Objective To explore the early effectiveness and influence on cartilage of local injection of multimodal drug cocktail (MDC) during anterior cruciate ligament reconstruction (ACLR). Methods Between February 2022 and August 2023, patients undergone arthroscopic ACLR using autologous hamstring tendons were selected as the study subjects. Among them, 90 patients met the selection criteria and were randomly divided into 3 groups (n=30) according to the different injection drugs after ligament reconstruction. There was no significant difference in baseline data such as gender, age, body mass index, surgical side, disease duration, preoperative thigh circumference, and preoperative levels of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), IL-1, matrix metalloproteinase 3 (MMP-3), MMP-13, and aggrecan (ACAN) in synovial fluid between groups (P>0.05). After the ligament reconstruction during operation, corresponding MDC (consisting of ropivacaine, tranexamic acid, and betamethasone in group A, and ropivacaine, betamethasone, and saline in group B) or saline (group C) were injected into the joint and tendon site, respectively. The length of hospital stay, postoperative tramadol injection volume, incidence of complications, degree of knee joint swelling and range of motion, visual analogue scale (VAS) score, International Knee Documentation Committee (IKDC) score, Lyshlom score, and Hospital for Special Surgery (HSS) score were recorded and compared between groups. The T2* values in different cartilage regions were detected by MRI examination and the levels of TNF-α, IL-6, IL-1, MMP-3, MMP-13, and ACAN in synovial fluid were detected by ELISA method. Results The patients in group A, B, and C were followed up (12.53±3.24), (13.14±2.87), and (12.82±3.32) months, respectively. All incisions healed by first intention. Compared with group C, group A and group B had shorter length of hospital stay, less tramadol injection volume, and lower incidence of complications, showing significant differences (P<0.05); there was no significant difference between group A and group B (P>0.05). The degree of knee swelling in group A was significantly less than that in group B and group C (P<0.05), but there was no significant difference between group B and group C (P>0.05). At 3, 6, 12, 24, and 48 hours after operation, VAS scores of group A and group B were significantly lower than those of group C (P<0.05); at 72 hours after operation, there was no significant difference among the three groups (P>0.05). At 3 days, 14 days, and 1 month after operation, the range of motion of knee joint in group A were significantly better than those in group C (P<0.05), and there was no significant difference between the other groups (P>0.05). At 1 month after operation, the IKDC score of group A and group B was significantly higher than that of group C (P<0.05); there was no significant difference among the three groups at other time points (P>0.05). There was no significant difference in Lyshlom score and HSS score among the three groups at each time point (P>0.05). At 14 days after operation, the levels of IL-1 and IL-6 in the synovial fluid in groups A and B were significantly lower than those in group C (P<0.05). There was no significant difference in the levels of TNF-α, MMP-3, MMP-13, and ACAN between groups A and B (P>0.05). At 1 month after operation, there was no significant difference in the above indicators among the three groups (P>0.05). At 3, 6, and 12 months after operation, there was no significant difference in the T2* values of different cartilage regions among the three groups (P>0.05). ConclusionInjecting MDC (ropivacaine, tranexamic acid, betamethasone) into the joint and tendon site during ACLR can achieve good early effectiveness without significant impact on cartilage.
