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1.
Br J Anaesth ; 124(3): 299-307, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31980156

RESUMO

BACKGROUND: Pain after anterior cruciate ligament reconstruction (ACLR) with autologous hamstring graft can be attributed to both arthroscopic surgery and the graft donor site. This study investigated whether donor site pain control was superior with the addition of either peri-hamstring injection or anterior division obturator nerve block in comparison with adductor canal block (ACB) alone. METHODS: Patients scheduled to undergo knee arthroscopy with ACLR using a graft from the ipsilateral hamstring were randomised to one of three groups. All patients received ACB and multimodal analgesia. Subjects in Group H received peri-hamstring local anaesthetic injection while subjects in Group O received an anterior division of the obturator nerve block, and subjects in Group C served as a control group (ACB alone). RESULTS: In 105 subjects undergoing ACLR, there was no significant difference between groups H, O, and C for the primary outcome of pain on movement as assessed by numerical rating scale (NRS) on knee flexion at 2 h after operation (P=0.11). There was no difference in NRS at any time point in the first 48 h after operation, nor was there a difference in oxycodone consumption between the three groups at 24 h (P=0.2). Worst knee pain was initially at the graft donor site in all three groups, which transitioned to anterior knee pain after 12 h. CONCLUSIONS: The addition of ultrasound-guided peri-hamstring injection or anterior division of obturator nerve block to ACB did not result in a significant reduction in pain or opioid consumption after ACLR with ipsilateral hamstring graft. CLINICAL TRIAL REGISTRATION: NCT01868282.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Tendões dos Músculos Isquiotibiais/transplante , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/efeitos adversos , Artroscopia/métodos , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Obturador , Medição da Dor/métodos , Dor Pós-Operatória/etiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodos , Adulto Jovem
2.
J Am Podiatr Med Assoc ; 109(4): 312-316, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762307

RESUMO

Compartment syndromes associated with arthroscopy have been rarely reported. Compartment syndrome after knee arthroscopy has been reported in some case reports, whereas we could find only one case report of acute compartment syndrome following ankle arthroscopy after Maisonneuve fracture. However, there has been no previous report of a case of acute compartment syndrome after ankle arthroscopy in an atraumatic patient. In this article, we present a case of acute compartment syndrome during ankle arthroscopic procedures in an atraumatic patient.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Artroscopia/efeitos adversos , Síndromes Compartimentais/etiologia , Cistos Glanglionares/cirurgia , Instabilidade Articular/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Tornozelo/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino
3.
Sports Health ; 11(6): 520-527, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31584340

RESUMO

CONTEXT: Superior labral anterior-posterior (SLAP) lesions often result in significant sporting limitations for athletes. Return to sport is a significant outcome that often needs to be considered by athletes undergoing the procedure. OBJECTIVE: To evaluate return to sport among individuals undergoing arthroscopic SLAP repair. DATA SOURCES: Four databases (MEDLINE, EMBASE, PubMed, and Cochrane) were searched from database inception through January 29, 2018. STUDY SELECTION: English-language articles reporting on return-to-activity rates after arthroscopic SLAP repairs were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data including patient demographics, surgical procedure, and return to activity were extracted. The methodological quality of included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS: Of 1938 screened abstracts, 22 articles involving a total of 944 patients undergoing arthroscopic SLAP repair met inclusion criteria. Of the total included patients, 270 were identified as overhead athletes, with 146 pitchers. Across all patients, 69.6% (657/944 patients) of individuals undergoing arthroscopic SLAP repair returned to sport. There was a 69.0% (562/815 patients) return to previous level of play, with a mean time to return to sport of 8.9 ± 2.4 months (range, 6.0-11.7 months). The return-to-sport rate for pitchers compared with the return-to-activity rate for nonpitchers, encompassing return to work and return to sport, was 57.5% (84/146 patients) and 87.1% (572/657 patients), respectively, after arthroscopic SLAP repair. CONCLUSION: Arthroscopic SLAP repair is associated with a fair return to sport, with 69.6% of individuals undergoing arthroscopic SLAP repair returning to sport. SLAP repair in pitchers has significantly decreased return to sport in comparison with nonpitching athletes. Athletes on average return to sport within 9 months postoperatively.


Assuntos
Artroscopia/métodos , Traumatismos em Atletas/cirurgia , Volta ao Esporte , Articulação do Ombro/lesões , Articulação do Ombro/cirurgia , Artroscopia/efeitos adversos , Artroscopia/reabilitação , Beisebol/lesões , Humanos , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Reoperação
4.
Medicine (Baltimore) ; 98(40): e17133, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577705

RESUMO

BACKGROUND: This study aimed to investigate the efficacy and safety between early preoperative administration and postoperative administration of oral meloxicam in patients underwent arthroscopic knee surgery (AKS). METHODS: Totally 296 patients with the intention to undergo AKS were recruited and randomly allocated as 1:1 ratio into early preoperative analgesia (EPA) group and postoperative analgesia (POA) group. Pain visual analog scale (VAS) score and severity (at rest and at flexion), patient global assessment (PGA) score, the consumption of rescue analgesia (pethidine), and adverse events were evaluated during the perioperation. And knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were assessed at baseline and at 3 months after AKS. RESULTS: Both pain VAS score and severity (at rest and at flexion) were decreased at 4, 8, and 12 hours, but similar at -24, -2, 24, 36, and 48 hours after AKS in EPA group compared with POA group. Besides, PGA score was lower at 4, 8, 12, and 24 hours, but similar at -24, -2, 36, and 48 hours after AKS in EPA group compared with POA group. As to the consumption of pethidine in perioperative period, it was decreased in EPA group compared with POA group. No difference was observed in knee ROM, IKDC score, Lysholm score, and adverse effects between EPA group and POA group. CONCLUSION: Early preoperative administration of meloxicam was a superior approach in pain control compared with postoperative administration in treating patients underwent AKS.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia/efeitos adversos , Articulação do Joelho/cirurgia , Meloxicam/uso terapêutico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Masculino , Meloxicam/administração & dosagem , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Fatores de Tempo
5.
BMC Infect Dis ; 19(1): 887, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651256

