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

The "International Knee Documentation Committee" (IKDC) evaluation form was created in 1992 in order to make easier the comparison of the results obtained in the U.S. and Europe in the knee ligament surgery using various procedures. In order to evaluate the performances of the IKDC system, it has been applied to the analysis of the results of 90 Marshall-MacIntosh ACL augmented-reconstructions, all having at least one year follow-up, and compared to the ARPEGE and Lysholm-Tegner systems. All 3 systems have in common a functional activity scale, nevertheless only the IKDC system takes into consideration the ligament examination. In this system, the assessment of the overall result is based on the combination of 4 parameter groups (patient subjective assessment, symptoms, range of motion, ligament examination). The lowest grade within a group determines the group grade. The worst group grade determines the final evaluation. According to the ARPEGE system, 79 per cent of good and excellent results were observed. This percentage increased up to 92.5 per cent with the Lysholm-Tegner system, and up to 82 per cent with the IKDC system. There was a positive and significant correlation between the IKDC system and the two others. The final result, when evaluated with the IKDC system, first depends on the ligament examination, while with the two other systems, pain appears to be the predominant parameter.
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PMID:[Results of Marshall-MacIntosh reconstruction according to 3 scoring systems (ARPEGE, Lysholm, IKDC). 90 cases reviewed with at least a one-year follow-up]. 806 99

We feel that some of the current prejudice against use of hamstring tendon grafts for ACL reconstruction has not been justified if one critically reviews the literature. In this article, we have tried to provide the reader with our current indications, present our current surgical technique, and review some of the outcome studies involving use of the hamstring tendons for ACL reconstruction. We also feel that some of the poor results of hamstring tendon ACL reconstructions previously reported resulted from the use of inadequate strength grafts (single-stranded grafts) and lack of rigid fixation on both ends of the graft (usually secondary to inadequate graft length). We feel that the technique described in this article addresses both of these issues. It is our clinical impression that, in appropriately selected patients, this technique produces stability and functional outcome similar to that obtained with patellar tendon grafts but results in less postoperative pain, a quicker return of quadriceps muscle function, and less donor site morbidity.
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PMID:The use of hamstring tendons for anterior cruciate ligament reconstruction. Technique and results. 826 23

Eighty-eight male patients following reconstruction of the anterior cruciate ligament (ACL; mean 24 months since operation) had a thorough clinical examination including instrumented measurement of laxity using the KT 1000. These results were correlated with an ultrasound (US) grading that evaluates the reconstruction itself as well as its functional behaviour during the anterior drawer test. Thirty-four magnetic resonance (MR) studies of 33 patients were available. Undoubtedly postoperative visualization of the reconstructed ACL is superior to that of both normal control ACL and acute trauma cases. Especially operative procedures which use the patellar or semitendinosus tendon lend themselves to accurate evaluation of the intraarticular reconstruction. The sensitivity, specificity, positive and negative predictive values and overall accuracy of US/MR versus the clinical laxity measurement are calculated to be 66.7%/96.0%, 71.2%%/23.8%, 59.5%/60.0%, 77.1%/83.3% and 69.4%/63.0% respectively. US has a satisfactory diagnostic value and performs similarly well on all these parameters. MR, on the other hand, correctly diagnoses nearly all unstable knees but is associated with a high number of false positives. There is no statistically significant, linear correlation between MR and US; r = -0.0769, P = 0.6706. Only three times did the reconstructed ACL appear normal on MR, whereas 48.5% of the reconstructions were graded type I (normal) on US. Clinical Consequences: Ultrasound and MRT should not be considered rival but rather complementary methods: ultrasound is a good method for documenting changes within the knee joint on an outpatient basis, while the indications for MR in the postoperative course are any occurrences of pain, instability or reinjury.
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PMID:[Importance of ultrasound in postoperative follow-up after reconstruction of the anterior cruciate ligament]. 843 75

Arthrofibrosis following ACL reconstruction is a well-recognized and disturbing complication. It may result in a greater functional deficit than the original ACL deficiency. The purposes of this retrospective study were to present our results of arthroscopic arthrolysis and gentle manipulation in 16 consecutive cases in the past almost 3 years, to determine and define the etiology and risk factors, to make recommendations regarding prevention and to develop a time-related management concept. All the 16 patients had previously undergone open ACL reconstruction and had developed arthrofibrosis. The average time from the index surgery to arthrolysis was 7.4 months (range 2.5-18.5 months) and the average follow-up was 17.6 months (range 6-38 months). After pathology-oriented arthroscopic debridement, notchplasty, cyclops resection etc., and following manipulation of the knee, range of motion was found to be improved in all cases at the final follow-up. The average of extension deficit was decreased from 20.0 degrees to 7.0 degrees and the flexion deficit from 34.4 degrees to 9.9 degrees. Only three patients regained normal range of motion compared to the other side. The only complication was an avulsion fracture of the fibula head which did not cause any lateral instability. No patient gained motion at the expense of joint stability. Patella baja was present in two and patellofemoral pain in seven cases at the final follow-up. Three patients underwent further surgery after the final follow-up. Arthrofibrosis, while having many causes, appears to be a preventable complication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Arthroscopic therapy of arthrofibrosis of the knee joint]. 845 47

