The effect of autotransfusion system in minimally invasive total knee arthroplasty.

PURPOSE: To evaluate the effect of autotransfusion system in minimally invasive total knee arthroplasty (TKA). MATERIALS AND METHODS: Seventy-one patients who underwent unilateral minimally invasive TKA between October 2009 and June 2010 were selected. The first group included 36 patients who received standard vacuum drainage and the second group, 35 patients who underwent autologous retransfusion drainage. In the first group, allogeneic blood transfusion was performed if the postoperative hemoglobin level was <7.0 g/dL or 7.0-8.0 g/dL with the presence of a medical complication and an anemic symptom. The second group received autotransfusion and allogeneic transfusion additionally according to the same criteria. Changes in the pre- and postoperative hemoglobin level, amount of auto- or allotransfusion, and frequency of allogeneic transfusion were assessed. RESULTS: Allogeneic transfusion was required in 13 patients (36.1%) in the first group and four patients (11.4%) in the second group. The mean allogeneic transfusion volume was significantly low in the second group compared to the first group (64.4 mL vs. 278.9 mL; p<0.05). The hemoglobin level on the 1st postoperative day compared to the preoperative level decreased by 22.6% in the first group and 11.7% in the second group. The postoperative hemoglobin level was higher in the second group (p<0.05). CONCLUSIONS: Minimally invasive unilateral TKA with an autotransfusion system can be beneficial in patients with no medical complications because of the decreased allogeneic transfusion.

Biomechanical evaluation of double bundle augmentation of posterior cruciate ligament using finite element analysis.

BACKGROUND: Posterior cruciate ligament injuries commonly occur during sports activities or motor vehicle accidents. However, there is no previous comparison study of single bundle reconstruction, double bundle reconstruction, and double bundle augmentation with respect to biomechanical characteristics such as stability and ligament stress. METHODS: A three-dimensional finite element model of a lower extremity including femur, tibia, cartilage, meniscus, collagen fibers, and four major ligaments was developed and validated. In addition to the intact, posterior cruciate ligament injured, single bundle reconstruction, double bundle reconstruction, and double bundle augmentation models were developed. Then, the posterior and rotational tibial translations as well as the ligament stresses were predicted for 89 N posterior force and 3 Nm internal torque, respectively, in the normal (no secondary deficiency) and the secondary deficiency cases using finite element analysis. FINDINGS: The posterior stability and ligament stresses following double bundle augmentation were superior to those of single and double bundle reconstructions, especially after secondary deficiency in the reconstructed grafts, despite little difference in posterior stability between double bundle reconstruction and augmentation in the normal case. Similarly, the double bundle augmentation had the greatest rotational stability while there was little advantage in ligament stress compared to those of the other reconstruction method. INTERPRETATION: Double bundle augmentation has advantages with regard to posterior and rotational stabilities as well as ligament stress in comparison with other reconstruction methods, especially following secondary deficiencies in the reconstructed grafts.

Injection-induced pyogenic arthritis of the shoulder joint.

This study reports the clinical results of treatment for injection-induced pyogenic arthritis of the shoulder joint. We followed up 13 patients who underwent operation for the treatment of pyogenic glenohumeral arthritis that developed after injections around the shoulder joint. Cultures identified Staphylococcus aureus in 6 patients and methicillin-resistant S aureus (MRSA) in 4. Finally, the University of California, Los Angeles Shoulder Score improved from 12.7 to 28.3 points. Four of the 9 patients with open surgery and 1 of 4 with arthroscopic surgery had good results; however, the other 8 patients reported poor results. Surgeons must be aware of the possibility of pyogenic arthritis when performing injections, especially in patients with underlying medical diseases. For treatment of injection-induced pyogenic arthritis of the shoulder joint, open surgery may be a better option than arthroscopic surgery.

Patient-controlled analgesia after arthroscopic rotator cuff repair: subacromial catheter versus intravenous injection.

