: identificación, atrapamiento, extracción y revisión. Consideraciones finales: La vía artroscópica por sus múltiples ventajas representa la modalidad quirúrgica más efectiva para el diagnóstico y tratamiento de pacientes con cuerpos libres articulares de la rodilla.

Introduction: Currently, there is a lack of information in the national literature concerning joint loose bodies in the knee joint. These occur as a consequence of traumatic, degenerative, inflammatory and ischemic injuries. Objective: To update knowledge on the most general aspects concerning joint loose bodies in the knee and the use of the arthroscopy procedure on its treatment. Method: Search and analysis of the information was performed on 59 days (January 1 to February 28, 2023) and the following keywords were used: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Based on the information obtained, a bibliographic review was made of a total of 211 articles published in the PubMed, Hinari, SciELO and Medline databases. The EndNote search manager and reference manager was used. Of the total of articles, 33 contributions selected for the review were used, 32 were published the last five years. Development: It was refered in the study on the positive diagnosis based on the history, clinical picture and imaging. In relation to the differential diagnosis of this entity, special emphasis is made up with all the conditions that produce joint blockage. Specifically, meniscal lesions are reviewed, as well as the most commonly used classifications according to size, origin, quantity and mobility. In relation to the arthroscopic treatment, the following four stages were described: identification, trapping, extraction and revision. Final considerations: The arthroscopic approach, due to its multiple advantages, represents the most effective surgical modality for the diagnosis and treatment of patients with joint loose bodies in the knee.

Introdução: Há poucas informações na literatura nacional sobre corpos articulares livres na articulação do joelho. Ocorrem como consequência de lesões traumáticas, degenerativas, inflamatórias e isquêmicas. Objetivo: Atualizar o conhecimento nos aspectos mais gerais dos corpos livres articulares no joelho e seu tratamento por via artroscópica. Método: A busca e análise das informações foi realizada em um período de 59 dias (1º de janeiro a 28 de fevereiro de 2023) e foram utilizadas as seguintes palavras: foreing body AND knee, articular loose body AND knee, free body AND knee, locking knee arthroscopy AND locking. Com base nas informações obtidas, foi realizada revisão bibliográfica de um total de 211 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline. O mecanismo de busca EndNote e o gerenciador de referências foram usados. Do total, 33 contribuições selecionadas foram utilizadas para realizar a revisão, sendo 32 dos últimos cinco anos. Desenvolvimento: Refere-se ao diagnóstico positivo baseado na história, quadro clínico e imagiologia. Em relação ao diagnóstico diferencial desta entidade, é dada especial ênfase a todas as condições que causam bloqueio articular. Especificamente, são revisadas as lesões meniscais, assim como as classificações mais utilizadas quanto ao tamanho, origem, quantidade e mobilidade. Em relação ao tratamento artroscópico, são descritas as quatro etapas, que consistem em: identificação, encarceramento, extração e revisão. Considerações finais: A abordagem artroscópica, por suas múltiplas vantagens, representa a modalidade cirúrgica mais eficaz para o diagnóstico e tratamento de pacientes com corpos livres articulares do joelho.

Artroscopia de rodilla en pacientes mayores de 64 años con gonartrosis primaria / Knee Arthroscopy In Patients Over 64 Years Of Age With Primary Gonarthrosis

Introducción: La gonartrosis es una entidad frecuente, que afecta especialmente a personas mayores de 60 años de edad. Para su tratamiento se combinan modalidades conservadoras y quirúrgicas y dentro de esta última, las realizadas por la vía artroscópica. Objetivo: Evaluar los resultados de las técnicas quirúrgicas por vía artroscópica en pacientes con gonartrosis primaria mayores de 64 años de edad. Métodos: Se realizó un estudio pre experimental de diseño (preprueba-posprueba) en 40 pacientes mayores de 64 años tratados por vía artroscópica con el diagnóstico de gonartrosis primaria, en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey de octubre 2012 a mayo de 2019. La investigación tiene un nivel de evidencia IV y recomendación D. Resultados: El promedio de edad de los pacientes estudiados fue de 69,6 años con predominio del sexo femenino sobre el masculino, y una razón de 3:1. La afección tricompartimental predominó en la mayoría de los enfermos, así como el grado IV según la clasificación de Outerbridge. Predominaron las lesiones de cartílago y meniscos asociadas. Los tratamientos por vía artroscópica más empleados fueron el desbridamiento y la meniscectomía parcial. Se detectó significación estadística entre un antes y un después. Conclusiones: Los resultados de la investigación muestran que los procedimientos realizados a través de la vía artroscópica en pacientes mayores de 64 años de edad con gonartrosis primaria son efectivos en más de la mitad de los enfermos(AU)

