Current “Legal Highs”

Background

A growing number of novel substances have been abused as recreational drugs by young people in the United States (US), Europe, and Australia. Called “legal highs,” these substances range from plant-based to completely synthetic compounds. Spice, Salvia, mephedrone, methylenedioxypyrovalerone (MDPV), and other cathinone derivatives have psychotropic effects and are marketed for recreational use through exploitation of inadequacies in existing controlled substance laws.

Objectives

This article reviews available literature on the most common “legal highs” as well as discussing the scientific basis for the legal difficulties in controlling trafficking in these novel substances.

Conclusions

“Legal highs” continue to increase in use in the US, Europe, and Australia. These substances are powerful, can mimic effects of more traditional drugs of abuse, and are intentionally manufactured to circumvent existing controlled substance laws. As controlled substance legislation may be inadequate in the face of the quickly evolving legal highs, physicians are likely to see an increase in the prevalence of legal highs.     

New Pharmacological Options for Treating Advanced Parkinson’s Disease

Background

Parkinson’s disease (PD) affects about 1% of the over 60 population and is characterized by a combination of motor symptoms (rest tremor, bradykinesia, rigidity, postural instability, stooped posture and freezing of gait [FoG]) and non-motor symptoms (including psychiatric and cognitive disorders). Given that the loss of dopamine in the striatum is the main pathochemical hallmark of PD, pharmacological treatment of the disease has focused on restoring dopaminergic neurotransmission and thus improving motor symptoms. However, the currently licensed medications have several major limitations. Firstly, dopaminergic medications modulate all the key steps in dopamine transmission other than the most powerful determinant of extracellular dopamine levels: the activity of the presynaptic dopamine transporter. Secondly, other monoaminergic neurotransmission systems (ie noradrenergic, cholinergic and glutamatergic systems are altered in PD and may be involved in a variety of motor and non-motor symptoms. Thirdly, today’s randomized clinical trials are primarily designed to assess the efficacy and safety of treatments for motor fluctuations and dyskinesia. Fourthly, there is a need for disease- modifying treatments (DMTs) that slow disease progression and reduce the occurrence of the very disabling disorders seen in late-stage PD.

Objective

To systematically review a number of putative pharmacological options for treating the main impairments in late-stage PD (ie gait disorders, cognitive disorders and behavioural disorders such as apathy).

Methods

We searched the PubMed database up until July 2013 with logical combinations of the following search terms: “Parkinson’s disease”, “gait”, “cognition”, “apathy”, “advanced stage”, “modulation”, “noradrenergic”, “cholinergic”, “glutamatergic” and “neurotransmission”.

Results

In patients undergoing subthalamic nucleus stimulation, the potentiation of noradrenergic and dopaminergic transmission by methylphenidate improves gait and FoG and may relieve apathy. However, the drug failed to improve cognition in this population. Potentiation of the cholinergic system by acetylcholinesterase inhibitors (which are licensed for use in dementia) may reduce pre-dementia apathy and falls. Modulation of the glutamatergic system by an N-methyl-D-aspartate receptor antagonist did not improve gait and dementia but may have reduced axial rigidity. A number of putative DMTs have been reported.

Discussion

Novel therapeutic strategies should seek to reduce the appearance of the very disabling disorders observed in late-stage PD. Dopamine and/or noradrenaline transporter inhibitors, anticholinesterase inhibitors, Peroxisome-proliferator-activated-receptor-agonists and iron chelators should at least be investigated as putative DMTs by applying a delayed-start clinical trial paradigm to a large population

Conclusions

There is a need for more randomized clinical trials of treatments for late-stage PD.     

Wound Debridement: Lessons Learned of When and How to Remove “Wild” Maggots

Background

Wounds, particularly chronic wounds, are a common presentation to the Emergency Department (ED), and in severe cases can contain maggots. Maggot debridement therapy is a popular technique for wound debridement, but is limited to the use of sterilized larvae due to concerns of contamination and invasion of “wild” maggots into healthy tissue. Wild maggots in chronic wounds, therefore, should be removed, yet there is no reported literature that describes a technique for their removal.

Objective

This article presents a step-by-step approach for the safe removal of “wild” larvae in a wound using Yankauer suction.

Case Report

We present a case of a homeless man presenting to the ED with a foot wound found to have “wild” maggots that required removal.

Conclusion

The technique described in this article is a simple, safe, and efficient way for the Emergency Physician to remove “wild” larvae from wounds.     