BACKGROUND: No study has compared pain control results between patient-controlled subacromial infusion and intravenous injection after arthroscopic shoulder surgery. HYPOTHESIS: Subacromial infusion of analgesics are more effective in pain alleviation than intravenous injection. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 2. METHODS: The authors prospectively analyzed 40 cases of arthroscopic rotator cuff repair that received patient-controlled analgesia. They divided the 40 cases into 2 groups: subacromial infusion group with 0.5% bupivacaine (group 1, 20 cases) and intravenous injection group with fentanyl and ketorolac tromethamine (group 2, 20 cases). The visual analog scale was used to record the patient's level of pain every 12 hours until postoperative 72 hours and the following 48 hours after the suspension of patient-controlled analgesia. RESULTS: The mean preoperative visual analog scale score during motions was 6.8 in group 1 and 5.8 in group 2. The immediate postoperative visual analog scale score was 7.6 and 7.4, respectively, for each group. At postoperative time periods, most of the scores of subacromial infusion at rest and during motions were lower than those of intravenous injection, but significant differences were not found between groups 1 and 2. CONCLUSION: Patient-controlled analgesia after arthroscopic rotator cuff repair showed that both subacromial infusion of bupivacaine and intravenous injection of fentanyl and ketorolac tromethamine were equally effective and clinically equivalent pain control methods.

Clinical results of arthroscopic bankart repair with knot-tying and knotless suture anchors.

PURPOSE: To compare the results of arthroscopic Bankart repair completed with knot-tying with results of the procedure performed with knotless suture anchors. METHODS: We evaluated 82 patients who underwent arthroscopic Bankart repair. A total of 61 patients were treated with knot-tying suture anchors, and 21 patients were treated with knotless suture anchors during the same period. In all, 75 male and 7 female patients were studied. Mean patient age at the time of operation was 24 years (range, 16 to 42 years), and the mean follow-up period had a duration of 29 months (range, 24 to 41 months' duration). RESULTS: Shoulder scores improved in both groups (P < .05). Postoperative pain, patient satisfaction score, and redislocation rate were significantly different between the 2 groups, with the knot-tying suture anchor group showing better results (P = .007, P = .007, and P = .012, respectively). In the knot-tying suture anchor group, 4.9% (3 patients) experienced redislocation and 1 patient underwent revision surgery. The redislocation rate in the knotless suture anchor group was 23.8% (5 patients), and 4 patients underwent revision surgery. CONCLUSIONS: The knot-tying and knotless suture anchor groups showed improvement in postoperative shoulder scores after arthroscopic Bankart repair. However, results after the knotless technique was performed were unsatisfactory when compared with results in the standard suture anchor group, particularly in terms of redislocation rate. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic study.

Clinical outcome of anterior shoulder instability with capsular midsubstance tear: a comparison of isolated midsubstance tear and midsubstance tear with Bankart lesion.

To analyze the clinical outcomes of patients with a midsubstance capsular tear for anterior shoulder instability, 21 shoulders with a midsubstance tear were reviewed. There were 7 isolated midsubstance tears (group I) and 14 combined midsubstance tears with Bankart lesions (group II). The Rowe score averaged 92.3 points with 6 excellent and 1 good one in group I. Group II scored 86.3 points with 8 excellent, 3 good, 2 fair, and 1 poor (P = .184). The Rowe score averaged 89.8 points for the cases with an arthroscopic procedure and 86.9 points with an open repair (P = .542). At the last follow-up, forward elevation increased by 6 degrees in group I and 8 degrees in group II (P = .432). External rotation decreased by 8 degrees and 16 degrees , respectively (P = .150). The clinical outcomes of anterior instability with a midsubstance tear were good in both groups. The loss of external rotation was greater in the cases with combined midsubstance tears and Bankart lesions than in those with an isolated midsubstance tear.

Long-term results of scapulothoracic arthrodesis of facioscapulohumeral muscular dystrophy.