Introduction: Gonarthrosis is a common entity that especially affects people over 60 years of age. For its treatment, conservative and surgical modalities are combined, and within the latter, those carried out by the arthroscopic route. Objective: To evaluate the results of arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years of age. Methods: A pre-experimental design study (pre-test-post-test) was carried out in 40 patients older than 64 years treated arthroscopically due to the diagnosis of primary gonarthrosis, at Manuel Ascunce Domenech University Hospital in Camagüey from October 2012 to May. of 2019. The research has a level of evidence IV and recommendation D. Results: The average age of the patients studied was 69.6 years, with a predominance of females, and a ratio of 3:1. Tricompartmental involvement prevailed in most of the patients, as well as grade IV according to the Outerbridge classification. Associated cartilage and meniscus injuries predominated. The most used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance was detected between before and after. Conclusions: The results of the investigation show that the procedures carried out through the arthroscopic route in patients older than 64 years of age with primary gonarthrosis are effective in more than half of the patients(AU)

Comparison on the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament by open surgery and minimally invasive surgery / 解剖学报

[Abstract] Objective To provide an optimized animal model for basic research by comparing the establishment of proprioceptive hypoesthesia model of anterior cruciate ligament (ACL) by open surgery and minimally invasive surgery. Methods Totally 30 normal cynomolgus monkeys were randomly divided into five groups: minimally invasive surgery group: unilateral ACL injury under arthroscope, n = 6; open surgery group: unilateral ACL injury through direct incision of knee joint, n = 6; minimally invasive sham operation group: unilateral ACL without injury through arthroscopic cleaning only, n = 6; open surgery group: unilateral ACL exploration without injury through direct incision of knee joint, n = 6; positive normal group: no surgical intervention, n = 6. Four weeks later, the neurophysiological examination [somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV)] was carried out. The macaque was killed and its unilateral ACL was stained with gold chloride. The number and variation of ACL proprioceptors were observed and recorded. Results In the aspect of neuroelectrophysiology, except the normal group, the latency of SEPs and MCV were prolonged, and the amplitude decreased. In terms of proprioceptors, the total number of minimally invasive surgery group: 578. 00± 12. 68, amplitude: 36. 33 ± 3. 72; total number of open surgery group: 367. 67 ± 9. 33, amplitude: 77. 00 ± 5. 55; total number of open sham operation group: 969. 00±18. 26, amplitude: 0±0; total number of normal group: 970. 46±16. 34, amplitude: 0± 0, the total number of proprioceptors decreased and the number of variation increased in all four groups except the normal group. At the same time, in the comparison of the two aspects, there were significant differences between the open operation group and the minimally invasive operation group, the open operation group and the open sham operation group, and the minimally invasive operation group and the minimally invasive sham operation group (P0. 05). Conclusion Both the open operation group and the minimally invasive operation group can build ACL proprioceptive hypoesthesia model, but the minimally invasive operation has less damage to the tissues around ACL, more scientific and single model, and less experimental error, which is of great significance in the basic research of ACL injury.

Knee subchondroplasty for management of subchondral bone cysts: a novel treatment method

Knee subchondroplasty (SCP) is one of the most novel minimally invasive methods for treating bone marrow lesions. The literature suggests that it is safe, with few complications and good outcomes. However, no studies have documented its usage for managing large subchondral bone cysts. This article outlines a case report and details the pearls and pitfalls of SCP in treating large subchondral bone cysts. Our patient underwent arthroscopic debridement with medial femoral condyle SCP. Mild posterior extravasation of synthetic bone substitute was observed on Postoperative Day 1, which was immediately rectified on revision arthroscopy. Gradual escalation of weight bearing and good pain relief were subsequently achieved, and the patient has remained complication-free after two years. No further extravasation were observed on repeat radiography. SCP is a feasible temporising measure that may help to delay the need for bone allograft or immediate knee arthroplasty in younger patients while retaining function and delaying loss of productivity.

