Anteromedialisation tibial tubercle osteotomy for recurrent patellar instability in young active patients: A retrospective case series

IntroductionRecurrent patellar instability can be a source of continued pain and functional limitation in the young, active patient population. Instability in the setting of an elevated tibial tubercle–trochlear groove (TT–TG) distance can be effectively managed with a tibial tubercle osteotomy. At the present time, clinical outcome data are limited with respect to this surgical approach to patellar instability.MethodsA retrospective chart review was performed to identify all cases of tibial tubercle osteotomy for the management of patellar instability performed at our institution with at least 1 year of post-operative follow-up. Patient demographic information was collected along with relevant operative data. Each patient was evaluated post-operatively with their outcomes assessed utilising a visual analogue score of pain, patient satisfaction, Tegner Activity Scale and Kujala score.Results31 patients (23 females and 8 males) with mean age of 27 years (17–43 years) and a mean BMI of 26.3 kg/m² (19.6–35.8) at time of surgery who underwent a tibial tubercle osteotomy as treatment for recurrent patellar instability were identified. The cohort had a mean follow up of 4.4 years (1.5–11.8 years). The mean pre-operative TT–TG distance was 18 mm (10–22 mm). The mean VAS pain score demonstrated a significant improvement from 6.8 (95% CI 6.1–7.5) at baseline to 2.8 (95% CI 1.9–3.7) post-operatively (p < 0.001). The Tegner score improved from 4.1 (95% CI 3.4–4.8) pre-operatively to 5.2 (95% CI 4.5–5.9) at the time of final follow up (p < 0.04). The Kujala score for anterior knee pain improved postoperatively from 62 (95% CI 55.4–68.7) to 76.5 (95% CI 69.5–83.5) at final follow up (p < 0.001). 26 of the 31 patients (83.8%) had good to excellent Kujala scores. 27 of 31 patients (87.1%) reported that they would undergo the procedure again if necessary.ConclusionFor the management of recurrent patellar instability in the setting of an increased tibial tubercle–trochlear groove distance, a corrective tibial tubercle osteotomy is an effective treatment modality to reliably prevent patellar instability while reducing pain and improving function in this cohort of young, active patients.     

Treatment of degenerative meniscal tear with intrameniscal injection of platelets rich plasma

PurposeThe purpose of this retrospective study was to describe our preliminary results of intra-meniscal administration of platelet rich plasma (PRP) in patients with degenerative meniscal tears of the knee.Material and methodTen patients with degenerative meniscal tears according to the Stoller classification and without knee osteoarthritis were included. There were 7 men and 3 women with a mean age of 40.4 ± 13.6 [SD] years (range: 18–59 years). Patients were prospectively assessed at baseline and 3- and 6-months after intra meniscal PRP administration. Evaluation included the knee injury and osteoarthritis outcome score (KOOS), pain visual analog scale, and return to competition and training. MRI follow-up was performed 6 months after PRP administration. Adverse events were recorded.ResultsVolume of injected PRP was standardized to 4.0 mL. Adverse events during PRP administration was moderate pain in 8 patients (8/10; 80%). Mean KOOS total score significantly improved from 56.6 ± 15.7 (SD) to 72.7 ± 18.5 (SD) (P = 0.0007). All six patients practicing sports regularly were able to recover competition or training. In seven patients who underwent MRI follow-up at 6 months, MRI showed stability of the meniscal tears and similar Stoller grades.ConclusionIntra-meniscal administration of PRP under ultrasound guidance directly into meniscal degenerative lesions is feasible and safe. Further randomized controlled studies are needed to definitely confirm the effectiveness of this procedure.     

Características da marcha de mulheres com fibromialgia: um padrão prematuro de envelhecimento

BackgroundFibromyalgia is a condition which involves chronic pain. Middle‐aged individuals with fibromyalgia seem to exhibit changes in gait pattern, which may prematurely expose them to a gait pattern which resembles that found in the elderly population.ObjectiveTo determine the 3 D spatial (linear and angular) gait parameters of middle‐aged women with fibromyalgia and compare to elderly women without this condition.Methods25 women (10 in the fibromyalgia group and 15 in the elderly group) volunteered to participate in the study. Kinematics was performed using an optoelectronic system, and linear and angular kinematic variables were determined.ResultsThere was no difference in walking speed, stride length, cadence, hip, knee and ankle joints range of motion between groups, except the pelvic rotation, in which the fibromyalgia group showed greater rotation (P < 0.05) compared to the elderly group. Also, there was a negative correlation with pelvic rotation and gluteus pain (r = –0.69; P < 0.05), and between pelvic obliquity and greater trochanter pain (r = –0.69; P < 0.05) in the fibromyalgia group.ConclusionMiddle‐aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed.     