Many patients with facioscapulohumeral muscular dystrophy eventually have instability of the scapula resulting from weakness of the scapula stabilizers. A subset of patients, however, has sufficient strength in the supraspinatus and deltoid muscles to flex and abduct the arm, if the scapula has been stabilized. The purpose of this study is to report the clinical results of six patients (9 shoulders) that underwent scapulothoracic arthrodesis for the treatment of limited shoulder motion and scapular winging caused by facioscapulohumeral muscular dystrophy. The average preoperative active flexion was 71 degrees , which improved to 109 degrees at the last follow-up. The UCLA Shoulder Score also rose from 18.4 points to 27.9 points at the last follow-up. All patients did well in activities of daily living after the procedure. Scapulothoracic arthrodesis is considered a successful treatment method for facioscapulohumeral muscular dystrophy, as it improves appearance, function, and tolerance to exercise.

Anatomic reconstructive surgery for posterolateral instability of the knee.

PURPOSE: We describe an anatomic reconstructive surgical procedure that simultaneously reconstructs the fibular collateral ligament, popliteal tendon, and popliteofibular ligament using split Achilles allograft, and compare the clinical results of this technique with those of the posterolateral corner sling procedure for posterolateral instability of the knee. TYPE OF STUDY: Case series. METHODS: Forty-six patients were treated for posterolateral instability of the knee between 1998 and 2002. The posterolateral corner sling procedure was performed in 25 patients (group A) and anatomic reconstructive surgery in 21 patients (group B). The minimum follow-up was 12 months. In all cases, arthroscopic evaluation was performed. Clinical review included the Lysholm knee scores and varus laxity and tibial external rotation assessment. RESULTS: The mean Lysholm knee scores were 54.8 points in group A and 54.4 points in group B before surgery, and 86.9 and 93.6 points at the time of the latest follow-up, respectively (P < .05). Tibial external rotation of 5 degrees more than the contralateral uninjured knee was present in 12% of group A and in 5% of group B (P < .05). Varus laxity of 5 mm greater than the contralateral knee was observed in 28% of group A and in 14% of group B (P < .05). CONCLUSIONS: Anatomic reconstruction of the posterolateral corner resulted in less varus laxity and tibial external rotation than did the posterolateral corner sling procedure. LEVEL OF EVIDENCE: Type IV, case series, no or historical control group.

Anterior shoulder stabilization in collision athletes: arthroscopic versus open Bankart repair.

BACKGROUND: Collision athletes are reported to be at high risk for redislocation after anterior stabilization of shoulder instability. Some authors have suggested that arthroscopic stabilization produces results similar to those of open stabilization. PURPOSE: To evaluate the results of anterior shoulder stabilization in collision athletes and to compare the clinical results between the arthroscopic and open methods. HYPOTHESIS: Open stabilization might produce better results than does arthroscopic stabilization in collision athletes. STUDY DESIGN: Cohort study; Level of evidence, 4. METHODS: Forty-eight shoulders of 46 collision athletes were enrolled for this study. The mean age of the patients at the time of surgery was 20 years, and the mean follow-up period was 72 months (range, 30-136 months). Sixteen shoulders underwent arthroscopic stabilization; 32 shoulders had open repairs. RESULTS: Visual analog scale, Rowe, and Constant scores improved after surgery, but no statistically significant difference was found between the arthroscopic and open repair groups. Thirty-seven athletes (83%) returned to near-preinjury sports activity levels (>/= 90% recovery) after operation. Two patients (4%) had subluxation and 6 (12.5%) had redislocation after surgery. The number of shoulders with postoperative subluxation or dislocation was 4 (25%) in the arthroscopic group and 4 (12.5%) in the open group (P = .041). Revision surgery was performed on 5 shoulders (10.4%). CONCLUSIONS: There were 8 (16.5%) instances of postoperative instability among the collision athletes studied. The arthroscopic group yielded a higher failure rate than did the open group. The authors believe open stabilization to be a more reliable method for anterior shoulder instability in collision athletes.