Effect of acupoint application of / 中国针灸

OBJECTIVE@#To compare the effect between acupoint application of @*METHODS@#A total of 62 KOA patients with knee swelling after knee arthroscopy were randomly divided into an observation group and a control group, 31 cases in each group. In the control group, cold compress was adopted after surgery, 3 times a day. On the basis of the treatment as the control group, acupoint application of @*RESULTS@#The VAS scores 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (@*CONCLUSION@#Acupoint application of

Bloqueo regional intraarticular con anestésicos locales en cirugía artroscópica de rodilla / Regional intra-articular block with local anesthetics in arthroscopic knee surgery

Resumen: Introducción: La técnica anestésica de elección para la artroscopía está determinada por los requerimientos quirúrgicos intraoperatorios y pretende optimizar la recuperación, el control del dolor postoperatorio y facilitar el alta precoz. Objetivo: Evaluar los resultados del bloqueo regional intraarticular con anestésicos locales en la cirugía artroscópica de rodilla. Material y métodos: Se realizó un estudio observacional, descriptivo, de corte transversal para evaluar los resultados del bloqueo regional intraarticular con anestésicos locales en la cirugía artroscópica de rodilla, en el Hospital Clínico Quirúrgico «Hermanos Ameijeiras¼, en el período comprendido entre febrero de 2013 y febrero de 2016. El estudio incluyó un total de 120 pacientes, distribuidos en dos grupos de 60 cada uno. Grupo AS: se utilizó anestesia subaracnoidea y Grupo AI: se realizó anestesia intraarticular con anestesia local. Resultados: El grupo etario más frecuente fue entre 60-69 años, 28.3% en el Grupo AS y 35.0% en el Grupo IA, sin diferencias significativas (p = 0.683). Predominó el sexo femenino sobre el masculino (42/18 vs 44/16), sin diferencias significativas (p = 0.839). Predominó el ASA I, en 56.7 y 43.3%, según técnica anestésica, sin diferencias significativas (p = 0.092). La rodilla derecha predominó sobre la izquierda. La entidad nosológica más frecuente fue la plica presente en 58.3% del Grupo AS y 60% en el Grupo IA (p = 0.408). La osteoartritis de rodilla, según grupos, se presentó en 46.7 % en el grupo AS y en 50.0% del grupo AI. El dolor postoperatorio estuvo presente en 21.7% del grupo AS y en 10% en el Grupo IA. Existieron diferencias significativas entre grupos (p = 0.0114). Las complicaciones según grupos, se presentaron en el doble de pacientes del grupo AS (30%) que en el Grupo IA (15%) con diferencias significativas (p = 0.049). Conclusiones: Los resultados del bloqueo regional intraarticular con anestésicos locales en la cirugía artroscópica de rodilla constituye una técnica anestésica fácil de realizar y que brinda seguridad al paciente.

Abstract. Introduction: The anesthetic technique of choice for arthroscopy is determined by the intraoperative surgical requirements and aims to optimize recovery, postoperative pain control and facilitate early discharge. Objective: To evaluate the results of intra-articular regional block with local anesthetics in arthroscopic knee surgery. Material and methods: An observational, descriptive, cross-sectional study was conducted to evaluate the results of the intra-articular regional block with local anesthetics in arthroscopic knee surgery at the «Hermanos Ameijeiras¼ Clinical Surgical Hospital, in the period between February 2013 and February 2016. The study included a total of 120 patients, distributed in two groups of 60 each. Group AS: subarachnoid anesthesia and Group AI: intra-articular regional block with local anesthetics. Results: The most frequent age group was between 60-69 years, 28.3% in group SA and 35.0% in group IA, without significant differences (p = 0.683). Female sex predominated over male (42/18 vs 44/16), without significant differences (p = 0.839). ASA I predominated, in 56.7% and 43.3%, according to anesthetic technique, without significant differences (p = 0.092). The right knee predominated over the left. The most frequent nosological entity was the escrow present in 58.3% of the AS group and 60% in the group IA (p = 0.408). Osteoarthritis of the knee, according to groups, was presented in 46.7% in the AS group and 50.0% in the AI group. Postoperative pain was present in 21.7% of the AS group and 10% in the Group IA. There were significant differences between groups (p = 0.0114). Complications according to groups occurred in twice as many patients in the AS group (30.0%) as in group IA (15.0%) with significant differences (p = 0.049). Conclusions: The results of intra-articular regional block with local anesthetics in arthroscopic knee surgery is an anesthetic technique that is easy to perform and provides patient safety.

