Incidence of venous thromboembolism after elective knee arthroscopic surgery: a historical cohort study.

BACKGROUND: The incidence of symptomatic venous thromboembolism (VTE) after knee arthroscopy is uncertain. OBJECTIVES: To estimate the incidence of symptomatic VTE after arthroscopic knee surgery. METHODS: In a population-based historical cohort study, all Olmsted County, MN, USA, residents undergoing a first arthroscopic knee surgery during the 18-year period of 1988-2005 were followed for incident deep venous thrombosis or pulmonary embolism. The cumulative incidence of VTE after knee arthroscopy was determined using the Kaplan-Meier product limit estimator. Patient age at surgery, sex, calendar year of surgery, body mass index, anesthesia characteristics, and hospitalization were tested as potential predictors of VTE using Cox proportional hazards modeling, both univariately and adjusted for age and sex. RESULTS: Among 4833 Olmsted County residents with knee arthroscopy, 18 developed postoperative VTE, all within the first 6 weeks after surgery. The cumulative incidence rates of symptomatic VTE at 7, 14, and 35 days were 0.2%, 0.3%, and 0.4%, respectively. The hazard for postoperative VTE was significantly increased for older patient age (hazard ratio = 1.34 for each 10-year increase in patient age; P = 0.03) and hospitalization either before or after knee arthroscopy (hazard ratio = 14.1; P < 0.001). CONCLUSIONS: The incidence of symptomatic VTE after arthroscopic knee surgery is very low. Older age and hospitalization are associated with increased risk. Routine prophylaxis to prevent symptomatic VTE is likely not needed in this patient population.

Reconstruction of the anterior cruciate ligament in patients over 50 years.

The records of patients aged 50 years or over who underwent primary reconstruction of the anterior cruciate ligament between 1990 and 2002 were reviewed. There were 35 knees in 34 patients that met the inclusion criteria. The mean age of the patients was 57 years (50 to 66) and the mean clinical follow-up was for 72 months (25 to 173). A total of 23 knees were reconstructed with patellar tendon allograft, and 12 with patellar tendon autograft. The mean pre-operative knee extension was 1 degrees (-5 degrees to 10 degrees) and flexion was 129 degrees (125 degrees to 150 degrees) and at follow-up these values were 0 degrees (-5 degrees to 5 degrees) and 135 degrees (120 degrees to 150 degrees), respectively. Pre-operatively there were 31 knees (89%) with a Lachman grade 2+ or 3+. Post-operatively, 33 knees (94%) were Lachman grade 0 or 1+. The mean pre- and post-operative International Knee Documentation Committee scores were 39 (23 to 72) and 90 (33 to 100) respectively. The mean pre- and post-operative Lysholm scores were 50 (18 to 68) and 92 (28 to 100) respectively and the mean University of California Los Angeles activity scores were 8.5 before injury (4 to 10), 4.3 (3 to 6) after injury and 8.3 (4 to 10) post-operatively. There were three graft failures (8.6%) requiring revision. We conclude that reconstruction of the anterior cruciate ligament in carefully-selected patients aged 50 years or over can achieve similar results to those in younger patients, with no increased risk of complications.

Creatine use among a select population of high school athletes.

OBJECTIVE: To determine the prevalence, frequency, and patterns of creatine use among a local population of high school athletes. SUBJECTS AND METHODS: Male and female high school athletes completed an anonymous questionnaire on creatine use during the August 1999 preparticipation examinations at a single institutional sports medicine center. RESULTS: A total of 328 students (182 males and 146 females) aged 14 to 18 years (mean +/- SD 15.2 +/- 1.3 years) completed the survey (100% response rate), although not all athletes answered each question. Twenty-seven athletes (8.2% of total group), 1 of whom was female, reported creatine use. Of these 27 athletes, 14 (52%) were taking creatine at the time of the survey. The frequency of creatine use among past and current users was equally distributed among rarely (30%), weekly (35%), and daily (35%). Creatine users were older than nonusers (mean 16.5 +/- 1.2 vs 15.0 +/- 1.3 years; P < .001). Of creatine users, 21 (78%) were male football players. Nineteen of 24 respondents (79%) believed creatine improved their performance. Overall, 78% of users either did not know how much creatine they were taking (12/22 respondents) or were taking greater than the recommended doses (5/22 respondents). Minor gastrointestinal side effects or muscle cramps were reported by 5 (20%) of 25 respondents. Creatine users were more likely than nonusers to know other creatine users (81% vs 22%; P < .001) and to use other supplements (67% vs 9%; P < .001). Creatine users obtained creatine information primarily from friends (74%) and purchased creatine predominantly from health food stores (86%). CONCLUSIONS: High school male and female athletes as young as 14 years use creatine. Of high school athletes participating in our study, 8.2% reported creatine use. Relatively minor side effects, diarrhea, cramps, and loss of appetite, were reported. Creatine users seem to believe that creatine improves their performance, but they may lack sufficient information to make informed decisions regarding creatine use. Further larger scale study is warranted.

Subtalar arthrodesis with internal compression for post-traumatic arthritis.

We studied retrospectively the results in 24 patients (25 feet) who had been treated by subtalar arthrodesis with internal compression for post-traumatic arthritis from 1988 to 1992. Fifteen patients were men (16 feet) and nine (9 feet) were women. Their mean age was 43 years (22 to 68), and the average duration of follow-up was four years (2 to 6). A single compression screw was used in all feet and iliac-crest bone grafting in ten. Union was achieved in 24 of the 25 feet (96%). Based on a clinical scale the results were excellent in 10 feet, good in 7, fair in 6, and poor in 2 and on the Angus and Cowell score they were good in 19 feet, fair in 4, and poor in 2. The two poor results were due to nonunion in one patient and reflex sympathetic dystrophy in the other. One reoperation was performed for nonunion. Eighteen patients (18 feet) were satisfied with the results, four were satisfied with reservations, and three were dissatisfied. Progressive ankle and midfoot arthritis did not occur in the absence of pre-existing degenerative changes in these joints. We conclude that isolated subtalar arthrodesis with internal compression was effective treatment for post-traumatic subtalar arthritis. Iliac-crest bone grafting was not routinely required.