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Background: Despite the suitable characteristics of ropivacaine as an epidural analgesic agent, such as better preservation of motor function and less neurotoxicity, we are aware of no data on its clinical application in pain management following lumbar spine surgery. The purpose of the present study was to evaluate the preemptive analgesic effects and safety of a single epidural injection of ropivacaine during lumbar arthrodesis. Methods: We performed a randomized, double-blinded, intention-to-treat study. Patients with planned one-level posterior lumbar interbody arthrodesis were randomly assigned to either the injection group (n = 32) or the control group (n = 34). The injection group received a 10-ml epidural injection of 0.1% ropivacaine twenty minutes before the skin incision at the planned vertebral level, and the control group received an epidural injection of 10 ml of 0.9% saline solution. A numeric rating scale (from 0 to 10) was measured at seven time points after surgery (at two, four, eight, twelve, twenty-four, and forty-eight hours and at the time of discharge), and the frequency of pushed-button patient-controlled analgesia and total fentanyl consumption were assessed at similar time points (up to two, up to four, up to eight, up to twelve, up to twenty-four, and up to forty-eight hours after surgery). Postoperative nausea and vomiting, the duration of the hospital stay, and the Likert satisfaction score at the time of discharge were evaluated. Results: There were no significant differences between the two groups preoperatively. The numeric rating scale score was higher until twelve hours (p < 0.05) and the frequency of button pushes was higher at every time point except eight to twelve hours (p < 0.05) in the control group as compared with the injection group. Fentanyl consumption until eight to twelve hours (p < 0.05) and total consumption (p < 0.001) at discharge were higher in the control group. There were no differences between the two groups in terms of postoperative nausea and vomiting, the duration of hospital stay, or the mean satisfaction score, and no transient motor weakness was seen in relation to epidural injection of ropivacaine. Conclusions: A single-dose epidural injection of 0.1% ropivacaine before lumbar spine surgery is effective for reducing early postoperative pain without related complications such as transient motor weakness. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Revision of an unsuccessful posterior cruciate ligament (PCL) reconstruction is a complicated clinical procedure with an outcome that may be less satisfactory than that after a typical primary PCL reconstruction. The purpose of this study was to evaluate the reasons for failure of primary PCL reconstructions and to determine the clinical outcomes of revision PCL reconstruction after a minimum of two years of follow-up. Methods: Twenty-eight revision PCL reconstructions were performed by a single surgeon. Four cases that involved diverse operative procedures and two cases with a duration of follow-up of less than twenty-four months were excluded; the outcomes of the remaining twenty-two reconstructions were analyzed at the time of the latest follow-up (at least twenty-four months postoperatively). A technique involving a double femoral tunnel, a modified tibial inlay, and Achilles tendon allograft was used in all twenty-two of these revision reconstructions. Seventeen patients (77%) underwent concomitant reconstruction of posterolateral corner structures. Knee stability was measured with use of posterior stress radiography as well as with a maximum manual displacement test utilizing a KT1000 arthrometer. The subjective International Knee Documentation Committee (IKDC) and objective Orthopadische Arbeitsgruppe Knie (OAK) scoring systems were used to evaluate the clinical outcome. Results: Nine (41%) of the primary PCL reconstructions most likely failed because of a single factor and thirteen (59%) most likely failed because of multiple factors. The most common probable causes of failure were posterolateral rotatory instability (seventeen knees, 77%) and improper graft tunnel placement (nine knees, 41%). Side-to-side differences during posterior stress radiography improved from 9.9 ± 2.8 mm preoperatively to 2.8 ± 1.8 mm at the time of the latest follow-up (p < 0.001). The subjective and objective clinical scores at the latest follow-up evaluation were significantly better than the preoperative scores (p < 0.001). Conclusions: Arthroscopic revision PCL reconstruction with use of the modified tibial-inlay double-bundle technique improved knee stability, as measured with posterior stress radiography and clinically, and outcomes. Associated pos-terolateral rotatory instability should be surgically corrected during PCL reconstruction to prevent graft failure resulting from abnormal opening of the lateral aspect of the tibiofemoral joint. [ABSTRACT FROM AUTHOR]

The article focuses on the case of a 25 year old man who presented to physicians with a four year history of pain and swelling in the anterolateral aspect of the right ankle. A discussion of a diagnosis of psuedoaneurysm of the anterior tibial artery which was given to the man and of successful treatment that he received with ultrasound guided compression therapy is presented.

The article presents two cases of stress fracture associated with a transcortical pin track which was drilled to allow placement of navigation trackers during a computer-navigated total knee arthroplasties. The two case provides information about the risk of the development of a stress fracture after placement of a transcortical pin. Therapeutic procedures to correct the situations are presented along with the discussion of the associated conditions.

BACKGROUND: The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure. METHODS: Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up. RESULTS: The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 ± 1.9 mm preoperatively to 3.4 ± 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 ± 2.1 mm preoperatively to 1.8 ± 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 ± 6.8 to 92.5 ± 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft. CONCLUSIONS: Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery. [ABSTRACT FROM AUTHOR]

Background: The tibial inlay method for reconstruction of the posterior cruciate ligament has been performed with the patient in the prone or lateral decubitus position. The purpose of this report is to present a modification of this method wherein the patient is positioned supine throughout the procedure. Methods: Between May 1995 and September 1998, twelve patients who had an isolated tear of the posterior cruciate ligament underwent reconstruction with use of the modified tibial inlay technique. Eleven patients were evaluated after a minimum duration of follow-up of two years. Stability was measured on posterior stress radiographs and with a maximum manual displacement test performed with a KT-1000 arthrometer. Clinical evaluation was carried out with use of the scoring systems of the Orthopädische Arbeitsgruppe Knie and the International Knee Documentation Committee. Second-look arthroscopy was performed in five patients at the time of follow-up. Results: The mean side-to-side difference in displacement (and standard deviation) was reduced from 10.8 ± 1.9 mm preoperatively to 3.4 ± 2.4 mm at the time of follow-up as measured on the stress radiographs, and it was reduced from 9.0 ± 2.1 mm preoperatively to 1.8 ± 1.2 mm at the time of follow-up as measured with the KT-1000 arthrometer. The average Orthopädische Arbeitsgruppe Knie score was improved from 71.6 ± 6.8 to 92.5 ± 4.8 points. All eleven patients had a satisfactory clinical outcome at the time of the final clinical evaluation. The second-look arthroscopic examination in the five patients showed no evidence of partial tearing or abrasion of the graft. Conclusions: Use of our modified tibial inlay technique for reconstruction of the posterior cruciate ligament achieved a good clinical result in eleven of twelve patients. The advantages of the technique are (1) minimal tendon abrasion at the posterior opening of the tibial tunnel, and (2) elimination of the need to change the patient's position during surgery. Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]