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

We report on the results of a prospective randomised controlled trial to evaluate the use of an intra-articular drain following arthroscopically assisted ACL reconstruction using patellar tendon autograft. Forty-nine patients were recruited for the trial and randomised into receiving or not receiving a drain following surgery. An independent observer who was blinded for the use of the drain assessed the knees for swelling, range of movement (ROM) and pain at 2, 4 and 6 weeks postoperatively. Muscle strength was assessed at 12 weeks following surgery using the KIN COM III isometric dynamometer. We found that the knees that were drained following surgery initially had less swelling and a better ROM. However, at 4 weeks this difference had disappeared. At 3 and 6 months, there was no functional difference between the two groups. We recommend that no drain be used following ACL reconstruction as removal of the drain is uncomfortable and carries theoretical and avoidable risks.
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PMID:Arthroscopically assisted ACL reconstruction. Is a drain necessary? 1289 51

We evaluated 13 reconstructions of the lateral collateral ligament (LCL) of the knee associated with a reconstruction of the ACL (n=6) and PCL (n=7). In all cases the LCL was reconstructed using a semitendinosus tendon graft through a tunnel in the fibular head and fixed in anatomical insertion of LCL at lateral femoral condyle. Patients were evaluated using the IKDC form. Lateral joint opening and posterior tibial translation were studied by radiographic stress views. The follow-up average was of 60 months (38-93). In the ACL group five patient were symptoms free while one reported moderate pain after strenuous activity. The lateral stress radiographs showed lateral joint opening of 0-2 mm in five knees, and 3-5 mm in one. In the PCL group four patients were symptom free while three complained mild to moderate pain or swelling. Lateral joint opening was 0-2 mm in six knees and 3-5 in one. External rotation at 30 degrees of flexion was 10 degrees in one and between 0-5 degrees in the remainder. Eleven of 13 patients returned to their preinjury level and two returned to one level lower. These findings indicate that the LCL can be successfully reconstructed with a free ST graft at the time of ACL or PCL reconstruction.
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PMID:Lateral collateral ligament reconstruction using a semitendinosus graft. 1461 86

Fifty patients were randomly recruited to receive either femoral nerve block (0.375% Bupivacaine) or an intraarticular local anaesthetic injection for pain control for arthroscopically-assisted ACL reconstruction. Both groups were evenly matched for age ( t-test p >0.05). Tourniquet time did not differ significantly between the groups ( t-test p=0.24). The VAS pain levels were not significantly different at 4 h and the first morning postoperatively in both groups. Femoral block (Median VAS: 20 & 18.5) did not confer a significant advantage (Mann Whitney U test p =0.36, 0.67) over intraarticular injection of bupivacaine (Median VAS: 18 & 20). There was no correlation between tourniquet time and postoperative pain ( r=0.19, 0.08). All patients but one were discharged home on the first postoperative morning. Our study demonstrates that pain levels can be sufficiently controlled by intraarticular infiltration of bupivacaine coupled with oral analgesia. The level of pain relief achieved could allow this procedure to be performed in a day surgery setting.
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PMID:BTB ACL reconstruction: femoral nerve block has no advantage over intraarticular local anaesthetic infiltration. 1474 Jan 55

Osteochondral lesions and osteoarthritis in young patients are often caused by chronic knee instability in varus malaligned knees. We present the indication, operative technique, and results of 57 patients treated by simultaneous high tibial osteotomy and cruciate ligament reconstruction. The indication for simultaneous high tibial valgus osteotomy and ACL reconstruction is chronic anterior knee instability in varus knees of patients under 40 years of age. In these patients, medial meniscus deficiency secondary to prior injuries and/or chronic knee instability have frequently led to unicompartmental (medial) tibiofemoral degenerative changes. The average correction angle of the osteotomy was 7 degrees (4-10). Subjectively, all patients reported an improvement of preoperative swelling, pain, and instability. Additional cartilage surgery or meniscus implantation did not significantly alter the clinical score values. Complications occurred in four patients. Unstable varus malangulated knees can be sufficiently treated by osteotomy and cruciate ligament plasty and is suggested as cost-effective therapy with good short-term results. Performing both operations in one procedure facilitates early rehabilitation and return of the patients back to the activities of daily living and sports.
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PMID:[Corrective osteotomy in primary varus, double varus and triple varus knee instability with cruciate ligament replacement]. 1487 12

A total of 344 patients underwent bilateral total knee replacement (TKR) using a different prosthesis on each side. Four knee prostheses were used: anterior and posterior cruciate-retaining (ACL-PCL), posterior cruciate-retaining (PCL), medial or lateral pivot (MLP), and posterior cruciate-substituting (PS). All patients had good or excellent results. The range of movement, relief from pain, alignment, and stability did not vary among any of the prostheses. Forty-one of 46 patients (89%) preferred the ACL-PCL to the PS knee and 27 of 35 patients (77%) the MLP knee to the PS knee. Of the patients with an ACL-PCL knee on one side and a MLP on the other, an equal number preferred each type. The MLP knee was preferred to the PCL by 34 (79%) patients. PS and PCL knees were preferred equally. Patients with bilateral TKRs preferred retention of both their cruciate ligaments or substitution with a medial or lateral pivot prosthesis.
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PMID:Patient preferences in knee prostheses. 1604 58

