scholarly journals A prospective randomized study of arthroscopic ACL reconstruction with adjustable- versus fixed-loop device for femoral side fixation

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Naiyer Asif ◽  
Mohammad Jesan Khan ◽  
K. P. Haris ◽  
Shah Waliullah ◽  
Anubhav Sharma ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Randomized Study ◽  
Graft Fixation ◽  
Prospective Randomized Study ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Group I ◽  
Group Ii ◽  
Femoral Side

Abstract Purpose Suspensory devices are extensively used in the management of anterior cruciate ligament (ACL) tear. They include fixed- and adjustable-loop devices. There are only a few studies comparing the efficacy of these two devices in the available literature. Therefore, the aim of this study is to compare clinical outcomes between the adjustable-loop device (group I) and fixed-loop device (group II). Materials and methods This was a prospective randomized study. Both groups were equivalent in demographic, preoperative, and intraoperative variables. Twenty-three patients underwent femoral side graft fixation with adjustable-loop and 20 with fixed-loop devices. Four patients were lost to follow-up. Assessment of clinical outcome was done with International Knee Documentation Committee (IKDC) score, Lysholm score, and knee stability tests (Lachman test and pivot shift test). Patient evaluation was performed preoperatively and finally postoperatively 2 years after surgery. Results Postoperative IKDC scores of group I and II were 91.9 ± 3.6 and 91.5 ± 3.6, respectively, and Lysholm scores were 91.0 ± 3.6 and 91.4 ± 3.5, respectively, after 2 years; however, the difference in the outcomes was statistically insignificant (p > 0.05). Twenty patients (87%) in group I and 17 patients (85%) in group II had a negative Lachman test (p = 0.8). Twenty-two patients (95.7%) in group I and 19 patients (95%) in group II had a negative pivot shift test (p = 0.9). Conclusion ACL reconstruction with fixed- and adjustable-loop suspensory devices for graft fixation gives equivalent and satisfactory clinical results. Level of evidence 1.

scholarly journals Could application of epinephrine improve hemostatic efficacy of hemoclips for bleeding peptic ulcers? A prospective randomized study

2013 ◽  
Vol 70 (9) ◽  
pp. 824-829 ◽  
Author(s):  
Sasa Grgov ◽  
Biljana Radovanovic-Dinic ◽  
Tomislav Tasic
Keyword(s):  
Combination Therapy ◽  
Combined Therapy ◽  
Randomized Study ◽  
Limiting Factors ◽  
Prospective Randomized Study ◽  
Peptic Ulcers ◽  
Endoscopic Method ◽  
Group I ◽  
Bleeding Peptic Ulcers ◽  
Group Ii

Background/Aim. Bleeding from peptic ulcers can be effectively and safely treated with endoscopic hemoclips therapy. However, due to certain limiting factors of hemoclips, application of combination with another endoscopic method may give better results. The aim of this study was to examine the efficacy and safety of endoscopic hemoclips therapy and to evaluate potential benefits of this therapy combined with epinephrine in the treatment of bleeding peptic ulcers. Methods. This prospective randomized study included 70 patients with bleeding gastric or duodenal ulcer. In 34 of the patients endoscopic hemoclips therapy was applied (group I), and in 36 of them a combined therapy of hemoclips and epinephrine (group II). Results. Initial hemostasis was achieved in most patients treated with endoscopic hemoclips therapy (94.1%) as well as in the patients treated with combination therapy (97.2%). After initial hemostasis achieved rebleeding occurred in 3 (9.3%) patients treated with hemoclips and in 2 (5.7%) patients treated with combination therapy, but this difference was not statistically significant (p > 0.05). The difference in the achieved final hemostasis between the group I (91.1%) and the group II (94.4%) was not statistically significant. Also, the differences between the two groups of patients in the need for blood transfusions, length of hospital stay, need for surgery and mortality were not statistically significant (p > 0.05). Conclusion. Endoscopic hemoclips therapy is effective and safe in treatment of bleeding peptic ulcers. Combination therapy of hemoclips and epinephrine has no advantage over hemoclips monotherapy.

scholarly journals Spinal Anaesthesia for Infra-umbilical Surgeries - A Prospective Randomized Study to evaluate the effectiveness of Dexmedetomidine as an adjuvant to Bupivacaine.