Clinical Impression and Ascites Appearance Do Not Rule Out Bacterial Peritonitis

Background

Previous research has demonstrated that physician clinical suspicion, determined without assessing fluid appearance, is not adequate to rule out spontaneous bacterial peritonitis (SBP) without fluid testing.

Study Objective

To determine the sensitivity of physician clinical suspicion, including a bedside assessment of fluid appearance, in the detection of SBP in Emergency Department (ED) patients undergoing paracentesis.

Methods

We conducted a prospective, observational study of ED patients with ascites undergoing paracentesis at three academic facilities. The enrolling physician recorded the clinical suspicion of SBP (“none,” “low,” “moderate,” or “high”), and ascites appearance (“clear,” “hazy,” “cloudy,” or “bloody”). SBP was defined as an absolute neutrophil count ≥250 cells/mm³, or culture pathogen growth. We defined “clear” ascites fluid as negative for SBP, and “hazy,” “cloudy,” or “bloody” as positive. A physician clinical suspicion of “none” or “low” was considered negative for SBP, and an assessment of “moderate” or “high” was considered positive. The primary outcome measure was sensitivity of physician clinical impression and ascites appearance for SBP.

Results

There were 348 cases enrolled, with SBP diagnosed in 43 (12%). Physician clinical suspicion had a sensitivity of 42% (95% confidence interval [CI] 29–55%) for the detection of SBP. Fluid appearance had a sensitivity of 72% (95% CI 58–83%).

Conclusion

Physician clinical impression, which included an assessment of fluid appearance, had poor sensitivity for the detection of SBP and cannot be used to exclude the diagnosis. Routine laboratory fluid analysis is indicated after ED paracentesis, even in patients considered to have a low degree of suspicion for SBP.     

Frequent Emergency Department Visits are More Prevalent in Psychiatric,Alcohol Abuse,and Dual Diagnosis Conditions than in Chronic Viral Illnesses Such as Hepatitis and Human Immunodeficiency Virus

Background

Repeat users of Emergency Departments (ED), so-called “frequent visitors,” place a substantial burden on limited ED resources. The illness features of frequent visitors have not been well defined, though chronic medical and psychiatric illness and substance abuse are implicated.

Study Objectives

This study assessed whether chronic conditions such as hepatitis C (HCV) and human immunodeficiency virus (HIV) are more prevalent in frequent ED users compared to a viral condition with relatively less disability, hepatitis B (HBV). As a comparison, psychiatric complaints and alcohol abuse were also compared in frequent and non-frequent visitors.

Methods

All visits to a university ED in a particular calendar year were retrospectively reviewed. Frequent visitors were defined as those who made four or more visits. Presenting complaints and past medical history were examined for HCV, HIV, HBV, psychiatric complaints, and alcohol abuse.

Results

Frequent visitors accounted for 28% of all ED visits. HCV, HIV, and alcohol abuse were more prevalent in frequent visitors than non-frequent visitors. People with HBV comprised a small proportion of both groups. Frequent visitors with psychiatric complaints were more prevalent than those with HBV or alcohol abuse. Psychiatric history comorbid with alcohol abuse and HCV with alcohol abuse were more prevalent in frequent vs. non-frequent visitors.

Conclusion

Although chronic hepatitis and psychiatric complaints are both implicated in frequent ED visits, patients with psychiatric complaints present to the ED more often. Patients with a “dual diagnosis” of psychiatric condition and alcohol abuse are likely to be frequent visitors. This population should be targeted for creative intervention strategies, both within and outside of the emergency system, that comprehensively screen for symptomatology and integrate mental health treatment with substance abuse interventions.     

Hospitalisation en court séjour pour reconstruction du ligament croisé antérieur : étude prospective comparative

Introduction

In France, the median duration of hospitalization for a reconstruction of the anterior cruciate ligament (ACL) is 3 days. The purpose of this study was to evaluate the feasibility and acceptability of hospitalization for one day for this surgery.

Patients and methods

A prospective study conducted in 2011 included patients who underwent surgery for an ACL rupture. Exclusion criteria were age > 60 years, scores ASA3-4 and patients unmanageable in short-stay. Two groups of patients were formed: “short-stay” with an output at D1 and “conventional hospitalization” with an output at D3. The postoperative analgesia protocol included analgesics I-II, morphine on demand during hospitalization. “Short-stay” group received a telephone follow-up (D1–D4). The primary outcome was patient satisfaction at D3. The secondary endpoints were postoperative pain assessed on a visual analogue scale at D3 and adverse events. Thirty patients were included in each group, 34 men and 26 women, mean age 29 ± 5 years.

