Sensibility loss after ACL reconstruction with hamstring graft.

Injury to the infrapatellar branch of the saphenous nerve (IPBSN), is known to cause regional hypoesthesia of the lower leg after anterior cruciate ligament (ACL) reconstruction. The aim of this study was to determine if the orientation of the graft harvest incision does influence the prevalence of postoperative hypoesthesia. Furthermore,to describe change, if any, of the hypoesthetic area, during the first postoperative year. Our hypothesis was that an oblique incision parallel to the nerve branch would reduce the incidence of this complication and the area with hypoesthesia after ACL reconstruction, compared to the vertical incision. Secondly, that the area with hypoesthesia is reduced over time. Fifty patients underwent a primary ACL reconstruction using hamstring graft. Twenty-five patients were operated using a vertical incision for graft harvest,and 25 were operated using a slightly oblique incision. Twelve days after surgery and at a one year follow-up the patients had their sensibility of the lower leg examined. We found that hypoesthesia is a common complication (88%) after hamstring ACL surgery. Change from vertical to slightly oblique incision did not reduce the morbidity.Furthermore, the area with sensory loss,felt by the patient shortly after surgery, was shown to decrease significantly by 46.3 percent after one year.

Swimmers' painful shoulder arthroscopic findings and return rate to sports.

Shoulder pain is the most common musculo-skeletal complaint in competitive swimmers. It remains one of the shoulder pain syndromes in overhead athletes where no golden standard of treatment exists. Eighteen competitive swimmers who all had undergone shoulder arthroscopy for therapy-resistant shoulder pain were retrospectively evaluated with respect to operative findings and ability to return to their sport after the operation. The most common finding at arthroscopy was labral pathology in 11 (61%) and subacromial impingement in five shoulders (28%). Operative procedures included debridement in 11 swimmers, partial release of the coraco-acromial ligament in four, and bursectomy in four. Sixteen (89%) responded to the follow-up evaluation. Nine swimmers (56%) were able to compete at preinjury level after 4 (2-9) months. Findings at arthroscopy suggest that the term "Swimmer's shoulder" covers a variety of pathologies including labral wearing and subacromial impingement. Arthroscopic debridement of labral tears or bursectomy in swimmers with shoulder pain has a low success rate with regard to return to sport. Further understanding and investigation of this syndromes complex pathophysiology is needed.

Mechanism of anterior cruciate ligament injuries in soccer.

One hundred and thirteen patients, consecutively admitted to our clinic with an anterior cruciate ligament (ACL) rupture sustained while playing soccer, were surveyed and the mechanism behind their injury analyzed. The diagnosis was made arthroscopically or by instrumented laxity testing. The findings showed that the vast majority of the injuries were of the non-contact type and that very few were associated with foul play. No player positions were over- or underrepresented and goal keepers are apparently just as prone to ACL injury as their teammates. The findings of this study have helped our understanding of the mechanism behind ACL injuries in soccer and could be an aid to establishing future prophylactic measures. The findings also emphasize that certain injury mechanisms on the soccer field should alert the physician and draw his attention to a possible ACL injury.

Clinical findings in competitive swimmers with shoulder pain.

We clinically evaluated 36 competitive swimmers who had shoulder pain; the majority were women. Twenty-three swimmers had unilateral shoulder pain and 13 had bilateral pain, making a total of 49 painful shoulders. Shoulder pain had been present significantly longer in swimmers with bilateral shoulder pain (mean, 104 weeks) than in swimmers with unilateral pain (mean, 33 weeks). Twelve shoulders exhibited signs of impingement without excessive humeral head translation. In 25 shoulders, concomitant signs of impingement and increased glenohumeral translation, together with a positive apprehension sign, were found. Four swimmers, who were generally joint hypermobile, exhibited bilateral impingement signs and excessive humeral head translation, most commonly in the anteroinferior direction. Four shoulders had excessive humeral head translation and apprehension without impingement. Lack of coordination in the scapulohumeral joint was seen significantly more often in symptomatic than in asymptomatic shoulders. Hawkin's test for impingement was more sensitive than Neer's test. Swimmers with shoulder pain have variable clinical findings. The majority demonstrate signs of impingement and increased humeral head translation in the anteroinferior direction together with a positive apprehension sign. This nontraumatic instability might result from wearing of the anteroinferior capsuloligamentous complex. The different clinical findings might represent different stages of the same condition.

