Effect of dexmedetomidine on postoperative pain in knee arthroscopic surgery; a randomized controlled clinical trial

Various drugs are administered intra-articularly to provide postoperative analgesia after arthroscopic knee surgery. The purpose of this study was to assess the analgesic effects of intra-articular injection of a dexmedeto-midine following knee arthroscopy. Forty six patients schadualed for arthroscopic knee surgery under general anaesthesia, were randomly devided into two groups. Intervention group received 1microg/kg dexmedetomidine [D] and isotonic saline. Control group received 25ml isotonic saline [P]. Analgesic effects were evaluated by measuring pain intensity [VAS scores] and duration of analgesia. There was no significant difference between the two groups in terms of age, sex and weight. The mean of post-operation pain severity in 1, 3, 6,12, and 24 h was significantly lower in the intervention group [D] in comparison w] to toe contio] group [P]. toe mean of toe tola] dose oftramado] consumption was significantly lower in the mterven-tion group in comparison with the control group [P<0.001]. Intra-articular injection of dexmedetomidine at the end of arthroscopic knee surgery, alleviates the patients' pain; reducing the postoperative need for narcotics as analgesics, and increase the first analgesic request after operation

Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] in Persian Speaking Patients with Knee Osteoarthritis

Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee Osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee Osteoarthritis. We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity. Reliability testing resulted in a Cronbach's alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool. Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson's correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey [P<0.005] and KOOS [P<0.0001]. The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee os-teoarthritis

[ comparison between the role of MRI and arthroscopy in the diagnosis of traumatic knee lesions]

The knee is one of the most frequently injured joints. Clinical tests in the diagnosis of meniscus and ligament injuries have limitations and it may not be possible to elicit objective signs repeatedly. MRI, has been shown to improve diagnostic accuracy in many knee disorders. Its principal attractiveness over arthroscopy is that, it is noninvasive. To determine the effectiveness of magnetic resonance imaging in the appropriate identification of traumatic intra articular knee lesions, we compared its findings with clinical examination and arthroscopy as a gold standard technique in a descriptive cross sectional study. Overall 100 patients with knee trauma were entered and completed the study. All patients had thorough clinical examination by experienced physicians. An MRI of the affected knee was requested in all patients. Arthroscopies were performed for all of them. Overall 55 knees were reported to have ACL tear arthroscopically, Meniscal injuries were found in 75 cases. We found correlation between posterior drawer test, MRI report of PCL tear and arthroscopic PCL tear. The sensitivity of MRI for detecting Meniscal tear: represented high, for bucket handle tear of medial meniscus, and high specificity for lateral meniscal tear. It is concluded that arthroscopy still remains the gold standard technique. More powerful MRI scan equipments with better soft wares will be needed in order to have much better diagnosis

Is Bristow-Latarjet operation effective for every recurrent anterior shoulder dislocation?

The treatment of recurrent anterior shoulder dislocation in patients who failed a supervised rehabilitation program is operative stabilization. Anatomical repair addressing the underlying pathology is the preferred method. We hypothesize that Bristow-Latarjet procedure is effective in all types of traumatic recurrent anterior shoulder dislocations, although in cases with Bankart lesion, Bankart operation is certainly preferred. Thirty-five shoulders on which a Bristow-Latarjet operation had been performed on account of traumatic recurrent anterior shoulder instability were followed up for an average of 24.6 months [range: 18 - 51]. The clinical outcome was measured according to Walch-Duplay Rating Sheet for Anterior Instability of the Shoulder at the latest follow-up. The clinical outcome was excellent in 11 [31%] patients and good in 24 [69%] patients. Two patients had redislocation that were treated nonoperatively and remained symptom-free at the latest follow-up. Radial nerve palsy occurred in one patient that spontaneously recovered after nine weeks. Although the treatment of anterior shoulder instability in patients with Bankart lesion and intact capsular material [without excessive laxity] is certainly Bankart operation, we claim that in almost all types of anterior shoulder instability, especially in patients with large Hill-Sachs lesions, glenoid bone loss, or excessive capsular laxity, the Bristow-Latarjet operation is associated with good or excellent results and can make the patient satisfied