Subject(s)
Athletic Injuries/therapy , Football/injuries , Orthopedic Surgeons , Professional Role , Athletic Injuries/diagnosis , Athletic Injuries/physiopathology , Attitude of Health Personnel , Delivery of Health Care, Integrated , Health Knowledge, Attitudes, Practice , Humans , Orthopedic Surgeons/psychology , Patient Care Team , United StatesABSTRACT
DESPITE the known benefits of regional anesthesia for patients undergoing joint arthroplasty, the performance of peripheral nerve blocks in patients with multiple sclerosis (MS) remains controversial. MS has traditionally been described as an isolated disease of the central nervous system, without involvement of the peripheral nerves, and peripheral nerve blockade has been suggested to be safe. However, careful review of the literature suggests that MS may also be associated with involvement of the peripheral nervous system, challenging traditional teachings. There is a paucity of evidence with regard to safety in using peripheral nerve regional anesthesia in these patients. This makes it difficult to provide adequate "informed consent" to these patients. This case report describes a patient with MS who sustained a severe brachial plexopathy after a total shoulder arthroplasty during combined general anesthesia and interscalene nerve block.
Subject(s)
Anesthesia, Conduction/methods , Brachial Plexus/injuries , Multiple Sclerosis/complications , Nerve Block/adverse effects , Nerve Block/methods , Osteoarthritis/surgery , Shoulder Joint/surgery , Aged , Humans , Hypothyroidism/complications , Male , Osteoarthritis/complications , Pain, Postoperative/etiologyABSTRACT
We present a case of a poly-L-lactic acid (PLLA) tibial bioabsorbable interference screw disengaging and migrating transcutaneously 12 months after successful anterior cruciate ligament reconstruction with quadrupled hamstrings autograft. No graft insufficiency or joint inflammatory reaction was present. The screw was removed surgically with no evidence of resorption. The graft was well incorporated into the tibial tunnel. The patient recovered without difficulties and returned to her preinjury level of activity. To our knowledge, this is the first case reported of disengagement and extrusion of a PLLA bioabsorbable interference screw.
Subject(s)
Absorbable Implants , Anterior Cruciate Ligament/surgery , Arthroscopy , Bone Screws , Foreign-Body Migration/surgery , Adult , Anterior Cruciate Ligament Injuries , Athletic Injuries/surgery , Equipment Failure , Female , Humans , Lactic Acid , Polyesters , PolymersABSTRACT
In this critical review, we summarize the literature comparing the 2 grafts most frequently used in reconstruction of the anterior cruciate ligament--patellar tendon and hamstring autografts. We evaluate the biomechanical properties, comorbidities, and clinical performance of the grafts and focus our review on clinical outcomes reported in prospective randomized studies. Although the overall profile of the autogenous hamstring graft with respect to biomechanics and side effects seems equal or superior to that of the patellar tendon graft, there is little difference in clinical outcomes. From review of prospective randomized trials and a large controlled retrospective study, the trend suggests if fixation is controlled, outcomes are similar with the 2 grafts, with the possible exception of when they are used with high-demand athletes, in whom patellar tendon grafts may show a slight disadvantage. Large-scale prospective randomized studies with careful data collection and control are needed to better define graft performance in vivo.
