Aseptic knee effusion associated with calcified guinea worms

Reported is a case of aseptic knee effusion associated with the presence of a calcified guinea worm, Dracunculus medinensis, in close proximity to the joint. The patient, a native of Nigeria, presented with chronic right knee pain and swelling. He did well with symptomatic treatment including non-steroidal antiinflammatory drugs, rest, ice, and elevation of the leg. Dracunculiasis is prevalent in parts of Asia and Africa, but has been described only rarely in the United States.     

Osteochondritis dissecans of the patellofemoral groove in athletes: unusual cases of patellofemoral pain

Five athletes who developed osteochondritis dissecans in the patellofemoral groove in the course of sports events at high school and college league level are described. They were male athletes complaining of anterior knee pain. When examining young people engaged in violent sports, it is well to remember that they might have osteochondritis dissecans in the patellofemoral groove. Clinically, four of the five patients under discussion were characterized by tight movements of the patella in a direction parallel to its transversal axis. X-ray studies in lateral projections and CT scans provided useful tools for definitive diagnosis, but AP radiography was no help in diagnosis. Release of a tight lateral retinaculum with or without drilling on the degenerated cartilage was effective in the treatment of osteochondritis dissecans of the patellofemoral groove in three of the four patients.     

Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft two-incision technique

Anterior cruciate ligament (ACL) reconstruction can be performed with a variety of techniques. Multiple graft sources for reconstruction are also available. The senior author (JRS) has used an arthroscopically assisted technique with 2 incisions that has achieved consistently good results. One incision is made over the patellar tendon, allowing harvest of the bone-patellar tendon-bone graft and tibial tunnel placement and graft fixation. A second lateral incision is used for femoral tunnel placement and fixation. This method has produced predictably good results and avoids some of the potential complications of endoscopic ACL reconstruction.     

Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty

BACKGROUND: After total knee arthroplasty, patients regularly suffer from severe pain. It is unclear whether epidural or systemic pain therapy is superior in terms of postoperative pain relief, patients' comfort and side effects. A new therapeutic approach, intraarticular opioids, has been suggested with the detection of opioid receptors in inflamed tissue. This method has proven suitable for clinical use in small operations (e.g. knee arthroscopy). In this study, we compared epidural analgesia and intraarticular application of morphine plus "on-demand" intravenous analgesia to "on-demand" intravenous analgesia alone. METHODS: Thirty-seven patients, scheduled for total knee arthroplasty, were randomly assigned to three treatment groups: in group 1 (EPI) patients received bolus doses of morphine via an epidural catheter; in group 2 (IA) an intraarticular bolus of 1 mg of morphine was applied at the end of the operation with subsequent use of a patient-controlled analgesia (PCA) pump; group 3 (Control), in which only PCA was provided, served as control for both analgesic procedures. Main outcome measures included visual analogue pain scales, total morphine consumption, and stress hormones. RESULTS: No statistically significant differences in visual analogue pain scales could be detected between the three groups. Application of intraarticular morphine did not reduce the amount of analgesics required for postoperative analgesia as compared to intravenous analgesia alone. Application of epidural morphine significantly suppressed beta-endorphine release, but did not significantly influence other stress hormones as compared to the control group. CONCLUSION: Epidural and intravenous analgesia after total knee arthroplasty are equivalent methods of pain relief. In major orthopaedic procedures, application of intraarticular morphine does not reduce analgesic requirements.     

Primary reconstruction of the medial collateral ligament in combined injury of the medial collateral and anterior cruciate ligaments Short-term results

We describe our experiences with 22 patients who underwent acute surgical intervention for complete combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in our hospital. In all patients, an arthroscopically guided repair of the MCL was performed, while the torn ACL was treated non-surgically. Primary reconstruction of the MCL in patients with complete disruptions of the MCL complex as well as the ACL reduces combined anteromedial instability to an isolated problem of the ACL. As a result of this treatment, the condition of 15 of 22 knees was improved, after an average duration of follow-up of 2 and a half years. In conclusion, our treatment strategy of an immediate repair of the MCL and reconstruction of the ACL when conservative treatment has failed seems safe and effective. Received: 30 January 1997 Accepted: 25 September 1997     

膝关节前交叉韧带损伤及重建后肌肉力量变化的研究

对ACL陈旧性损伤、急性损伤、手术重建以及未损伤对象四个样本组 ,在等长条件下膝关节肌肉屈伸、旋内 ,旋外、内收和外展的力量情况进行了对比测试。共记录了 5 4个研究对象的 80组测试结果。结果表明各样本组肌肉力量比值在不同方向上存在显著性差异。该结果可能有助于解释ACL损伤及重建后神经肌肉系统的补偿机制 ,并提示通过选择性地训练某些肌肉可达到有效的康复效果。     

