Rehabilitation concerns following anterior cruciate ligament reconstruction.

Rehabilitation following anterior cruciate ligament reconstruction is a subject of controversy in the orthopaedic and rehabilitation literature. With an increasing number of these operations currently being performed and with the advent of arthroscopically assisted ACL reconstruction over the past several years, particular rehabilitation needs and problems have been identified in association with these patients. Various authors have stressed one or a combination of a few basic themes which outline the basic rehabilitation concerns following ACL reconstruction. The most fundamental concern is the need to initiate motion very soon after surgery. Prolonged postoperative immobilisation is known to cause serious complications after ACL reconstruction which can be avoided by early motion. Positions or activities which may apply excessive stress to a newly reconstructed ACL must also be considered. The amount of protection required by the graft will vary depending upon the type of graft used and the quality of fixation obtained intraoperatively. Most authors agree that nonweightbearing, active resistive quadriceps exercises should be avoided for an extended period, while closed chain exercises may be initiated much earlier. Strength recovery is obviously important for the quadriceps postoperatively, but maximal strength returns of all of the muscles about the knee must be pursued. Hamstring strength is of particular concern as this may provide an active support to the reconstructed ACL. Sensory loss in the knee after ACL disruption should also be addressed during rehabilitation, prior to a patient's return to full athletic activity. Progressive neuromuscular re-education exercises which rely on sensory input from intact pericapsular structures are encouraged. A final concern is the role of bracing after ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Complications of myelography after partial metrizamide withdrawal.

Lumbar metrizamide myelography (LMM) has been associated with a high incidence of side effects. A total of 94 patients underwent LMM for suspected disc disease or spinal stenosis. In Group 1 a 22-gauge spinal needle was used. Containing the same amount and concentration of metrizamide, an 18-gauge spinal needle was used in Group 2 after which there was partial withdrawal of the metrizamide (average withdrawal: 73%). In Group 1 a total of 38% of patients experienced one side effect whereas 8.5% had two side effects. In Group 2 a total of 8.5% of patients experienced one side effect and 4.25% had two side effects. This study demonstrates a statistically (P less than 0.003) lower incidence of side effects with metrizamide withdrawal after myelography.

Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results.

Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.

Preliminary results with abrasion arthroplasty in the osteoarthritic knee.

A retrospective survey of 110 patients treated by arthroscopic debridement of the knee joint was conducted; 73 of 100 operations included abrasion arthroplasty. The average follow-up period was one year. All patients had Grade IV articular changes. Overall, 60% of the patients who underwent abrasion arthroplasty showed improvement, while the knee was unchanged in 34% and worse in 6%. The results were best in patients younger than 40 years of age. Forty-one patients had medial compartment abrasion in concert with pathologic medial meniscal conditions; 53% of these patients were improved. In a comparable group of 37 patients treated by medial compartment debridement and medial meniscectomy without abrasion only 32% showed improvement. Thus, tentative results in this small series of patients treated by abrasion arthroplasty are encouraging. Further investigations in a larger series are warranted to determine the long-term results of the procedure.