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 95-100
Author(s):  
Talib Khan ◽  
Ubaid Ahmad Sheikh ◽  
Shaqul Qamar Wani ◽  
Zarka Sarwar
Keyword(s):  
Postoperative Analgesia ◽  
Randomized Study ◽  
Sensory Block ◽  
University Teaching ◽  
Prospective Randomized Study ◽  
P Value ◽  
Maximum Height ◽  
Duration Of Action ◽  
Group I ◽  
Group Ii

Background: Spinal anesthesia is commonly used anesthetic modality worldwide but with the limitation of relatively short duration of action and complain of post-operative pain. However, the addition of adjuvants have intensified and increased the duration of sensory block with concommitent prolongation of the duration of postoperative analgesia. Study design and settings: This prospective randomized study was conducted in the Department of Anesthesia, Pain and Critical Care at the University Teaching Hospital. Methods: 60 patients irrespective of their age and gender were randomized equally into two groups, and received 3ml of total drug volume intrathecally (IT) viz 2.5 ml of hyperbaric bupivacaine 0.5% mixed with 0.5 ml of normal saline in Group I and 0.5 ml of 5 mcg of Dexmedetomidine in Group II respectively. Results: The maximum height of sensory block achieved were dermatomes T 6.5 ± 1.43 in Group I, and T 6.20 ± 1.28 in Group II (P value, 0.794 > 0.05) with time required to reach T10 sensory block level was 6.70 ± 0.98 min. in Group I and 5.50 ± 1.00 min. in Group II (P value, 0.001) The time to reach Bromage scale 3 was   15.70 ± 2.56 min. in Group I and 8.55 ± 1.67min. in Group II (P value, < 0.001) The time of first rescue dose requested by patient was 196.75 ± 15.16 min. in Group I, and 359.50 ± 49.79 min. in Group II (P value,  0.01)                                           Conclusions: Dexmedetomidine in doses of 5 µg as adjuvants to hyperbaric 0.5% bupivacaine intrathecally produced a significantly quick onset and longer duration of motor and sensory block with benefit prolonged postoperative analgesia. JMS 2018: 21 (2):95-100

scholarly journals Comparison between functional outcome of arthroscopic anterior cruciate ligament reconstruction using single bundle six fold and four fold semitendinosus and gracilis graft

2018 ◽  
Vol 4 (2) ◽  
pp. 220
Author(s):  
Rahul G. Jaju ◽  
Jeevan B. Tonde
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Single Bundle ◽  
Lachman Test ◽  
Anterior Drawer Test ◽  
Anterior Cruciate

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">With increase participation in sports activities, anterior cruciate ligament (ACL) tear is a common and functionally disabling injury. Hamstring tendon as autografts for arthroscopic ACL reconstructions have shown good clinical and functional outcome in patients. The purpose of present study was to compare the functional outcome of arthroscopic Anterior Cruciate ligament (ACL) reconstruction using single bundle six fold and four fold ST and G graft.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This was a prospective study conducted between period June 2008 to December 2010.181 patients undergoing ACL reconstruction were screened and 113 patients fulfilling the inclusion exclusion criteria were selected for the study</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">All patients completed a minimum of 1 years follow up. In 4 fold group 27.50% were having grade 1 anterior drawer test 22.50% were having grade 1 Lachman test and 17.50% had grade 1 pivot shift test as compared to 6 fold group 6.66% had grade 1 anterior drawer test, 11.66% had grade 1 Lachman test, and 3.33% had grade 1 pivot shift test respectively which was statistically significant (p&lt;0.05). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Arthroscopic ACL reconstruction using six fold graft is effective modality of treatment in patient with ACL deficient knee. Six fold graft is thicker in diameter and cross sectional area as compared to four fold graft which occupies more surface area of normal ACL foot print and gives better stability of knee joint in both AP and rotational plane.</span></p><p> </p>

Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Outcomes for Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring-Tendon Autografts

2019 ◽  
Vol 47 (14) ◽  
pp. 3531-3540 ◽  
Author(s):  
Dany Mouarbes ◽  
Jacques Menetrey ◽  
Vincent Marot ◽  
Louis Courtot ◽  
Emilie Berard ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Donor Site ◽  
Lysholm Score ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Donor Site Pain ◽  
Site Pain

