Intraoperative Adductor Canal Block for Augmentation of Periarticular Injection in Total Knee Arthroplasty: A Cadaveric Study.

BACKGROUND: Function is often sacrificed for pain control after total knee arthroplasty. Motor-sparing blocks, including adductor canal block (ACB) and periarticular injection (PAI), have gained interest to address this compromise. Our study evaluates the anatomic feasibility, accuracy, and safety of intraoperative ACB as an adjunct to PAI by analyzing 3 different injection orientations and needle configurations. METHODS: Eleven cadaveric knees underwent a standard medial parapatellar arthrotomy. Blunt dissection through the suprapatellar recess was performed. Using a 10-mL syringe, various colors of dyed liquid gelatin were injected toward the proximal and distal adductor canal (AC) using 3 needle configurations. Medial dissection of the knee for each specimen was performed. The position of each needle and location of injected dye was identified and described relative to the AC. RESULTS: Accuracy of each injection orientation and/or needle configuration was different: 86% for a blunt needle in the distal AC, 57% for blunt needle in the proximal AC, and 14% for a spinal needle in the proximal AC. Puncture of the femoral artery was observed with the spinal needle 43% of the time and had the closest average proximity to the femoral artery with a distance of 5.9 mm. There were no vascular punctures using blunt needles, and the average distance from the femoral artery with proximal and distal orientation was 10.2 mm and 15.4 mm, respectively. CONCLUSION: Intraoperative ACB augmentation of PAI appears to be anatomically feasible and safe. There was decreased accuracy and increased risk of vascular puncture using a 3.5-inch spinal needle. A blunt 1.5-inch needle directed toward the distal AC had the highest accuracy while minimizing vascular injury.

Professional and informal mental health support reported by Canadians aged 15 to 24.

BACKGROUND: The prevalence of mental health problems in Canada is highest among youth and young adults. Relatively little is known about where they seek support and the factors related to help-seeking. DATA AND METHODS: Based on the 2012 Canadian Community Health Survey-Mental Health, this study describes professional and informal mental health support reported by Canadians aged 15 to 24. RESULTS: In 2012, 12% of 15- to 24-year-olds reported that, in the previous 12 months, they had consulted health professionals about emotional, mental or substance use problems; 27% reported consulting informal sources such as family and friends. Young Canadians with mood, anxiety or substance disorders, one or more chronic physical conditions, higher levels of distress, or who had a traumatic childhood experience were more likely than their contemporaries who did not have these risk factors to report contact with professional and informal sources of support. Those with multiple needs-related factors had significantly higher odds of reporting contact with professional and informal sources. INTERPRETATION: More than one in ten young Canadians consulted professionals and about a quarter sought informal support for mental health problems in the past year. The percentages were higher among those with multiple risk factors.

Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey-Mental Health.

BACKGROUND: Past research and national survey data on Canadians' perceived need for mental health care (MHC) have focused on unmet needs overall, and have not considered specific types of MHC needs or the extent to which needs are met. DATA AND METHODS: Using data from the 2012 Canadian Community Health Survey-Mental Health, this article describes the prevalence of perceived MHC needs for information, medication, counselling and other services. The degree to which each type of need was met is explored. Associations between risk factors for having MHC needs and the extent to which needs were met are investigated. RESULTS: In 2012, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months. Two-thirds (67%) reported that their need was met; for another 21%, the need was partially met; and for 12%, the need was unmet. The most commonly reported need was for counselling, which was also the least likely to be met. Distress was identified as a predictor of perceived MHC need status. INTERPRETATION: Many Canadians are estimated to have MHC needs, particularly for counselling. People with elevated levels of distress are significantly more likely to have unmet and partially met MHC needs than to have fully met MHC needs, regardless of the presence of mental or substance disorders.

Radiographic identification of the primary medial knee structures.

BACKGROUND: Radiographic landmarks for medial knee attachment sites during anatomic repairs or reconstructions are unknown. If identified, they could assist in the preoperative evaluation of structure location and allow for postoperative assessment of reconstruction tunnel placement. METHODS: Radiopaque markers were implanted into the femoral and tibial attachments of the superficial medial collateral ligament and the femoral attachments of the posterior oblique and medial patellofemoral ligaments of eleven fresh-frozen, nonpaired cadaveric knee specimens. Both anteroposterior and lateral radiographs were made. Structures were assessed within quadrants formed by the intersection of reference lines projected on the lateral radiographs. Quantitative measurements were performed by three independent examiners. Intraobserver reproducibility and interobserver reliability were determined with use of intraclass correlation coefficients. RESULTS: The overall intraclass correlation coefficients for intraobserver reproducibility and interobserver reliability were 0.996 and 0.994, respectively. On the anteroposterior radiographs, the attachment sites of the superficial medial collateral ligament, posterior oblique ligament, and medial patellofemoral ligament were 30.5 +/- 2.4 mm, 34.8 +/- 2.7 mm, and 42.3 +/- 2.1 mm from the femoral joint line, respectively. On the lateral femoral radiographs, the attachment of the superficial medial collateral ligament was 6.0 +/- 0.8 mm from the medial epicondyle and was located in the anterodistal quadrant. The attachment of the posterior oblique ligament was 7.7 +/- 1.9 mm from the gastrocnemius tubercle and was located in the posterodistal quadrant. The attachment of the medial patellofemoral ligament was 8.9 +/- 2.0 mm from the adductor tubercle and was located in the anteroproximal quadrant. On the lateral tibial radiographs, the proximal and distal tibial attachments of the superficial medial collateral ligament were 15.9 +/- 5.2 and 66.1 +/- 3.6 mm distal to the tibial inclination, respectively. CONCLUSIONS: The attachment locations of the main medial knee structures can be qualitatively and quantitatively correlated to osseous landmarks and projected radiographic lines, with close agreement among examiners.