Mucoid degeneration of the ACL is an unusual entity that has only been recently described. The imaging features of this entity have been described to a sufficient degree to provide diagnostic criteria, and its appearance can be characteristic. It is important to recognize this entity as a chronic process as its presentation and appearance can mimic a tear of the ACL. The etiology of mucoid degeneration of the ACL is unclear, but it may represent part of a continuum between early degeneration of the collagen fibrils of the ACL and frank formation of a ganglion cyst. The mucoid degeneration usually produces symptoms similar to those of an intra-articular mass, but pain may also be associated with this process. Treatment may require partial or complete resection of the ACL, but percutaneous aspiration of the fluid components of the affected ACL may also be effective at alleviating the associated symptoms.
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PMID:Mucoid degeneration of the anterior cruciate ligament: a case report. 1549 Aug 57

Daycase ACL reconstruction is commonly performed under general anaesthesia with a patella tendon graft. We report our experience with hamstring reconstruction under regional anaesthesia. Over a 14-month period, 104 daycase arthroscopic ACL reconstructions were performed by one surgeon and one anaesthetist. All operations were performed under spinal anaesthesia with a femoral nerve block. Patients were discharged with oral analgesia, brace and a cryocuff. One hundred and two patients were prospectively evaluated with a visual analogue pain score (0-10) and a patient satisfaction questionnaire. Of these 102 patients, 101 (99%) were happy to be discharged on the same day. One patient was admitted from the daycase unit, and one patient was re-admitted. Patients were very satisfied with the pain relief provided. The mean visual analogue pain score was 1.0 at discharge, 1.8 in the middle of the first night, and 2.1 on the first post-op day. Patients experienced significantly more pain the day after surgery than the evening of surgery (p=0.04). We conclude that hamstring ACL reconstruction under regional anaesthesia is well tolerated by patients as a daycase procedure.
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PMID:Daystay hamstring ACL reconstruction performed under regional anaesthesia. 1602 96

We prospectively assessed 51 arthroscopy assisted anterior cruciate reconstructions done over two years as day cases. We looked at the clinical results, postoperative pain control and patient satisfaction. There were 45 males and 6 females, with ages ranging from 18 to 52 years. A hamstring graft was used in 38 patients while 13 patients had reconstructions using the patellar tendon. Forty-nine patients were successfully discharged on the same day while 2 patients had to be admitted due to excessive drainage. Six patients had additional procedures at the time of surgery. The mean time interval from injury to surgery was 27 months (range: 2 to 180). Forty-six patients had an excellent to good outcome as regards satisfaction with one poor result. Pain control was not a major issue with any of the other patients included in the study. Our study demonstrates that day case arthroscopic ACL reconstruction is a safe procedure with minimal to absent morbidity.
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PMID:Day case anterior cruciate ligament reconstruction: a study of 51 consecutive patients. 1603 4

Rehabilitation after ACL (anterior cruciate ligament) reconstruction has drastically changed over the last decade, with the adoption of a more aggressive approach, right from the first day after surgery. Progress in the effectiveness of rehabilitation is based on improvements in operative techniques, as well as on the encouraging results of histological studies regarding graft healing. Despite a huge amount of research papers on this topic, a rehabilitation golden standard still has not been established, due to the complexity of this problem. In this review, we point out the basic principles of rehabilitation after arthroscopically assisted ACL reconstruction based on actual practices, as well as the importance of specific procedures for the prevention of complications during the postoperative period. The importance of range-of-motion exercises, early weight bearing, an appropriate gait scheme, patella mobilisation, pain and oedema control, as well as stretching and balance exercises is explained. The functional advantages of closed kinetic chain exercises, as well as their influence on the graft are also described, in comparison to open kinetic chain exercises. The fundamentals of returning to sports are revealed and the specific aspects of rehabilitation regarding graft choice are pointed out. While waiting for new clinical investigations, which are expected to enable the establishment of a rehabilitation golden standard, the outlined principles should be followed. The complexity of this injury requires treatment in highly specialised institutions.
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PMID:[Basic principles of aggressive rehabilitation after anterior cruciate ligament reconstruction]. 1675 56

Meniscal substitution is a fundamental procedure to prevent osteoarthritis of the knee after massive meniscectomy. Stone, Steadman and Rodkey have developed a bioreadsorbable collagen matrix (CMI) which acts as a scaffold to restore the original medial meniscal. The objective of this study was to prospectively evaluate the results of CMI implantation at a follow up from a minimum of 6 to a maximum of 8 years. Eight patients (mean age 25) were evaluated at a final observation point from 6 to 8 years after CMI implantation. Inclusion criteria were an irreparable meniscal tear or a previous meniscectomy involving the medial meniscus. Follow up evaluation included Cincinnati Knee Rating Scale (CKRS), IKDC, subjective evaluation and X-ray and MRI control. There were no complications related to the device. All patients were able to return to day activities without limitations 3 months after surgery. Both subjective CKRS score and objective IKDC score showed improvement in all cases except one patient with an ACL re-injury. In two cases scores were slightly worse from 2 years after surgery to the final observation point. The other five cases obtained maximum score at final follow-up. In four cases the absence of pain remained until the final observation point, while in four cases a low entity of pain was described at long term follow-up. MRI showed in five cases mixoid degeneration signal, two had normal signal with reduced size, while one patient had no recognizable implant. Six patients had preserved cartilage and articular space, with no changes respect to pre-op control. Arthroscopic second look evaluation has been performed in three cases, revealing in two cases the presence of the implant, although with a reduced size respect to the original one, while in one case the CMI was almost disappeared. Our small series of eight patients prospectively followed from 6 to 8 years of follow-up has shown highly satisfactory results. Although the aspect of the implant was mostly abnormal, the implant may have helped reduce the deterioration of the knee joint at final observation time.
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PMID:Arthroscopic collagen meniscus implant results at 6 to 8 years follow up. 1684 45


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