RESUMO

BACKGROUND: Arthroscopic partial meniscectomy is a common procedure in orthopedic practice. Infections are uncommon complications of this procedure with an incidence rate of 0,01% - 3,4%. Staphylococcus spp are the predominant causative agents in such cases. We present a case of knee septic arthritis caused by α-hemolytic Streptococcus. CASE PRESENTATION: A 22-year-old woman diagnosed with obesity (body mass index [BMI] 35 kg/m2) but with no other major comorbidities underwent an arthroscopic selective meniscectomy with administration of intravenous cefazolin for antibiotic prophylaxis. After an uneventful period of 2 months, the patient returned with pain, fever and a discharging sinus at the site of anterolateral arthroscopic portal. Blood tests and magnetic resonance imaging revealed osteomyelitis involving the tibial plate. Cultures of synovial fluid obtained from the knee and a pharyngeal swab yielded α-hemolytic Streptococcus. Five days later, the patient underwent arthroscopic debridement with partial synovectomy. Intraoperative specimens yielded α-hemolytic Streptococcus. The patient received intravenous piperacillin/tazobactam, followed by an associative regimen of amoxicillin and clindamycin with clinical, laboratory and instrumental evidence of symptom resolution. CONCLUSION: The incidence of knee septic arthritis after arthroscopic partial meniscectomy is 0.01-3.4%. This infection is usually caused by Staphylococcus spp. and in rare cases by commensal bacteria, such as α-hemolytic streptococci, secondary to transient bacteremia. Screening of the colonized area is important to prevent possible transient bacteremia. Diagnosis is based on isolation of the causative organisms from synovial fluid cultures, and treatment comprises arthroscopic debridement with individualized systemic antibiotic therapy based on the results of an antibiogram.


Assuntos
Artrite Infecciosa/microbiologia , Artroscopia/efeitos adversos , Bacteriemia/tratamento farmacológico , Meniscectomia/efeitos adversos , Osteoartrite do Joelho/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Bacteriemia/etiologia , Desbridamento/métodos , Feminino , Humanos , Osteoartrite do Joelho/tratamento farmacológico , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Streptococcus/patogenicidade , Líquido Sinovial/microbiologia , Adulto Jovem
6.
BMC Musculoskelet Disord ; 20(1): 448, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615502

RESUMO

BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a progressive disease that leads to collapse and the development of secondary arthritis. The preferred management of ONFH remains controversial. Arthroscopic-assisted management of ONFH is a new and evolving approach for hip preservation. We hypothesis that arthroscopy is able to improve ONFH outcomes by achieving accurate and minimally invasive decompression while successfully addressing concomitant intraarticular pathologies resulting in reliable mid-term outcomes. METHODS: This was a retrospective cohort analysis. All patients had atraumatic ONFH with a precollapse lesion and a minimum follow-up of 5 years. RESULTS: A total cohort of 11 hips (8 patients) was identified. The mean patient follow-up was 7 years ±1.48 years (range, 64-118 months). The Ficat-Alret classification found on preoperative imaging was Stage I-3 (27.2%), IIa-4 (36.4%), and IIb-4 (36.4%) hips. Four (36.4%) hips experienced mechanical issues, including locking, catching, and buckling. The most common concomitant pathology addressed at the time of arthroscopy, was labral repair/debridement-8 (73%), followed by microfracture-7 (64%). At final follow-up, 6 hips (54.5%) had not converted to THA. Upon further stratification, Stage I-100%, Stage IIa-75%, for a combined 87%, had not converted to THA, in contrast, 100% of hips categorized as Stage IIb had converted to THA. Ficat-Alret staging, especially Stage IIb, was significantly associated with conversion to THA. (p-value = 0.015) There were 0% major or minor complications. CONCLUSIONS: To our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA. LEVEL OF EVIDENCE: Level IV, Case Series.


Assuntos
Artroscopia/métodos , Descompressão Cirúrgica/métodos , Necrose da Cabeça do Fêmur/cirurgia , Tratamentos com Preservação do Órgão/métodos , Adolescente , Adulto , Artroplastia de Quadril/estatística & dados numéricos , Artroscopia/efeitos adversos , Descompressão Cirúrgica/efeitos adversos , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/patologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/diagnóstico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Radiografia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
7.
J Pediatr Orthop ; 39(10): 510-515, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599860