Surgical approaches to intramedullary nailing of the tibia: Comparative analysis of knee pain and functional outcomes

IntroductionPost-operative knee pain is common following intramedullary nailing of the tibia, regardless of surgical approach, though the exact source is controversial. Historically, the most common surgical approaches position the knee in hyperflexion, including patellar tendon splitting (PTS) and medial parapatellar (MPP). A novel technique, the semi-extended lateral parapatellar approach simplifies patient positioning, fracture reduction, fluoroscopic assessment, and implant insertion. It also avoids violation of the knee joint capsule. However, this approach has not yet been directly compared against the historical standards. We hypothesised that in a comparison of patient outcomes, the semi-extended approach would be associated with decreased knee pain and better function relative to knee hyperflexion approaches.MethodsA trauma patient database from a Level I centre was queried for patients who underwent intramedullary nailing of the tibia between 2009 and 2013. Patients were surveyed for knee pain severity (NRS scale 1 to 10) and location, and completion of the Lysholm Knee Scale (LKS). Data was compared between the semi-extended lateral parapatellar, medial parapatellar, and tendon splitting groups regarding knee pain severity, location, total LKS, and individual knee function scores from the Lysholm questionnaire. Pre-hoc power analysis determined the necessary sample size (n = 34). Post-hoc analysis utilised two-way ANOVA analysis with a significance threshold of p < 0.05.ResultsComparison of knee pain severity between the groups found no significant difference (p = 0.69), with average ratings of: semi-extended (3.26), PTS (3.59), and MPP (3.63). Analysis found no significant differences in total LKS score (p = 0.33), with average sums of: semi-extended (75.97), MPP (77.53), and PTS (81.68). Individual knee function scores from the LKS were similar between the groups, except for limping, with MPP being significantly worse (p = 0.04). There was no significant difference in knee pain location (p = 0.45).ConclusionIn this adequately-powered study, at minimum 1 year follow-up there were no significant differences between the 3 approaches in knee pain severity, location, or overall function. The three were significantly different in post-operative limping, with medial parapatellar having the lowest score. The semi-extended lateral parapatellar approach vastly simplifies many technical aspects of nailing compared to knee hyperflexion approaches, and does not violate the knee joint.     

Effect of intra-articular injection of midazolam and/or bupivacaine on postoperative analgesia after arthroscopic knee surgery

BackgroundA variety of analgesic techniques have been used to manage postoperative pain after arthroscopic knee surgery. We investigated the hypothesis that intra-articular midazolam would result in lower pain score and reduced analgesic requirements.MethodsOne-hundred patients undergoing arthroscopic meniscectomy were allocated randomly to receive intra-articular 20 mL of isotonic saline containing 50 μg/kg midazolam (midazolam group (group M),the bupivacaine group (group B) received 0.25% (20 mL) bupivacaine, and the midazolam with bupivacaine group (group MB) received bupivacaine 0.25% and 50 μg/kg of midazolam in 20 mL. The postoperative analgesia was assessed using visual analog score at rest and during movement at 1/2 h, 1 h, 2 h, 6 h, 12 h, and 24 h.ResultsPatients in group MB showed significantly lower visual analog scores, both at rest and during movement, long time to first postoperative analgesic request, as well as reduced total analgesic consumption than the other two groups.ConclusionIntraarticular administration of midazolam in combination with bupivacaine improves the quality of postoperative analgesia after arthroscopic meniscectomy.     