Results

Patients in group “short-stay” were on average more satisfied than the “conventional hospitalization” group, P = 0.01. The pain was significantly less pronounced in the “short-stay” group, P = 0.00001. No complications occurred.

Conclusion

Inpatients short-stay were significantly more satisfied and less painful than those in conventional hospitalization group. Future studies should evaluate the feasibility of ambulatory surgery for ACL reconstruction.     

Emergency Department Team Communication with the Patient: The Patient's Perspective

Background

Effective communication is important for the delivery of quality care. The Emergency Department (ED) environment poses significant challenges to effective communication.

Objectives

The objective of this study was to determine patients' perceptions of their ED team's communication skills.

Methods

This was a cross-sectional study in an urban, academic ED. Patients completed the Communication Assessment Tool for Teams (CAT-T) survey upon ED exit. The CAT-T was adapted from the psychometrically validated Communication Assessment Tool (CAT) to measure patient perceptions of communication with a medical team. The 14 core CAT-T items are associated with a 5-point scale (5 = excellent); results are reported as the percent of participants who responded “excellent.” Responses were analyzed for differences based on age, sex, race, and operational metrics (wait time, ED daily census).

Results

There were 346 patients identified; the final sample for analysis was 226 patients (53.5% female, 48.2% Caucasian), representing a response rate of 65.3%. The scores on CAT-T items (reported as % “excellent”) ranged from 50.0% to 76.1%. The highest-scoring items were “let me talk without interruptions” (76.1%), “talked in terms I could understand” (75.2%), and “treated me with respect” (74.3%). The lowest-scoring item was “encouraged me to ask questions” (50.0%). No differences were noted based on patient sex, race, age, wait time, or daily census of the ED.

Conclusions

The patients in this study perceived that the ED teams were respectful and allowed them to talk without interruptions; however, lower ratings were given for items related to actively engaging the patient in decision-making and asking questions.     

Évaluation d’un protocole de kinésithérapie ambulatoire pour la prise en charge des coxarthroses et conflits antérieurs fémoro-acétabulaires des sportifs

Introduction

Hip osteoarthritis and femoroacetabular impingement frequently affect sportsmen and are origins of permanent incapacity. The therapic behaviour before surgery step is not yet established. Physiotherapy is often suggested but it is still difficult to prescribe it correctly. The main goal of our study is to show superiority, both in terms of decrease of pain and increase of sportive activity, of the process “PROTOCOX” including both physiotherapy and manual therapy in comparison with a physiotherapy process “CONTROLE”.

Method

Twenty-six sportive patients of the “Institut régional de médecine du sport de Haute Normandie (IRMSHN)” have been included in the study in an 18-month period. Our secondary aims are to show improvement of life quality and range of motion. Several data including HOOS and Lequesne index have been harvested before and after the six sessions and after 3 months.

Results

For patients (n = 11) of the “PROTOCOX” group (P = 0.034), a significant improvement of the HOOS index, mainly on pain (P = 0.04) and allowing an increase of sportive activity (P = 0.007). After 3 months, there was still a transitory improvement allowing an increase of sportive activity for 75% of the patients (n = 8) of the “PROTOCOX” group in comparison of 18.2% for the “CONTROLE” patients.

Conclusion

The “PROTOCOX” process is simple and practicable in liberal sector, and gives benefits in terms of decrease of pain and sportive activity increase with a reduce number of sessions and its transitory efficiency stays at mid term.     

A randomized controlled trial of adding intravenous pantoprazole to conventional treatment for the immediate relief of dyspeptic pain

Introduction

Acute, severe dyspeptic pain is a common condition in the emergency department. Despite the traditional “GI cocktail” (GI indicates gastrointestinal), an intravenous (IV) proton pump inhibitor (PPI), a novel acid-lowering drug, has recently been used to treat this condition. The aim of this study was to evaluate the immediate effect of IV pantoprazole in addition to the conventional GI cocktail in the relief of severe dyspeptic pain.

Methods

This double-blind, randomized, controlled study was conducted in the emergency department of an urban tertiary-care hospital from January 2011 to October 2011. Selected patients with severe dyspeptic pain were randomized to treatment with a placebo, antacid, and antispasmodic (conventional group) or IV pantoprazole, antacid, and antispasmodic (pantoprazole group). The self-reported 100-mm visual analog scale score, adverse effects, and overall satisfaction were evaluated in 15-minute intervals for 60 minutes.

