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R. Michael Meneghini - One of the best experts on this subject based on the ideXlab platform.
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Extensor Mechanism Reconstruction Using Marlex Mesh: Is Postoperative Casting Mandatory?
Journal of Arthroplasty, 2020Co-Authors: Leonard T. Buller, Lucian C. Warth, Evan R. Deckard, R. Michael MeneghiniAbstract:Abstract Background Extensor mechanism (EM) disruption after total Knee arthroplasty is a catastrophic complication. Reconstruction using monofilament polypropylene mesh (Marlex Mesh; CR Bard, Franklin Lakes, NJ) has emerged as the preferred treatment, but reports are limited to the designing institution. This study describes a nondesigner experience and compares 2 postoperative immobilization strategies: long leg cast vs Knee Immobilizer. Methods A retrospective review of consecutive EM reconstructions between 2012 and 2019 was performed. Primary repairs and allograft reconstructions were excluded, leaving 33 Knees (30 patients) who underwent Marlex reconstruction. Mean time from disruption to reconstruction was 14 months, and 14 of 33 (42%) had previous repair or reconstruction attempts. The mean age was 69 years, and mean body mass index was 35 kg/m2. Postoperatively, extension was maintained using a Knee Immobilizer in 19 of 33 (58%) patients, whereas 14 of 33 (42%) patients were long leg casted. Kaplan-Meier analysis determined all-cause survivorship free of mesh failure. Results At mean 25-month follow-up, 19 of 33 (58%) EM reconstructions were functioning. Excluding explanted infections (5 recurrent and 2 new), 19 of 26 (73%) EM reconstructions were in situ. Six-year survivorship was 69% and not influenced by immobilization type (cast: 67%, Immobilizer: 71%; P = .74). Extensor lag was not associated with immobilization type, improving from a mean preoperative lag of 43° to a mean postoperative lag of 9°. Among successes, University of California at Los Angeles activity and Knee Injury and Osteoarthritis Outcome Score - Joint Replacement score improvements exceeded minimal clinically important difference (2.2-3.3 and 52.5-64.0, respectively). Conclusion Marlex mesh EM reconstruction is a durable and reliable treatment with acceptable clinical results achievable outside the designer institution. Provided sufficient duration and compliance with postoperative immobilization, similar outcomes can be obtained with either a cast Immobilizer or a Knee Immobilizer.
Leonard T. Buller - One of the best experts on this subject based on the ideXlab platform.
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Extensor Mechanism Reconstruction Using Marlex Mesh: Is Postoperative Casting Mandatory?
Journal of Arthroplasty, 2020Co-Authors: Leonard T. Buller, Lucian C. Warth, Evan R. Deckard, R. Michael MeneghiniAbstract:Abstract Background Extensor mechanism (EM) disruption after total Knee arthroplasty is a catastrophic complication. Reconstruction using monofilament polypropylene mesh (Marlex Mesh; CR Bard, Franklin Lakes, NJ) has emerged as the preferred treatment, but reports are limited to the designing institution. This study describes a nondesigner experience and compares 2 postoperative immobilization strategies: long leg cast vs Knee Immobilizer. Methods A retrospective review of consecutive EM reconstructions between 2012 and 2019 was performed. Primary repairs and allograft reconstructions were excluded, leaving 33 Knees (30 patients) who underwent Marlex reconstruction. Mean time from disruption to reconstruction was 14 months, and 14 of 33 (42%) had previous repair or reconstruction attempts. The mean age was 69 years, and mean body mass index was 35 kg/m2. Postoperatively, extension was maintained using a Knee Immobilizer in 19 of 33 (58%) patients, whereas 14 of 33 (42%) patients were long leg casted. Kaplan-Meier analysis determined all-cause survivorship free of mesh failure. Results At mean 25-month follow-up, 19 of 33 (58%) EM reconstructions were functioning. Excluding explanted infections (5 recurrent and 2 new), 19 of 26 (73%) EM reconstructions were in situ. Six-year survivorship was 69% and not influenced by immobilization type (cast: 67%, Immobilizer: 71%; P = .74). Extensor lag was not associated with immobilization type, improving from a mean preoperative lag of 43° to a mean postoperative lag of 9°. Among successes, University of California at Los Angeles activity and Knee Injury and Osteoarthritis Outcome Score - Joint Replacement score improvements exceeded minimal clinically important difference (2.2-3.3 and 52.5-64.0, respectively). Conclusion Marlex mesh EM reconstruction is a durable and reliable treatment with acceptable clinical results achievable outside the designer institution. Provided sufficient duration and compliance with postoperative immobilization, similar outcomes can be obtained with either a cast Immobilizer or a Knee Immobilizer.
