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Guidelines for Managing ACL Injuries

Guidelines for Managing ACL Injuries

Anterior cruciate ligament (ACL) tears are among the most common injuries that occur in athletes participating in high-demand sports. Research has shown that people who suffer these injuries are at higher risk for developing arthritis later in life, and women are more likely to suffer an ACL injury with certain sports when compared with men. “Over 100,000 ACL injuries occur each year in the United States,” says Kevin G. Shea, MD. “These injuries are typically treated with surgical reconstruction in young active people, but patients often are concerned about how well they will be able to participate in sports and physical activities after surgery. They can also have a psychological and emotional impact on patients.” Key Recommendations Recently, the American Academy of Orthopaedic Surgeons (AAOS) released clinical practice guidelines (CPG) on the management of ACL injuries. The CPG strongly recommends that physicians obtain a relevant patient history and perform a musculoskeletal exam of the lower extremities when diagnosing ACL injuries. Use of knee radiographs and MRI may be useful for some patients for evaluation of these injuries. Another important issue is the timing of treatment, according to the CPG. “In appropriate candidates, reconstructive surgery may best be performed within 5 months of an ACL injury,” says Dr. Shea, who chaired the AAOS work group that developed the guidelines. “Active patients who wait too long to have their ACL surgically repaired are at risk for additional injury to the knee.” He adds that non-surgical treatment may be appropriate for some patients, including those who are less active or who do not place significant demands on their knee. An appropriate rehab...
ACC 2015

ACC 2015

New research was presented at ACC.15, the annual scientific sessions of the American College of Cardiology, from March 14 to 16 in San Diego. The features below highlight some of the studies that emerged from the conference. CPAP Decreases Acute HF Rehospitalization Rates The Particulars: Prior research has identified sleep-disordered breathing in heart failure (HF) as a significant risk factor for patients with different forms of HF that can impact clinical outcomes. However, data are lacking on whether compliance with continuous positive airway pressure (CPAP) treatment influences readmission rates among patients with acute HF and sleep apnea. Data Breakdown: Patients who had been hospitalized for HF and determined to have sleep apnea within 4 weeks of discharge were examined for a study. Among those who were compliant with their CPAP treatment, average pulmonary artery systolic pressure levels decreased, whereas non-compliant patients experienced an increase in these levels. The average number of rehospitalizations decreased by 0.8 visits from baseline to 6 months follow-up in the compliant group but increased by 1.1 visits in the non-compliant group. Take Home Pearl: Compliance with CPAP therapy appears to reduce 6-month readmission rates among patients with acute decompensated HF who are found to have sleep apnea shortly after being discharged from the hospital. Sedentary Behavior & Coronary Artery Calcification The Particulars: Physical activity has been shown to have multiple cardiovascular benefits in numerous studies, but no definitive relationship has been shown between physical activity and coronary artery calcification (CAC). Little is known about the relationship between sedentary behavior and CAC, independent of physical activity. Data Breakdown: For a study, researchers analyzed data on more...

Can Patients Chew Gum Immediately Before Surgery?

A study presented at the American Society of Anesthesiologists (ASA) meeting in October of last year found that patients who chew gum in the immediate preoperative period may safely undergo surgery. The authors, based at the University of Pennsylvania, found that gum chewing increases saliva production and the volume of fluid in the stomach, but stomach acidity was equivalent to that of non-gum chewers. An article about the study said The mean gastric volume, or total amount of liquid in the stomach, was statistically higher in patients who chewed gum before their procedure (13ml) versus those who did not (6ml). A 7 mL difference might be statistically significant, but surely is not clinically important. The research differed from previous studies because it involved patients who underwent upper gastrointestinal endoscopy, which enabled the investigators to recover all of the fluid in the stomach for testing. Prior studies had been done using nasogastric tubes, and it was impossible to determine whether all gastric fluid was recovered when the tubes were suctioned. The study involved 34 gum chewers who were allowed to chew any type or any amount of gum, compared to 33 patients who did not chew gum. Another article quoted its lead author. “We found that although chewing gum before surgery increases the production of saliva and therefore the volume of stomach liquids, it does not affect the level of stomach acidity in a way that would elevate complication risks,” explains Dr. Goudra. He says patients shouldn’t be encouraged to chew gum before procedures involving anesthesia, but the habit shouldn’t necessitate the cancellation or delay of scheduled cases if other aspiration...
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