Results

Eighty-seven eligible cases were enrolled in the study. Forty-four and 43 patients were randomized in the conventional group and pantoprazole group, respectively. There was no difference in the mean 60-minute visual analog scale scores between the treatment groups. The rate of “responders,” additional drug use, adverse effects, and patient satisfaction were similar between the groups.

Conclusion

Intravenous PPI provides no additional benefit over the conventional GI cocktail in the relief of acute, severe dyspeptic pain. Because of its neutral effect and higher cost, the use of IV PPI to treat such conditions should be discouraged in general clinical practice.     

Ophthalmic Presentation in the Emergency Department: A Case Report of a Girl With “Shimmering Eyes”

Background

Ophthalmic complaints are commonplace in the emergency department (ED) and are often initial presentations of a systemic illness. We present a 2-year-old girl presenting to the ED with ataxia and “shimmering” eyes.

Case Report

The patient was diagnosed with opsoclonus-myoclonus syndrome (OMS) involving involuntary, multi-vectorial (mostly horizontal), conjugate fast eye movements without intersaccadic intervals. The ophthalmic presentation led to a paraneoplastic work-up, which revealed an abdominal mass measuring 5.3 × 3.3 × 4.3 cm, suggestive of neuroblastoma. The patient's opsoclonus improved after a 5-day course of dexamethasone and intravenous immunoglobulin.

Why should an emergency physician be aware of this?

This case illustrates the importance of recognizing pathognomonic ophthalmic complaints in the ED. We present an overview of classic ophthalmic presentations associated with systemic illnesses.     

Changes in Gross Motor Function and Health-Related Quality of Life in Adults With Cerebral Palsy: An 8-Year Follow-Up Study

Objective

To describe changes in gross motor function and health-related quality of life (HRQOL) in adults with cerebral palsy (CP).

Design

An 8-year follow-up survey.

Setting

Participants who completed the baseline survey in 2003 were invited.

Participants

The sample of adults with CP (N=54; response rate=37%) included a “younger group” (group 1; n=31; age, 23–27y; 15 women) and an “older group” (group 2; n=23; age, 33–42y; 10 women).

Interventions

Not applicable.

Main Outcome Measures

The Gross Motor Function Classification System (GMFCS), Self-Rated Health (SRH), the Health Utility Index Mark III (HUI₃), and the Assessment of Quality of Life (AQoL).

Results

Eight years after the initial survey, 27% of the participants in the combined group had deteriorations on the GMFCS, 52% on the SRH, 44% on the HUI₃, and 25% on the AQoL. Members of group 1 reported stable scores as they made the transition to adulthood, while many of the group 2 members experienced declines, with relative risk of 1.47 (95% confidence interval [CI], 0.16–2.24) on the GMFCS, 1.36 (95% CI, 0.83–2.23) on the SRH, 1.19 (95% CI, 0.66–2.15) on the HUI₃, and 3.17 (95% CI, 1.12–9.00) on the AQoL.

Conclusions

Although much attention has focused on the transitions of persons with CP during their late teens and early 20s, this research found that deteriorations in the GMFCS levels and the HRQOL were most evident in adults in their late 20s and 30s. More detailed longitudinal studies are required to evaluate the longer-term health outcomes among persons with CP into their 30s and beyond.     

No Diversion in Western Massachusetts

Background

Massachusetts (MA) instituted a moratorium on ambulance diversion (“No Diversion”) on January 1, 2009.

Study Objectives

Determine whether No Diversion was associated with changes in Emergency Department (ED) throughput measures.

Design

Comparison of three 3-month periods. Period 1: 1 year prior (January–March 2008); Period 2: 3 months prior (October–December 2008); Period 3: 3 months after (January–March 2009).

Setting

Seven EDs in Western MA; two – including the only Level I Trauma Center – were “high” diversion (≥562 h/year) and 5 were “low” diversion (≤260 h/year). For “all,” “high” diversion and “low” diversion ED groups, we compared mean monthly throughput measures, including: 1) total volume, 2) number of admissions, 3) number of elopements, 4) length of stay for all, admitted and discharged patients. Mean absolute and percent changes were estimated using mixed-effects regression analysis. Linear mixed models were run for “all,” “high” and “low” diversion EDs comparing means of changes between periods. Results are presented as mean change per month in number and percent, and 95% confidence intervals were calculated. We specified that a clinically significant effect of No Diversion had to meet two criteria: 1) there was a consistent difference in the means for both the Period 1 vs. Period 3 comparison and the Period 2 vs. Period 3 comparison, and 2) both comparisons had to achieve statistical significance at p ≤ 0.01.

