ABSTRACT
BACKGROUND: The authors conducted this study to determine whether septation of the first dorsal compartment is more prevalent in de Quervain tenosynovitis, and whether this contributes to failure of corticosteroid injection therapy. METHODS: A retrospective review of 79 consecutive patients (85 wrists) with symptomatic de Quervain tenosynovitis treated with surgical release was performed. The number of corticosteroid injections performed preoperatively and the presence of first dorsal compartment septation determined intraoperatively were recorded. Correlation between the number of steroid injections and the presence of septation was evaluated. In addition, 48 matched cadaver upper extremities (96 wrists) that had not previously undergone surgery for de Quervain disease were evaluated for the presence of first dorsal compartment septation. The prevalence of septation was compared between matched wrists and against the surgically treated clinical cohort. RESULTS: In the clinical cohort, 61.2 percent of wrists contained a septated first dorsal compartment. There was no correlation between the presence of a septated first dorsal compartment and the number of steroid injections before surgical release. In the cadaver portion of the study, 72.9 percent of wrists contained septa. There was no significant difference in the prevalence of septated first dorsal compartments between groups. CONCLUSIONS: In the present study, the majority of wrists contained a septated first dorsal compartment, with no difference in the prevalence of septa between surgically treated patients and a cadaver sample that had not undergone prior surgical release. Furthermore, there was no correlation between the presence of septa and the number of preoperative corticosteroid injections administered. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Subject(s)
De Quervain Disease/pathology , Adrenal Cortex Hormones/administration & dosage , Adult , Aged , Cadaver , Case-Control Studies , De Quervain Disease/drug therapy , De Quervain Disease/surgery , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Retrospective Studies , Treatment Failure , Young AdultABSTRACT
Hamstring anterior cruciate ligament (ACL) reconstructions fixed inside both bone tunnels have a shorter initial working length, and thus should be stiffer than those fixed outside both bone tunnels. We used meta-analysis to compare 4-stranded hamstring ACL reconstructions using the 2 fixation methods with reconstructions using patellar tendon autografts. A Medline database search of English-language articles published through June 2004 yielded 36 studies that met the inclusion criteria: 5 intratunnel fixation studies (569 patients), 10 extra-tunnel fixation studies (604 patients), and 24 patellar tendon studies (1592 patients). Three studies included both patellar tendon and hamstring reconstructions. Demographically, all 3 groups were similar. There was no significant difference in the percentage of knees restored to normal instrumented laxity measurements between the 3 groups, nor was there a difference in graft failure rate. Patient satisfaction and return to preinjury activity rates were similar between the intratunnel fixation and patellar tendon groups and were significantly lower for the extra-tunnel fixation group. Good International Knee Documentation Committee scores did not correlate with good patient satisfaction or return to preinjury activity.