RESUMO

BACKGROUND: Retroversion of the acetabulum is a cause of pincer impingement. Symptomatic retroversion has traditionally been treated with anteverting periacetabular osteotomy (PAO). However, arthroscopic rim trimming can also treat pincer impingement associated with acetabular retroversion. The purpose of this study was to report the outcomes and radiographic findings in a series of adolescent patients with symptomatic acetabular retroversion treated arthroscopically. METHODS: Data were prospectively gathered at a single institution using an established hip preservation registry. Patients below 18 years with a retroverted acetabulum that underwent primary hip arthroscopy with 2-year follow-up were included. Acetabular retroversion was defined by 3 radiographic criteria: the presence of crossover, ischial spine sign, and posterior wall sign. Radiographic measurements of the lateral center-edge angle, anterior center-edge angle, alpha angle, and crossover percentage were reported preoperatively and postoperatively. Patient-reported outcome (PROs) measures included the modified Harris Hip Score, the non-Arthritic Hip Score, Hip Outcome Score Sports Subscale, visual analog scale, and patient satisfaction, recorded at 3 months, 1 year, and 2 years, postoperatively. In addition, International Hip Outcome Tool scores were gathered at 2 years. RESULTS: Between April 2008 and July 2014, there were 43 patients (48 hips) treated with hip arthroscopy who met the inclusion criteria. The average age was 16.1 years (range, 13.9 to 17.9 y) and there were 38 females and 10 males. The average follow-up was 50.4 months, with a minimum of 2 years. Statistically significant improvements in all PROs were found at 2 years postoperatively. There were 9 hips with lateral center-edge angle ≤25 degrees; the PROs of this group was not different than patients with normal coverage. Three patients underwent arthroscopic revision. No patient subsequently underwent anteverting PAO during the study period. There were no reported complications. CONCLUSIONS: Femoroacetabular impingement caused by acetabular retroversion treated with hip arthroscopy demonstrates good outcomes at 2 years with a low complication rate. Symptomatic adolescents may be safely and successfully treated arthroscopically, potentially avoiding anteverting PAO. STUDY DESIGN: Level of evidence 4-case series.


Assuntos
Acetábulo/cirurgia , Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Acetábulo/diagnóstico por imagem , Adolescente , Artroscopia/efeitos adversos , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/etiologia , Seguimentos , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Radiografia , Reoperação , Resultado do Tratamento
8.
Iowa Orthop J ; 39(1): 95-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413682

RESUMO

Background: Revision hip arthroscopy often serves as a measure for a failed primary hip arthroscopy procedure. The purpose of this study was to examine the rate, timing, and risk factors for revision hip arthroscopy using a large national database. Methods: The Humana administrative claims dataset was reviewed from 2007 through the second quarter of 2015 to identify patients undergoing hip arthroscopy using Current Procedural Terminology (CPT) codes and laterality modifiers. Patients with subsequent ipsilateral revision hip arthroscopy were identified and the rate and timing of these revisions determined. Subgroup analysis was performed to determine effects of gender, age, body mass index (BMI), osteoarthritis diagnosis, and specific hip arthroscopy procedure on revision rates. Results: There were 1807 hip arthroscopy procedures identified with a revision rate of 4% (total of 72 procedures). Of the revision procedures, 43% occurred within 6 months after the index procedure, and 86% occurred within 18 months. Age < 50 years was the only significant predictor of revision hip arthroscopy (OR 2.03, CI 1.173.53) with an even distribution across younger age groups. An osteoarthritis diagnosis, gender, and BMI did not represent significant risk factors for revision (OR 0.87, 0.98, 0.9 and CI 0.5-1.51, CI 0.6-1.59, CI 0.37-2.12, respectively). Chondroplasty was the most common procedure leading to revision (46%) followed by labral repair (37%). The most common revision procedures were chondroplasty (44%) followed by femoroplasty (38%). Conclusions: Overall, 4% of hip arthroscopy procedures underwent revision arthroscopy over the 8-year period. Revision was associated with age < 50, and revisions were most frequently performed for femoroacetabular impingement. The majority of revisions occurred within 18 months after the index procedure.Level of Evidence: IV.


Assuntos
Artroscopia/efeitos adversos , Impacto Femoroacetabular/cirurgia , Osteoartrite do Quadril/cirurgia , Reoperação/estatística & dados numéricos , Fatores Etários , Artroscopia/métodos , Bases de Dados Factuais , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Prognóstico , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento
9.
J Shoulder Elbow Surg ; 28(10): 1911-1917, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31401126

RESUMO

BACKGROUND: Soft tissue fluid retention due to irrigation is relatively common after shoulder arthroscopy. The objective of this study was to compare fluid retention of 2 irrigation systems of shoulder arthroscopy: gravity flow irrigation and automated pump. METHODS: Patients undergoing shoulder arthroscopy were enrolled prospectively and randomized into 2 groups using gravity flow system (GFS) or automated pump system (APS) for irrigation. Net weight gain was the primary outcome measurement to determine periarticular fluid retention. Change in deltoid diameter and postoperative pain were also compared. RESULTS: Forty-two patients were included in the study. There were no statistically significant differences between the GFS and APS groups regarding demographics, surgical procedures, duration of surgery, or the amount of irrigation fluid used. The APS group had greater weight gain per hour (1.46 ± 0.36 kg/h vs. 1.1 ± 0.38 kg/h) than the GFS group. A strong correlation was found between the amount of fluid used and the weight gain in both the GFS and APS groups. But a strong correlation between duration of surgery and weight gain was found in the APS group only. The APS group also had a greater mean deltoid diameter increase (3.33 ± 1.56 cm vs. 2.1 ± 1.44 cm) and a higher postoperative first-hour visual analog pain scale score (5.81 ± 2 vs. 3.62 ± 1.6). CONCLUSION: APS causes more fluid retention than GFS in shoulder arthroscopy when used for equal duration in similar procedures. Use of APS, prolongation of surgery, and increased amounts of irrigation fluid increase weight gain as a result of fluid retention.