Results

According to pre-determined criteria, no clinically significant changes were found in any ED group in mean monthly volume, admissions, elopements, or length-of-stay for any patient disposition group.

Conclusion

No Diversion was not associated with significant changes in throughput measures in “all,” “high” diversion and “low” diversion EDs.     

Management of Subcutaneous Emphysema with “Gills”: Case Report and Review of the Literature

Background

Subcutaneous emphysema is often a symptom of a serious pathologic condition but rarely requires direct treatment. Subcutaneous emphysema itself occasionally may interfere with effective cardiopulmonary resuscitation and require direct intervention.

Objective

The aim of this article is to present a case of subcutaneous emphysema during cardiac arrest and to describe a therapeutic technique that we call the “gills” procedure, as well as the background and rationale for this and other similar techniques.

Case Report

A 56-year-old man sustained cardiac arrest in the setting of a perforated duodenal ulcer with massive subcutaneous emphysema and pneumomediastinum that interfered with effective cardiopulmonary resuscitation. A “gills” procedure consisting of bilateral skin incisions over the clavicles was performed, with the return of spontaneous circulation.

Conclusion

Subcutaneous emphysema and pneumomediastinum can cause tension physiology, impairing normal cardiovascular and pulmonary function. Only with release of this tension can normal cardiopulmonary function return. The gills procedure is one of several possible therapeutic options.     

Neck Pain Driving Index: Appropriateness of the Rating Scale and Unidimensionality of the Strategic,Tactical, and Operational Levels

Objective

To establish an appropriate scoring system using Rasch scores for the strategic, tactical, and operational levels of the Neck Pain Driving Index (NPDI) and to refine the NPDI by testing the unidimensionality of each driving performance level using Rasch analysis.

Design

Cross-sectional.

Setting

Tertiary institution.

Participants

Individuals with chronic whiplash-associated disorders (WAD) (N=123).

Interventions

Not applicable.

Main Outcome Measure

The NPDI, which was developed to evaluate self-reported driving difficulty in people with chronic WAD.

Results

On the basis of Rasch analyses, modifications were made to the response format, changing it from a 0 to 4 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty, 4=unable to drive because of the injury) to a 0 to 3 scale (0=no difficulty, 1=slight difficulty, 2=moderate difficulty, 3=great difficulty and unable to drive because of the injury). Unidimensionality of the strategic and operational levels was confirmed. Modification of the tactical level was necessary to ensure its unidimensionality. After removing the tasks “driving near (your) collision site,” “driving in a bad weather condition,” and “driving at night,” unidimensionality of the 4-item tactical level was confirmed. A 9-item NPDI was established. A table converting raw total scores into Rasch scores was created for each level.

Conclusions

This study established the 9-item NPDI, and its 3 subsections (strategic, tactical, and operational levels) are unidimensional. The magnitude of self-reported driving difficulty at each of the 3 subsections can be assessed with the use of a 0 to 3 scale and Rasch scores.     

Synthetic Cannabinoid Intoxication: A Case Series and Review

Background

Synthetic cannabinoid receptor agonists are becoming increasingly popular with adolescents as an abused substance. Chronic use of these drugs can lead to addiction syndrome and withdrawal symptoms similar to cannabis abuse. Due to their potential health risk, several countries have banned these substances.

Objectives

To report the clinical presentation and legislation status of synthetic cannabinoids in “Spice” products and alert the health care community about the identification and risk assessment problems of these compounds.

Case Reports

We retrospectively reviewed cases presenting to our Emergency Department (ED) during a 3-month period with chief complaints of Spice drug use before arrival. Six cases presented to our ED after using Spice drugs. Two patients were admitted after reporting seizures. All but one presented with tachycardia. Two patients had hallucinations. The average length of ED observation was 2.8 h. No patient with seizures had recurrent episodes.

Conclusion

Spice drugs can cause potentially serious health care conditions that necessitate ED evaluation. Most cases can be discharged from the ED after a period of observation. Legal issues surrounding these drugs are yet to be finalized in the United States.     

A one-day “Helping Babies Breathe” course improves simulated performance but not clinical management of neonates

Objective

“Helping Babies Breathe” (HBB) is a simulation-based one-day course developed to help reduce neonatal mortality globally. The study objectives were to (1) determine the effect on practical skills and management strategies among providers using simulations seven months after HBB training, and (2) describe neonatal management in the delivery room during the corresponding time period before/after a one-day HBB training in a rural Tanzanian hospital.

