People who have surgery to repair a common knee ligament injury show improvement in knee function as long as 15 years after undergoing the operation, new research shows.
Injuries to the anterior cruciate ligament (ACL), which links the thigh bone to the shin bone, are common among young people, and typically treated by repairing the ligament. But recent studies have suggested that for some people, intensive physical therapy to strengthen and stabilize the joint may be enough.
In the current study, Dr. Britt Elin Olestad of Oslo University Hospital Ulleval, Norway, and her colleagues investigated long-term knee function and osteoarthritis in 221 patients between 15 and 50 years old who were treated with ACL repair between 1990 and 1997—evaluating patients six months, one year, two years, and 10 to 15 years after the surgery.
When professional athletes in sports like football and rugby are injured, they commonly get injections of pain-numbing anesthetics to help them stay in the game. Now a new study suggests that, while safety concerns remain, most athletes may not suffer any long-term harm from the practice.
Injections of local anesthetics, like bupivacaine and lidocaine, temporarily block sensation in a limited area around the injection site.
While the injections have long been used in some pro sports to keep athletes in the game, the practice has only been “presumed” to be generally safe—with few studies having actually looked at the question, according to the researchers on the new work.
It is a time most families look forward to every year – summertime. For parents, the warm summer months are often filled with family vacations and cookouts. For kids, it is a chance to play outdoors and enjoy a few months without homework. However, doctors at Nationwide Children’s Hospital have recently noticed a trend in injuries that occur in children during the summer months that are both predictable and preventable.
With the long school days in the past, most kids become more active during the summer and often have more free time. Kathy Nuss, MD, associate medical director of Trauma Services at Nationwide Children’s Hospital, and a team of doctors, have narrowed down a list of the most common mechanisms of injuries that cause children to end up in hospitals during the summer months.
• Falls – Falls are constantly topping the list of summer injuries. While objects such as trampolines have proven to be dangerous, many injuries arise from things that parents may assume are much safer.
Preteen hockey players are more than three times as likely to get hurt if body checking is allowed, researchers from Canada said Tuesday, and the smallest kids take the hardest hits.
While the findings might not come as a huge surprise, Canada is split on whether or not to permit 11- and 12-year-olds, the so-called Pee Wees, to use the technique, in which players use their bodies to knock over opponents.
High injury rates have been a mainstay of the arguments against body checking, but not all studies have reached the same conclusions. For instance, another Canadian study recently suggested it might be safe for kids as young as 9 years old to use body checking.
Widespread use of the Canadian C-spine rule by triage nurses in emergency departments would ease discomfort of trauma patients and improve patient flow in overcrowded emergency departments in Canada and abroad, according to a study (pre-embargo link only) http://www.cmaj.ca/embargo/cmaj091430.pdf in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca.
A clinical decision rule called the Canadian C-spine rule, which helps clinicians with diagnostic or therapeutic decisions, was previously developed for c-spine evaluation. It was designed to help physicians “clear” the c-spine without radiography and to decrease immobilization time. If nurses were also able to follow this clinical decision rule, it could improve trauma care efficiency in Canadian hospitals.
Canadian emergency departments annually treat 1.3 million patients with blunt force trauma from falls or vehicle accidents and who are at risk of injury to the cervical spine. Most of these patients are alert and their conditions stable. Less than 1% have C-spine fractures.
Karen Schroeder’s voice, recorded on a CD, reminded her son, Ryan, of his 4-H project when he was 10 and decided to raise pigs. “You bid on three beautiful squealing black and white piglets at the auction,” she said softly. “We took them home in the trunk of our Lincoln Town Car, because we didn’t have a truck.”
Recordings from Ryan’s mother, father or sister were played through headphones for him four times a day. They were part of a new clinical trial investigating whether repeated stimulation with familiar voices can help repair a coma victim’s injured brain networks and spur his recovery.
In January 2009, Ryan, a 21-year-old college student from Huntley, Ill., was in a coma after he had been flung from his snowmobile into a tree during an ice storm. He had a traumatic brain injury; the fibers of his brain had been twisted and stretched from the impact.
Using simple handheld tools, physical therapist Laurie Eickhoff carefully rubs patient Lisa Maharry’s leg to treat her Achilles injury with a new therapy intended to stimulate the body’s normal healing process.
Maharry has received augmented soft tissue manipulation, or ASTYM, at Ingersoll Physical Therapy since January. The clinic, affiliated with Accelerated Rehabilitation Centers, is one of a few providers in the metro area and about 30 in Iowa that offer the treatment.
Eickhoff has used the technique on a dozen patients since November. Some were referred by physicians, while others were existing patients she transitioned into the therapy after trying other measures.
Patients undergoing knee or hip replacements recover more quickly when treated with targeted pain-blocking medications that may eliminate the need for general anesthesia during surgery and intravenous narcotics drugs after surgery.
The February issue of Mayo Clinic Health Letter explains the newer pain management options and their benefits.
A decade ago, patients undergoing hip or knee replacements were almost exclusively given general anesthesia during surgery and intravenous narcotic pain medications afterward. This approach works for most people and still is commonly practiced. But both general anesthesia and intravenous narcotic drugs can cause nausea, vomiting, grogginess, decreased bowel function and other side effects.
Though hot tubs, whirlpools and spas are widely used for relaxation and fun, they can pose serious risk for injury. Over the past two decades, as recreational use of hot tubs has increased, so has the number of injuries. A recent study conducted by the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that from 1990-2007, the number of unintentional hot tub-related injuries increased by 160 percent, from approximately 2,500 to more than 6,600 injuries per year.