Prophylaxis for the prevention of venous thromboembolism after total knee arthroplasty. A comparison between unfractionated and low-molecular-weight heparin.

We compared the efficacy and safety of low-molecular-weight heparin with that of low-dose unfractionated heparin in the prevention of venous thromboembolism after total knee arthroplasty in a prospective, randomized, multicenter trial. One hundred and eighty-five patients were randomly assigned to two groups: ninety-two received low-molecular-weight heparin (forty milligrams of enoxaparin the evening before the operation and once a day subsequently) and ninety-three received unfractionated heparin (5000 international units the evening before the operation and three times a day thereafter). The prophylaxis was continued until bilateral ascending venography was performed six to nine days after the operation or, if venography was not done, until the eighth postoperative day. Venography revealed a prevalence of deep-vein thrombosis of 27 per cent (twenty-five of ninety-three patients) in the group that received unfractionated heparin and 23 per cent (twenty-one of ninety-two patients) in the group that received low-molecular-weight heparin. The difference was not significant (p = 0.6). Five patients (5 per cent) who received unfractionated heparin and 3 patients (3 per cent) who received low-molecular-weight heparin had a deep-vein thrombosis in the proximal veins. Two patients who received unfractionated heparin and one who received low-molecular-weight heparin had clinical symptoms suggestive of a pulmonary embolism. None of these three patients had a positive ventilation-perfusion scan. There were no deaths, major bleeding episodes, or wound hematomas necessitating operative intervention or discontinuation of the anticoagulation in the series.(ABSTRACT TRUNCATED AT 250 WORDS)

[Consequences of arthroscopic meniscal resection]. / Følger efter artroskopisk meniskresektion.

The functional and radiological consequences of arthroscopic meniscal resection were assessed in an 8.5 years follow up of 136 patients. Twenty three percent had undergone re-arthroscopy. Function related pain in the operated knee was reported by 44% of the patients. Radiological degenerative changes appeared in significantly more of the operated knees than in the knees not operated. The combination of varus knees and resection of the medial meniscus or valgus knees and lateral resection was associated with significantly more degenerative changes than after resection in knees with normal alignment. Resection of flap tears was associated with more re-operations and more function related knee pain than resection of bucket-handle lesions.

Increased blood loss after preoperative NSAID. Retrospective study of 186 hip arthroplasties.

We have evaluated bleeding during and after hip replacement in 186 patients in relation to preoperative intake of nonsteroidal anti-inflammatory drugs (NSAID) combined with low molecular weight heparin. NSAID was associated with increased preoperative bleeding and blood transfusion requirements.

Soreness in lower extremities and back is reduced by use of shock absorbing heel inserts.

Soccer referees participating in large soccer tournaments may develop overuse injuries. In this study the effect of shock absorbing heel inserts in the incidence of soreness was investigated. Forty-eight referees were randomly selected to wear shock absorbing heel inserts (SAH) in the 5 day-tournament, while 43 referees were the control group. A daily questionnaire inquiring about complaints from the locomotive system was completed for each referee and in case of any soreness they were examined by doctors to document and classify the anatomical site. Calf, thigh, back, achilles tendon and knee were the most common localizations of overuse symptoms. The incidence of soreness in achilles tendon, calf and back were significantly reduced by the use of (SAH) inserts.

Arthroscopic partial meniscectomy: a long-term follow-up.

