Background:In the currently published literature, a higher risk for developing arthrofibrosis after anterior cruciate ligament (ACL) reconstruction has been reported for female patients, adolescents, early surgery or concomitant procedures, and the use of a patellar tendon autograft. There is a lack of evidence regarding other graft choices or factors.Hypothesis:Multiple risk factors will play a significant role in the development of arthrofibrosis after ACL reconstruction. Specifically, we hypothesized that the risk of manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA) would be affected by graft choice and patient demographic factors.Study Design:Case-control study; Level of evidence, 3.Methods:The charts of all patients who underwent ACL reconstruction over a 10-year period at a single academic institution were queried from an electronic medical record database and reviewed at a minimum of 6 months after ACL reconstruction, with the collection of demographic and surgical data. The relative risk for undergoing MUA and/or LOA was calculated for each analyzed risk factor.Results:A total of 2424 ACL reconstructions were included, with a chart review at a mean of 56.7 months after surgery (range, 7.6-124.0 months). The rate of MUA and/or LOA for arthrofibrosis was 4.5%. A statistically significantly increased relative risk was found for infection (5.45), hematoma requiring evacuation (3.55), ACL reconstruction with meniscal repair (2.83), use of a quadriceps tendon autograft (2.68), age <18 years (2.39), multiple concomitant procedures (1.69), contact injury (1.62), female sex (1.60), and surgery within 28 days of injury (1.53), and a statistically significantly decreased relative risk was found for revision ACL reconstruction (0.30), age >25 years (0.34), and use of a tibialis anterior allograft (0.36). In the multivariate regression model, the use of a quadriceps tendon autograft (P = .00007), infection (P = .00126), and concomitant meniscal repair (P = .00194) were independent risk factors, whereas revision ACL reconstruction (P = .0024) was an independent protective factor.Conclusion:Graft type, infection, concomitant meniscal repair, and primary reconstruction are significant risk factors for undergoing MUA or LOA after ACL reconstruction.
Standard fixation plates are sufficient for the fixation of small transverse fractures, but caution should be utilized particularly with comminution and nontransverse fracture patterns.
Objectives: Peripheral nerve blocks are commonly performed as a part of multimodal pain control regimens, especially for outpatient surgical procedures. Femoral nerve blocks (FNB) have been the traditional gold standard nerve block in the setting of ACL reconstruction; however, adductor canal blocks (ACB) have emerged as a promising alternative. While early findings show less quadriceps strength deficits following adductor canal blocks, results comparing analgesia from adductor canal nerve blockade to femoral nerve blockade are inconsistent. The purpose of this study was to compare adductor canal nerve block to femoral nerve block for pain control following ACL reconstruction. Methods: This study was a prospective, single-blinded, randomized, controlled, parallel single-center trial. 77 adult patients receiving ACL reconstruction were enrolled between December 2015 and April 2016. All patients received either a traditional FNB or an ACB immediately prior to surgery. All patients were given a post-operative smartphone application to record medication usage, pain scores, hours of sleep, and time to straight leg raise for one week following ACL reconstruction. Results: Of the 77 patients recruited, 64 patients were analyzed (83.1%). 13 patients were lost to follow-up. There were no statistically significant differences in post-operative pain, home medication use, recovery room time, or hours of sleep between the two study groups. Patients receiving an ACB had significantly shorter time to straight leg raise and reported greater satisfaction with acute post-operative pain control. Conclusion: Adductor canal nerve blockade had similar analgesic outcomes, improved post-operative mobility, and greater patient satisfaction with pain control than femoral nerve blockade. Our study supports the use of adductor canal block as a viable alternative to femoral nerve block following ACL reconstruction.
Immobilization is often needed for the treatment of wrist and hand injuries. The current best method of immobilization for several types of injuries has yet to be elucidated with little being reported on the functional differences of each type of immobilization. The purpose of this study is to compare the functional outcome between healthy young volunteers with a 24-hour short arm cast (SAC) versus thumb spica cast (TSC) immobilization. A total of 50 healthy volunteers completed a baseline typing assessment and a Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity functional scoring assessment. Participants in group 1 were randomly initially assigned to a TSC of their dominant hand followed by an SAC, whereas participants in group 2 were randomly initially assigned to a TSC of their nondominant hand followed by an SAC. The volunteers completed the typing assessment and PROMIS assessment at the end of the 24-hour casting period. A total of 50 participants were enrolled in the study with 25 in group 1 and 25 in group 2. There was a 24.3-point difference between the average PROMIS score for participants with SAC compared with participants with TSC (93 vs. 68.7; = 0.0001). There was a significant difference between the typing speed and accuracy of participants with SAC compared with participants with TSC ( = 0.0001). There is a significant difference in functionality of a TSC immobilization versus an SAC immobilization according to the PROMIS functional outcome score and typing speed in a 24-hour casting period. SAC immobilization should be considered to have a possible similar effect in pathologic conditions instead of TSC immobilization given these findings even though a 24-hour period is not enough to provide adequate long-term conclusions. I, prospective comparative study.
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