Ultrasound Versus Landmarks for Great Toe Arthrocentesis.

BACKGROUND: Several studies have demonstrated ultrasound (US) is superior to traditional landmark (LM)-based techniques for large and medium joint aspiration; however, no studies of sufficient size have evaluated these interventions in the smaller toe joints. The purpose of this study was to determine if US provides an advantage over LM for successful first-pass aspiration of first metatarsophalangeal joint (1st MTPJ) effusions. METHODS: A cross-over, cadaveric trial evaluating the interventions of US and LM. Eighteen emergency medicine residents performed four US and four LM aspirations each of 1st MTPJ effusions simulated in fresh-frozen cadavers. The initial intervention utilized was randomized. The primary outcome measured was aspiration success or failure. A secondary outcome measured was time in seconds taken to complete a successful aspiration. RESULTS: A total of 144 1st MTPJ aspirations were attempted-72 by US and 72 by LM. US was the initial intervention used in 9 of 18 (50%) participants. Fifty-seven of 72 (79.2%) US attempts were successful, while 53 of 72 (73.6%) LM attempts were successful (95% confidence interval 69.5%, 83.3%; p = 0.56). Successful US aspirations took 43.7 seconds (±31.0), whereas successful LM aspirations averaged 34.0 seconds (±24.3). The mean difference in time to successful aspiration was 9.7 seconds (95% confidence interval 20.3, -0.9; p = 0.07). There was no statistically significant difference in success and time between US and LM. CONCLUSION: In this study, US did not prove superior to LM for first-pass aspiration of 1st MTPJ effusions.

Autologous hamstring anterior cruciate ligament reconstruction in patients older than 40.

The primary objective in this retrospective review was to assess the patient-specific outcomes and clinical utility of anterior cruciate ligament (ACL) reconstruction using the autologous quadruple-band hamstring technique in patients older than 40. Study results agree with the recent literature and demonstrate the effectiveness of an alternative to the bone-patellar tendon-bone (BPB) technique-an alternative with potentially decreased postoperative morbidity. Results also support the recent conclusion that age alone should not be a limiting factor in whether ACL reconstruction should be performed. We found that appropriately selected patients may experience significant improvements in stability, function, and pain after ACL reconstruction with the quadruple-band hamstring autograft technique. For outcomes after ACL reconstruction, there seems to be no significant difference between the sexes or between patients with and without associated injuries in this population. This study also supports use of the autologous hamstring technique as a viable option for older patients-with results similar to those of the BPB technique. The autologous hamstring technique was associated with excellent patient satisfaction and excellent functional outcome with limited postoperative morbidity. This technique may become the preferred approach for the older athlete, given its limited morbidity and equivalent clinical stability.