Resorbable fillers reduce stress risers from empty screw holes.

Background: Empty screw holes after hardware removal are stress risers that weaken bone and can lead to refracture in an active individual. We sought to reduce these stress risers. We hypothesize that resorbable screws used as hole fillers would (1) provide immediate strength and (2) maintain this strength during resorption.

Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up.

The purpose of this study was to assess arthroscopic repair of rotator cuff tears at a minimum of 2 years postoperatively with both patient-derived and objective outcome measures, including the use of magnetic resonance imaging (MRI), to evaluate repair status. Evaluated were 49 shoulders in 47 consecutive patients. The American Shoulder and Elbow Surgeons score, Constant and Murley score, Simple Shoulder Test, Rowe score, Visual Analog Pain Scale, and the Medical Outcomes Study Short Form-12 Mental Component Scale all improved significantly (P < .

Zolpidem reduces postoperative pain, fatigue, and narcotic consumption following knee arthroscopy: a prospective randomized placebo-controlled double-blinded study.

Sixty-eight patients undergoing outpatient knee arthroscopy for treatment of meniscal tears or loose bodies were divided into three treatment groups (zolpidem [24 patients], control [24 patients], and placebo [20 patients]). All groups received postoperative hydrocodone and ibuprofen. Patients in the zolpidem group received a single dose of zolpidem tartrate for the first seven postoperative nights.

Rapid progression of chondral disease in the lateral compartment of the knee following meniscectomy.

We present 2 cases of severe, rapidly progressive chondral disease in the lateral compartment within 12 months after meniscectomy. In both cases, the lateral compartment was salvaged with simultaneously performed cartilage repair techniques and meniscal transplantation. The first case is of a 16-year-old boy who suffered a complex irreparable posterior horn lateral meniscus tear that was treated with an aggressive partial meniscectomy, and developed a rapid onset of severe lateral compartment symptoms associated with a focal grade IV chondral defect of the lateral femoral condyle within 10 months of his index meniscectomy.

The indications and technique for meniscal transplant.

Meniscal allograft transplantation (MAT) has moved into mainstream orthopedics. With proper patient selection, and recognition and treatment of comorbid conditions, MAT offers a solution that can at least temporarily decrease pain and increase function. This article reviews the basic science of meniscal mechanics, the pathomechanics of meniscal injury, and MAT indications and techniques.

Cartilage restoration, part 2: techniques, outcomes, and future directions.

In part 1 of this 2-part Current Concepts article, the authors reviewed the basic science of normal articular and meniscal cartilage and its response to injury. They reviewed the historical perspectives and basic science behind these various methods and presented a rationale for patient evaluation, treatment selection, and timing. In part 2, the authors review the specific indications for the treatment of chondral injuries and describe the techniques and outcomes of the various treatment options, including palliative, reparative, and restorative procedures.

Cartilage restoration, part 1: basic science, historical perspective, patient evaluation, and treatment options.

Surgical procedures designed to treat focal chondral lesions are evolving and are supported by basic science principles of cartilage physiology and known responses to injury. Selecting the proper treatment algorithm for a particular patient depends on careful patient evaluation, including the recognition of comorbidities such as ligamentous instability, deficient menisci, or malalignment of the mechanical limb axis or extensor mechanism. These comorbidities may need to be treated in conjunction with symptomatic chondral injuries to provide a mutually beneficial effect.

The familial incidence of carpal tunnel syndrome in patients with unilateral and bilateral disease.

The controversy has been considerable regarding the incidence of familial carpal tunnel syndrome. Of particular interest is the relationship between bilateral disease and familial incidence. In this study, we compare the incidence of familial carpal tunnel syndrome in patients with the syndrome in one, both, or neither hands.

Posterior cruciate ligament reconstruction: current trends.

A survey was conducted of the Herodicus Society membership to assess the current status of treating posterior cruciate ligament (PCL) injuries and compared to a similar survey conducted in 1991. The survey addressed indications, graft choice, surgical technique, graft tensioning, and graft fixation. Seventy-eight active surgeons were sent a 34-question survey pertaining to isolated PCL injuries.

Evaluation of postoperative bupivacaine infusion for pain management after anterior cruciate ligament reconstruction.

Purpose: Postoperative pain control has received increasing attention by health care providers in the new millennium. In fact, pain was called the "sixth vital sign" by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. The continued challenge of effective, safe analgesia in the outpatient setting has promoted the use of various devices designed to deliver local anesthetic directly to the surgical site.

The risks of overly effective postoperative epidural analgesia.

Continuous epidural analgesia is frequently used to provide supplemental postoperative pain control. Epidural analgesia has the potential to mask the early symptoms that signal impending complications after even routine surgical procedures. We report a case of sciatic nerve palsy following epidural anesthesia after an uncomplicated leg length correction.

Compartment syndrome of the arm: a complication of noninvasive blood pressure monitoring during thrombolytic therapy for myocardial infarction.

We report a rare case of tricep compartment syndrome caused by a hematoma which resulted from noninvasive blood pressure monitoring (NIBPM) during thrombolytic therapy. Clinicians administering thrombolytic agents should be aware of the risk of bleeding and compartment syndrome at the site of NIBPM. Appropriate preventative measures should be instituted when using automated pneumatic cuffs.