The purpose of this study was to evaluate the long-term isokinetic muscle performance after ACL surgery and to analyze by a multiple stepwise regression which factors (if any) predict the overall outcome. The study subjects were 119 patients who had a complete rupture of the ACL and had been treated surgically at the Tampere University Hospital between 1981 and 1990. They were divided into the acute group (N = 62) and into the chronic group (N = 57) according to the time delay between the injury and the ACL surgery. The isokinetic strength measurements of the quadriceps and hamstring muscles were performed on average 4 years after the operation using Cybex II and Cybex 6000 dynamometers (Lumex Inc., Ronkokoma, NY, USA). The peak torques were determined at speeds of 60 and 180 degrees/s and the peak work at speed of 180 degrees/s. The measurements revealed that after the ACL surgery there was still a considerable thigh muscle strength deficit especially in extension of the injured extremity, the average extension strength deficit ranging from 9 to 20%. The extension strength deficit was significantly more prominent in the chronic (18-20%) than in the acute group (9-15%). The extension strength deficit was significantly greater ar the slower (15-20%) than higher (9-18%) speed of the isokinetic movement. In both the acute and chronic groups, a multiple stepwise regression analysis indicated that patellofemoral pain and flexion deficit of the knee were the factors that most frequently and significantly associated with the strength deficits. At the higher speed of the isokinetic movement, these two factors accounted 20% and 21% for the variation seen in the quadriceps strength deficit of the acute group and the chronic group. No correlation could be found between age, sex, height, weight, body mass index, length of the follow-up time, injury type, athletic activity level, immobilization method, knee stability, and the isokinetic muscular performance.
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PMID:Isokinetic muscle performance after anterior cruciate ligament surgery. Long-term results and outcome predicting factors after primary surgery and late-phase reconstruction. 873 78

Retrospective clinical and radiographic evaluation was performed on 41 patients seen at the Salzburg General Hospital Department of Traumatology on average 2 years following ACL reconstruction. In 26 patients (61%) clinical examination revealed pain trigger points over the donor site of the midthird patellar tendon and in the patellofemoral joint. Functional pain during kneeling activities was observed in 19 patients (46%). Objective measurement of the length of the patellar tendon in bilateral radiographs demonstrated exactly equal patellar tendon length in both knees in 11 patients (27%). The radiographs showed tendon shortening following harvesting of the midthird patellar tendon by 1-3 mm in 7 patients (17%), by 4-6 mm in 16 (39%), and by 6-9 mm in 7 (17%). Average length change in the patellar tendon on the donor side was -3 mm, representing a patellar tendon shortening of 9.8%. On the basis of the OAK score, however, good and very good results were recorded in 33 patients (80%). On the whole, these good overall results were compromised only be patellar tendon defect morbidity. In addition to the local scarring problems at the donor site, shortening of the patellar tendon was observed with changes to patella position and interference with the mechanics of the patellofemoral joint. Tendon shortening can be explained on the basis of cicatricial contraction in the process of autorepair to the tendon defect. The problems affecting the patellofemoral joint are inherent in the therapy and must be treated as a negative factor. In the case of patients whose work requires mainly a kneeling position and those who make significant functional demands of the extension system of the knee, a critical assessment is required of the use of the midthird patellar tendon for anterior cruciate ligament reconstruction.
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PMID:The tendon defect after anterior cruciate ligament reconstruction using the midthird patellar tendon--a problem for the patellofemoral joint? 873 11

Outpatient ACL reconstructive surgery is a recent trend in orthopaedics. The Visiting Nurse Association (VNA), a large home care agency in Northern Virginia, provides skilled rehabilitation nursing care to these patients during the immediate postoperative period. Home care nurses visit these patients upon discharge from the hospital on the day of surgery and revisit on the first postoperative day. The nurses administer injections for pain, assess and reinforce dressings, evaluate the operative extremity for circulatory and sensory changes and instruct the clients regarding postoperative protocols. Patients who have received home health nursing following ACL reconstruction have recovered successfully without rehospitalization.
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PMID:Outpatient ACL surgery: the role of the home health nurse. 886 82

