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1.
Monitoring exercise-induced muscle damage indicators and myoelectric activity during two weeks of knee extensor exercise training in young and old men.
Heckel, Z, Atlasz, T, Tékus, É, Kőszegi, T, Laczkó, J, Váczi, M
PloS one. 2019;(11):e0224866
Abstract
This study considered the effects of repeated bouts of short-term resistive exercise in old (age: 64.5±5.5 years; n = 10) and young men (age: 25.1±4.9 years; n = 10) who performed six knee extension exercise bouts over two weeks using various markers of exercise-induced muscle damage and electromyographic activity. We found that time-course changes in quadriceps isometric torque, creatine kinase activity, and muscle soreness in the two groups were similar. However, recovery in the acute torque deficit was mediated by more favourable electromyographic activity changes in the young group than in the older adults group. Muscle elastic energy storage and re-use assessed with dynamometry was selectively improved in the young group by the end of the protocol. Serum myoglobin concentration increased selectively in old group, and remained elevated with further bouts, suggesting higher sarcolemma vulnerability and less effective metabolic adaptation in the older adults, which, however, did not affect muscle contractility.
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2.
Laser-assisted lipolysis for knee remodelling: a prospective study in 30 patients.
Moreno-Moraga, J, Trelles, MA, Mordon, S, Unglaub, F, Bravo, E, Royo de La Torre, J, Sanz, I, Servell, P, Betrouni, N, Leclère, FM
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology. 2012;(2):59-66
Abstract
BACKGROUND Unsightly fat knees are a frustrating aesthetic deformity exacerbated by genetic predisposition and resistance to diet. This article reports our experience with laser-assisted lipolysis (LAL) in knee remodelling. METHODS A total of 30 patients were treated for unsightly fat knees with LAL. The 924/975-nm diode laser used in this study consists of two lasers, one emitting at 924 nm and another at 975 nm. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat, in dual emission mode at 924/975 nm. Patients were asked to fill out a satisfaction questionnaire. Ultrasound was used to measure the fat thickness pre-and post-operatively. RESULTS Other than one patient who developed mild hyperpigmentation that disappeared after 2 months, there were no complications in the series. Pain during the anaesthesia and discomfort after the procedure were minimal. Return to normal activities never took longer than 2 days and mean downtime was 0.92 days. Of the 30 patients, 29 would recommend this treatment. Overall satisfaction was high with both patients and investigators and was validated by ultrasound measurements demonstrating a systematic decrease in fat thickness. CONCLUSION LAL in knee remodelling is a safe and reproducible technique, particularly appreciated by patients. The procedure allows for a reduction in the amount of adipose deposits while providing concurrent skin contraction.
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3.
Monitoring markers of muscle damage during a 3 week periodized drop-jump exercise programme.
Kamandulis, S, Skurvydas, A, Snieckus, A, Masiulis, N, Aagaard, P, Dargeviciute, G, Brazaitis, M
Journal of sports sciences. 2011;(4):345-53
Abstract
The aim of this study was to examine changes in indirect markers of muscle damage during 3 weeks of stretch-shortening exercise with a progressively increasing load and continued modulation of various key training variables. Eight healthy untrained men performed a drop-jump programme involving a progressive increase in load impact with respect to the number of jumps performed, drop (platform) height, squat depth amplitude, and addition of weights. Maximal concentric and isometric knee extensor strength were assessed immediately before and 10 min after each training session. Voluntary and 100 Hz-stimulation-evoked torque decreased acutely after each training session relative to pre-exercise values (P < 0.05) but recovered before the subsequent training session. Post-exercise plasma creatine kinase activity increased from 162.2 ± 56.2 IU · l(-1) to 284.3 ± 116.3 IU · l(-1) at 48 h after the first training session (P < 0.05) and remained marginally elevated throughout the training period. The present results indicate that detrimental muscle damage can be avoided with drop-jump training even with the gradual introduction of more demanding exercise induced by increasing the volume, intensity, and muscle stretch amplitude. These findings suggest that the human neuromuscular system is highly adaptable to progressively varied loading demands during stretch-shortening exercise training.
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4.
Pre-synaptic modulation of quadriceps arthrogenic muscle inhibition.