Laurie A. Hiemstra - One of the best experts on this subject based on the ideXlab platform.
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PAPER 084: THE EFFFECT OF Knee IMMOBILIZATION ON POST-OPERATIVE PAIN FOLLOWING AN ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION: A RANDOMIZED CLINICAL TRIAL
2010Co-Authors: Laurie A. Hiemstra, Mark Heard, Greg Buchko, Treny M. Sasyniuk, Jeremy Reed, Brad MonteleoneAbstract:Purpose: To determine if patients randomized to a Knee Immobilizer following a primary hamstring tendon anterior cruciate ligament (ACL) reconstruction have lower visual analog scale (VAS) pain scores at day two postoperative than patients who do not wear a Knee Immobilizer. Method: Patients aged 18–40 with symptomatic ACL deficiency as determined by MRI or physical exam who met the study inclusion criteria were eligible. Patients meeting intra-operative inclusion critiera were randomized (Immobilizer or no Immobilizer) during wound closure. The Immobilizer used was a soft unhinged brace with velcro straps and three metal bars (Breg). Pre, intra and post operative protocols were standardized. Analgesic use and VAS scores were recorded at: one hour after surgery, 8am and 8pm for the first two days postoperative, and 5pm for days 3–14 postoperative. Patients were examined by the surgeon within 14–28 days postoperative. Based on a published survey and the literature, the primary outcome was patient self-assessed pain using a 0–100mm VAS (no pain-worst pain) at day 2 postoperative. Secondary outcomes included: analgesic use, complications, and range of motion. A sample size estimate was calculated resulting in 44 patients per group. A total of 102 patients were enrolled; 88 randomized and 14 excluded intra-operatively. Recruitment was achieved within 11 months. Results: There was no difference in mean VAS pain scores at 2 days post-operative between immobilized and non-immobilized patients (32.6 and 35.2, respectively; p=0.59, 95% CI −6.99, 12.3). Regardless of group allocation, the greatest pain reported was on the evening of day 1 post-operative. Throughout the first week, patients medicated to a pain level of approximately 30/100. There were no differences between groups in medication consumed, range of motion or complications. At 2 days post-operative all patients randomized to the Immobilizer group reported that they worn their brace 76–100% of the time. Conclusion: No differences in pain were detected between immobilized and non-immobilized patients at any point during 14 days post ACL reconstruction. Based on these findings, a Knee Immobilizer is not recommended post-operatively for pain control. This study does not address other reasons for Immobilizer use such as graft protection or range of motion.
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Knee Immobilization for Pain Control After a Hamstring Tendon Anterior Cruciate Ligament Reconstruction A Randomized Clinical Trial
The American journal of sports medicine, 2008Co-Authors: Laurie A. Hiemstra, Greg Buchko, Treny M. Sasyniuk, Jeremy Reed, S. Mark Heard, Bradley J. MonteleoneAbstract:Background: This study will attempt to evaluate the efficacy of Knee immobilization on patient pain levels after an anterior cruciate ligament reconstruction.Hypothesis: There is no difference in visual analog scale pain scores 2 days after anterior cruciate ligament reconstruction between patients who wear a Knee Immobilizer and those who do not wear a Knee Immobilizer.Study Design: Randomized clinical trial; Level of evidence, 1.Methods: Patients aged 18 to 40 years who met study inclusion criteria were eligible. Patients meeting intraoperative inclusion critiera were randomized (Immobilizer or no Immobilizer) after wound closure. The Immobilizer used was a soft, unhinged brace with Velcro® straps. Preoperative, intraoperative, and postoperative protocols were standardized. The primary outcome was patient self-assessed pain using a 0-to-100-mm visual analog scale at day 2 after surgery. Secondary outcomes included pain and analgesic use in the first 14 days after surgery, complications, and range of mot...
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Knee immobilization in the immediate post-operative period following ACL reconstruction: a survey of practice patterns of Canadian orthopedic surgeons.