Assuntos
Artroscopia/efeitos adversos , Músculo Deltoide , Edema/etiologia , Ombro , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/instrumentação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Estudos Prospectivos , Articulação do Ombro/cirurgia , Irrigação Terapêutica/métodos , Ganho de Peso , Adulto Jovem
10.
Trials ; 20(1): 533, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455407

RESUMO

BACKGROUND: A classical approach to produce interscalene brachial plexus block (ISBPB) consistently spares the posterior aspect of the shoulder and ulnar sides of the elbow, forearm, and hand, which are innervated by the lower trunk of the brachial plexus (C8-T1). As an alternative to the classical approach, a caudal approach to ISBPB successfully produces anesthesia of the ulnar sides of the elbow, forearm, and hand. However, its beneficial effects on anesthesia in the posterior aspect of the shoulder have not been investigated. In addition, the C8 nerve root is not routinely selectively blocked during ISBPB. Therefore, we will compare the C5 to C7 and C5 to C8 nerve root blocks during a caudal approach to ISBPB to assess the clinical benefit of C8 nerve blocks for the surgical anesthesia of the posterior aspect of the shoulder. METHODS/DESIGN: In this prospective parallel-group single-blind randomized controlled trial, 74 patients scheduled to undergo arthroscopic shoulder surgery under ISBPB are randomly allocated to receive the C5 to C7 or C5 to C8 nerve root block at a 1:1 ratio. The primary outcome is pain intensity, which is rated as 0 (no pain), 1 (mild pain), or 2 (severe pain), during the introduction of a posterior portal into the glenohumeral joint. The secondary outcomes are (1) the extent of the ipsilateral sensory, motor, hemidiaphragmatic, and stellate ganglion blockade, (2) changes in the results of a pulmonary function test, (3) incidence of complications related to ISBPB, (4) postoperative numerical pain rating scale scores, (5) patients' satisfaction with the ISBPB, (6) dose and frequency of analgesic use, and (7) incidence of conversion to general anesthesia. DISCUSSION: This study is the first to evaluate the beneficial effects of the C8 nerve root block during ISBPB, which has rarely been performed due to the technical challenge in visualizing and blocking the C8 nerve root. It is expected that a C8 nerve root block performed during ISBPB will provide sufficient surgical anesthesia of the posterior aspect of the shoulder, which cannot be achieved by a classical approach to ISBPB. TRIAL REGISTRATION: ClicnicalTrials.gov, NCT03487874 . Registered on 4 April 2018.


Assuntos
Artroscopia , Bloqueio do Plexo Braquial/métodos , Bloqueio do Plexo Cervical/métodos , Dor Pós-Operatória/prevenção & controle , Dor de Ombro/prevenção & controle , Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial/efeitos adversos , Bloqueio do Plexo Cervical/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia , Ombro/inervação , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
BMC Musculoskelet Disord ; 20(1): 312, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272448

RESUMO

BACKGROUND: People who have had anterior cruciate ligament reconstruction (ACLR) are at a high risk of developing tibiofemoral joint (TFJ) osteoarthritis (OA), with concomitant meniscal injury elevating this risk. This study aimed to investigate OA-related morphological change over 2 years in the TFJ among individuals who have undergone ACLR with or without concomitant meniscal pathology and in healthy controls. A secondary aim was to examine associations of baseline TFJ cartilage defects and bone marrow lesions (BML) scores with tibial cartilage volume change in ACLR groups. METHODS: Fifty seven ACLR participants aged 18-40 years (32 isolated ACLR, 25 combined meniscal pathology) underwent knee magnetic resonance imaging (MRI) 2.5 and 4.5 years post-surgery. Nine healthy controls underwent knee MRI at the ~ 2-year intervals. Tibial cartilage volume, TFJ cartilage defects and BMLs were assessed from MRI. RESULTS: For both ACLR groups, medial and lateral tibial cartilage volume increased over 2 years (P <  0.05). Isolated ACLR group had greater annual percentage increase in lateral tibial cartilage volume compared with controls and with the combined group (P = 0.03). Cartilage defects remained unchanged across groups. Both ACLR groups showed more lateral tibia BML regression compared with controls (P = 0.04). Baseline cartilage defects score was positively associated with cartilage volume increase at lateral tibia (P = 0.002) while baseline BMLs score was inversely related to medial tibia cartilage volume increase (P = 0.001) in the pooled ACLR group. CONCLUSIONS: Tibial cartilage hypertrophy was apparent in ACLR knees from 2.5 to 4.5 years post-surgery and was partly dependent upon meniscal status together with the nature and location of the underlying pathology at baseline. Magnitude and direction of change in joint pathologies (i.e., cartilage defects, BMLs) were less predictable and either remained stable or improved over follow-up.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Artroscopia/efeitos adversos , Osteoartrite do Joelho/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Lesões do Menisco Tibial/cirurgia , Adulto , Lesões do Ligamento Cruzado Anterior/complicações , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/patologia , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Tíbia/diagnóstico por imagem , Tíbia/patologia , Lesões do Menisco Tibial/complicações , Fatores de Tempo , Adulto Jovem
12.
J Shoulder Elbow Surg ; 28(11): 2098-2102, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31262638

