Post-operative problems following anterior cruciate ligament reconstruction.

Seventy adult patients were studied during the postoperative rehabilitation period following anterior cruciate ligament reconstruction in order to investigate the role of pre-, intra-, and postoperative factors in range of motion and graft problems. A standard bone-patellar tendon-bone autograft was used for the reconstruction. Pre- and intraoperative factors such as concomitant injuries, time from injury to surgery, age, sex, and tunnel placement were recorded. Tunnel placement was recorded on intraoperative radiographs of the final guide pin placement and compared to pin placement on cadaver knees. The results indicated a significant relation between early reconstruction (< 1 month) following the injury and range of motion problems during the early rehabilitation period (P < 0.001). This relation disappeared by the end of the first postoperative year. Prolonged surgery was also associated with early motion problems (P < 0.05). Graft laxity or failure was correlated with an earlier return of range of motion (P < 0.05). We hypothesized that graft failure can have a biologic cause rather than a mechanical one since intraoperative X-rays indicated a near-anatomic tunnel placement in this patient group when compared to ideal placement in the cadaver knees.

An evaluation of pre- and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy. A prospective, randomized, double-blinded study.

The potential benefits of a nonsteroidal antiinflammatory drug to 67 patients undergoing knee arthroscopy were evaluated in a prospective, randomized, placebo-controlled, double-blinded study. Group A received the drug (diclofenac, 75 mg twice daily) for 3 to 5 days before and for 7 days after surgery. Group B received a placebo preoperatively and the drug postoperatively. Group C received a placebo at both times. Codeine was available postoperatively for all patients if needed. Outcomes reported by the subjects included pain, crutch use, and return to activities. Outcomes assessed by physicians included knee effusion, range of motion, and gait. Knee flexion and extension strengths were measured isokinetically pre- and postoperatively. Pain scores on the 1st postoperative day were higher in Group C than in Group A. Pain scores at all other time points were not significantly different in the three treatment groups. Groups A and B required less codeine during the first 72 hours after surgery than Group C (mean, 2.9 +/- 1.0 versus 6.8 +/- 1.0 pills). Recovery of function, recovery of strength, and physical examination parameters were not significantly different in the three treatment groups. Diclofenac was an effective analgesic in the immediate postoperative period. Recovery from arthroscopy, however, was not enhanced by taking the drug.

Are calcium intakes and physical activity patterns during adolescence related to radial bone mass of white college-age females?

The determinants of bone mass, i.e., size and density, in young adult women after cessation of growth in length of the bones are not well understood. Usual dietary calcium (Ca) intakes and physical activity (PA) patterns during the post-pubertal half-decade have been considered as two important factors contributing to bone mass. In the present hypothesis-generating cross-sectional study, radial bone mineral content and density were measured by single-photon absorptiometry at two sites containing different proportions of trabecular and cortical bone tissue in 705 healthy, Caucasian college women (18-22 years). Ca intake during high school and college, as estimated by milk and cheese intake only, was categorized into low, moderate and high groups; and physical activity, estimated during the same time frame, was also categorized into low, moderate and high groups. Bone measurements were related to both long-term dietary Ca intake from milk and cheese and long-term PA in sports, dance or other exercises, as assessed by recall. By univariate analyses, both distal and mid-radial bone mineral content (BMC) and areal bone mineral density (BMD) were found to be positively related to gynecological age (GA) (p less than 0.01). Also, independent effects of long-term Ca intake (p less than 0.05) on distal BMC and BMD, and of long-term PA (p less than 0.05) on distal and mid-BMC and BMD were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Postarthroscopy analgesia with bupivacaine. A prospective, randomized, blinded evaluation.

The analgesic effect of intraarticular bupivacaine injected at the conclusion of knee arthroscopy done under general anesthesia was investigated in a prospective, randomized, and blinded fashion. Pain scores, the use of analgesic medications, crutch use, weight-bearing, activity level, and difficulty sleeping the night after surgery were all unaffected by the use of bupivacaine. The apparent lack of effect is most likely due to rapid clearance from the knee, leaving only a transient, 1 to 2 hours of potential benefit. In this study, the patients were already quite comfortable during this time period due to the routine use of intraoperative narcotics. The preoperative level of knee discomfort was found to be a major determinant of postoperative discomfort. Other much less important factors were synovial and chondral shaving, sex of the patient, and experience of the surgeon.