According to the study, published in the online issue of the American Journal of Preventive Medicine, 73 percent of the patients with hot tub-related injuries were older than 16 and approximately one half of all injuries resulted from slips and falls. Lacerations were the most commonly reported injuries (28 percent) and the lower extremities (27 percent) and the head (26 percent) were the most frequently injured body parts.
“While the majority of injuries occurred among patients older than 16, children are still at high risk for hot tub-related injuries,” said study author Lara McKenzie, PhD, principal investigator at the Center for Injury Research and Policy at Nationwide Children’s Hospital. “Due to the differing mechanisms of injury and the potential severity of these injuries, the pediatric population deserves special attention.”
Animal research is suggesting new ways to aid recovery after spinal cord injury. New studies demonstrate that diet affects recovery rate and show how to make stem cell therapies safer for spinal injury patients. The findings were presented at Neuroscience 2009, the annual meeting of the Society for Neuroscience and the world’s largest source of emerging news on brain science and health.
In other animal studies, researchers identified molecules that encourage spinal cord regeneration and ways to block molecules that discourage it. The findings may help shape therapies for the more than one million people in North America who have spinal cord injuries.
Research released today shows that:
Children younger than 12 are at heightened risk of suffering a spinal injury during a car accident—possibly because standard seat belts often do not fit them properly, researchers report.
In a study of children treated for car accident injuries at two Australian hospitals, researchers found that those younger than 12 were seven times more likely than their older counterparts to sustain a serious spine injury. [abs]
All of the 72 children and teenagers in the study had been restrained at the time of the accident. The higher spine-injury risk before age 12 “may reflect the adequacy of seat belt fit,” the researchers report in the Archives of Disease in Childhood.
Investigators from Hospital for Special Surgery have shown that a biodegradable scaffold or plug can be used to treat patients with damaged knee cartilage. The study is unique in that it used serial magnetic resonance imaging (MRI) and newer quantitative T2 mapping to examine how the plug incorporated itself into the knee. The research, abstract 8372, will be presented during the annual meeting of the American Orthopedic Society for Sports Medicine, July 9-12, in Keystone, Colo.
“The data has been encouraging to support further evaluation of this synthetic scaffold as a cartilage repair technique,” said Asheesh Bedi, M.D., a fellow in sports medicine and shoulder surgery at Hospital for Special Surgery who was involved with the study. Dr. Bedi performed analysis of MRI scans of patients primarily treated by Riley Williams, M.D., director of the Institute for Cartilage Repair at Hospital for Special Surgery. “The Trufit plug has been designed to have mechanical properties that are similar to cartilage and bone,” Dr. Bedi said.
Damage to so-called articular cartilage can occur in various ways, ranging from direct trauma in a motor vehicle accident to a noncontact, pivoting event on the soccer field. “Articular cartilage lacks the intrinsic properties of healing—you are essentially born with the articular cartilage that you have,” Dr. Bedi said. Left untreated, these injuries can increase loads placed on the remaining intact cartilage and increase the risk of progression to degenerative arthritis. One way to treat patients with symptomatic chondral lesions is an OATS procedure, in which cartilage is transferred from one portion of the knee to treat another. Because this is a “robbing Peter to pay Paul” situation, researchers at Hospital for Special Surgery set out to examine whether they could use a biodegradable plug, the Trufit CB plug, to fill the donor site. The goal was to monitor how the plug incorporated itself into the knee and to evaluate the quality of the repair cartilage.
Active older adults no longer have to settle for a wobbly knee after injuring their anterior cruciate ligament (ACL), according to a new article in the Mayo Clinic Health Letter.
The ACL is the key ligament stabilizing the knee, and is especially important for holding the joint steady during jumping, pivoting and twisting. When a person ruptures the ACL—an injury typically accompanied by a loud popping sound and severe pain—it can be repaired using a piece of tendon from the leg or from a cadaver.
However, until fairly recently, ACL repair hadn’t been considered an option for people over 50, or even in some cases people in their 40s, according to the Health Letter article. Instead, these individuals would undergo physical therapy to restore strength and balance. Non-surgical treatment can improve knee function, but it doesn’t completely restore knee stability, so older patients had to curtail their activity levels.
Nearly one-fifth of trauma patients who undergo CT evaluation have incidental findings, according to a study performed by Columbus Radiology Corp. at Grant Medical Center in Columbus, OH.
Incidental findings during trauma evaluation are a growing concern for physicians in regards to the diagnosis and management of those findings. The study showed that 230 out of 1,256 patients (18.3%) who underwent CT of the cervical spine during an initial trauma evaluation had incidental findings. The incidental findings were stratified as trauma related and not trauma related. Results showed that incidental findings were associated with age, injury severity score and mechanism of injury.
“There are a lot of CT scans performed and as technology has advanced we are beginning to image more and more anatomy. With that we are identifying more incidental findings,” said Shella Farooki, MD, lead author of the study. “Our study found that patients who were older and had a higher injury severity score were more likely to have incidental findings. Additionally, injuries related to falls vs. motor accidents had a higher percentage of incidental findings,” she said.
In the near future, there may not be enough orthopaedic surgeons to provide joint replacements to all who need them. According to two new studies presented at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), the number of patients requiring hip or knee replacement surgery is likely to soon outpace the number of surgeons who can perform the procedure.
According to a study co-authored by Thomas K. Fehring, M.D., if the number of orthopaedic surgeons able to perform total joint replacements continues at its current rate:
• In 2016, 46 percent of needed hip replacements and 72 percent of needed knee replacements will not be able to be completed.
“I was somewhat shocked at the shortfall that we predicted,” says Dr. Fehring, an orthopaedic surgeon at OrthoCarolina Hip and Knee Center in Charlotte. “This is life-changing surgery, offering patients the chance to be mobile, and a very high percentage of patients may not be able to receive it.”