RESUMO

BACKGROUND: There is currently no consensus regarding the safe timing interval between corticosteroid shoulder injections and future shoulder arthroscopies. Our study assessed the relationship between preoperative corticosteroid injection timing and shoulder arthroscopy infectious outcomes. METHODS: We used an insurance database to identify and sort all shoulder arthroscopy patients by corticosteroid shoulder injection history within 6 months before surgery. Patients who received injections were stratified by the timing of their most recent preoperative injection. The overall infection rate and rate of severe infections requiring treatment through intravenous antibiotics or surgical débridement in the 6-month postoperative period were compared using χ2 tests between the injection cohorts and a control group of patients defined as those with no injection history. RESULTS: We identified 50,478 shoulder arthroscopy patients, of whom 4115 received injections in the 6-month preoperative period. We found a significant increase in both the overall infection rate (P < .0001) and severe infection rate (P < .0001) in patients who received injections within 2 weeks before surgery (n = 79; 8.86% and 6.33%, respectively) compared with those who received no injections in the 6-month preoperative period (n = 46,363; 1.56% and 0.55%, respectively). No other significant differences were observed. CONCLUSIONS: Our results suggest that in patients who have received corticosteroid injections, shoulder arthroscopic procedures may be safely performed after at least 2 weeks has passed since the most recent injection to minimize the risk of postoperative infection. In addition, procedures performed within 2 weeks of an injection may increase the risk of postoperative infection.


Assuntos
Corticosteroides/administração & dosagem , Artroscopia/efeitos adversos , Artropatias/cirurgia , Articulação do Ombro , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Desbridamento , Esquema de Medicação , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade
13.
J Shoulder Elbow Surg ; 28(9): 1824-1834, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31324503

RESUMO

HYPOTHESIS: The aim of this meta-analysis was to compare the safety, efficacy, and opioid-sparing effect of liposomal bupivacaine (LB) vs. nonliposomal local anesthetic agents (NLAs) for postoperative analgesia after shoulder surgery. METHODS: A systematic literature review of randomized controlled clinical studies comparing the efficacy of LB with NLAs in shoulder surgery was conducted. Seven level I and II studies were included in the meta-analysis, and shoulder surgical procedures included arthroscopic rotator cuff repair and shoulder arthroplasty. Bias was assessed using The Cochrane Collaboration's tool. The primary outcome measures were visual analog scale pain scores and opioid consumption 24 and 48 hours after shoulder surgery. Subgroup analysis was performed for the method of LB administration (interscalene nerve block vs. local infiltration). RESULTS: A total of 7 studies (535 patients) were included in the final meta-analysis comparing LB (n = 260) with NLAs (n = 275). No significant difference was found between the LB and NLA groups in terms of visual analog scale pain scores at 24 hours (95% confidence interval, -1.02 to 0.84; P = .86) and 48 hours (95% confidence interval, -0.53 to 0.71; P = .78). Both groups had comparable opioid consumption at both 24 hours (P = .43) and 48 hours (P = .78) postoperatively and with respect to length of stay (P = .87) and adverse events (P = .97). Subgroup analysis demonstrated comparable efficacy irrespective of the method of administration of LB. CONCLUSION: LB is comparable to NLAs with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after arthroscopic rotator cuff repair and total shoulder arthroplasty.


Assuntos
Analgésicos Opioides/uso terapêutico , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Ombro/cirurgia , Artroplastia do Ombro/efeitos adversos , Artroscopia/efeitos adversos , Bloqueio do Plexo Braquial , Humanos , Tempo de Internação , Lipossomos , Medição da Dor , Dor Pós-Operatória/etiologia , Lesões do Manguito Rotador/cirurgia
14.
Cochrane Database Syst Rev ; 7: CD012128, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31322289