Background: Comprehensive studies evaluating quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction are lacking. The optimal choice of graft between bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and QT is still debatable. Hypothesis: The current literature supports the use of QT as a strong autograft with good outcomes when used in ACL reconstruction. Study Design: Meta-analysis; Level of evidence, 2. Methods: A systematic search of the literature was performed in PubMed, MEDLINE, Cochrane, and Ovid databases to identify published articles on clinical studies relevant to ACL reconstruction with QT autograft and studies comparing QT autograft versus BPTB and HT autografts. The results of the eligible studies were analyzed in terms of instrumented laxity measurements, Lachman test, pivot-shift test, Lysholm score, objective and subjective International Knee Documentation committee (IKDC) scores, donor-site pain, and graft failure. Results: Twenty-seven clinical studies including 2856 patients with ACL reconstruction met the inclusion criteria. Comparison of 581 QT versus 514 BPTB autografts showed no significant differences in terms of instrumented mean side-to-side difference ( P = .45), Lachman test ( P = .76), pivot-shift test grade 0 ( P = .23), pivot-shift test grade 0 or 1 ( P = .85), mean Lysholm score ( P = .1), mean subjective IKDC score ( P = .36), or graft failure ( P = .50). However, outcomes in favor of QT were found in terms of less donor-site pain (risk ratio for QT vs BPTB groups, 0.25; 95% CI, 0.18-0.36; P < .00001). Comparison of 181 QT versus 176 HT autografts showed no significant differences in terms of instrumented mean side-to-side difference ( P = .75), Lachman test ( P = .41), pivot-shift test grade 0 ( P = .53), Lysholm score less than 84 ( P = .53), mean subjective IKDC score ( P = .13), donor-site pain ( P = .40), or graft failure ( P = .46). However, outcomes in favor of QT were found in terms of mean Lysholm score (mean difference between QT and HT groups, 3.81; 95% CI, 0.45-7.17; P = .03). Conclusion: QT autograft had comparable clinical and functional outcomes and graft survival rate compared with BPTB and HT autografts. However, QT autograft showed significantly less harvest site pain compared with BPTB autograft and better functional outcome scores compared with HT autograft.

Comparison of single-layer continues or two-layer interrupted pancreatojejunal suture in Frey procedure for treatment of chronic pancreatitis: a prospective randomized study

2019 ◽  
Vol 91 (5) ◽  
pp. 1-5
Author(s):  
Audrius Šileikis ◽  
Saulius Jurevičius ◽  
Mykolas Butvila ◽  
Kęstutis Strupas
Keyword(s):  
Chronic Pancreatitis ◽  
Surgical Treatment ◽  
Randomized Study ◽  
Single Layer ◽  
Prospective Randomized Study ◽  
Complex Method ◽  
Frey Procedure ◽  
Group I ◽  
Duration Of Surgery ◽  
Group Ii

Background Many patients with chronic pancreatitis are elected for surgery when endoscopic interventions are ineffective. Duodenum preserving pancreatic head resection introduced by Charles F. Frey is the most common procedure used for surgical treatment of chronic pancreatitis. However, technical aspects of this procedure have not been studied extensively. Goal Our prospective randomized study is aimed to compare usage of single-layer continuous (I group) and two-layer interrupted sutures (II group) in constructing pancreatojejunostomy after Frey procedure. Methods and materials In a period between 2009 and 2016, a total of 103 patients, diagnosed with chronic pancreatitis and determined medical indications for surgical treatment were included into the study and randomized into group I (52 patients) and group II (51 patients). Preoperative, intraoperative patient characteristics and postoperative results were compared between both groups. Results Mean duration of surgery was statistically shorter in group I - 210 min., while in group II - 240 min (p =0,004). Pancreatojejunoanastomosis construction time was shorter in group I - 19 (±6) min versus 51 (±18) min in group II, p <0,001. No statistically relevant differences were observed in postoperative morbidity: group I - 51,9 % and group II - 45,1 % (p = 0,177) and mortality: group I - 3,8 % and group II - 2 % (p = 0,636). Conclusions Frey procedure using single-layer continuous pancreatojejunostomy is safe, fast and less complex method in surgical treatment of chronic pancreatitis.

