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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An analysis of 1,000 consecutive arthroscopies of the knee, representing almost 10 years' experience, has made it possible to identify the patient in whom arthroscopy is deemed essential, very useful, or in some instances, superfluous. In the latter category are the young, often teenagers, with pain as their main symptom and no positive physical findings. In osteochondritis dissecans, added information beyond that supplied by X-rays was obtained infrequently, and routine arthroscopy for chondromalacia of the patella is probably unnecessary. Pain and other symptoms in the older age group are more likely to be the result of intra-articular pathology. Arthroscopy has been most helpful in making an accurate diagnosis, planning a surgery, and in some cases, avoiding unnecessary surgery. When a meniscal tear is suspected and arthrotomy comtemplated, arthroscopy is done routinely because it is now evident that the diagnostic accuracy of arthroscopy in experienced hands is at least 20% greater than clinical diagnostic accuracy. As a research tool, arthroscopy has proved to be an excellent method of adding to our knowledge of the fate of damaged articular cartilage. As a therapeutic tool, its use in meniscectomy and other forms of intra-articular surgery has established a new frontier for orthopedic surgery. Intra-articular arthroscopic surgery requires special training and more than average technical skill.
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PMID:The place of arthroscopy in the diagnosis and treatment of internal derangement of the knee: an analysis of 1000 cases. 741 97

The results of use of twenty-nine patellar resurfacing prostheses in twenty-eight patients were studied. The diagnosis was osteoarthritis in twenty-two knees, chondromalacia in five knees, and habitual dislocation with severe osteoarthritis in two. The follow-up time was from three to six years. A cemented chromium-cobalt prosthesis was used. Of the twenty-nine knees studied, two were rated excellent; fourteen, good; three, fair; and ten, poor. Failure was always due to unrelieved pain.
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PMID:Resurfacing of the patella. 743 Jan 81

Arthroscopy of the knee joint was performed in 126 patients complaining of symptoms in the patello-femoral joint. In about one-third of these cases the arthroscopic findings in the patello-femoral joint were normal, whereas the remainder had varying degrees of chondromalacia or arthrosis. The classification of changes agreed well with an independent classification carried out in conjunction with surgery. In one-third of the cases there were additional findings which could explain the knee symptoms, more than half of these being degenerative changes reminiscent of an early gonarthrosis located in the femuro-tibial joint. There were no complications arising from the arthroscopy procedure which was well tolerated by the patients. It is concluded that arthroscopy is a helpful tool for differential diagnosis in patients with patello-femoral pain and for classification of degenerative changes in this joint.
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PMID:Arthroscopy of the patello-femoral joint. 743 90

Degenerative changes in load-bearing joints are often combined with altered intramedullary circulation. This may cause an alteration in intramedullary pressures. It has been said that articular symptoms are connected with a change in intramedullary pressures being high they are suspected to cause pain. In this investigation the intramedullary pressure has been evaluated in chondromalacia and osteoarthrosis of the patella. A comparison has been made with normal patellae. A biopsy needle was drilled into the intramedullary bone of the patella and connected with a registering unit. In a control group an average value of 19 mm Hg was registered. In the condromalacia group the mean intramedullary pressure was 44 mm Hg and in osteoarthrosis 37 mm Hg.
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PMID:Intramedullary pressure of the patella in Chondromalacia. 745 3

A discussion of bruxism, mandibular deviation and hypermobility problems producing temporomandibular joint (TMJ) and masticatory muscle pathology is presented. The pathophysiology of painful masticatory muscle hyperactivity, TMJ dysfunction and chondromalacia are presented. The role that pain mediators play in the degradation of TMJ fibrocartilage, acute synovitis and joint and muscle pain is analyzed. Isokinetic and stretching exercises are described to assist in correcting or preventing pathology and dysfunction of these structures.
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PMID:Mandibular exercises to control bruxism and deviation problems. 758 99

Chondromalacia and patellofemoral osteoarthritis are common diseases that cause pain and disablement of the knee. Conservative therapy is not always effective. Since 1983 we have used isolated polyethylene patellar prosthesis for patella resurfacing of 19 patients with patellofemoral osteoarthritis. After an average of 44.9 months follow-up, we found the treatment was not as satisfactory as earlier trials. The main reason is the wide erosion of femoral condyle caused by the polyethylene patella. To overcome this shortness, we designed a new type of patellofemoral prosthesis which is named Y-L-Q. From January, 1991 to November, 1993, we used this prosthesis to treat 16 knees of 13 patients with patellofemoral osteoarthritis. Most of those patients improved both symptomatically and functionally. The good to excellent results rate was 87.5% (14/16 knees) at the time of an average 16 months follow-up. The early results of our experience with patellofemoral resurfacing are encouraging, and extended follow-ups are in progress.
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PMID:Patella and patellofemoral resurfacing (37 cases report). 771 67