RESUMO

BACKGROUND: Osteoarthritis affecting the knee is common and represents a continuum of disease from early cartilage thinning to full-thickness cartilage loss, bony erosion, and deformity. Many studies do not stratify their results based on the severity of the disease at baseline or recruitment. OBJECTIVES: To assess the benefits and harms of surgical intervention for the management of symptomatic mild to moderate knee osteoarthritis defined as knee pain and radiographic evidence of non-end stage osteoarthritis (Kellgren-Lawrence grade 1, 2, 3 or equivalent on MRI/arthroscopy). Outcomes of interest included pain, function, radiographic progression, quality of life, short-term serious adverse events, re-operation rates and withdrawals due to adverse events. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase up to May 2018. We also conducted searches of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform for ongoing trials. Authors of trials were contacted if some but not all their participants appeared to fit our inclusion criteria. SELECTION CRITERIA: We included randomised controlled trials that compared surgery to non-surgical interventions (including sham and placebo control groups, exercise or physiotherapy, and analgesic or other medication), injectable therapies, and trials that compared one type of surgical intervention to another surgical intervention in people with symptomatic mild to moderate knee osteoarthritis. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials and extracted data using standardised forms. We analysed the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS: A total of five studies involving 566 participants were identified as eligible for this review. Single studies compared arthroscopic partial meniscectomy to physical therapy (320 participants), arthroscopic surgery (debridement ± synovectomy ± chondroplasty) to closed needle joint lavage with saline (32 participants) and high tibial osteotomy surgery to knee joint distraction surgery (62 participants). Two studies (152 participants) compared arthroscopic surgery (washout ± debridement; debridement) to a hyaluronic acid injection. Only one study was at low risk of selection bias, and due to the difficulty of blinding participants to their treatment, all studies were at risk of performance and detection bias.Reporting of results in this summary has been restricted to the primary comparison: surgical intervention versus non-surgical intervention.A single study, included 320 participants with symptoms consistent with meniscal tear. All subjects had the meniscal tear confirmed on knee MRI and radiographic evidence of mild to moderate osteoarthritis (osteophytes, cartilage defect or joint space narrowing). Patients with severe osteoarthritis (KL grade 4) were excluded. The study compared arthroscopic partial meniscectomy and physical therapy to physical therapy alone (a six-week individualised progressive home exercise program). This study was at low risk of selection bias and outcome reporting biases, but was susceptible to performance and detection biases. A high rate of cross-over (30.2%) occurred from the physical therapy group to the arthroscopic group.Low-quality evidence suggests there may be little difference in pain and function at 12 months follow-up in people who have arthroscopic partial meniscectomy and those who have physical therapy. Evidence was downgraded to low quality due to risk of bias and imprecision.Mean pain was 19.3 points on a 0 to 100 point KOOS pain scale with physical therapy at 12 months follow-up and was 0.2 points better with surgery (95% confidence interval (CI) 4.05 better to 3.65 points worse with surgery, an absolute improvement of 0.2% (95% CI 4% better to 4% worse) and relative improvement 0.4% (95% CI 9% better to 8% worse) (low quality evidence). Mean function was 14.5 on a 0 to 100 point KOOS function scale with physical therapy at 12 months follow-up and 0.8 points better with surgery (95% CI 4.3 better to 2.7 worse); 0.8% absolute improvement (95% CI 4% better to 3% worse) and 2.1% relative improvement (95% CI 11% better to 7% worse) (low quality evidence).Radiographic structural osteoarthritis progression and quality of life outcomes were not reported.Due to very low quality evidence, we are uncertain if surgery is associated with an increased risk of serious adverse events, incidence of total knee replacement or withdrawal rates. Evidence was downgraded twice due to very low event rates, and once for risk of bias.At 12 months, the surgery group had a total of three serious adverse events including fatal pulmonary embolism, myocardial infarction and hypoxaemia. The physical therapy alone group had two serious adverse events including sudden death and stroke (Peto OR 1.58, 95% CI 0.27 to 9.21); 1% more events with surgery (95% CI 2% less to 3% more) and 58% relative change (95% CI 73% less to 821% more). One participant in each group withdrew due to adverse events.Two of 164 participants (1.2%) in the physical therapy group and three of 156 in the surgery group underwent conversion to total knee replacement within 12 months (Peto OR 1.76, 95% CI 0.43 to 7.13); 1% more events with surgery (95% CI 2% less to 5% more); 76% relative change (95% CI 57% less to 613% more). AUTHORS' CONCLUSIONS: The review found no placebo-or sham-controlled trials of surgery in participants with symptomatic mild to moderate knee osteoarthritis. There was low quality evidence that there may be no evidence of a difference between arthroscopic partial meniscectomy surgery and a home exercise program for the treatment of this condition. Similarly, low-quality evidence from a few small trials indicates there may not be any benefit of arthroscopic surgery over other non-surgical treatments including saline irrigation and hyaluronic acid injection, or one type of surgery over another. We are uncertain of the risk of adverse events or of progressing to total knee replacement due to very small event rates. Thus, there is uncertainty around the current evidence to support or oppose the use of surgery in mild to moderate knee osteoarthritis. As no benefit has been demonstrated from the low quality trials included in this review, it is possible that future higher quality trials for these surgical interventions may not contradict these results.


Assuntos
Artroscopia , Osteoartrite do Joelho/cirurgia , Artroscopia/efeitos adversos , Humanos , Osteoartrite do Joelho/tratamento farmacológico , Medição da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença
15.
Acta Chir Orthop Traumatol Cech ; 86(3): 216-219, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31333187

RESUMO

PURPOSE OF THE STUDY The purpose of this study is to investigate the acute and long term effectiveness of kinesio taping applied following shoulder arthroscopy in relieving pain and reducing swelling. MATERIAL AND METHODS This study included 50 patients undergone shoulder arthroscopy between June 2016 and December 2017 in our clinic. Patients were randomly assigned into two groups. Group I consisted of patients who had kinesiotherapy; while Group II consisted of control patients whom we applied sham taping with no effect. Pre and postoperative pain and swelling status of patients were recorded and groups were compared. RESULTS Comparing two groups, we found that kinesio taping significantly reduced pain levels in the early post-operative period. However, we didn't detect any significant difference in reduction of shoulder swelling between two groups. CONCLUSIONS Kinesio taping could be an alternative treatment in relieving pain after shoulder arthroscopy. However, we didn't find a significant reduction in swelling in shoulder. Key words:kinesio taping, arthroscopy, shoulder.


