Efficacy of rofecoxib for pain control after knee arthroscopy: a prospective, randomized, double-blinded clinical trial.

PURPOSE: To determine if rofecoxib 50 mg administered 1 hour preoperatively to patients undergoing arthroscopic knee surgery reduces postoperative pain, provides a narcotic-sparing effect, and reduces time spent in recovery. TYPE OF STUDY: Prospective, randomized, double-blinded clinical trial. METHODS: Fifty patients (age range, 30 to 60 years) undergoing knee arthroscopy under spinal anesthesia were randomized to receive either 50 mg of rofecoxib or placebo 1 hour preoperatively. Postoperatively, pain was assessed in recovery, 8 hours postoperatively, and 24 hours postoperatively, using a 100-mm visual analog scale. Pain medication usage was monitored for 24 hours and time in recovery room was determined. Mann-Whitney tests determined significance between groups. RESULTS: Patients in the rofecoxib group showed significantly lower pain scores at 8 and 24 hours postoperatively. They also showed a significant reduction in postoperative narcotic consumption. CONCLUSIONS: Rofecoxib 50 mg as a single preoperative dose should be considered as part of a perioperative analgesic plan in arthroscopic knee surgery. LEVEL OF EVIDENCE: Level I, Therapeutic Study (randomized controlled trial).

Quadriceps tendon rupture.

Rupture of the quadriceps tendon is an uncommon yet serious injury requiring prompt diagnosis and early surgical management. It is more common in older (>40 years) individuals and sometimes is associated with underlying medical conditions. In particular, bilateral spontaneous rupture may be associated with gout, diabetes, or use of steroids. Clinical findings typically include the triad of acute pain, impaired knee extension, and a suprapatellar gap. Imaging studies are useful in confirming the diagnosis. Although incomplete tears may be managed nonsurgically, complete ruptures are best treated with early surgical repair.

Rheumatoid arthritis of the wrist.

The wrist is the most commonly involved joint in the upper extremity of patients with rheumatoid arthritis. Up to 75% of patients will develop wrist problems during the course of the disease. Cartilage degeneration and synovitis cause the typical skeletal erosions, ligamentous laxity, deformity, and tendon problems seen in the disease. Treatment involves a multidisciplinary approach with careful coordination of the primary care physician, rheumatologist, orthopaedic surgeon, and other members of the care team. As rheumatoid arthritis is a systemic, polyarticular disease, it is critical to consider the entire patient in any management decision. Initial management is usually non-operative and involves pharmacological treatment, activity modification, and possibly bracing. Operative treatments are geared to limit the negative effects of the disease, namely pain, loss of function, and deformity. Numerous procedures have been described. Common procedures from tenosynovectomy/synovectomy, distal radio-ulnar joint arthroplasty, arthrodesis, and total wrist arthroplasty are reviewed.