scholarly journals The Anterolateral Structure of the Knee Does Not Affect Anterior and Dynamic Rotatory Stability in Anterior Cruciate Ligament Injury: Quantitative Evaluation With the Electromagnetic Measurement System

2019 ◽  
Vol 47 (14) ◽  
pp. 3381-3388 ◽  
Author(s):  
Daisuke Araki ◽  
Takehiko Matsushita ◽  
Yuichi Hoshino ◽  
Kanto Nagai ◽  
Kyohei Nishida ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Lachman Test ◽  
Electromagnetic Measurement System ◽  
The Mean ◽  
Anterior Cruciate ◽  
Electromagnetic Measurement ◽  
Tibial Translation ◽  
Acl Deficient

Background: The biomechanical function of the anterolateral structure (ALS), which includes the anterolateral joint capsule and anterolateral ligament (ALL), remains a topic of debate. Hypothesis: The ALS contributes to knee joint stability during the Lachman test and the pivot-shift test in anterior cruciate ligament (ACL)–deficient knees. Study Design: Controlled laboratory study. Methods: Fourteen fresh-frozen hemipelvis lower limbs were used. For 7 specimens, the anterior one-third of the ALS and the residual ALS were cut intra-articularly with a radiofrequency device. Subsequently, the ACL was cut arthroscopically. For the other 7 specimens, the ACL was cut first, followed by the anterior one-third of the ALS and the residual ALS intra-articularly. During the procedures, the iliotibial band (ITB) was kept intact. At each condition, the anterior tibial translation (ATT) during the manual Lachman test and the acceleration of posterior tibial translation (APT) and the posterior tibial translation (PTT) during the manual pivot-shift test were measured quantitatively with an electromagnetic measurement system. The mean values of those parameters were compared among 6 groups (ACL intact, one-third ALS cut, all ALS cut, ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut). Results: The mean ATTs during the Lachman test and the mean APTs and PTTs in the ACL-cut conditions (ACL cut, ACL/one-third ALS cut, and ACL/all ALS cut) were significantly larger than those under the ACL-intact conditions (ACL intact, one-third ALS cut, all ALS cut) ( P < .01). However, no statistically significant differences were observed among the intact, one-third ALS–cut, and all ALS–cut conditions, within the ACL-intact or ACL-cut conditions. Conclusion: Intra-articular dissection of the ALS did not increase the ATT during the Lachman test or the APT and PTT during the pivot-shift test under the intact condition of the ITB, regardless of the integrity of the ACL. When the ITB is intact, the ALS does not have a significant role in either anterior or dynamic rotatory knee stability, while the ACL does. Clinical Relevance: Recent growing interest about ALL reconstruction or ALS augmentation may not have a large role in controlling either anterior or dynamic rotatory knee instability in isolated ACL-deficient knees.

Single-bundle patellar tendon versus non-anatomical double-bundle hamstrings ACL reconstruction: a prospective randomized study at 8-year minimum follow-up

2010 ◽  
Vol 19 (3) ◽  
pp. 390-397 ◽  
Author(s):  
Stefano Zaffagnini ◽  
Danilo Bruni ◽  
Giulio Maria Marcheggiani Muccioli ◽  
Tommaso Bonanzinga ◽  
Nicola Lopomo ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Randomized Study ◽  
Double Bundle ◽  
Prospective Randomized Study ◽  
Single Bundle

scholarly journals Preoperative Knee Instability Affects Residual Instability as Evaluated by Quantitative Pivot-Shift Measurements During Double-Bundle ACL Reconstruction

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095902
Author(s):  
Yusuke Kawanishi ◽  
Masahiro Nozaki ◽  
Makoto Kobayashi ◽  
Sanshiro Yasuma ◽  
Hiroaki Fukushima ◽  
...  
Keyword(s):  
Angular Velocity ◽  
General Anesthesia ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Pivot Shift Test ◽  
Important Indicator ◽  
Quantitative Measurements ◽  
Double Bundle Acl Reconstruction