A follow-up study was conducted to clarify the clinical and radiological long-term consequences of arthroscopic meniscus resection. One hundred thirty-six patients who had unilateral arthroscopic resection of an isolated meniscal tear attended for an interview and a physical and radiological examination. Follow-up averaged 8.5 years, with a range of 7.9-11.6 years. The reoperation rate was as high as 22.8%, but was the lowest in the bucket handle tear group (13%). Pain after exercise was less frequent among patients treated for a bucket handle tear compared to other lesions. Fifty-three percent of the patients had at least one of the Fairbanks change in the operated knee and only 22% in the control knees. The radiographic result was not influenced by the type of meniscus lesion nor were high age or intraoperatively described cartilage damage factors of significance. Malalignment less than 4 degrees of valgus and greater than 10 degrees of valgus was found to be a significant risk factor for the development of degenerative changes following meniscus resection.

Thromboprophylaxis in patients with hip fractures: a prospective, randomized, comparative study between Org 10172 and dextran 70.

A prospective, randomized, assessor-blind trial has been undertaken to compare the thromboprophylactic effect and safety of the heparinoid Org 10172 (a mixture of low molecular-weight sulfated glycosaminoglycuronides) and dextran 70 in patients operated on for hip fracture. Prestudy biostatistical calculations led to the need for 260 patients. Three hundred eight patients were randomized and 19 were excluded after randomization, the majority because of postponed surgery. Analyses were made on the 289 patients on an intention-to-treat basis, as well as on the 247 patients given correct prophylaxis. Diagnosis of deep vein thrombosis was based on bilateral ascending phlebography on postoperative days 10 through 12. The frequency of deep vein thrombosis on an intention-to-treat basis was 10% in the Org 10172 group and 30% in the dextran 70 group and, on the basis of correct prophylaxis, 12% and 31%, respectively, both differences being significant (p less than 0.001). Two-month mortality rates were equal in the groups. Three fatal pulmonary emboli were seen in the dextran group. Significantly more patients in the dextran group received postoperative transfusions; no other differences in various hemorrhagic parameters were seen. Thus it can be concluded that Org 10172 has a significantly better thromboprophylactic effect than does dextran in patients with hip fractures without significant side effects.

Postoperative pain treatment after open knee surgery: continuous lumbar plexus block with bupivacaine versus epidural morphine.

The anesthetic and side effects of a continuous lumbar plexus block ("3-in-1" block) were compared with that of epidurally administered morphine after open knee surgery. Twenty-two patients were randomized into two groups in this prospective, double-blind study. At the end of surgery, catheters were inserted for all the patients into both the femoral nerve sheath and the epidural space. Pain treatment was given as either bupivacaine in the femoral catheter or morphine in the epidural catheter, with saline in the other catheter. All treatments were given as a bolus dose followed by continuous infusion. If the patients had pain, they were given morphine intramuscularly on demand. The pain scores and supplemental morphine consumption were low in both groups and did not differ significantly. Lumbar plexus block produced a statistically significant a lower incidence of nausea, vomiting, pruritus and urinary retention. Although no significant differences in pain relief were shown between the two methods, we conclude that postoperative lumbar plexus block is preferable for postoperative pain relief because there is a lower frequency of side effects.

The use of fibrinogen uptake test in screening for deep vein thrombosis in patients with hip fracture.

255 hip fracture patients were studied by 125I-fibrinogen uptake test and bilateral phlebography. We found the sensitivity of fibrinogen scanning to be 44% for the non-operated limb and 50% for the calves. The predictive value of a negative result was found to be 92% and 93% respectively. We conclude that the use of fibrinogen uptake test as single diagnosticum is not valid and can only be recommended in combination with phlebography when studying patient where the frequency of DVT is expected to be low.

A long-term follow-up of the effect of repeated corticosteroid injections for stenosing tenovaginitis.

Ninety-three consecutive adult patients with stenosing tenovaginitis of 104 digits have been treated by corticosteroid injections repeated at three week intervals up to thrice in partial responders. At follow-up after 3-15 years, partial relapse had occurred in two patients, who now and then experienced triggering but without pain or locking. Complete relief of symptoms was obtained in 76%. There were no complications and the success rate was independent of sex, age, duration of symptoms, the digit involved, or associated diseases. These results are superior to those previously reported following a single injection.