Safety and efficacy of adipose-derived mesenchymal stem cells for knee osteoarthritis: A systematic review and m-analysis

ObjectiveThis research aimed to study the safety and efficacy of adipose-derived mesenchymal stem cells (ADMSCs) for knee osteoarthritis (OA).MethodsWe used six databases to search for records and then screened them for eligibility. In both randomized and non-randomized studies, the risk of bias was assessed. The data were then retrieved and used in single-arm and double-arm analyses using Comprehensive Meta-Analysis (CMA) Version 3.0 and RevMan Version 5.3, respectively.ResultsBased on the study's inclusion criteria, we included 15 studies with a total of 463 patients. According to our single-arm analyses, there was a significant improvement in quality of life (QOL) among the three dose subgroups (high, medium, and low doses), as measured by SF-36 scores after a year of follow-up [low dose: mean (M) = ?23.99; 95% confidence interval (CI) [?31.49 to ?16.49]; P < 0.001; medium dose: M = ?15.96; 95% CI [?23.5 to ? 8.42]; P < 0.001; high dose: M = ?19.31; 95% CI [?28.02 to ?10.59], P < 0.001] and the knee injury and osteoarthritis outcome score (KOOS) QOL sub-score after six months following ADMSCs injection in the low-dose group (M = 24.9; 95% CI [4.3 to 45.6]; P < 0.05). Moreover, after three months of follow-up, we detected significant pain reduction as measured by the numeric pain rating scale (NPRS), with no significant difference between the low and medium doses (low dose: M = ?3.12; 95% CI [?5.09 to ?1.14]; P < 0.01; medium dose; M = ?2.17; 95% CI [?3.13 to ?1.21]; P < 0.001). However, after a year, the results were no longer significant. Despite finding no significant difference between them after 6 and 12 months post-treatment in the Visual Analogue scale (VAS) scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, double-arm analyses revealed significant pain reduction in the ADMSCs group over the control after 12 months as estimated by the WOMAC pain sub-score (mean difference (MD) = ?1.85, 95% CI [?3.55, ?0.15], P < 0.05). After six months, the low dosage group's knee functions and activity levels improved significantly, as determined by the WOMAC physical function and stiffness subscales (M = ?23.79; 95% CI [?38.43 to ?9.16]; P = 0.001; M = ?10.25; 95% CI [?17.31 to ?2.59]; P < 0.01, respectively), as well as the KOOS scores after a year (P < 0.01 for all KOOS subscales). In the ADMSCs injections group, there were no serious adverse effects [event rate (ER) = 0.11; 95% CI [0.03–0.3]; P = 0.001].ConclusionIn the present single-arm meta-analysis, ADMSCs were associated with significant reduction in pain and improvement in QOL and knee functions in patients with knee OA. However, double arm analyses did not confirm these positive findings, which may be returned to the small sample size of included patients. Therefore, to introduce ADMSCs into clinical practice and establish guidelines for their use, more randomized controlled clinical trials with large sample sizes and long-term follow-ups are needed.     

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Purpose

The purpose of the present epidemiologic study is to record the radiographic presence of trochlear dysplasia and patella alta in patients who undergo anterior cruciate ligament (ACL) reconstruction as a potential underlying factor for post-operative anterior knee pain (AKP).

Methods

All consecutive cases of skeletally-mature ACL-deficient knees that would undergo ACL reconstruction in three different hospitals were prospectively included during a six-month period. Inclusion criteria were acute and sub-acute ACL injury with no previous ipsilateral knee operation. Patients with chronic ACL tears, prior-to-ACL-injury history of patellar instability or other PF disorders were excluded from the study.

Results

A total of 299 knees were included (mean age 32 ± ten years). Forty-four (14.7 %) knees had a positive ‘crossing sign’ in the lateral X-rays and 255 (85.3 %) had no sign of trochlear dysplasia (p < 0.01). Among the cases with trochlear dysplasia, 41 (93 %) had type A trochlear dysplasia with the presence only of the ‘crossing sign’ and three (7 %) had type C trochlear dysplasia. Patellar height results included a mean Caton-Deschamps index of 1.0 ± 0.14 (0.5–1.4). Twenty (6.6 %) knees had an index of less than 0.8, and two (0.6 %) knees had an index less than 0.6. In contrast, 15 (5.0 %) knees had an abnormal value of more than 1.2, indicating patella alta.

Conclusions

The most important finding of the study is the increased prevalence of trochlear dysplasia and patella alta in patients with ACL injury, when compared to the incidence of trochlear dysplasia and patella alta in the general population in the literature. This finding could sound as an alert of a possible additional risk factor for post-operative anterior knee pain after ACL reconstruction.     

