Periarticular injection and hamstring block versus placebo for pain control in anterior cruciate ligament reconstruction: A randomized controlled trial.

PURPOSE: To study the effectiveness of periarticular infiltration (PI), including the proximal donor site vs. placebo in anterior cruciate ligament (ACL) reconstruction. METHOD: A total of 44 patients were randomized in two groups assigned to receive PI or placebo. The perioperative protocol was the same for both groups. The principal outcome was pain measured at 8 and 24 h by a visual analog scale (VAS). The pain was registered in the knee and the proximal donor site. Pain scores were also assessed to determine whether the VAS improvement would reach the threshold values reported for the minimal clinically significant difference. The secondary outcome was the need for opioid rescue medication. RESULTS: Patients receiving PI exhibited lower pain values in the knee at 8 h (mean PI 35.00 ± 5.76 vs. placebo 60.23 ± 4.52 p = 0.01) and at 24 h (mean PI 37.23 ± 5.62 vs. placebo 55.55 ± 3.41 p = 0.008). These results were above the threshold for clinical significance. No improvements were found in proximal donor site pain and consumption of opioid rescue medication. Complications were comparable between the two groups. CONCLUSION: PI significantly reduced pain in the knee vs. placebo after ACL reconstruction with hamstring autograft at 8 and 24 h after surgery. The instillation of part of the mixture in the proximal hamstring stump did not result in any improvement LEVEL OF EVIDENCE I: Level I, randomized controlled trial.

Effectiveness of hallux valgus surgery on improving health-related quality of life: A follow up study.

BACKGROUND: Hallux valgus (HV) negatively impacts health-related quality of life (HRQoL). Patientreported outcome measures (PROMs) are increasingly used in clinical studies of the foot and ankle. We aimed to evaluate the effect of HV surgery on PROMs (i.e., pain scales, general HRQoL, and region-specific scales) and radiological angles. Additionally, we aimed to determine whether the effect on these outcomes depends on the type of surgery (including open and percutaneous techniques) and if it is influenced by potential confounding factors (i.e., age, HVA, 1-2 IMA, body mass index (BMI), and distal metatarsal articular angle (DMAA). METHODS: This was a longitudinal prospective study. We collected the clinical data of all patients who underwent surgery for symptomatic HV deformity in the orthopedic department of the Virgen de la Luz Hospital of Cuenca (Spain).The clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Hallux metatarsophalangeal-interphalangeal (HMI) scale, visual analogue scale (VAS), Manchester Oxford foot questionnaire (MOXFQ), short form health survey (SF-12) and European Quality of Life-5 Dimensions (EQ-5D). RESULTS: A total of 72 patients (70 women, 97.2%) were included in the study 72 (72 feet).The AOFAS pre-post-surgery score changed from 42.16 (SD: 10.11) to 83.31 (SD: 6.23). Considering AOFAS domains, the pre-post change was from 14.17 (SD: 9.15) to 33.19 (SD: 4.69) for pain, from 27.22 (SD: 3.90) to 37.94 (SD: 2.78) for function, and from 0.78 (SD: 2.38) to 12.18 (SD: 3.45) for alignment. For other clinical outcomes was VAS score from 5.01(SD: 1.26) to 1.26 (SD: 0.96) and MOXFQ score from 61.44 (SD: 7.09) to 12.35 (SD: 4.85). SF-12 (physical) changed from 36.26 (SD: 5.32) to 47.06 (SD: 4.82), SF-12 (mental) from 38.23 (SD: 8.04) to 46.49 (SD: 4.16), and EQ5-D from 0.64 (SD: 0.008) to 0.90 (SD: 0.10). CONCLUSIONS: Our data confirmed the improvements in the clinical and radiological outcomes after HV surgery, and provided some evidence of these improvements not depending on the type of surgery or on some potential confounding factors such as BMI, HVA, 1-2 IMA, and DMAA.

La práctica del Tai Chi previene las caídas en el anciano institucionalizado: un ensayo clínico / The practice of Thai-Chi prevents falls in the institutionalized elderly: a clinical trial

Objetivo. Determinar si la práctica de dos horas de Tai Chi semanal durante 9 meses disminuye el riesgo de caídas en ancianos de edad igual o superior a 65 años. Diseño. Ensayo clínico con aleatorización por grupos sin cegamiento. Emplazamiento. Dos residencias de ancianos de la ciudad de Cuenca. Participantes. Un total de 94 ancianos institucionalizados, de entre 65 y 90 años. Grupo control de 43 y grupo de intervención de 51 practicantes de Tai Chi. Mediciones principales. Mediante entrevista semanal, realizada por uno de los investigadores, se recogieron como eventos principales el número de caídas, número de fracturas, número de tropiezos y pérdidas de equilibrio. Resultados. La incidencia de caídas en el grupo de Tai Chi fue del 13,7% y en el grupo control del 32,5% (p < 0,03); Razón de Riesgo [RR] = 0,42, lo que supone una Reducción de Riesgo (RAR) del 18,8%. Como resultado de estas caídas, 5 ancianos de los controles(11,6%) sufrieron fracturas óseas y ninguna en el grupo de Tai Chi (p < 0,02). Encontramos diferencias estadísticamente significativas en cuanto al número de tropiezos, 16 en el grupo de Tai Chi (31,3%) y 49 en los controles (113,9%) (p<0,04; RR = 0,28; RAR = 0,826).Igualmente las diferencias en el número de pérdidas de equilibrio fue significativa, 12 en el grupo de Tai Chi (23,5%) y 37 en el grupo control (86%) (p < 0,02; RR = 0,27; RAR =0,625).Conclusiones. La práctica regular de Tai Chi probablemente disminuye el número de caídas, la incidencia de fracturas, el número de tropiezos y las pérdidas de equilibrio en pacientes ancianos institucionalizados (AU)

Objective. To determine whether practicing Thai Chi for 2 hours a week for 9 months decreases the risk of falls in elderly people aged 65 years or over living in residential care homes. Design. Randomised, non-blind clinical trial with two groups. Setting. Two residential care homes in the city of Cuenca. Participants. A total of 94 institutionalized elderly persons between 65 and 90 years. The control group comprised 43 persons and the Thai Chi group 51 persons. Main measurements. The main measurements were number of falls and their severity, the number of stumbles and losses of balance determined by a weekly interview with one of the investigators. Results. The incidence of falls was 13.7% in the Tai Chi group and 32.5% in the control group. (p <0.03); Relative Risk, (RR) = 0.42, representing a risk reduction of 18.8%. Five elderly persons in the control group (11.6%) and none in the Thai Chi Group (p< 0.02) suffered bone fractures as result of the falls. We found significant differences in the number of stumbles, 16 in the Thai Chi group (31.3%) and 49 in control group (113.9%) (p<0.04;RR = 0.28; RAR = 0.826). Likewise, the differences in the number of losses of balance was significant, 12 in the Thai Chi group (23.5%) and 37 in the control group (86%) (p < 0.02;RR = 0.27; RAR = 0.625).Conclusions. Regular Thai Chi practice may reduce the number of falls, the incidence of bone fractures, the number of stumbles and losses of balance in elderly people living in residential care homes (AU)