ABSTRACT
Thirty-five consecutive anterior cruciate ligament (ACL) reconstructions were performed in an ambulatory surgical unit using a bone-patellar tendon-bone autograft. Patients were evaluated postoperatively to determine the amount of pain medication used, the readmission rate, postoperative complications, and cost. Outpatient ACL reconstruction led to a savings of $4700 compared with the cost of performing the same procedure in a hospital operating room with an overnight admission. This study demonstrates that outpatient ACL reconstruction, using local analgesia intraoperatively and oral narcotic pain medication postoperatively, is a safe and cost-effective procedure with minimal to no morbidity.
Subject(s)
Ambulatory Surgical Procedures , Anterior Cruciate Ligament Injuries , Anterior Cruciate Ligament/surgery , Knee Injuries/surgery , Pain, Postoperative/prevention & control , Adolescent , Adult , Analgesia , Anesthesia, Local , Arthroscopy , Endoscopy , Female , Humans , Intraoperative Period , Male , Middle Aged , Tibial Meniscus Injuries , Treatment OutcomeABSTRACT
Twenty-four posterior cruciate ligaments (PCLs) harvested at the time of total knee arthroplasty (TKA) were histologically compared with an age-matched group of 36 PCLs harvested from above-knee amputations, cadavers, and bone bank donors. Ligaments were considered histologically abnormal and degenerative if either loose, mucoid, myxoid, or cystic changes were noted. The magnitude of degeneration was defined as normal, slight, mild, moderate, or marked, based on the amount of tissue demonstrating change. Examination of the PCLs from the TKA group demonstrated 17% normal ligaments, 20% with mild focal changes, and 63% with marked degenerative changes. The control group demonstrated 45% normal cruciate ligaments and 33% with slight, 11% with mild, and 11% with moderate focal changes. No PCL from the control group showed marked changes. The overall degenerative changes between these two groups were found to be statistically significant (P < .001). This study demonstrated that the PCL obtained at the time of TKA is characterized by distinct histologic degenerative changes that are different from age-related changes (P < .001) and that the PCL is not spared degenerative changes in involved osteoarthritic knees. This may help explain the finding that the PCL in osteoarthritic knees is biomechanically abnormal. Many studies have reported excellent results with TKA systems that retain the PCL, implying that a completely normal PCL is not required or that neural input is sufficient for proper kinematic knee function in knees that have undergone total joint arthroplasty.
Subject(s)
Knee Joint , Osteoarthritis/pathology , Posterior Cruciate Ligament/pathology , Aged , Aged, 80 and over , Female , Humans , Knee Prosthesis , Male , Middle AgedABSTRACT
Endoscopic carpal tunnel release has been shown to decrease postoperative recovery time in patients undergoing surgery for carpal tunnel syndrome. There is, however, some controversy concerning the safety and reliability of the procedure. We performed endoscopic carpal tunnel release utilizing the two portal technique described by Chow on 20 fresh cadaver specimens. There were no injuries noted in any of the vital structures including the ulnar artery, superficial palmar arch, third common digital nerve or flexor tendons. The transverse carpal ligament was found to be completely transected in 95% of the specimens. Hyperextension of the wrist significantly displaces the vital structures both dorsally and distally. The use of a slotted cannula and specially designed blades protect the surrounding structures during the procedure. Based on this study, endoscopic carpal tunnel release using the technique described by Chow may be performed reliably without injury to any of the vital structures.
Subject(s)
Carpal Tunnel Syndrome/pathology , Endoscopy , Wrist Joint/pathology , Carpal Tunnel Syndrome/surgery , HumansABSTRACT
A protein of molecular size 180 kilodaltons is associated with 10-nanometer filaments in neurons and is immunologically distinct from smaller putative neurofilament subunits and from 10-nanometer filament proteins in nonneuronal cells, such as myotubes and fibroblasts. Neurons do not contain vimentin, the major filament protein in many other cells, including the nonneuronal cells in cultures of neural tissue.