Seventy-three ACL-deficient knees were reconstructed using a modified Zarins and Rowe arthroscopic procedure utilizing the semitendinosus tendon and iliotibial band (ITB). Fifty of 73 patients returned for 2- to 5-year follow up. On follow-up visit each patient completed a questionnaire pertaining to subjective results, including level of pain and return to, activities. Physical examination included the Lachman test, anterior drawer, pivot shift, and anterior subluxation tests (using the Stryker KT 1000), each graded 0 to 3. All patients have shown a statistically significant improvement between preoperative and postoperative knee scores (P < .0001). According to the knee scoring scale, 34 patients (68%) were clinically rated as excellent, 12 (24%) as good, 4 (8%) as fair, with no poor results. All patients have returned to pre-injury jobs (or school), while most resumed some level of sporting activities. No patients complained of patella femoral symptoms postoperatively. Complications included pain over the staple which was used for fixing the ITB to the tibia, requiring removal in 5 patients. These preliminary results are encouraging, with 92% of the patients rating good to excellent. This modified procedure offers advantages over other procedures, as it is entirely arthroscopic with minimal incisions, does not damage the extensor mechanism, and permits an enhanced rehabilitation program.
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PMID:A prospective, clinical study evaluating arthroscopic ACL reconstruction using the semitendinosus and iliotibial band: 2- to 5-year follow up. 904 89

The authors reviewed early clinical results in two groups of patients treated by arthroscopy-assisted (group I) and miniarthrotomy (group II) anterior cruciate ligament reconstruction. An autogenous midthird patellar tendon was used in all cases. Both groups were similar in regard to age, sex and type of injury; the same postoperative rehabilitative protocol was used. The data collected included total surgery time, blood loss, pain medication use, length of hospital stay, Lachman test results at 2, 6 and 12 weeks postoperatively; pivot shift test supplemented Lachman test at 6 months follow-up. Two statistically significant differences were found only: the blood loss was smaller in group I and surgery time was shorter in group II. Range of motion was better in group I only initially; at three months follow-up no differences were noted. The study results suggest that both open and arthroscopically assisted ACL reconstruction with midthird patellar tendon graft yield similar early clinical results.
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PMID:[Arthroscopy or arthrotomy in anterior cruciate ligament reconstruction with autogenous bone-tendon-bone-graft]. 937 70

The objective of this study was to arthroscopically analyse the morphology and dynamics of variants of the anterior horn of the medial meniscus of the knee (VAMM) and to then consider the pathological significance of these variants. VAMM was defined as knees in which the anterior horn of the medial meniscus is not attached to the tibia. Between April 1992 and March 1995, arthroscopy was performed on 953 knees of 903 patients. At the time of this examination, observation and probing were performed to determine the condition of the synovium, the synovial plica, the cartilage in all compartments, the meniscus, the cruciate ligaments, and the popliteal tendon. In particular, detailed examination was made of the anterior horn of the medial meniscus with regard to the point of insertion to the tibia and the degree of movement in knee flexion/ extension. Cases of VAMM diagnosed on the basis of the arthroscopic findings were classified into the following four categories: the ACL (anterior cruciate ligament) type, where the anterior horn of the medial meniscus was attached to the ACL; the transverse ligament type, where the anterior horn of the medial meniscus was attached to the transverse ligament; the coronary ligament type, where the anterior horn of the medial meniscus was attached to the coronary ligament; and the infrapatellar fold type, where the anterior horn of the medial meniscus was attached to the infrapatellar synovial fold. These patients were then analyzed with regard to the arthroscopic findings and the intra-articular lesions other than VAMM. In 98 (10.9%) of the total patients, 103 knees were classified as VAMM. Classification of those 103 knees using the above criteria showed 39 ACL type knees, 51 transverse ligament type knees, 11 coronary ligament type knees, and 2 infrapatellar fold type knees. The arthroscopic findings indicated that the anterior horn of the medial meniscus was not attached directly to the tibia in any of these knees. Probing and flexion/extension of the knee revealed hypermobility at the anterior horn of the medial meniscus. In this study, anterior knee pain syndrome was diagnosed in 12 (11.7%) of the 103 VAMM knees. In addition, there was no clear history of trauma in 20 of 23 knees found to have an isolated medial meniscus tear. In these cases, even detailed arthroscopic observation proved the causes of the symptoms or injury. On the basis of these findings, we surmised that the anterior portion shows hypermobility at the time of flexion/extension of the knee, regardless of the type of VAMM. In this study, we discussed the possibility that the existence of VAMM may become the cause of pain or injury to the meniscus.
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PMID:Arthroscopic studies of variants of the anterior horn of the medical meniscus. 944 26


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