Clinical outcomes comparing arthroscopic vs open ankle arthrodesis

BackgroundOver the last twenty years, minimally invasive ankle arthrodesis has evolved into a well-tolerated and safe procedure. It has grown in favor to open ankle arthrodesis due to shorter length of stay and fewer complications recorded. This paper aims to compare the clinical outcomes of arthroscopic vs open ankle arthrodesis at 24-months followup.MethodsFrom 2004 to 2015, we reviewed a prospectively collected database in a tertiary hospital foot and ankle registry. 28 feet that underwent arthroscopic ankle arthrodesis were matched to 56 feet that underwent open ankle arthrodesis for age, sex and body mass index (BMI). Visual analogue scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-hindfoot Scores and Short Form Health Survey (SF-36) were obtained to assess clinical outcomes. These parameters were collected before surgery, at 6 months and 24 months after surgery.ResultsThe arthroscopic group demonstrated significant less pain in the perioperative period (arthroscopic: 1.9 ± 1.2, open: 3.8 ± 1.1, p < 0.001) and shorter length of hospitalization stay (arthroscopic: 2.1 ± 0.7 open: 3.5 ± 1.7, p < 0.001). Patients who underwent arthroscopic ankle arthrodesis also reported a higher SF-36 score on physical functioning at 6 months (arthroscopic: 58.4 ± 27.1, open: 47.1 ± 24.0, p < 0.05) and higher AOFAS Ankle-hindfoot Scale score at 24-months (arthroscopic: 78.9 ± 18.9, open: 68.9 ± 24.7, p < 0.05). There were no postoperative complications in the arthroscopic group but 11 in the open group, including 9 which required followup operations. There was no significant difference in length of operative procedure between both groups.ConclusionsWe conclude that the arthroscopic group displayed better clinical outcomes compared to the open group at the 24 months followup. The advantages of arthroscopic ankle arthrodesis include significantly less perioperative pain, higher AOFAS Ankle-hindfoot scores at 24 months, shorter length of stay, fewer postoperative complications and followup operations.Level of evidenceLevel III, retrospective comparative series.     

The effect of multimodal balanced anaesthesia and long term gabapentin on neuropathic pain,nitric oxide and interleukin-1β following breast surgery

ObjectivesTo evaluate the effect of multimodal balanced anaesthesia and gabapentin (6 months) on neuropathic pain qualities, nitric oxide (NO) and interleukin 1-beta (IL-1β).MethodologyThis randomized study was conducted on 50 women scheduled for conservative breast surgery for cancer followed by chemotherapy and/or radiotherapy. Women enrolled into two groups; either to receive balanced general anaesthesia (GA) (control group) or ultrasound guided thoracic paravertebral with GA, multimodal balanced anaesthesia, (intervention group). Nociceptive pain was evaluated for 24 h. Neuropathic pain was evaluated using pain questionnaire 1 month postoperatively and neuropathic pain scale at 1, 3, 6 and 9 months. Gabapentin was prescribed to women reporting neuropathic pain 1 month postoperatively and for 6 months. NO and IL-1β were measured before operation, 1, 3, 6 & 9 months, postoperatively. Their relationship with neuropathic pain was assessed.ResultsNociceptive pain was less in intervention group than control group immediately post operative, 4 h after surgery at rest and 8 h with movement. Neuropathic pain started few days postoperatively, in both groups. Its onset, sites, duration and precipitating factors did not differ between the groups. Sensitive, hot pain and unpleasantness reduced significantly 1 month postoperatively, in intervention group. Two months later, itchy, dull and sharp pain was significantly less in intervention group. At 6 months, most of neuropathic pain items except sharp and deep pain lowered significantly in intervention group. At 9 months, hot and superficial pain was still less in intervention group. NO decreased significantly 1 and 3 months postoperatively, while IL-1β was significantly lower through different times, in intervention group. IL-1β correlated well with neuropathic pain intensity and unpleasantness.ConclusionBreast surgery for cancer was associated with neuropathic pain that continued for 9 months after surgery. Multimodal balanced GA had positive impact on acute nociceptive and neuropathic pain. Gabapentin reduced almost all neuropathic pain qualities.     