Clinical application of enhanced recovery after surgery in the perioperative period of anterior cruciate ligament reconstruction / 中国组织工程研究

BACKGROUND: Anterior cruciate ligament injury, with an increasing incidence in recent years, will seriously impact the motor function of the knee joint. Rehabilitation exercise after anterior cruciate ligament reconstruction is directly related to whether the patient can obtain ideal joint function. It is of important clinical significance to introduce the concept of enhanced recovery after surgery (ERAS) into the perioperative management of arthroscopic anterior cruciate ligament reconstruction. OBJECTIVE: To explore the clinical effect of ERAS in the perioperative period of anterior cruciate ligament reconstruction. METHODS: Sixty patients with anterior cruciate ligament injury, who were treated in the Department of Orthopedics, Renmin Hospital of Wuhan University from July 2016 to July 2018, were randomly divided into ERAS group (n=30) and traditional treatment group (n=30). Postoperative Visual Analogue Scale score, recovery time of knee range of motion, Lysholm knee scoring scale score, hospitalization duration, patients’ satisfaction rating were compared between the two groups. The implementation of the study complied with the Declaration of Helsinki and the relevant ethical requirements of Wuhan University Renmin Hospital, and all the enrolled patients were fully informed of the trial process. RESULTS AND CONCLUSION: The Visual Analogue Scale scores in the ERAS group were significantly lower than those in the traditional treatment group at 1, 24 hours, 2, 3, and 7 days after surgery (P < 0.05). The time that the range of motion returned to 30°, 60°, 90° and 120° after surgery in the ERAS group was significantly less than that in the traditional treatment group (P < 0.05). The Lysholm knee scoring scale scores in 3 months and 6 months after surgery in the ERAS group were significantly higher than those in the traditional treatment group (P < 0.05). The length of hospitalization in the ERAS group was significantly lower than that in the traditional treatment group (P < 0.05). The patients’ satisfaction rating in the ERAS group was significantly higher than that in the traditional treatment group (P < 0.05). To conclude, the introduction of ERAS concept into the perioperative management of anterior cruciate ligament reconstruction has obvious merits in reducing anxiety, relieving postoperative pain, reducing postoperative complications, promoting early recovery of patients and accelerating the recovery of knee joint function.

Effects of intraarticular tramadol, magnesium and ketamine on postoperative pain in arthroscopic meniscectomy / Efeitos de tramadol, magnésio e cetamina por via intra-articular sobre a dor pós-operatória em meniscectomia artroscópica

Abstract Objective: Postoperative pain control is important in terms of early recovery and rehabilitation in arthroscopic meniscectomy. For this purpose, we aimed to compare the effects of intraarticular tramadol, magnesium, and ketamine with combinations of pericapsular bupivacaine on postoperative pain and recovery in arthroscopic meniscectomy. Methods: Ninety patients who underwent arthroscopic meniscectomy were enrolled in the study. Group T was given tramadol, Group K was given ketamine, and Group M was given magnesium reconstituted intraarticularly, and all groups received periarticular bupivacaine. Comparisons were made in terms of the patients' postoperative Visual Analogue Scale scores with and without movement, need for additional analgesics, first analgesic time, mobilization times, adverse effects, and satisfaction with the analgesics. Results: The Visual Analogue Scale scores were lowest in Group T at 0 minutes, and were higher in the 15th and 30th minutes and 1st, 2nd, and 6th hours. Visual Analogue Scale values with movement were found to be high in Group M at 0 and 15 minutes, but they were found to be higher in group T in the 30th minute, 1st, 2nd and 6th hour. The groups were similar in terms of postoperative additional analgesic use, number of analgesic use, and satisfaction with analgesics; however, the first analgesic time was earlier in Group M, and the first mobilization time was earlier in Group K. Conclusion: Intraarticular ketamine enables early mobilization and less need for additional analgesics, it also provides a better analgesic effect in comparison with intraarticular tramadol and magnesium.