Objective To compare the early effectiveness of arthroscopic repair of moderate rotator cuff tears with single-row modified Mason-Allen technique and double-row suture bridge technique. MethodsThe clinical data of 40 patients with moderate rotator cuff tears who met the selection criteria between January 2021 and May 2022 were retrospectively analyzed. Among them, 20 cases were repaired with single-row modified Mason-Allen suture technique (single-row group) and 20 cases with double-row suture bridge technique (double-row group). There was no significant difference in gender, age, disease duration, rotator cuff tear size, and preoperative visual analogue scale (VAS) score, Constant-Murley score, and T2* value between the two groups (P>0.05). The VAS score, Constant-Murley score (including subjective influence, pain, flexion, internal rotation, external rotation, abduction, and muscle strength score) were compared between the two groups before operation and at 6 weeks, 3, 6, and 12 months after operation. Functional MRI and ultrashort-echo-time (UTE)-T2* technique were performed to calculate T2* value and quantitatively evaluate the healing of rotator cuff tissue; and the healing of rotator cuff was evaluated by Sugaya classification at 12 months after operation. ResultsPatients in both groups were followed up 1 year. There was no complication such as muscle atrophy, joint stiffness, or postoperative rotator cuff tear. The intra-group comparison showed that the scores of pain, subjective influence, flexion, abduction, and muscle strength in Constant-Murley scores at each time point after operation in the two groups were significantly higher than those before operation, while VAS scores were significantly lower than those before operation (P<0.05). Internal rotation, external rotation, and total score of Constant-Murley score in the two groups were lower at 6 weeks due to abduction immobilization within 6 weeks after operation, and gradually increased at 6 months after operation, with significant differences at 3, 6, and 12 months after operation when compared with those before operation and at 6 weeks after operation (P<0.05). The T2* values of the two groups showed a downward trend over time, and there were significant differences between the two groups at other time points (P<0.05), except that there was no significant difference between at 6 and 12 months after operation in the single-row group and between at 3, 6, and 12 months after operation in the double-row group (P>0.05). The comparison between groups showed that the VAS score and T2* values of the double-row group were significantly lower than those of the single-row group at 6 weeks, 3 months, 6 months, and 12 months after operation (P<0.05). The scores of subjective influence, flexion, abduction, and internal rotation in the double-row group were significantly better than those in the single-row group at 6 weeks and 3 months after operation (P<0.05), and the external rotation score and total score in the double-row group were significantly better than those in the single-row group at 3 months after operation (P<0.05), but there was no significant difference at 6 and 12 months after operation (P>0.05). There was no significant difference in muscle strength and pain scores between the two groups at 6 weeks, 3 months, 6 months, and 12 months after operation (P>0.05). There was no significant difference in the results of Sugaya classification between the two groups at 12 months after operation (Z=1.060, P=0.289). Conclusion The effectiveness of arthroscopic repair of moderate rotator cuff tears with modified Mason-Allen technique and double-row suture bridge technique is satisfactory, but suture bridge technique is helpful to the early rehabilitation training of shoulder joint and the recovery of motor function of patients.
ObjectiveTo summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction (ACLR), and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR. MethodsThe literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed, and the effects of improving postoperative pain were reviewed. ResultsCurrently, physical therapy and oral medication have advantages such as economy and simplicity, but the effect of improving postoperative pain is not satisfactory, often requires a combination of intravenous injection or intravenous pump, which is also a common way to relieve pain. However, in order to meet the analgesic needs of patients, the amount of analgesic drugs used is often large, which increases the incidence of various adverse reactions. Local infiltration analgesia (LIA), including periarticular or intra-articular injection of drugs, can significantly improve the early postoperative pain of ACLR, and achieve similar postoperative effectiveness as nerve block. LIA can be used as an analgesic technique instead of nerve block, and avoid the corresponding weakness of innervated muscles caused by nerve block, which increases the risk of postoperative falls. Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR, especially the analgesic effects of periarticular injection are more satisfactory. It can also avoid the risk of cartilage damage caused by intra-articular injection. However, the postoperative analgesic effect and timeliness still need to be improved. It is possible to consider combining multimodal mixed drug LIA (combined with intra-articular and periarticular) with other pain intervention methods to exert a synergistic effect, in order to avoid the side effects and risks brought by single drugs or single administration route. LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR. ConclusionEarly pain after arthroscopic ACLR still affects the further functional activities of patients, and all kinds of analgesic methods can achieve certain effectiveness, but there is no unified standard at present, and the advantages and disadvantages of various analgesic methods need further research.