Assuntos
Artroscopia/efeitos adversos , Fita Atlética , Edema/terapia , Dor Pós-Operatória/terapia , Articulação do Ombro/cirurgia , Dor de Ombro/terapia , Artralgia/etiologia , Artralgia/terapia , Artroscopia/métodos , Edema/etiologia , Humanos , Dor Pós-Operatória/etiologia , Dor de Ombro/etiologia
16.
Pain Physician ; 22(4): E351-E360, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337179

RESUMO

BACKGROUND: There is a relationship between sleep, pain, and chronic opioid utilization. This has been poorly explored in general, and especially in patients undergoing orthopaedic surgery. Fewer studies have investigated this relationship based on a sleep diagnosis present both before and after surgery. OBJECTIVES: To identify the association between insomnia and sleep apnea and downstream opioid use and medical utilization (visits and cost) in the 2 years following arthroscopic hip surgery. STUDY DESIGN: A retrospective cohort. SETTING: The US Military Health System. METHODS: This was a consecutive cohort of individuals undergoing hip arthroscopy in the Military Health System (MHS). Medical utilization data were abstracted from the MHS Data Repository between 2003 and 2015, representing 1 year prior and 2 years after surgery for every individual. Sleep disorder diagnoses (insomnia and sleep apnea) were identified using International Classification of Disease codes, and opioid utilization was determined from pharmacy data based on American Hospital Formulary Service codes 280808 and 280812. Sleep disorders present before surgery were used as predictors in multivariate logistic regression, and sleep disorders present after surgery were examined for associations with the outcomes using the Chi-square tests. The dependent variables in both cases were downstream medical utilization (costs, visits, and opioid use). RESULTS: Of 1870 eligible patients (mean age 32.3 years; 44.5% women), 165 (8.8%) had a diagnosis of insomnia before surgery and 333 (17.8%) after surgery; whereas 93 (5.0%) had a diagnosis of apnea before surgery and 268 (14.3%) after surgery. A diagnosis of insomnia before surgery predicted having at least 3+ opioids prescriptions after surgery (adjusted odds ratio, 1.97 [95% confidence interval, 1.39, 2.79]) and greater downstream total medical visits and costs in the 2 years after surgery. However, the number of individuals with a diagnosis of insomnia or apnea after surgery more than doubled, and was significantly associated with chronic opioid use, all-cause medical and all hip-related medical downstream visits and costs in the 2 years after surgery. LIMITATIONS: The use of observational data and claims data are only as good as how it was entered. CONCLUSIONS: Sleep disorders prior to surgery predicted chronic opioid use and medical utilization after surgery. However, a much higher rate of individuals had sleep apnea and insomnia present after surgery, which were significantly associated with chronic opioid use and greater total and hip-related medical utilization (visits and costs). Screening for sleep disorders prior to surgery may be important, but an even higher rate of sleep disorders may be developed after surgery, and continued screening after surgery may have greater clinical merit. Assessing quality of sleep during perioperative management may provide a unique opportunity to decrease pain and chronic opioid use after surgery. KEY WORDS: Pain, opioid use, insomnia, sleep apnea, orthopaedic surgery, military medicine, health care utilization.


Assuntos
Artroscopia , Articulação do Quadril/cirurgia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Síndromes da Apneia do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Analgésicos Opioides/uso terapêutico , Artroscopia/efeitos adversos , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Estados Unidos
17.
J Shoulder Elbow Surg ; 28(9): e291-e303, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31227466

RESUMO

BACKGROUND: Comparing techniques of general anesthesia and regional anesthesia in arthroscopic shoulder surgery, some studies have shown differences in the intensity of immediate postoperative pain and neuroendocrine response, but the inflammatory response when using balanced general anesthesia (BGA) vs. an ultrasound-guided (USG) single-dose interscalene block (SDIB) has not been compared. MATERIALS AND METHODS: In a single-center, prospective, randomized clinical trial, the inflammatory response of 2 groups of 10 patients scheduled to undergo arthroscopic shoulder surgery was evaluated through measurement of a panel of cytokines that act on cells of the adaptive immune response to promote or inhibit inflammation, chemokines involved in chemotaxis, the erythrocyte sedimentation rate (ESR), the high-sensitivity C-reactive protein (CRP) level, and the white blood cell (WBC) count in 3 blood samples (before anesthesia, immediately postoperatively, and 24 hours postoperatively) with 2 types of anesthesia (BGA vs. USG SDIB). Postoperative pain intensity (immediately, at 12 hours, and at 24 hours) was also assessed. RESULTS: The ESR and CRP level increased significantly at 24 hours after surgery; however, the increase in ESR (P < .0001) and CRP level (P < .0001) was lower in the USG SDIB group. Significant increases in the levels of soluble interleukin 2 receptor α (P = .022) and interleukin 12p40 (P = .016) occurred in the immediate postoperative period in the USG SDIB group. Immediate postoperative pain showed a significant increase (P < .001) in the BGA group. CONCLUSIONS: In arthroscopic shoulder surgery, the use of a USG SDIB compared with the use of BGA is possibly associated with improved pain control in the immediate postoperative period and lower immunosuppression, even at 24 hours after surgery.