Resumo Objetivo: O controle da dor pós-operatória é importante para recuperação e reabilitação precoces em meniscectomia artroscópica. Portanto, nosso objetivo foi comparar os efeitos de tramadol, magnésio e cetamina administrados por via intra-articular em associação com bupivacaína pericapsular sobre a dor e a recuperação após meniscectomia artroscópica. Métodos: Noventa pacientes submetidos à meniscectomia artroscópica foram incluídos no estudo. O Grupo T recebeu tramadol, o Grupo K recebeu cetamina e o Grupo M recebeu magnésio em doses reconstituídas por via intra-articular e todos os grupos receberam bupivacaína por via periarticular. As avaliações foram feitas mediante comparação dos escores em escala visual analógica no pós-operatório dos pacientes em movimento e em repouso, necessidade de analgésicos adicionais, tempo até a primeira necessidade de analgésico, tempo de mobilização, efeitos adversos e satisfação com os analgésicos. Resultados: Os escores da escala visual analógica foram menores no minuto zero e maiores nos minutos 15 e 30 e nas horas 1, 2 e 6 no Grupo T. Os escores da escala visual analógica em movimento foram maiores nos minutos zero e 15 no Grupo M e maiores no minuto 30 e nas horas 1, 2 e 6 no Grupo T. Os escores dos grupos foram semelhantes em relação à necessidade de analgésico adicional no pós-operatório, ao consumo de analgésico e à satisfação com os analgésicos, mas os tempos até a primeira necessidade de analgesia e até a primeira mobilização foram mais curtos nos grupos M e K, respectivamente. Conclusão: A administração intra-articular de cetamina permite mobilização precoce e diminui a necessidade de analgésicos adicionais, além de proporcionar um melhor efeito analgésico em comparação com tramadol e magnésio por via intra-articular.

Knee arthroscopy-assisted ambulatory surgery:Practice and considerations / 医学研究生学报

Objective Ambulatory surgery(AS),with its simple procedures and efficient utilization of resources,is an ef-fective means of improving medical efficiency.The aim of this study was to improve the daily procedures of AS by analyzing the perform-ance and results of knee arthroscopy-assisted AS. Methods This study included 188 cases of knee arthroscopic surgery performed from March to August 2017,97 of them treated in the Ambulatory Surgery Center(group A)and the other 91 in the conventional ward (group B). We compared the average hospital stay,hospitalization expenses,and postoperative complications between the two groups of patients. Results Compared with group B,group A showed a significantly shorter hospital stay([95.0±41.3]vs[25.5±0.8]h, P<0.05)and lower hospitalization expenses([28 699.6±11331.1]vs[22231.7±7152.2]RMB,P<0.05). No statistically significant difference was observed in the incidence rate of postoperative complications at 1 and 3 days after surgery,1 case of bleeding in group A and 1 case of leg swelling in group B. Conclusion Ambulatory surgery in our hospital needs to be further improved on the basis of accelerated rehabilitation surgery as the core concept,precision medicine as the approach,and individualized treatment as the goal.

Effects of Intra-articular Injection of Tranexamic Acid on Joint Swelling,Pain and Recovery of Joint Function in Patients with Simple Meniscus Injury / 中国药房

