Novel drug product to improve joint motion and function and reduce pain after arthroscopic anterior cruciate ligament reconstruction.

PURPOSE: OMS103HP, an investigational drug product containing ketoprofen, amitriptyline, and oxymetazoline, is added to arthroscopic irrigation solution. OMS103HP was evaluated in patients undergoing arthroscopic anterior cruciate ligament reconstruction to assess the drug's safety and ability to improve postoperative knee function and motion, reduce postoperative pain, and allow earlier return to work. METHODS: This was a prospective, double-blind, vehicle-controlled, parallel-group, randomized study. Allograft anterior cruciate ligament reconstruction patients in both treatment and vehicle control groups were monitored for safety and efficacy (e.g., measurements of knee function and motion, pain, and return to work) over a 30-day postoperative period. The efficacy endpoints of primary interest were assessed by use of both responder and time-to-event analyses. RESULTS: There were statistically significant differences (P < or = .05) between the OMS103HP and vehicle control groups in the endpoints of knee function (knee function composite and straight-leg raise component of knee function composite), range of motion (median number of days to maximum passive flexion of 90 degrees or greater without pain and time to discontinuation of continuous passive motion), quadriceps and hamstring muscle strength, successful pain management, and return to work. The overall incidences of adverse events and abnormal clinical laboratory values for both OMS103HP- and vehicle-treated subjects were similar, and none was attributed to OMS103HP. CONCLUSIONS: The clinical benefits of OMS103HP in this study were reduced postoperative pain; improved postoperative knee motion, quadriceps and hamstring muscle strength, and knee function; and earlier return to work as measured by surgeons, nurses, and physical therapists across repeated clinic visits and rehabilitation sessions and recorded by patients in daily diaries. The drug was well tolerated.

Acute compartment syndrome of the thigh in a football athlete: a case report and the role of the vacuum-assisted wound closure dressing.

We present a case of compartment syndrome of the thigh due to blunt injury in a Division I American football player managed with fasciotomy and vacuum-assisted wound closure. This case report discusses the vacuum-assisted wound closure dressing as an alternative to more traditional closure techniques such as suture retention devices and split-thickness skin grafting. We feel that any surgeon involved in performing fasciotomies should be familiar with this increasingly used closure device and its potential complications.

Anterior cruciate ligament reconstruction using cryopreserved allografts.

Primary ACL reconstruction historically has been done using autograft tissues whereas allografts have been limited to revision cases and patients who are older or with lower physical demands because some animal studies suggested a slower biologic incorporation rate. The purpose of the current study was to evaluate the effectiveness of the cryopreserved Achilles tendon allograft in primary ACL reconstruction in a consecutive series of athletes. Fifty consecutive patients with a strenuous or moderate preinjury activity level, as defined by the International Knee Documentation Committee (IKDC), had ACL reconstruction using cryopreserved Achilles tendon allografts secured with bioabsorbable interference screws. Five patients were professional athletes. The average age of the patients was 36 years (range, 17-50 years). A 3- to 5-year followup study was done in all of the patients using the IKDC form. Tunnel widening was measured in the lateral radiographs at the widest level. The overall outcome was normal or nearly normal in 94% of the patients. No failures were reported in this series. Forty-six patients (92%) returned to their same preinjury sport activity level. The average KT-1000 side-to-side difference was 2.3 mm. Average tibial tunnel widening was 2.7 mm (range, 0-6 mm); no significant correlation was observed between increased tunnel size and a fair or poor clinical outcome. This experience shows that favorable results can be obtained with cryopreserved Achilles tendon allografts in athletes in whom avoiding donor site morbidity may be an issue in terms of a prompt return to sport.

Monopolar thermal treatment of symptomatic anterior cruciate ligament instability.

Patients with anterior cruciate ligament instability resulting from incomplete tears or elongation in continuity without ligament detachment historically have been treated conservatively or by graft replacement. The literature is sparse regarding alternative treatments. The current study presents experience using monopolar thermal repair on 28 consecutive knees with partial anterior cruciate ligament tears all symptomatically unstable. All lesions were less than 6 months old (average, 77 days; range, 7-180 days) and with a difference of 6 mm or more (average, 9 mm; range, 6-13 mm) when comparing both knees using KT-1000 evaluation. Incomplete tears of the anterior cruciate ligament were seen at arthroscopic evaluation. The rehabilitation protocol included use of a brace for at least 6 weeks and progressive weightbearing. A 2-year minimum followup (range, 24-35 months) was done in all patients following the International Knee Documentation Committee guidelines. The overall outcome was normal or nearly normal in 96% of the patients. One failure occurred at 8 weeks. Twenty-six knees had a KT-1000 difference between 0 and 2 mm (average, 1.9 mm). Because thermal application causes death to some of the cells directly treated, it should be taken into account in selection and application. Immediately after thermal use, the anterior cruciate ligament, although thicker and tighter, is at first weaker than normal. Rehabilitation and compliance are critical during early ligament healing. This procedure seems to be a reasonable alternative to anterior cruciate ligament grafting in selected patients.

Electrothermal assisted shoulder capsulorraphy--monopolar.

Monopolar electrothermal stabilization of the shoulder shows considerable promise as a treatment alternative in athletes and patients with recurrent instability. Range of motion is preserved, recovery is faster than with open procedures, there is little disruption or alteration of inherent anatomy, and, most importantly, results at 2 years appear comparable to other surgical procedures in high-demand populations. The procedure is technically easy to perform, and the complication rate is low. Success depends on surgeon's understanding of the applications of RF energy, the use of proper surgical technique, careful patient selection, attention to the rehabilitation program, and the patient's compliance with postoperative protocol. Long-term follow-up is necessary to determine if results for this procedure deteriorate over time, especially in patients with multidirectional instability.

Controversial topics in shoulder arthroscopy.

This is a review of the symposium entitled Controversial Topics in Shoulder Arthroscopy 2001, presented at the Arthroscopy Association of North America 20th Annual Meeting in Seattle, Washington in April of 2001. The covered topics include micro-instability, partial thickness rotator cuff tears, pathology of the biceps tendon, and thermal capsulorrhaphy.