The incidence of deep venous thrombosis after arthroscopic knee surgery.

We retrospectively reviewed the records of 2050 arthroscopic knee surgeries performed at The Orthopedic Specialty Hospital from January 1993 to December 1994. The number of clinically detected deep venous thromboses, with confirmation by duplex ultrasonography, was determined. Prospectively, preoperative and postoperative duplex ultrasonographic images were completed on 239 patients divided into 2 groups: those undergoing nonligament, intraarticular arthroscopic surgery (N = 131) and those undergoing arthroscopically assisted ligament surgery and extraarticular or osteotomy surgery (N = 108). For the retrospective study, the incidence of deep venous thrombosis was 0.24%. Prospectively, seven total deep venous thromboses were identified (rate, 2.9%), with five being identified within 8 days of surgery in asymptomatic patients (rate, 2.1%). There were no statistically significant associations or correlations between the development of deep venous thrombosis and patient personal data or surgical variables, respectively. The difference in the rate of deep venous thrombosis between the two prospective groups was not statistically significant; however, patients who had more invasive surgery tended to be at higher risk for developing deep venous thrombosis. A cost-benefit analysis did not support the routine use of duplex ultrasonography to detect deep venous thrombosis in patients undergoing arthroscopic knee surgery.

A biomechanical and clinical evaluation of a patellofemoral knee brace.

A clinical and biomechanical evaluation of a patellofemoral knee brace was conducted to determine subjectively and objectively if the brace was effective in controlling knee motion and relieving patellofemoral pain symptoms. The subjective results indicated that the patellofemoral brace was able to significantly improve the level of perceived knee stability and decrease the level of pain experienced by all the subjects during their daily living and athletic activities. The objective results showed that the patellofemoral brace had no effect on knee flexion angle during gait or level walking, stair ascent, or stair descent for 2 groups of subjects (patellofemoral patients and controls). Joint pain and stability are affected by factors other than knee flexion angle.

Infrapatellar contracture syndrome. Diagnosis, treatment, and long-term followup.

Infrapatellar contracture syndrome is an uncommon but recalcitrant cause of reduced range of motion after knee surgery or injury. The results and conclusions presented here are based on a retrospective clinical study evaluating the long-term outcome in 75 patients who developed infrapatellar contracture syndrome. These 75 patients (76 knees) were evaluated at an average followup of 53 months after the index (inciting) procedure or injury. Comparing subgroups within the study population, factors that correlated with poorer results or more severe infrapatellar contracture syndrome were found to be acute anterior cruciate ligament repair or reconstruction, the use of patellar tendon autograft for anterior cruciate ligament reconstruction, nonisometric graft placement, multiple surgical procedures, use of closed manipulation, and the development of patella infera. We concluded that appropriate procedures can substantially increase the range of motion in patients with infrapatellar contracture syndrome. However, residual functional morbidity persists in many patients, and the outcome, as determined by subjective knee function scores, is only fair. The natural history of an anterior cruciate ligament-deficient knee appears to be more benign than the natural history of a knee that develops infrapatellar contracture syndrome.

Detailed analysis of patients with bilateral anterior cruciate ligament injuries.

To better understand anatomic and other possible predisposing factors for anterior cruciate ligament injuries, we retrospectively studied 31 patients with noncontact, bilateral injuries of this ligament. The 31 patients were carefully matched by age, sex, height, weight, and activity level with 23 control subjects who had no history of knee injury. All 54 subjects underwent a full clinical knee examination, joint hypermobility tests, a hamstring tightness assessment, a computerized tomography scan analysis, and a plain view radiographic analysis, and were asked to provide a complete immediate-family history of knee ligament injury. In addition, the 31 patients in the experimental group underwent a KT-1000 arthrometer knee laxity examination and were also asked to provide an injury profile, including mechanism of injury, treatment received for each injury, and the time interval between injuries. Measurements obtained from the computerized tomography scan analysis demonstrated a significantly wider lateral femoral condyle in the experimental group compared with the control group, indicating that certain anatomic factors may predispose people to anterior cruciate ligament injury. A significant difference was also found in the incidence rate of anterior cruciate ligament injury in the family history of the experimental group compared with the control group, indicating a possible congenital aspect of this injury.

[Oral contraceptives and alopecia]. / Anovulatorios y alopecia.

PIP: 5 cases of diffuse alopecia in women who took oral contraceptives are studied. 3 cases developed male pattern baldness during the time they were taking the pills. 2 cases began losing their hair after having stopped medication and these resembled postpartum baldness. 1 woman did not regain here hair 20 months after having stopped medication . The effects of female sex hormones on hair follicles are discussed. Contraceptives induce a condition of pseudopregnancy, and should be considered as possible toxic causes of alopecia. However, the incidence of alopecia among users of oral contraceptives is very low.^ieng