Background: The pivot-shift test is an important indicator of functional outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). Preoperative instability as indicated by the pivot-shift test is associated with residual instability after ACLR. Few studies have used quantitative means to evaluate the pivot shift after ACLR. Purpose: To investigate the relationship between preoperative and residual instability and to identify the risk factors for residual instability by using quantitative measurements of the pivot shift. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 91 patients undergoing primary double-bundle ACLR were retrospectively enrolled. Quantitative measurements of instability for ACL-deficient knees (ACLD) and uninjured contralateral knees (intact) preoperatively, as well as ACLR knees intraoperatively, were performed under general anesthesia using the pivot-shift test, with inertial sensors to measure acceleration and external rotational (ER) angular velocity. The ratios of intact to ACLD (ACLD/I) and intact to ACLR (ACLR/I) were measured. Patients who showed an ACLR/I of >1 were classified into the residual instability group, and those with an ACLR/I of ≤1 were classified into the noninstability group. Regarding demographic, surgical, and quantitative measurement factors, between-group comparisons and multivariate logistic regression were conducted for predictors of residual instability. Receiver operating characteristic curves were used to evaluate the correlations between ACLD/I and ACLR/I and the cutoff value of ACLD/I in predicting residual instability. Results: The predictive factors for intraoperative residual instability included female sex (odds ratio [OR], 0.3 [95% CI, 0.1-0.9]; P = .034) and ACLD/I for acceleration (OR, 1.6 [95% CI, 1.2-2.1]; P < .001), and ACLD/I for ER angular velocity (OR, 1.9 [95% CI, 1.2-3.1]; P = .013). Correlations between ACLD/I and ACLR/I were moderate with respect to both acceleration ( r = 0.435; P < .001) and ER angular velocity ( r = 0.533; P < .001). The cutoff points for ACLD/I were 4.9 for acceleration (sensitivity, 65.1%; specificity, 85.7%; area under the curve [AUC], 0.76) and 2.4 for ER angular velocity (sensitivity, 80.0%; specificity, 50.0%; AUC, 0.74). Conclusion: Greater preoperative instability was a risk factor for residual instability as measured intraoperatively by a quantitatively evaluation in the pivot shift during ACL reconstruction. Quantitative measurements of instability during the pivot shift mechanism under general anesthesia may enable surgeons to predict postoperative residual instability.

Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study

2017 ◽  
Vol 9 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Deepak Bose ◽  
Rasheeda Beegum
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Randomized Study ◽  
Operation Time ◽  
Prospective Randomized Study ◽  
Cord Clamping ◽  
Group I ◽  
Sublingual Misoprostol

ABSTRACT Introduction The increasing incidence of cesarean sections in India has caused a rise in the incidence of postpartum hemorrhage (PPH). There has been expanding interest in the role of misoprostol and tranexamic acid (TXA) in preventing and managing PPH during lower (uterine) segment cesarean section (LSCS). However, the lack of a published study comparing the efficacies of these drugs prompted us to conduct this study. Aims and objectives To compare the efficacies of sublingual misoprostol (600 μg) and intravenous TXA injection (500 mg) in reducing blood loss during LSCS by assessing intraoperative blood loss, perioperative hemoglobin (Hb) fall, and need for additional uterotonic agents. Materials and methods A total of 163 pregnant patients undergoing emergency/elective LSCS during the study period from 2013 to 2014 were randomly assigned to two groups — group I (82) received sublingual misoprostol 600 μg and group II (81) intravenous TXA 500 mg at cord clamping. Visual estimation of blood loss was done and 48 hours postoperative Hb and packed cell volume were measured to compare with preoperative values. Need for added uterotonics, blood transfusion, and adverse effects of drugs was assessed. The two groups were again subgrouped based on presence or absence of risk factors for PPH. Results The TXA significantly reduced blood loss compared with misoprostol (416 vs 505 mL) in patients without high-risk factors for PPH. Misoprostol caused significantly higher minor side effects while TXA reduced operation time. Conclusion The TXA can be routinely used after cord clamping along with oxytocin in patients undergoing elective/emergency LSCS to reduce perioperative blood loss, especially in those without risk factors for PPH. How to cite this article Bose D, Beegum R. Sublingual Misoprostol vs Intravenous Tranexamic Acid in reducing Blood Loss during Cesarean Section: A Prospective Randomized Study. J South Asian Feder Obst Gynae 2017;9(1):9-13.

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