OBJECTIVE:To investigate the effects of intra-articular injection of tranexamic acid on joint swelling,pain and recovery of joint function in patients with simple meniscus injury. METHODS:A total of 62 patients with simple meniscus injury receiving arthroscopic surgery of the knee in orthopedics department of Chongqing people's hospital during Oct. 2016-Apr. 2017 were selected and divided into control group and observation group according to random table,with 31 cases in each group. Both groups received meniscus excision or trimming under knee arthroscopy. Control group was given intra-articular injection of 0.9%Sodium chloride injection 10 mL after wound suture. Observation group was given intra-articular injection of Tranexamic acid for injection 2.0 g added into 0.9% Sodium chloride injection 10 mL after wound suture. The drainage tube was not placed in all the patients,The tourniquet was loosened after the pressurized dressing of wound. Circumferential diameter of the knee and VAS scores of 2 groups were observed before surgery,1,3,5 and 7 d after surgery. Lysholm scores were observed before and one month after surgery. The occurrence of ADR was recorded. RESULTS:There was no statistical significance in circumferential diameter of the knee,VAS score or Lysholm score between 2 groups before surgery(P>0.05). 1,3,5 and 7 d after surgery,circumferential diameter of the knee in 2 groups was significantly bigger than before surgery,but the observation group was significantly smaller than the control group 1,3 d after surgery,with statistical significance(P<0.05). There was no statistical significance in circumferential diameter of the knee between 2 groups 5 and 7 d after surgery(P>0.05). VAS score of observation group 1,3 d after surgery and control group 1,3 and 5 d after surgery were significantly higher than before surgery,but the observation group was significantly lower than the control group 1,3,5 d after surgery,with statistical significance(P<0.05). There was no statistical significance in observation group 5,7 d after surgery and control group 7 d after surgery,compared to before surgery and 7 d after surgery(P>0.05).One month after surgery,Lysholm scores of 2 groups were significantly higher than before surgery,and the observation group was significantly higher than the control group,with statistical significance(P<0.05). No severe ADR was found in 2 groups during medication,and there also was not deep venous thrombosis after surgery. CONCLUSIONS:Intra-articular injection of tranexamic acid can effectively reduce the degree of early knee swelling after knee arthroplasty,relieve postoperative early pain.It promotes the recovery of knee function with good safety.

Protocolo de Investigación: Validación de Resonancia Magnética en Meniscopatías Comparado con Artroscopía. Pacientes de Traumatología del Hospital de Especialidades José Carrasco Arteaga. Cuenca - Ecuador. 2016-2017 / Research Protocol: Validation of Magnetic Resonance Imaging for Meniscal Injuries Compared with Arthroscopy. Trauma Patients of the Specialty Hospital José Carrasco Arteaga. Ecuador basin. 2016-2017

INTRODUCCIÓN: La resonancia magnética es un método de imagen no invasivo que valora satisfactoriamente las meniscopatías, contribuyendo significativamente a su diagnóstico y evitando la realización de artroscopias innecesarias. El objetivo es determinar la validez del estudio de RM para el diagnóstico de las meniscopatías en comparación con la artroscopía, en pacientes del servicio de traumatología del Hospital de Especialidades José Carrasco Arteaga de Cuenca-Ecuador, entre Abril 2016 y Marzo 2017. METODOLOGÍA: Es un estudio de prueba diagnóstica, y evalúa los pacientes con diagnóstico clínico de meniscopatía, tratados en el servicio de traumatología del hospital, durante el periodo Abril 2016 a Marzo 2017. Los hallazgos de la RM serán contrastados con la exploración artroscópica posterior, la información será recogida mediante un formulario. El análisis estadístico se utiliza el Chi2 para establecer asociación entre variables y tablas de doble entrada para validar pruebas diagnósticas, con nivel de seguridad del 95 %, mediante el software estadístico SPSS. RESULTADOS ESPERADOS: Existe mayor validez diagnóstica del estudio de RM para el diagnóstico de las meniscopatías, comparado con la artroscopia.(au)

INTRODUCTION: Magnetic Resonance Imaging is a noninvasive imaging method that satisfactorily evaluates meniscal injuries, significantly contributing to its diagnosis and avoiding unnecessary arthroscopies. The aim determine the validity of the MRI study for the diagnosis of meniscal injuries compared to arthroscopy in patients from the traumatology service of the Hospital of Specialties Jose Carrasco Arteaga of Cuenca - Ecuador between April 2016 and March 2017. METHODOLOGY: Validation study of a diagnostic test, evaluated the patients with clinical diagnosis of meniscal injuries, treated in the traumatology service of the hospital, period from April 2016 to March 2017. The findings of the MRI of contrasting with the exploration posterior arthroscopy, this information will be collected through a form. The statistical analysis, Chi2 used to establish an association between variables and double-entry tables to validate diagnostic tests, with a 95 % safety level, using SPSS statistical software. EXPECTED RESULTS: There is greater diagnostic validity of the MRI study for the diagnosis of meniscopathies compared to arthroscopy(au)

