To the Editor, We read the article “Integrating IPACK (Interspace between the Popliteal Artery and Capsule of the Posterior Knee) Block in an Enhanced Recovery after Surgery Pathway for Total Knee Arthroplasty—A Prospective Triple-Blinded Randomized Controlled Trial” by Pai et al in the Journal for Knee Surgery (2022) with great interest1. We applaud the authors in finding that when added to an enhanced recovery after surgery pathway consisting of a spinal anesthetic, adductor canal nerve catheter, and surgeon-administered periarticular joint infiltration (PAI), the IPACK block did not significantly impact postoperative opioid consumption or measured functional outcomes on postoperative day 1. Interestingly, the authors found that addition of the IPACK block did significantly decrease posterior knee pain. We found this notable as both the IPACK block and PAI target the posterior knee capsule. Innervation of the posterior knee capsule is complex and includes branches of the obturator, sciatic, common fibular, and tibial nerves2. PAI has variable effectiveness in this anatomical area3. Prior studies have shown that addition of the IPACK and adductor canal blocks to PAI provides superior analgesia and decreases opioid consumption in TKA4. This study found that the IPACK block resulted in improved posterior knee analgesia compared to PAI. This could signify that an ultrasound-guided approach may be more consistent in targeting the posterior knee capsule. The authors also astutely mention concern for local anesthetic toxicity (LAST). Peripheral nerve blocks, especially in the lower extremity, have a decreased risk of LAST compared to PAI5. Further study of the effectiveness of the IPACK block compared to PAI may show that the IPACK is a reasonable replacement of PAI, while also potentially decreasing the risk of LAST. We greatly appreciate the work Dr. Pai and team performed to further our understanding of posterior knee analgesia and its contribution toward the creation of patient care pathways that target analgesia and prioritize patient safety.
Background: Ulnar Collateral Ligament (UCL) reconstruction of the elbow, a Tommy John surgery, is a common procedure often performed in throwing athletes. Autograft tendon has traditionally been utilized, although recently allograft tendon has been of interest due to the possibility of decreasing donor site morbidity. There is a lack of literature on patient outcomes and complication rates following the use of allograft tendon for UCL reconstruction. Currently, there is no consensus on utilizing autograft versus allograft tendon for UCL reconstruction.Methods: A PRISMA compliant literature search in online databases Medline, Cochrane and Embase was performed for level 4 and higher studies through June 2019. Any studies reporting clinical outcome results of allograft reconstruction were included. Exclusion criteria included studies unrelated to primary UCL reconstruction, studies specifically looking at revision UCL reconstruction, epidemiological studies, case reports, studies lacking raw data, technique articles, biomechanical studies, cadaveric studies, studies with outcomes unrelated to graft choice, and studies with outcomes unrelated to the use of allograft tendon for reconstruction. Studies were analyzed for graft type, functional scores, return to play rate, and complication rates.Results: Three out of 103 studies met inclusion criteria. Two cohort studies and 1 retrospective review were included in this review. No significant differences in functional outcomes regardless of scoring system utilized, return to play rate, or complication rates were found between allograft versus autograft. Conclusion:The use of allograft tendon appears to have similar outcomes regarding functional scores, return to play, and complication rates compared to autograft tendon. Use of allograft tendon seems to be a viable option for UCL reconstruction, though further studies are needed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.