Postoperative Analgesic Efficacy of Different Volumes and Masses of Ropivacaine in Posterior Brachial Plexus Block

Background and objectivesThe efficacy of posterior brachial plexus block for shoulder surgeries is demonstrated by different authors. However, there is no consensus on the ideal mass and volume of local anesthetic to be employed. The objetive of this study was to compare different volumes and masses of ropivacaine in posterior brachial plexus block in arthroscopic surgeries of the shoulder.MethodSixty patients > 18 years, physical status ASA I and II, scheduled for unilateral arthroscopic surgeries of the shoulder were randomly placed in three groups: A (10 mL to 0.5%), B (20 mL to 0.5%), C (5 mL to 1%). The block was performed with a 22G needle of 100 mm connected to neurostimulator, in a point 3 cm lateral to the midpoint of C6 and C7 interspace, being injected the solution corresponding to each group. The postoperative pain was evaluated at the recovery room and within the first 24 hours of the postoperative period. The groups were compared on length of time until the first complaint of pain, visual numeric scale (VNS) score and morphine consumption within the first 24 hours.ResultsThere was no statistically significant difference between the three groups related to age, weight and height. There was no difference in length of time until the first complaint of pain, VNS scores over three and morphine consumption in the postoperative period between the groups.ConclusionsThis study concluded that 5 mL of 1% ropivacaine promoted analgesic efficacy similar to 10 mL or 20 mL of 0.5% ropivacaine in the posterior brachial plexus block using neurostimulator.     

Bloqueo del plano del músculo erector de la columna para analgesia de dolor lumbar crónico: serie de casos

BackgroundChronic low back pain (CLBP) is a frequent condition, poorly managed with conventional treatments. The ultrasound-guided erector spinae plane block has increasingly been used in the management of acute and chronic pain. We aimed to determine this technique's analgesic efficacy in patients with moderate to severe CLBP.MethodsTen consecutively selected patients: adults, regularly followed in our Pain Clinic with moderate/severe long-term CLBP refractory to pharmacological treatment, VAS > 4. Prospective data collection: before the intervention –demographical data, past medical history, current pain therapies, VAS pain level, Brief Pain Inventory– Short Form and Neuropathic Pain Questionnaire; 30 minutes after – VAS and satisfaction level; 24 and 72 hours, 7 days and 1 month after - complications and pain level.ResultsMajority of females (90%), mean age of 70.3 years-old. All had primary musculoskeletal CLBP. 90% experienced severe pain (VAS > = 7) in the last 24 hours. Half presented neuropathic characteristics. Patients were very satisfied with the technique (mean: 8.75) with immediate pain relief (VAS mean: 2.3). 24 and 72 hours, 7 days and 1 month after the treatment VAS means were 3.2, 3.1, 3.8 and 6.2. We report a 20.8 days duration mean. No short or long-term complications.Discussion and conclusionsUltrasound-guided erector spinae plane block has preliminary advantages in CLBP: easily performed with low complications risk, immediate discharge home with absence of motor block, 100% efficacy at short and medium-terms. Even though pain's relief was shorter than a month, it is a useful tool allowing patients’ well-being, physical rehabilitation and exercise during this period.     

Dor lombar inespecífica em adultos jovens: fatores de risco associados

ObjectiveThe aim of the study was to evaluate potential risk factors related to low back pain in the daily routines of two sets of youths: individuals complaining of chronic low back pain and a control group.MethodsThe sample consisted of 198 university‐age students (male and female) aged between 18 and 29. In accordance with back pain diagnoses, they were separated into two groups: with or without nonspecific chronic low back pain. Both groups were evaluated by a “blinded” observer with no knowledge to the presence or otherwise of lower back pain. Questionnaires concerning clinical‐demographic characteristics, life style, quality of life (SF‐36 questionnaire), pain visual analogical scales (VAS), and physical examination were applied.ResultsA univariate analysis showed a statistically significant association (P < 0.05) with the presence of low back pain and some factors. There was a negative association between low back pain and the following variables: BMI, health self‐assessment, VAS and some SF‐36 domains (physical functioning, body pain, general health, vitality, social functioning). There was a positive correlation with the following variables: global pain by VAS, presence of diffuse pain and number of tender points. However, the multivariate analysis showed statistically significant correlations (P < 0.05) between low back pain and few variables: global pain VAS and number of tender points.ConclusionSome variables related to chronic diffuse pain and lower quality of life might be associated to chronic low back pain in young adults. However, longitudinal studies are necessary.     

Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis

BackgroundThis pilot study investigated whether semi-rigid and soft orthoses had an effect on pain, disability and functional limitation in participants with chronic rheumatoid hindfoot involvement.MethodsParticipants with chronic hindfoot pain were randomly assigned to 2 groups, commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses. The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention, which lasted for 3 months. Following a 2 week washout period, each group was switched over to the other type of orthoses.ResultsNine female participants (mean age 52.2 years (SD 9.1); mean weight 71 kg (SD 12.64); mean height 160 cm (SD 5.18)) with a mean RA duration of 11.7 years (SD 7.83), and a mean ankle/subtalar joint pain duration of 5.7 years (SD 2.62), completed the programme. Mean improvement in FFI score for both orthoses resulted in the same statistical significance (p = 0.001). Statistically significant reduction in pain, disability and functional limitation was observed for both interventions, together with improvement in the Ritchie Articular Index score.ConclusionBoth Subortholene and EVA orthoses significantly reduced pain, disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis.     

Nature’s wrath—The effect of weather on pain following orthopaedic trauma

BackgroundDespite frequent complaints by orthopaedic trauma patients, to our knowledge there is no data regarding weather’s effect on pain and function following acute and chronic fracture. The aim of our study was to investigate the influence of daily weather conditions on patient reported pain and functional status.MethodsWe retrospectively examined prospectively collected data from 2369 separate outpatient visits of patients recovering from operative management of acute tibial plateau fractures, acute distal radius fractures, and chronic fracture nonunions. Pain and functional status were assessed using a visual analogue scale (VAS) and the DASH and SMFA functional indexes. For each visit date, the mean temperature, difference between mean temperature and expected temperature, dew point, mean humidity, amount of rain, amount of snow, and barometric pressure were recorded. Statistical analysis was run to search for associations between weather data and patient reported pain and function.ResultsLow barometric pressure was associated with increased pain across all patient visits (p = 0.007) and for patients at 1-year follow-up only (p = 0.005). At 1-year follow-up, high temperature (p = 0.021) and high humidity (p = 0.030) were also associated with increased pain. No significant association was noted between weather data and patient reported functional status at any follow-up interval.ConclusionsPatient complaints of weather influencing pain after orthopaedic trauma are valid. While pain in the immediate postoperative period is most likely dominated by incisional and soft tissue injuries, as time progresses barometric pressure, temperature, and humidity impact patient pain levels. Affirming and counseling that pain may vary based on changing weather conditions can help manage patient expectations and improve satisfaction.     

Acupuntura na fibromialgia: um estudo randomizado‐controlado abordando a resposta imediata da dor

ObjectiveTo evaluate the efficacy of acupuncture in the treatment of fibromyalgia, considering the immediate response of the visual analogue pain scale (VAS) as its primary outcome.MethodsRandomized, controlled, double‐blind study including 36 patients with fibromyalgia (ACR 1990) selected from the outpatient rheumatology clinic, Santa Casa de Misericórdia, Ponta Grossa, PR. Twenty‐one patients underwent an acupuncture session, under the principles of the traditional Chinese medicine, and 15 patients underwent a placebo procedure (sham acupuncture). For pain assessment, the subjects completed a Visual Analogue Scale (VAS) before and immediately after the proposed procedure. The mean change in VAS was compared among groups.ResultsThe variation between the final and initial VAS values was –4.36 ± 3.23 (P = 0.0001) in the treatment group and –1.70 ± 1.55 in the control group (P = 0.06). The difference in terms of amplitude of variation of VAS (initial – final VAS) among groups favored the actual procedure (P = 0.005). The effect size (ES) for the treatment group was d = 1.7, which is considered a large effect. Although small, the statistical power of the sample for these results was very relevant (94.8%).ConclusionAcupuncture has proven effective in the immediate pain reduction in patients with fibromyalgia, with a quite significant effect size.     