Analysis of risk factors related to venous thromboembolism after knee arthroscopy / 中国内镜杂志

Objective To determine the risk factors related to venous thromboembolism after knee arthroscopy. Methods A retrospective study including patients from Feb 2012 to Mar 2016 was carried out to analyze the risk factors of venous thromboembolism after knee arthroscopy. A 1 : 2 matched control group was generated according to the surgeon and the date. Preoperative and perioperative data were collected with respect to age, gender, body mass index, smoking, blood fat, surgical procedure, the time length of ligating tourniquet, anesthesia methods, surgery time and Caprini evaluation. Univariate and multivariate analyses were performed. Results 29 cases of venous thromboembolic events (VTEs) occurred, resulting in an incidence rate of 1.17%. Factors associated with an elevated risk of postoperative VTEs included age OR

COMBINED INSIDE-OUT AND ALL-INSIDE TECHNIQUE IN BUCKET-HANDLE MENISCUS TEARS

ABSTRACT Objective: To determine the outcomes after combined inside-out and all-inside repair technique of bucket-handle meniscus tears. Methods: A retrospective review was made of patients with bucket-handle meniscus tears repaired with combined techniques, using the all-inside technique in posterior meniscal tears and the inside-out technique in the middle part of the meniscal tears. Meniscal healing was assessed clinically using Barrett's criteria and MRI. Results: The study comprised 52 patients with a mean age of 28.4 years old (range, 19-52 years old). The mean follow-up period was 31.3 months (range, 24-59 months). Two patients had ACL re-rupture, and complete meniscal healing was achieved in all but one patient. Although improved from preoperative status, Tegner and Lysholm scores were lower in the ACL reconstructed patients than in the intact ACL patients. Conclusion: Combined inside-out and all-inside meniscal repair technique is a successful and cost-effective treatment method in bucket-handle meniscus tears. Level of Evidence IV, Therapeutic Study.

Acupuncture-assisted Anesthesia Describe Cerebral State Index under the Steady-state Anesthesia of Sevoflurane / 浙江中医药大学学报

Objective]To investigate the effect of acupuncture-assisted anesthesia on cerebral state index(CSI) under the steady-state anesthesia of sevoflurane. [Methods] Fifty patients scheduled for elective knee arthroscopy operation were randomly divided into two groups with 25 in each. All patients were induced with sevoflurane, the end-tidal concentrations of sevoflurane in two groups were adjusted to 1.0 MAC and maintained for 15 min after tracheal intubation, acupuncture-assisted anesthesia was used on the affected side in group A, Yanglingquan(GB34) and Zusanli(ST36) were selected as the acupoints. The positive and negative electrodes of the electropuncture apparatus(G8650) were respectively connected with Yanglingquan(GB34) and Zusanli(ST36). People reccived transcutaneous electrical acupoint stimulation with condensation-rarefaction wave(2/15 Hz, 8~12mA) untill the end of operation, patiant's body types SBP, SDP, MAP, HR and CSI were recorded at lying still for 5 min(T1), steady state of sevoflurane(T2), acupuncture-assisted anesthesia after 20 and 30 min(T3, T4). [Results] SBP, DBP, MBP, HR and CSI at T3~T4 were significantly lower in group A than those in group B and T2(P<0.05). [Conclusion]Acupuncture-assisted anesthesia can reduce the CSI under the steady-state anesthesia of sevoflurane and lower blood pressure and heart rate at the same time.

Minimum effective local anesthetic dose of intra-articular ropivacaine with dexmedetomidine for analgesia in patients undergoing knee arthroscopy / 临床麻醉学杂志

