ABSTRACT
BACKGROUND: Tear of the anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. Reconstruction of this ligament is often required to restore functional stability of the knee. Outcome of ACL reconstruction is significantly affected by how the graft is fixed to the bone. This study is to determine if there is a different clinical outcome after cortical versus cortical-cancellous suspension femoral fixation in hamstring based anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: This is a retrospective comparative study conducted between 2006 and 2010. We enrolled patients who underwent arthroscopic ACL reconstruction. Sixty two patients met inclusion criteria and 41 agreed to come for followup assessment. Median age was of 28 years (range 18-39 years). Demographic baseline profile of both groups was similar. The femoral fixation devices were cortical (n = 16) and cortical-cancellous suspension techniques (n = 25). The average period of evolution at the time of assessment was 40 months (range 12-72 months). The patients were examined according to Lachman test (using Rolimeter knee tester), anterior drawer test, pivot shift test, International Knee Documentation Committee questionnaire, and Tegner-Lysholm knee scoring scale. RESULTS: The objective evaluation of the patients (Lachman test) showed better results in terms of stability in the group of patients who underwent the cortical-cancellous suspension method. These differences were not reflected in the assessment of activity level (Tegner-Lysholm), where both groups showed the same results. CONCLUSIONS: ACL reconstruction with both cortical and cortical-cancellous suspension femoral fixation techniques show the same clinical results at medium long followup. However, cortical-cancellous fixations seem to provide greater stability to the reconstruction.
ABSTRACT
BACKGROUND: Knee osteoarthritis is a disease that affects a third of the population over 65 years of age, and it is increasingly becoming a motive for consultation and a source of pain and disability. The gold standard surgical treatment is a total knee arthroplasty; however, 15% to 30% of patients who have undergone surgery continue to experience pain and functional limitation. METHODS: A double-blind, randomized clinical study compared neurolysis using traditional radiofrequency (RF) to local anesthetic and corticosteroid block of the superolateral, superomedial, and inferomedial branches of the knee genicular nerves in patients who had total knee arthroplasty but still experience pain. RESULTS: Twenty-eight patients, 14 on each treatment arm, were followed for over a 1-year period. A reduction in pain and significant joint function improvement during the first 3 to 6 months was shown, with similar results using both techniques. No adverse effects were noted. An improvement in both disability and quality of life was observed, as well as a reduction in the need for analgesics in both treatment groups. CONCLUSIONS: Further clinical trials need to be undertaken, with a larger sample size, in order to demonstrate the efficacy of this technique and to detect the possible appearance of any long-term adverse effects.
Subject(s)
Denervation/methods , Nerve Block/methods , Osteoarthritis, Knee/surgery , Pain Management/methods , Aged , Anesthetics, Local , Arthroplasty, Replacement, Knee , Double-Blind Method , Female , Humans , Knee Joint/innervation , Male , Middle Aged , Pain MeasurementABSTRACT
Presentamos el caso de una mujer de 40 años con dolor en ambas muñecas que aparece de forma progresiva y de meses de evolución. Se acompaña de parestesias, probablemente por atrapamiento del nervio mediano. Un adecuado diagnóstico diferencial incluye las patología congénitas y adquiridas. Tras la exploración física y hallazgos radiológicos se llega al juicio clínico final (AU)
We present the case of a 40 year-old woman with progressive pain in both wrists of months of evolution, and accompanied by paresthesia, probably due to median nerve entrapment. An appropriate differential diagnosis includes both congenital and acquired pathologies. Final diagnosis is reached after physical examination and radiological findings (AU)
