Comparison of Outcomes of Two Femoral Fixation Devices in Hamstring Anterior Cruciate Ligament Reconstruction.

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.

Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis.

Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment.

Liberación endoscópica del túnel cubital. Técnica quirúrgica y resultados preliminares / Endoscopic cubital tunnel release. Surgical technique and preliminary results

Introducción: Estudios recientes sugieren que la descompresión simple del túnel cubital es tan efectiva como otras técnicas quirúrgicas. La liberación endoscópica se ha aplicado satisfactoriamente en el tratamiento quirúrgico del síndrome del túnel cubital. Presentamos la técnica quirúrgica y los resultados obtenidos con la descompresión endoscópica del nervio cubital en el codo. Material y método: Entre el año 2011 y 2012, 7 pacientes (edad media, 50 años, rango 43-61 años), 5 hombres y 2 mujeres, fueron sometidos a la descompresión endoscópica del nervio cubital en el codo. Todos los pacientes presentaron signos clínicos típicos de síndrome del túnel cubital y estudios neurofisiológicos positivos (5 moderada y grave 2). Los pacientes fueron clasificados según la clasificación de McGowan: 6 codos (86,7%) fueron clasificados como grado II y 1 (14,3%) como grado III. La puntuación media en la clasificación Gabel y Amadio fue de 4,7 puntos. Resultados: El seguimiento medio fue de 9 meses (rango 4-12). Después de la operación, 3 casos (42,8%) fueron clasificados como grado I en la clasificación McGowan y 3 estaban asintomáticos. Un paciente no cambió su graduación (grado III) tras la cirugía. La puntuación media en la clasificación de Gabel y Amadio aumentó hasta 8,14 puntos: los resultados fueron excelentes o buenos en 6 de los 7 casos. Todos los pacientes mejoraron después de la cirugía, se mostraron satisfechos con el procedimiento y regresaron a sus actividades previas en una media de 26 días. Un paciente mostró disestesias alrededor del área de la cicatriz. No hubo otras complicaciones. Conclusiones: La liberación endoscópica del nervio cubital, en pacientes seleccionados, presenta buenos resultados a corto plazo, especialmente para el alivio de la sintomatología sensitiva y en términos de satisfacción del paciente. Además, la tasa de complicaciones es muy baja, consiguiendo una recuperación precoz de los pacientes. No obstante, esta técnica debe ser comparada con el resto en estudios aleatorizados a largo plazo. Nivel de evidencia: Serie de casos, nivel IV de evidencia (AU)

Purpose: Recently, several studies suggested that simple decompression is as effective as other surgical techniques in cubital tunnel syndrome. A technique of endoscopic release of the cubital tunnel has been successfully applied to surgical treatment of this disease. We present our technique and results with endoscopic decompression in cubital tunnel syndrome. Materials and methods: Between 2011 and 2012, 7 patients (mean age, 50 years; range, 43-61 years), 5 males and 2 females, underwent endoscopic decompression of the ulnar nerve at the elbow. All patients presented with typical clinical signs and neurophysiologic studies (5 moderate and 2 severe). Patients were categorized by stage of cubital tunnel syndrome according to McGowan classification: 6 (86,7%) were classified as grade II and 1 (14,3%) grade III. The average score in Gabeland Amadio classification was 4,7 points. Results: The mean postoperative follow-up examination was 9 months (range 4–12). Postoperatively, 3 cases (42,8%) were classified as grade I in McGowan classification and 3 asymptomatic. One patient did not change its classification stage (grade III). The average score in Gabel and Amadio classification improve to 8,14 points: outcomes were excellent or good in 6 of7 cases. All patients improved after surgery, were satisfied with the procedure and returned to full activities within 26 days. One patient showed burning sensation around scar area. There were no other complications. Conclusions: Endoscopic release of the ulnar nerve at elbow, in selected patients, has good short-term outcomes, especially for the relief of sensory symptoms and patient satisfaction. Also, the complication rate is very low, achieving early recovery of patients. However, randomized prospective studies with long-term follow-up should be performed to compare this technique in the treatment of cubital tunnel syndrome. Level of evidence: Case series, level IV (AU)