Twenty-nine consecutive arthroscopic assisted anterior cruciate ligament (ACL) reconstructions of the knee were retrospectively studied to evaluate the incidence of patella baja and the correlation of the finding with patellofemoral pain after the ligament surgery. The central one third of the patellar ligament was used and positioned isometrically. The patellar ligament defect was sutured closed. The incidence of patellar chondromalacia at the time of surgery was 24%. The incidence of medial femoral condyle chondromalacia was 59%. The incidence of symptoms of patellofemoral pain after surgery was 14%. Patella baja occurred in 76% of the ligament reconstructions. Two knees showed unexplained patellar tendon lengthening. There was no statistical difference in the results between the knees with and without baja. Postoperative symptoms of patellofemoral pain correlated best with chondromalacia of the patella or the medial femoral condyle at the time of the surgical procedure. Use of the central one third of the patellar tendon with closure of the defect does lead to baja; however, the presence of this radiographic finding does not correlate with patellofemoral pain.
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PMID:Patella baja in anterior cruciate ligament reconstruction of the knee. 811 23

Twenty-nine cases of operative arthroscopy of the ankle were done between 1985 and 1989 for synovial impingement of the ankle. The average age of the patients was 37 years. All patients (17 men, 12 women) reported an earlier history of injury, with 24 of the patients (83%) noting chronic ankle pain after an inversion injury and 5 of the patients (17%) reporting a previous ankle fracture. Physical examination elicited anterolateral tenderness at the ankle in all cases with associated anteromedial pain in 4 patients. A demonstrable "click" was evident in 6 of the patients (21%) on forced dorsiflexion of the ankle. All patients failed conservative treatment including physical therapy and nonsteroidal antiinflammatory drugs. Surgery was performed at an average of 36 months postinjury. Ankle arthroscopy revealed extensive hypertrophic synovial thickening and scar tissue anterolaterally, indicating synovial impingement in all patients. Associated chondromalacia of the distal tibia was seen in 21% of the patients. Operative arthroscopy included partial synovectomy and debridement of the hypertrophic tissue and partial shaving chondroplasty of the tibia when indicated. Postoperatively, patients were weightbearing as tolerated. Results were assessed subjectively and objectively. At 25-month followup 26 patients had excellent or good results and 3 had fair results; there were no poor results. There were no major complications, including infection or neurovascular compromise. The 3 patients with associated ankle instability comprised the "fair" result group and eventually required lateral ankle reconstruction. Thus, chronic ankle pain due to synovial impingement can be safely, predictably, and effectively treated by operative ankle arthroscopy.
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PMID:Arthroscopic treatment of synovial impingement of the ankle. 846 10

The results of 320 patients after holmium:YAG laser treatment in comparison to conventional mechanical methods during a 2-year period were analyzed in a prospective, randomized study. The following knee injuries were included in the study: meniscal lesion, chondromalacia, combined meniscal/cartilage lesion, rheumatoid synovitis and femoropatellar pain syndrome. Because strict inclusion criteria were used, the patient series is homogeneous, not only in terms of sex, age, injured side and intrasurgical diagnosis, but also because the initial values of the Lysholm score modified after Klein are similar. After 2 years, the results of the laser series were significantly improved, whereas the results for the conventional series, especially for chondromalacia and synovitis, did not show the same improvement. Analysis of the effect of various instrumentation and the laser system itself show differing results for the different knee disorders. The hemostatic effect of the holmium-YAG laser was excellent during surgery for all knee disorders, including surface treatment. The operation time for laser surgery was not prolonged, as is often stated. This study shows that chondromalacia, combined meniscal-cartilage lesions and chronic rheumatoid synovitis are treated more effectively and with better results with the holmium-YAG laser than with conventional arthroscopic methods. Furthermore, laser treatment of meniscectomy and lateral retinacular release is also better than mechanical techniques. This study demonstrates the feasibility of the holmium-YAG laser for arthroscopic surgery. A combination of different instruments seems to be most effective.
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PMID:[Arthroscopic holmium-YAG laser compared to conventional procedures on the knee joint. 2-year results of a randomized prospective study]. 862 48

From 1988 to 1992 at the Department of orthopaedic surgery, School of medicine, University of Zagreb 21 arthroscopic knee joint abrasions were performed as palliative treatment of osteoarthritis. There were 13 male patients (61.9%) and eight female patients (38.1%); the age of the patients ranged from 17 to 69 years (the average of 42.2 years). The femorotibial angle ranged from -2 to 10 degrees (the average of 5.3 degrees). The average degree of osteoarthritis was 2.1 and of chondromalacia 3.5 degrees. In the majority of cases the abrasion was performed in the medial femoral condyle and the patella; in a smaller number of cases it was performed in the medial tibial condyle, and in the lateral tibial condyle in only one patient. Also, debridement was performed in most of the patients; in four patients cleansing of the medial menisci was made, while in two patients loose joint bodies had to be removed. The average follow-up time was 2.8 years, ranging from 12 months to 5 years. According to HSS score, treatment results were excellent and very good in 15 patients (71.4%), satisfactory in four patients (19.0%) and poor in two patients (9.5%). The authors conclude that the arthroscopic abrasion is good, non-invasive palliative method of treatment of primary knee osteoarthritis. The arthroscopic abrasion method yields good short-term results (from 2 to 5 years) in view of reducing pain and improving joint function.
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PMID:[Treatment of gonarthrosis with arthroscopic abrasion]. 864 16


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