Assuntos
Anestesia Geral , Bloqueio do Plexo Braquial/métodos , Citocinas/sangue , Inflamação/sangue , Adulto , Idoso , Artroscopia/efeitos adversos , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Feminino , Humanos , Inflamação/etiologia , Subunidade p40 da Interleucina-12/sangue , Subunidade alfa de Receptor de Interleucina-2/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Ombro/cirurgia , Ultrassonografia de Intervenção
18.
Clin J Sport Med ; 29(4): 276-280, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31241528

RESUMO

OBJECTIVE: The incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) after pediatric knee arthroscopy is unknown. The purpose of this study was to determine the incidence of venous thromboembolism (VTE) after knee arthroscopy in the pediatric and adolescent population in a high-volume center. DESIGN: Retrospective cohort study. SETTING: Tertiary care children's hospital. PATIENTS: All patients who underwent arthroscopy of the knee for a sports-related injury by 2 surgeons were reviewed. Chief complaint, past medical/surgical history, medications, procedure performed, intraoperative findings, intraoperative complications, and postoperative recovery were reviewed. The incidences of postoperative VTE within 30 days after the procedure were reviewed. RESULTS: Seven hundred forty-six (358 male and 388 female patients) knee arthroscopies performed from September 2011 to October 2016 by 2 pediatric orthopedic surgeons specializing in sports-related injuries were included. The average age was 15.2 ± 2.72 years. Five patients were suspected to have either DVT or PE postoperatively (0.67%). The overall incidence of symptomatic confirmed VTE after knee arthroscopic procedures was 0.27% (one DVT after a partial lateral meniscectomy and one PE after fixation of an osteochondral lesion). CONCLUSIONS: The incidence of VTE after pediatric sports medicine knee arthroscopies is low, 0.27%. Patients who present with calf swelling or pain, chest pain, or shortness of breath after arthroscopic surgery should be examined closely. LEVEL OF EVIDENCE: Level III.


Assuntos
Artroscopia/efeitos adversos , Articulação do Joelho/cirurgia , Complicações Pós-Operatórias/epidemiologia , Embolia Pulmonar/etiologia , Trombose Venosa/etiologia , Adolescente , Traumatismos em Atletas/cirurgia , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos
19.
Eur J Orthop Surg Traumatol ; 29(7): 1485-1491, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31236684

RESUMO

The purpose of this research is to evaluate the results of arthroscopic suture fixation with fiber wires used as treatment for ACL avulsion fracture, and to determine how effective such a technique is when it comes to restoring of knee function. This prospective study involves 28 patients, who underwent arthroscopic fixation of displaced ACL avulsion fractures at Saint Paul Hospital (Hanoi) from January 2014 to March 2018. The first 3 weeks were not marked with any abnormalities associated with postoperative sutures and hematomas; infectious complications were not detected either. Postoperative displacement of fracture fragments did not take place among the patients involved in the study. At the 3-month follow-up, the average IKDC score was 90.7 (range 76-100), and the average Lysholm score was 93.6 (range 82-100). The percentage of excellent scores was 42.9% (12 patients), good scores accounted for 50% (14 patients), while fair/poor scores accounted for 3.6% each (one patient on each score). The percentage of excellent/good scores was 92.9% in total. This study shows that ACL avulsion fracture can be treated effectively by arthroscopic suture fixation with fiber wires. In fact, this technique may restore knee function and stability.


Assuntos
Ligamento Cruzado Anterior , Fixação Interna de Fraturas/métodos , Fratura Avulsão/cirurgia , Técnicas de Sutura , Fraturas da Tíbia/cirurgia , Adulto , Artroscopia/efeitos adversos , Fios Ortopédicos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fratura Avulsão/fisiopatologia , Hospitais , Humanos , Articulação do Joelho/fisiopatologia , Escore de Lysholm para Joelho , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/instrumentação , Fraturas da Tíbia/fisiopatologia , Vietnã , Adulto Jovem
20.
J Shoulder Elbow Surg ; 28(6S): S146-S153, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196509

RESUMO

BACKGROUND: The Distress and Risk Assessment Method (DRAM) predicts poor outcomes in spine, hip, and knee surgery. Unlike other areas of orthopedic surgery, DRAM scores are not predictive of lower postoperative patient-reported outcomes after arthroscopic rotator cuff repair (RCR). PURPOSE: As concerns for opioid dependence and abuse grow, the purpose of this study was to analyze the correlation between preoperative DRAM scores, modified Zung scores, and postoperative narcotic use in patients who underwent arthroscopic RCR. MATERIALS AND METHODS: This prospective cohort study identified and enrolled patients >18 years of age with full-thickness rotator cuff tears at a single institution. Patients with prior shoulder surgery, greater than 1-tendon RCR, and preoperative narcotic use were excluded. One-hundred and fifty patients were enrolled, with 114 (76%) completing all preoperative and postoperative questionnaires. Preoperative DRAM scores were collected from every patient. Postoperative narcotic use was evaluated via survey and converted to total morphine equivalents. RESULTS: Increased preoperative DRAM scores predicted higher postoperative morphine equivalent units (P = .002, r = 0.29). When dividing patients into those <17 or ≥17 on the modified Zung score, 44 of 114 (39%) met criteria for "at risk or depressed." This group showed a statistically significant trend toward higher postoperative morphine equivalent unit intake (P = .004). CONCLUSION: Baseline psychological distress (DRAM) can predict narcotic requirements after RCR and serve as a powerful tool to identify patients at risk for increased narcotics requirements postoperatively. In our cohort, 39% of patients showed evidence of baseline depression, which highlights a potential role of the modified Zung score to identify patients in need of preoperative psychological counseling.


Assuntos
Artroscopia/efeitos adversos , Entorpecentes/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Lesões do Manguito Rotador/cirurgia , Estresse Psicológico/psicologia , Adulto , Idoso , Artroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Estudos Prospectivos , Medição de Risco/métodos , Lesões do Manguito Rotador/complicações , Dor de Ombro/tratamento farmacológico , Dor de Ombro/etiologia , Inquéritos e Questionários , Resultado do Tratamento , Escala Visual Analógica
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