Objective To observe the minimum effective local anesthetic dose of intra-articular ropivacaine with dexmedetomidine for analgesia after knee arthroscopy in patients.Methods Seventy-two patients (35 males,37 females,aged 60-75 years,ASA grade Ⅰ or Ⅱ)undergoing knee arthro-scopy under total intravenous anesthesia were randomly divided into two groups (n =36 each):ropiv-acaine group (group R)and ropivacaine with dexmedetomidine group (group DR);Ropivacaine was injected intra-articularly in group C,and dexmedetomidine 1 μg/kg with ropivacaine was injected intra-articularly in group DR.ED50 of ropivacaine was determined by the sequence method.VAS score3 two hours after operation was rated as effective.The initial dose was 3 mg and according to the effective or ineffective results in previous patient,a dose of ropivacaine was decreased or increased 1.1 times to the previous patient.BP,HR,VAS Score,and OAA/S score were recorded five minutes preoperatively(T0 ),1 h (T1 ),2 h (T2 ),3 h (T3 ),6 h (T4 ),12 h (T5 ),24 h (T6 ),and 48 h (T7 ) after operation in two groups.Results There was no significant difference between the two groups with regard to the BP,HR,VAS Score,and OAA/S score.ED50 of ropivacaine for analgesia after knee arthroscopy was 0.31% (95%CI 0.30%-0.32%),and ED50 of ropivacaine with dexmedetomi-dine for analgesia after knee arthroscopy was 0.14% (95% CI 0.14%-0.1 5%). Conclusion Intra-articular administration of ropivacaine with dexmedetomidine could provide superior postoperative analgesia.The dose of ropivacaine for analgesia after knee arthroscopy should be reduced when combined with dexmedetomidine in patients.

Anestesia raquidea versus anestesia intrarticular en cirugia artroscopica de rodilla / Spinal anesthesia versus intra-articular anesthesia in arthroscopic surgery of the knee

Introducción: La artroscopia de rodilla es el procedimiento quirúrgico más común para tratar pacientes con lesiones meniscales o condrales. El objetivo de este trabajo fue comparar la eficacia de la anestesia raquídea versus la intrarticular en artroscopias simples de rodilla, evaluar la calidad de la anestesia, describir la incidencia de los efectos adversos y determinar las complicaciones en ambos casos. Materiales y Métodos: Estudio prospectivo, aleatorizado para comparar dos procedimientos anestésicos mediante la evaluación de la edad, el tiempo de cirugía, la duración de la anestesia, el tiempo de internación, el dolor, la conformidad con el procedimiento y los costos. Se utilizó el test t de Student para las estadísticas y probabilidades. Nivel de significación: p <0,05. Resultados: Se incluyó a 70 pacientes, 35 fueron operados con anestesia intrarticular y 35, con anestesia raquídea. El tiempo de internación fue mayor en el grupo de anestesia raquídea (7.34 h; rango 4-11) que en el grupo de anestesia intrarticular (3.43 h; rango 2-5), p <0,0001. En la variable costo, hubo una diferencia significativa a favor de la anestesia intrarticular con respecto a la anestesia raquídea (p <0,0001). Conclusión: Las ventajas encontradas a favor de la anestesia intrarticular fueron: estadías hospitalarias acortadas, se evitaron efectos indeseables de la anestesia raquídea (bloqueo motor, náuseas, vómitos, hipotensión, pérdida transitoria de esfínter urinario y retención urinaria [globo vesical]); disminución de los costos y mayor aceptación de los pacientes.

Introduction: Knee arthroscopy is the most common surgical procedure to treat patients with meniscal and/or chondral injuries. The aim of this study was to compare the efficacy of spinal vs. intra-articular anesthesia in knee arthroscopy, to assess the quality of anesthesia, to describe the incidence of adverse effects and to determine the complications in both cases. Methods: Prospective, randomized study to compare two anesthetic procedures evaluating age, duration of surgery, duration of anesthesia, length of hospitalization, pain, patient satisfaction and costs. Student t test was used for statistics and probabilities. Level of significance: p <0.05. Results: Seventy patients were included, 35 were operated on under intra-articular anesthesia and 35 received spinal anesthesia. Hospital stay was longer in the spinal anesthesia group (7.34 hours; range 4-11) than in the other group (3.43 hours; range 2-5, [p <0.0001]). The cost variable showed a significant difference in favour of intra-articular anesthesia compared to spinal anesthesia (p <0.0001). Conclusion: The advantages found in favour of intra-articular anesthesia were: shortened hospital stays, avoidance of the undesirable effects of spinal anesthesia (motor block, nausea, vomiting, hypotension, transient loss of urinary sphincter and urinary retention [distended bladder]), reduced costs and increased patient acceptance.