Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up.

The purpose of this study was to assess arthroscopic repair of rotator cuff tears at a minimum of 2 years postoperatively with both patient-derived and objective outcome measures, including the use of magnetic resonance imaging (MRI), to evaluate repair status. Evaluated were 49 shoulders in 47 consecutive patients. The American Shoulder and Elbow Surgeons score, Constant and Murley score, Simple Shoulder Test, Rowe score, Visual Analog Pain Scale, and the Medical Outcomes Study Short Form-12 Mental Component Scale all improved significantly (P < .001) between the preoperative and final follow-up evaluations. MRI found 22% of repairs had recurrent tears. The presence of a recurrent tear correlated significantly with patient age (P < .009) and extension of the tear to the infraspinatus (P < .009). Active forward flexion, abduction, external rotation, and strength in forward flexion correlated inversely with the presence of a recurrent tear (P < .05). At minimum 2-year follow-up, arthroscopic repair of rotator cuff tears produced significant improvements in both patient-derived and objectively measured variables.

Zolpidem reduces postoperative pain, fatigue, and narcotic consumption following knee arthroscopy: a prospective randomized placebo-controlled double-blinded study.

Sixty-eight patients undergoing outpatient knee arthroscopy for treatment of meniscal tears or loose bodies were divided into three treatment groups (zolpidem [24 patients], control [24 patients], and placebo [20 patients]). All groups received postoperative hydrocodone and ibuprofen. Patients in the zolpidem group received a single dose of zolpidem tartrate for the first seven postoperative nights. Patients in the placebo group received a gelatin capsule similar in appearance to zolpidem and patients in the control group received only hydrocodone and ibuprofen. Patients in the control group demonstrated significantly worse mean daily postoperative pain and more daily postoperative fatigue on visual analog scales when compared with the zolpidem group (P=.03 and P=.04, respectively). Patients in the placebo group had worse daily postoperative pain and more daily postoperative fatigue when compared to the zolpidem group, although these differences did not reach statistical significance (P=.15, power=0.6; and P=.27, power=0.48, respectively). Patients in the control group consumed significantly higher quantities of hydrocodone/acetaminophen postoperatively (P=.04) than patients in the zolpidem group. Finally, patients in the placebo group consumed higher quantities of hydrocodone/acetaminophen than the zolpidem group although the difference did not reach statistical significance (P=.4; power=0.15). Power was calculated for each insignificant relationship based on observed effect and sample sizes and variances. This study demonstrates that sleep and fatigue may be an important factor in the effective pain management following knee arthroscopy. Future postoperative treatment regimens should address sleep and fatigue to maximize analgesic effects in these patients.

The indications and technique for meniscal transplant.

Meniscal allograft transplantation (MAT) has moved into mainstream orthopedics. With proper patient selection, and recognition and treatment of comorbid conditions, MAT offers a solution that can at least temporarily decrease pain and increase function. This article reviews the basic science of meniscal mechanics, the pathomechanics of meniscal injury, and MAT indications and techniques. A brief description of treatment of comorbid conditions and the outcomes of MAT is also provided.