Anterior knee pain in runners after a half-marathon race

BackgroundAnterior knee pain has been associated with sports activity, especially long-distance running and endurance sports. It is important to determine the incidence of anterior knee pain (AKP) in runners after a half-marathon race and identify possible risk factors associated.MethodsCross-sectional study where runners from a half marathon race were randomly invited to participate. Participants were recruited at the race kit pickup site the day before the race. Eligible participants completed a survey regarding demographic information, running experience and training details. An orthopedic surgeon performed a physical examination and recorded the medical history. At the finish line, the participants were evaluated again for possible new injuries.ResultsA total of 205 runners were included in the study, with a 98.5% follow-up rate (n = 203). 24% of runners had an injury at the end of the race (n = 49). Anterior knee pain was the most frequent injury (n = 12), followed by iliotibial band syndrome (n = 10), muscle cramps (n = 7) and hamstring tears (n = 4). Anterior knee pain had a statistically significant association with insufficient stretching of the hamstrings (p = 0.048) and finishing the race in more than 2 h (p = 0.014).ConclusionsAnterior knee pain was the most frequent new injury in the half-marathon runners after the competition. Spending more than 2 h to finish the race and stretching the hamstrings by less than 70° in the supine position were risk factors for anterior knee pain.     

Combined preoperative femoral and sciatic nerve blockade improves analgesia after anterior cruciate ligament reconstruction: a randomized controlled clinical trial

Study objectiveTo compare preoperative femoral (FNB) with combined femoral and sciatic nerve block (CFSNB) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction.DesignProspective, randomized clinical trial.SettingAmbulatory surgery center affiliated with an academic medical center.PatientsSixty-eight American Society of Anesthesiology physical status I and II patients undergoing arthroscopic ACL reconstruction.InterventionsSubjects randomized to the CFSNB group received combined femoral and sciatic nerve blocks preoperatively, whereas patients randomized to the FNB group only received femoral nerve block preoperatively. Both groups then received a standardized general anesthetic with a propofol induction followed by sevoflurane or desflurane maintenance. Intraoperative pain was treated with fentanyl. Pain in the postanesthesia care unit (PACU) was treated with ketorolac and opiates. Patients with significant pain despite ketorolac and opiates could receive a rescue nerve block.MeasurementsOur primary outcome variable was highest Numeric Rating Scale (NRS) pain score in PACU. NRS pain scores, opioid consumption, opioid adverse effects, and patient satisfaction were assessed perioperatively until postoperative day 3.Main resultsThe highest PACU NRS pain score was significantly higher in the FNB group compared with the CFSNB group (7 [3-10] vs 5 [0-10], P = .002). The FNB group required significantly larger doses of opioids perioperatively (31.8 vs 19.8 mg intravenous morphine equivalents, P < .001). PACU length of stay was significantly longer in the FNB group (128.2 vs 103.1 minutes, P = .006). There was no significant difference in opioid consumption, pain scores, or patient satisfaction on postoperative days 1-3 between groups.ConclusionsPreoperative CFSNB for arthroscopic ACL reconstruction improves analgesia, decreases opioid consumption perioperatively, and decreases PACU length of stay when compared with FNB alone.     

Efficacy of preoperative melatonin versus pregabalin on perioperative anxiety and postoperative pain in gynecological surgeries

BackgroundWe compared the efficacy of melatonin and pregabalin on perioperative anxiety and postoperative pain in patients undergoing laparoscopic gynecological surgeries.MethodsIn this randomized double-blind study, 40 patients, 25–35 yr undergoing gynecological surgeries were divided into 2 equal groups to receive either melatonin capsule 6 mg (Group M), or pregabalin capsule 150 mg (Group P) 1 h before induction of general anesthesia. Our primary outcome was preoperative acute anxiety level 1 h after drug administration, 1, 6, and 12 h after operation. The secondary outcomes were postoperative visual analog scale (VAS) for pain, analgesic consumption, sedation level using the inverted observer’s assessment of alertness/sedation scale (OAA/S) scale, and incidence of adverse effects.ResultsThe anxiety scores decreased significantly >50% after premedication in both groups compared to baseline values (p < 0.01) with no statistically significant difference between the two groups (30.4 ± 4.5 in group M versus 31.7 ± 4.2 in group P, p > 0.05). Postoperative VAS for pain, time for first analgesic demand and number of patients requiring postoperative analgesia did not differ between groups, and the sedation score was higher in melatonin group compared to pregabalin group 1 h after drug (3.45 ± 0.7 versus 1.95 ± 0.6, p < 0.001, respectively) and at all the subsequent readings postoperatively with equal incidence of adverse effects in both groups.ConclusionOral melatonin 6 mg or pregabalin 150 mg administered 1 h before operation had reduced perioperative anxiety and postoperative pain in patients undergoing gynecological surgeries, without untoward sedative effects in the pregabalin group compared to melatonin group.