ABSTRACT
INTRODUCTION: Although 200 000 adolescents undergo anterior cruciate ligament reconstruction (ACLR) surgery annually, no benchmarks for pediatric post-ACLR pain management exist. We created a multicenter, prospective, observational registry to describe pain practices, pain, and functional recovery after pediatric ACLR. METHODS: Participants (n=519; 12-17.5 years) were enrolled from 15 sites over 2 years. Data on perioperative management and surgical factors were collected. Pain/opioid use and Lysholm scores were assessed preoperatively, on postoperative day 1 (POD1), POD3, week 6, and month 6. Descriptive statistics and trends for opioid use, pain, and function are presented. RESULTS: Regional analgesia was performed in 447/519 (86%) subjects; of these, adductor canal single shot was most frequent (54%), nerve catheters placed in 24%, and perineural adjuvants used in 43%. On POD1, POD3, week 6, and month 6, survey response rates were 73%, 71%, 61%, and 45%, respectively. Over these respective time points, pain score >3/10 was reported by 64% (95% CI: 59% to 69%), 46% (95% CI: 41% to 52%), 5% (95% CI: 3% to 8%), and 3% (95% CI: 1% to 6%); the number of daily oxycodone doses used was 2.8 (SD 0.19), 1.8 (SD 0.13), 0, and 0. There was considerable variability in timing and tests for postdischarge functional assessments. Numbness and weakness were reported by 11% and 4% at week 6 (n=315) and 16% and 2% at month 6 (n=233), respectively. CONCLUSION: We found substantial variability in the use of blocks to manage post-ACLR pain in children, with a small percentage experiencing long-term pain and neurological symptoms. Studies are needed to determine best practices for regional anesthesia and functional assessments in this patient population.
ABSTRACT
Between 1991 and 2000, 30 patients with 31 resections of giant cell tumors of bone were treated (average followup, 4.9 years; range, 1-9.6 years). Intralesional resection with curettes and a high-speed burr and reconstruction with polymethylmethacrylate cementation or bone grafting was used for salvageable, nonexpendable bones. Wide resection and allograft reconstruction was done in nonexpendable bones that were too destroyed for salvage. Adjuvant treatments were used for all intralesional procedures and when wide resection with a close margin was obtained. Adjuvant treatments included hydrogen peroxide instillation in 30 patients, electrocautery in 27 patients, phenol irrigation in 26 patients, sterile water irrigation in 15 patients, and polymethylmethacrylate cementation in 15 patients. There have been only two (6.4%) local recurrences, one in bone and one in soft tissue. Both patients had intralesional resections initially and both had salvage procedures with wide resections of the recurrent tumors. The 5-year recurrence-free survivorship was 93%. A delayed ray amputation for failed bone graft of the little finger was the only amputation. In all other patients, a functional limb was preserved. Wide resection only is required when bone salvageability is impractical. Intralesional curettage and high-speed burr resection, when supplemented with the adjuvant therapies as described, is adequate for the majority of patients with giant cell tumor of bone. A proposed treatment algorithm is presented.