Methods

The one-day HBB training was conducted by Tanzanian master instructors in April 2010. Two simulation scenarios; “routine care” and “neonatal resuscitation” were performed by 39 providers before (September 2009) and 27 providers after (November 2010) the HBB training. Two independent raters scored the videotaped scenarios. Overall “pass/fail” performance and different skills were assessed. During the study time period (September 2009–November 2010) no HBB re-trainings were conducted, no local ownership was established, and no HBB action plans were implemented in the labor ward to facilitate transfer and sustainability of performance in the delivery room at birth. Observational data on neonatal management before (n = 2745) and after (n = 3116) the HBB training was collected in the delivery room by observing all births at the hospital during the same time period.

Results

The proportion of providers who “passed” the simulated “routine care” and “neonatal resuscitation” scenarios increased after HBB training; from 41 to 74% (p = 0.016) and from 18 to 74% (p ≤ 0.0001) respectively. However, the number of babies being suctioned and/or ventilated at birth did not change, and the use of stimulation in the delivery room decreased after HBB training.

Conclusion

Birth attendants in a rural hospital in Tanzania performed significantly better in simulated neonatal care and resuscitation seven months after one day of HBB training. This improvement did not transfer into clinical practice.     

Effect of Low-Osmolality Intravenous Contrast on Serum Osmolal Gap in Adults

Background

Contrast media used today is considered “low-osmolality.” No study has evaluated the effect of intravenous contrast media on the measurement of the osmolal gap in adult patients.

Objective

To determine if “low-osmolality” intravenous contrast media administered to adult patients undergoing computed tomography (CT) of the abdomen and pelvis affects the osmolal gap.

Methods

We performed a prospective pilot study in the Emergency Department of a university-affiliated tertiary care center. Patients were enrolled if they were age ≥18 years and <60 years and the treatment team had ordered an abdomen and pelvis CT with intravenous (i.v.) contrast procedure and a serum basic metabolic panel (BMP) that included serum glucose, blood urea nitrogen, and sodium. Once enrolled, a serum osmolality and serum ethanol level was ordered and obtained on the same blood draw as the BMP before the CT. Patients were excluded if they had detectable ethanol on laboratory screen, if they were suspected to have ingested methanol, ethylene glycol, isopropanol, mannitol, or underwent CT with i.v. contrast within the prior 24 h. Paired samples were compared using the Wilcoxon signed-rank test.

Results

Of the 100 patients screened, 18 patients were lost due to withdrawal of consent or missing data. The median of the osmolal gap pre-CT was 8.18 with an interquartile range of 4.76–11.15. The median of the osmolal gap post-CT was 11.23 with an interquartile range of 7.29–14.83. The difference in the osmolal gap was a median of 2.34 (p = 0.0003) with an interquartile range of −1.32–5.97.

Conclusion

Although the effect in our study was small, clinicians should be aware of the ability of contrast media to increase the osmolal gap.     

Fonction et niveau d’activité physique deux à cinq ans après la reconstruction du ligament croisé antérieur (LCA)

Objectives

Evaluation of functionality and level of physical activity in patients 2 to 5 years after anterior cruciate ligament reconstruction.

Material and methods

A nonrandomized study, which included consecutive patients (n = 31) who underwent ACL reconstruction and were evaluated 2-5 years after ligament reconstruction. The surgical techniques used were the bone-patellar tendon-bone graft (BTB), quadriceps tendon (QT) and semitendinosus gracilis tendons (ST-G). The clinical evaluation included the Tegner activity Index (TI), Lysholm Index (LI), Index Knee Outcome Survey (KOS) in their sub-divisions “Total”, “Activities of Daily Living” and “Functionality” (KOS-T, KOS-ADL, KOS-IF) and Noyes Test (NT). The Package for Social Sciences (SPSS) version 17.0 for Windows was used for the statistical study.

Results

Before injury, the TI was 6.74 and after injury 4.35; the LI average was 89.55; the KOS-T was 70.48, KOS-ADL 30.48 and KOS-FI 39.95; and the NT gave a symmetry score of 96.6%. No significant correlations were found between the values of the TI before and after injury, or between the values of the LI and KOS-ADL, and the LI and NT.

Conclusion

ACL injury is associated with a high number of meniscal and chondral injuries, with direct impact on the prognosis of these patients’ sport activity and a reduction in activity levels. This reduction is not accompanied by a significant functional loss and normal daily activities are unaffected. The motivation of the patient and medical advice are considered key factors in promoting recovery to the pre-lesional level.