膝色素沉着绒毛结节性滑膜炎的手术治疗

对12例膝色素沉着绒毛结节性滑膜炎病例的临床观察表明:关节镜检查有助于本病的诊断;局限型可采取单纯结节切除术,而弥漫型应采取综合治疗措施。作者指出,这是防止复发、保持关节正常活动范围行之有效的方法。     

关节镜下紧缩术治疗重度膝内侧副韧带断裂

目的 探讨关节镜下紧缩术治疗重度膝内侧副韧带断裂,并评价其临床治疗效果。方法 关节镜下探查12例膝内侧副韧带及其他主要结构的损伤,对Ⅲ度膝内侧副韧带体部断裂进行紧缩术。结果 12例患者平均随访6~30个月,Lysholm评分由术前40.0分提高到80.6分,所有患者屈膝30°外翻应力试验阴性,应力下摄X线片示双膝内侧关节间隙差异从术前9.5 mm减少至3.3 mm。结论早期关节镜下重度膝内侧副韧带断裂紧缩术,具有损伤小、早期恢复膝关节稳定性的优点。     

Bone Mineral Density in the Proximal Femur and Contralateral Knee After Total Knee Arthroplasty

Osteoarthrosis (OA) is often associated with pain and disability, which are relieved after total knee arthroplasty (TKA), but the nature of bone changes associated with OA is controversial. We examined preoperative hip and contralateral knee bone mineral density (BMD) in patients requiring TKA and monitored the BMD changes postoperatively. Sixty-nine patients, scheduled to have TKA for osteoarthrotic knees, had both hips and contralateral knee BMD measured by dual-energy X-ray absorptiometry (DXA) at the time of operation (baseline) and at 1 yr after operation. X-rays of the knee joints were also taken to evaluate the severity of OA. Preoperatively, 27% and 38% of the patients had total hip BMD Z-score more than 1 SD in the operated side and contralateral hips, respectively. In all regions of interest (ROI), the mean baseline BMD of the affected side proximal femur was significantly lower than that of the contralateral side (p < 0.0005-0.019). The severity of OA was not associated with BMD. During 1-yr follow-up, the postoperative knee status and the physical activity of the patients (AKS score) improved. However, neither the hip nor the nonoperated knee BMDs increased. Knee OA is associated with significantly lower BMD values in the affected side compared with the contralateral hip, and these levels remained similar or decreased during a 1-yr follow-up. We conclude that improved mobility after TKA does not improve the effects of preoperative disuse-associated bone loss in the short term.     

术前口服罗非昔布对双膝关节置换术后疼痛和全身炎性反应的影响

目的探讨术前环氧化酶2抑制剂罗非昔布是否能增强双膝关节置换术后吗啡的镇痛作用,及其对术后全身炎性反应的影响.方法 30例因关节炎需行双膝关节置换手术患者,通过抓阄方法随机分为罗非昔布加硬膜外镇痛组(RE组)和硬膜外镇痛组(E组),每组15例.RE组在术晨口服罗非昔布25 mg,其余同E组.所有患者均以异氟醚、硬膜外0.75%布比卡因复合维持麻醉.术毕连接患者自控镇痛泵 (1.2 mg/ml布比卡因加0.1 mg/ml吗啡加0.02 mg/ml氟哌利多)镇痛72 h.分别在术前、术毕、及术后2、6、12、24、48 h时抽取股静脉血,检测白细胞总数及分类,以及炎性细胞因子白介素6、8、10和肿瘤坏死因子-α.术后24、48、72 h各进行疼痛评分,记录比较每日吗啡用量、镇痛满意度、镇痛期间副作用以及术中出血量和术后关节引流量.结果复合罗非昔布可明显降低术后24 h静息、48 h静息和活动时疼痛评分.RE组提高术后24 h镇痛满意度为100%,高于E组60%(χ2＝6.71,P<0.01).RE组术后24 h平均吗啡消耗量为6.8 mg明显低于E组8.1 mg,(t=-2.71,P<0.05).RE组血白细胞和嗜中性粒细胞数在12 h和24 h明显低于E组.RE组血浆白介素6含量在术后48 h,白介素8含量在术后24 h明显低于E组.RE组术毕、术后6 h、12 h肿瘤坏死因子-α明显低于E组(t值分别为-2.4、-2.25、-2.41,P值均<0.05).结论术前口服罗非昔布可明显改善双膝置换术后疼痛,增加镇痛满意度,减轻全身炎性反应,减少吗啡用量.