The effect of a nonsteroidal antiinflammatory drug on the healing of ligaments.

Because of the increasing number of ligament sprains being treated with nonsteroidal antiinflammatory drugs (NSAIDs), this study was undertaken to document the effects of one such drug on ligament healing in an experimental setting. Male Sprague-Dawley rats weighing between 400 and 500 g were used to evaluate the effect of the NSAID piroxicam on the healing of an experimental injury to the medial collateral ligament (MCL). The following factors were varied in the experiments: dosage, days of treatment, and the day postinjury when treatment was begun. Piroxicam-treated rats were compared to placebo-treated rats in terms of the drug's effect on the mechanical strength of the healing ligament. The ligaments were mechanically tested in tension to failure at a constant deformation rate of 0.25 mm/sec on a materials testing machine. Administration of piroxicam on Days 1 to 6 postinjury resulted in a 42% increase in strength at Day 14 postinjury for the piroxicam-treated ligaments (P less than 0.01) when compared with the placebo-treated controls. Neither doubling nor halving the standard piroxicam dose significantly altered this increased healing strength. Biochemical analysis of collagen synthesis demonstrated a suggestive, although not statistically significant, increase in collagen synthesis and collagen content in the piroxicam-treated healing ligament. In separate experiments, piroxicam had no effect on the healed ligament at 21 days or on the strength of uninjured ligaments. In conclusion, piroxicam increased the early strength of healing ligaments in the rat when the drug was administered for short periods of time after injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Dislocation of the acromioclavicular joint. An end-result study.

The cases of 127 patients who had an acute dislocation of the acromioclavicular joint were studied. Fifty-two patients, with an average follow-up of 10.8 years, were managed operatively, and seventy-five patients, with an average follow-up of 9.5 years, were managed non-operatively. Using a rating system that included subjective, objective, and roentgenographic criteria, it did not appear that reduction of the acromioclavicular joint was necessary to obtain consistently good results. Operative management, using either coracoclavicular or acromioclavicular fixation, was associated with a higher rate of complications than non-operative treatment. The use of a sling for four weeks without reduction of the joint, followed by a graduated exercise program, led to acceptable clinical results. In patients who had persistent pain and stiffness of the acromioclavicular joint, or in whom symptomatic post-traumatic arthritis developed, resection of the distal part of the clavicle reliably produced significant improvement.

Bone density in women: college athletes and older athletic women.

Bone density was studied in intercollegiate athletes and older athletic women. Single-photon densitometry was used to assess bone density parameters at a new distal radial site, the midradius, and the first metatarsus. Dual-photon densitometry assessed bone density of the lumbar spine. Eleven intercollegiate tennis players, 23 swimmers, and 86 older "athletic" women from 23 to 75 years of age were compared with age-matched nonathletic controls. "Athletic" describes adult women who exercised at least three times per week, 8 or more months of the year, for a minimum of 3 years. The radius and metatarsus bone content of intercollegiate athletes was significantly above control values. Lumbar spine density was significantly higher only in tennis players. Mean bone density values for adult "athletic" women were also significantly greater than in age-matched controls. In the oldest athletic group (55-75 years of age) bone measurement values in radius and lumbar spine were in the same range as for younger "athletic" women. In contrast, after 50 years of age, these values in the control population decreased by 0.7%/year. Therefore the largest variance (increase) from age-matched controls occurred in the oldest "athletic" group. Also, we have established a distal radial density value (using our modified site) below which we consider women "at risk" and recommend further bone health evaluation. Only two adult athletic women greater than 55 years of age fell into this category. It is concluded from this cross-sectional study that a regularly maintained athletic program for adult women may reduce the rate of "normal" bone mass loss accompanying age, particularly postmenopausally.(ABSTRACT TRUNCATED AT 250 WORDS)