Is intraoperative bleeding control useful after tourniquet release in arthroscopic anterior cruciate ligament reconstruction?

BackgroundArthroscopic anterior cruciate ligament (ACL) reconstruction is a common orthopedic surgery, and rehabilitation is very important to achieve successful postoperative results. Postoperative hemarthrosis causes pain and limitation of movement, which prolongs the rehabilitation period. For these reasons, various strategies are used to reduce hemarthrosis in patients undergoing ACL reconstruction. This study aimed to evaluate the effect of bleeding control after releasing the tourniquet in ACL reconstruction surgery on the amount of hemarthrosis and pain in the postoperative period.MethodologyA total of 60 patients who underwent arthroscopic single-bundle ACL reconstruction were enrolled in this prospective randomized control study. Bleeding control with the radiofrequency (RF) probe after releasing the tourniquet was done at the end of the arthroscopic ACL reconstruction in 30 patients (coagulation group) while bleeding control was not done for the other 30 patients (control group). Both groups were compared in terms of the degree of hemarthrosis using the Coupens and Yates classification in the early postoperative period and the degree of pain using the Visual Analog Scale (VAS) score and postoperative complications.ResultsIn both groups, isolated ACL reconstruction was performed in 10 patients, additional partial meniscectomy in three patients, and additional arthroscopic meniscus repair in 17 patients. There was no statistically significant difference between the coagulation and control groups in terms of VAS (p > 0.05) and the degree of hemarthrosis (p > 0.05). Although the duration of tourniquet application was similar in both groups (p = 0.78), the duration of anesthesia was significantly longer in the coagulation group (p = 0.001). There was no significant difference between the groups in terms of postoperative complications.ConclusionsBleeding control with the RF probe after tourniquet release does not yield superior outcomes. More research with larger populations is needed to confirm these findings

Fatigue Behavior of Nitinol Anterior Cruciate Ligament Graft and Inappropriate Femoral Tunnel Placement: Single-Stage Revision Anterior Cruciate Ligament Reconstruction Surgery

Anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee, and progressive instability and disability may develop in a significant number of patients. The incidence of ACL reconstruction is rapidly increasing, as is the number of failures. Although ACL reconstruction is a common procedure, less than satisfactory outcomes have been reported to occur in up to 25% of patients. The reasons for clinical failure after ACL reconstruction are numerous but can be broadly separated into 3 categories: technical, biological, and mechanical failures. It is generally thought that poor tunnel positioning (especially the femoral tunnel) is the most common technical error. Revision ACL reconstruction can be performed in 1 or 2 stages. The decision to perform a multistage approach is based on the position and size of the original tunnels. The varied success rates and associated advantages and disadvantages of each method have resulted in controversy as to the best treatment for revision ACL surgery. We describe our preferred operative technique to remove a fractured nitinol synthetic ACL graft and manage single-stage revision ACL reconstruction without bone grafting

The Effects of Platelet Rich Plasma (PRP) on Tendon-To-Bone Tunnel Healing in a Rabbit Model

The purpose of this study was to investigate whether PRP would enhance the tendon-bone attachment because platelets contains growth factors. We demonstrated that PRP had a positive effect when compared to control group on the tendon-to-bone healing at both time points (6 and 12 weeks in a rabbit model). The presence of growth factors in PRP may be the possible mechanism for enhanced healing.</p

Comparison of analgesic effects of intra-articular tenoxicam and morphine in anterior cruciate ligament reconstruction

This study compared the analgesic effect of intra-articular injection of tenoxicam with that of morphine on postoperative pain after anterior cruciate ligament (ACL) reconstruction. Forty-two patients undergoing arthroscopically ACL reconstructions using hamstring tendons underwent the same anesthetic protocol. The patients were randomized to receive 25 ml normal saline, 20 mg tenoxicam in 25 ml normal saline, or 2 mg morphine in 25 ml normal saline. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. We found both that both intra-articular tenoxicam and intra-articular morphine provided better analgesia than that in the control group. Although pain scores were similar between tenoxicam and morphine groups 30 min postoperative, the analgesic requirements in with tenoxicam were significantly lower than those with morphine group 3-6 h postoperatively

Median sinirin oluşum varyasyonlarının incelenmesi

&Ouml;ZET Ama&ccedil;: &nbsp; &nbsp; Bu &ccedil;al&yacute;&thorn;mada, kol seviyesinde median sinirin olu&thorn;um varyasyonlar&yacute;n&yacute; belirlemek amac&yacute;yla yap&yacute;ld&yacute;. Hastalar ve Y&ouml;ntem: &nbsp; &nbsp; Bu ama&ccedil;la aksilla ve kol seviyesinde 30 kadavran&yacute;n median sinirlerinin olu&thorn;umlar&yacute;, klasik diseksiyon y&ouml;ntemi ile a&ccedil;&yacute;l&yacute;p incelendi. Bulgular: &nbsp; &nbsp; Median sinir varyasyonu 30 olgunun 7&rsquo;sinde g&ouml;r&uuml;ld&uuml;.Varyasyonlu median sinirler &uuml;&ccedil; k&ouml;k&uuml;n birle&thorn;mesi ile olu&thorn;uyordu. K&ouml;klerden biri fasciculus medialis&rsquo;ten, di&eth;eri fasciculus lateralis&rsquo;ten, bir di&eth;eri ya do&eth;rudan fasciculus lateralis&rsquo;ten veya musculocutaneus sinir yoluyla fasciculus lateralis&rsquo;ten geliyordu. Varyasyonlu yedi olgunun be&thorn;inde &uuml;&ccedil;&uuml;nc&uuml; k&ouml;k distalde fasciculus lateralis&rsquo;ten do&eth;up burada median sinirle birle&thorn;iyordu. Di&eth;er iki olguda &uuml;&ccedil;&uuml;nc&uuml; k&ouml;k fasciculus lateralis&rsquo;ten, ancak musculocutaneous sinirin olu&thorn;umundan sonra distalde, buradan gelen dallardan olu&thorn;arak median sinirle birle&thorn;iyordu. Sonu&ccedil;: &nbsp; &nbsp; Aksillar b&ouml;lge ve kol seviyesinde yap&yacute;lacak cerrahi m&uuml;dahalelerde bu varyasyonlar&yacute;n bilinmesi &ouml;nem arzetmektedir. Anahtar Kelimeler &nbsp; &nbsp; : Median Sinir, Varyasyon. SUMMARY FORMATION VARIATIONS OF MEDIAN NERVE Purpose: &nbsp; &nbsp; The aim of this study is determining anomalous formations of the median nerve in the arm. Patients and Methods: &nbsp; &nbsp; For this purpose, the course of the median nerve was investigated in the arms of 30 adults cadavers. Results: &nbsp; &nbsp; Median nerves of 30 cadavers were inspected with classical dissection method from the level of axilla to the arm. Anatomic variations of the median nerve were detected in 7 cadavers. In these cadavers the median nerves were formed by the fusion of three roots; one of them coming from the medial fascicle, one from the lateral fascicle, and one from the lateral fascicle either directly or through the musculocutaneous nerve. In five of seven cadavers with variation, the third root arose from the lateral fascicle and was joined to the median nerve at the distal level. In the remaining two cases, the third root arose from the branches coming from the lateral fascicle and joined to the median nerve distal to the origination of the musculocutaneous nerve. Conclusion: &nbsp; &nbsp; The anatomic variations of the median nerve must be kept in mind to avoid mistakes in surgical operations of the axillary region and the arm. Key Words: &nbsp; &nbsp; Median Nerve, Variation. &nbsp; &nbsp;</p