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 2006Co-Authors: Laurie A. Hiemstra, Kim Veale, T. M. SasyniukAbstract:OBJECTIVE This study was designed to determine the practice patterns and rationale for Knee Immobilizer use in immediate post-operative period following an anterior cruciate ligament (ACL) reconstruction. DESIGN Descriptive cross-sectional survey. SETTING Canada. PARTICIPANTS A random sample of 50% of Canadian orthopedic surgeons registered with the Canadian Orthopaedic Association (COA). MAIN OUTCOME MEASURE Self-reported survey responses regarding Knee Immobilizer use, surgeon characteristics, graft type and type of practice. RESULTS Complete survey response rate was 36.1% (122/338). There was a lack of consensus regarding Knee Immobilizer use; 47.7% of responding surgeons use a Knee Immobilizer in the immediate post-operative period while 52.3% do not. There were no trends in characteristics such as fellowship training, number of years in practice and type of practice between surgeons who use and do not use a Knee Immobilizer. The reported reasons for immobilization were: pain reduction in the post-operative period (51.6%), graft site protection (38.7%), maintaining full extension (19.4%) and habit (12.9%). The length of time the Immobilizer was used ranged from 5-42 days. CONCLUSIONS The lack of consensus reported in the current study and published literature reflects a lack of scientific evidence in the area of post-operative Knee immobilization. The need for a randomized clinical trial to assess the efficacy of Knee Immobilizer use after ACL reconstruction is evident. The authors recommend using peri-operative pain as an outcome measure in future studies investigating immobilization in the immediate post-operative period.
Bradley J. Monteleone - One of the best experts on this subject based on the ideXlab platform.
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Knee Immobilization for Pain Control After a Hamstring Tendon Anterior Cruciate Ligament Reconstruction A Randomized Clinical Trial
The American journal of sports medicine, 2008Co-Authors: Laurie A. Hiemstra, Greg Buchko, Treny M. Sasyniuk, Jeremy Reed, S. Mark Heard, Bradley J. MonteleoneAbstract:Background: This study will attempt to evaluate the efficacy of Knee immobilization on patient pain levels after an anterior cruciate ligament reconstruction.Hypothesis: There is no difference in visual analog scale pain scores 2 days after anterior cruciate ligament reconstruction between patients who wear a Knee Immobilizer and those who do not wear a Knee Immobilizer.Study Design: Randomized clinical trial; Level of evidence, 1.Methods: Patients aged 18 to 40 years who met study inclusion criteria were eligible. Patients meeting intraoperative inclusion critiera were randomized (Immobilizer or no Immobilizer) after wound closure. The Immobilizer used was a soft, unhinged brace with Velcro® straps. Preoperative, intraoperative, and postoperative protocols were standardized. The primary outcome was patient self-assessed pain using a 0-to-100-mm visual analog scale at day 2 after surgery. Secondary outcomes included pain and analgesic use in the first 14 days after surgery, complications, and range of mot...
Lucian C. Warth - One of the best experts on this subject based on the ideXlab platform.
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Extensor Mechanism Reconstruction Using Marlex Mesh: Is Postoperative Casting Mandatory?
Journal of Arthroplasty, 2020Co-Authors: Leonard T. Buller, Lucian C. Warth, Evan R. Deckard, R. Michael MeneghiniAbstract:Abstract Background Extensor mechanism (EM) disruption after total Knee arthroplasty is a catastrophic complication. Reconstruction using monofilament polypropylene mesh (Marlex Mesh; CR Bard, Franklin Lakes, NJ) has emerged as the preferred treatment, but reports are limited to the designing institution. This study describes a nondesigner experience and compares 2 postoperative immobilization strategies: long leg cast vs Knee Immobilizer. Methods A retrospective review of consecutive EM reconstructions between 2012 and 2019 was performed. Primary repairs and allograft reconstructions were excluded, leaving 33 Knees (30 patients) who underwent Marlex reconstruction. Mean time from disruption to reconstruction was 14 months, and 14 of 33 (42%) had previous repair or reconstruction attempts. The mean age was 69 years, and mean body mass index was 35 kg/m2. Postoperatively, extension was maintained using a Knee Immobilizer in 19 of 33 (58%) patients, whereas 14 of 33 (42%) patients were long leg casted. Kaplan-Meier analysis determined all-cause survivorship free of mesh failure. Results At mean 25-month follow-up, 19 of 33 (58%) EM reconstructions were functioning. Excluding explanted infections (5 recurrent and 2 new), 19 of 26 (73%) EM reconstructions were in situ. Six-year survivorship was 69% and not influenced by immobilization type (cast: 67%, Immobilizer: 71%; P = .74). Extensor lag was not associated with immobilization type, improving from a mean preoperative lag of 43° to a mean postoperative lag of 9°. Among successes, University of California at Los Angeles activity and Knee Injury and Osteoarthritis Outcome Score - Joint Replacement score improvements exceeded minimal clinically important difference (2.2-3.3 and 52.5-64.0, respectively). Conclusion Marlex mesh EM reconstruction is a durable and reliable treatment with acceptable clinical results achievable outside the designer institution. Provided sufficient duration and compliance with postoperative immobilization, similar outcomes can be obtained with either a cast Immobilizer or a Knee Immobilizer.