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Gian Luigi Canata, Valentina Casale, Alfredo Chiey
Purpose: This study was conducted to identify the most effective method of postoperative pain management, comparing the intravenous opiate infusion protocol with the use of a single periarticular local anesthetic infiltration (LAI) in patients undergoing total knee arthroplasty (TKA) surgery.
Methods: 50 patients submitted to TKA surgery between 2013 and 2015 were divided into two groups.
Buprenorphine was administered intravenously to the patients in Group A, while the Group B patients received a single periarticular LAI(ropivacaine and ketorolac) during surgery.
Pain was assessed using a visual analog scale (VAS) and the knee injury and osteoarthritis outcome score.
Hemoglobin and hematocrit were measured in the early postoperative period and at 40 days post-surgery.
Range of motion and inflammatory markers were also assessed. statistical analysis was performed using student’s t-test.
Results: Student’s t-test showed no significant difference between the groups in functional outcomes or blood values, but a difference in VAs score on the day of surgery was found (p < 0.0001), in favor of Group B.
Conclusions: LAI considerably reduces postoperative pain, allowing rapid mobilization and accelerating functional recovery.
Level of evidence: Level I, prospective single-blind randomized trial.
Gian Luigi Canata, Valentina Casale
Symptomatic osteochondral lesions of the talus are a common cause of ankle pain and frequently occur among recreational and professional athletes. These lesions are being increasingly diagnosed and a great variety of treatment approaches exist. Since the talar cartilage has poor repair capacity, the aim of treatment paradigms is to restore the joint surface with a repair tissue as similar as possible to the original cartilage to provide good long-term results. Multiple surgical approaches have been described over the past years in order to identify the ideal treatment option. Arthroscopic debridement and bone marrow stimulation techniques have increasingly gained consensus. We aimed to review the available evidence on these arthroscopic minimally invasive approaches for osteochondral talar lesions.
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