Palmieri, RM, Weltman, A, Edwards, JE, Tom, JA, Saliba, EN, Mistry, DJ, Ingersoll, CD
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2005;(5):370-6
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Abstract
Arthrogenic muscle inhibition (AMI) impedes rehabilitation following knee joint injury by preventing activation of the quadriceps. AMI has been attributed to neuronal reflex activity in which altered afferent input originating from the injured joint results in a diminished efferent motor drive to the quadriceps muscles. Beginning to understand the mechanisms responsible for muscle inhibition following joint injury is vital to control or eliminate this phenomenon. Therefore, the purpose of this investigation is to determine if quadriceps AMI is mediated by a presynaptic regulatory mechanism. Eight adults participated in two sessions: in one session their knee was injected with saline and in the other session it was not. The maximum Hoffmann reflex (H-reflex), M-wave, reflex activation history, plasma epinephrine, and norepinephrine were recorded at: baseline, post needle stick, post lidocaine, and 25 and 45 min post effusion. Measures for the control condition were matched to the effusion condition. The percent of the unconditioned reflex amplitude for reflex activation history and the maximum H-reflex were decreased at 25 and 45 min post effusion as compared to measures taken at baseline, post needle stick, and post lidocaine (P<0.05). No differences were noted for the maximum M-wave or plasma epinephrine and norepinephrine levels in either the effusion or noneffusion admission (P>0.05). No differences were detected at any time interval for any measure during the control admission (P>0.05). Quadriceps AMI elicited via an experimental knee joint effusion is, at least in part, mediated by a presynaptic mechanism.
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A comparison of psoas compartment block and spinal and general anesthesia for outpatient knee arthroscopy.
Jankowski, CJ, Hebl, JR, Stuart, MJ, Rock, MG, Pagnano, MW, Beighley, CM, Schroeder, DR, Horlocker, TT
Anesthesia and analgesia. 2003;(4):1003-1009
Abstract
UNLABELLED The optimal anesthetic technique for outpatient knee arthroscopy remains controversial. In this study, we evaluated surgical operating conditions, patient satisfaction, recovery times, and postoperative analgesic requirements associated with psoas compartment block, general anesthetic, or spinal anesthetic techniques. Sixty patients were randomized to receive a propofol/nitrous oxide/fentanyl general anesthetic, spinal anesthesia with 6 mg of bupivacaine and 15 micro g of fentanyl, or psoas compartment block with 40 mL of 1.5% mepivacaine. All patients received IV ketorolac and intraarticular bupivacaine. The frequency of postanesthesia recovery room admission was 13 (65%) of 20 for patients receiving general anesthesia, compared with 0 of 21 for patients receiving spinal anesthesia and 1 (5%) of 19 for patients receiving psoas block (P < 0.001). The median time from the end of surgery to meeting hospital discharge criteria did not differ across groups (131, 129, and 110 min for general, spinal, and psoas groups, respectively). In the hospital, 45% of general anesthesia patients received opioid analgesics, compared with 14% of spinal anesthesia and 21% of psoas block patients (P = 0.087). There was no difference among groups with respect to the time of first analgesic use or the number of patients requiring opioid analgesia. Pain scores were highest in patients receiving general anesthesia at 30 min (P = 0.032) and at 60, 90, and 120 min (P < 0.001). Patient satisfaction with anesthetic technique (P = 0.025) and pain management (P = 0.009) differed significantly across groups; patients receiving general anesthesia reported lower satisfaction ratings. We conclude that spinal anesthesia or psoas block is superior to general anesthesia for knee arthroscopy when considering resource utilization, patient satisfaction, and postoperative analgesic management. IMPLICATIONS Outpatient knee arthroscopy may be performed using a variety of anesthetic techniques. We report that spinal anesthesia and psoas compartment block are superior to general anesthesia when considering resource utilization, patient satisfaction, and postoperative analgesic management.
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Unilateral spinal block for outpatient knee arthroscopy: a dose-finding study.
Borghi, B, Stagni, F, Bugamelli, S, Paini, MB, Nepoti, ML, Montebugnoli, M, Casati, A
Journal of clinical anesthesia. 2003;(5):351-6
Abstract
STUDY OBJECTIVE To evaluate the onset time, success rate, and recovery profile of unilateral spinal anesthesia produced with 4 mg, 6 mg, and 8 mg of 0.5% hyperbaric bupivacaine. DESIGN Prospective, randomized, blinded study. SETTING Outpatient anesthesia unit at a University Hospital. PATIENTS 90 ASA physical status I and II outpatients, who were scheduled for elective knee arthroscopy. INTERVENTIONS After standard intravenous midazolam premedication (0.05 mg/kg) and crystalloid infusion (7 mL/kg) were given, patients were placed in the lateral decubitus position on the operative side, and randomly allocated to receive spinal block with either 4 mg (Group 4, n = 30), 6 mg (Group 6, n = 30), or 8 mg (Group 8, n = 30) of 0.5% hyperbaric bupivacaine injected slowly (3 mL/min) with the needle orifice directed toward the dependent side using a 25-gauge Whitacre needle. The lateral decubitus position was maintained for 15 minutes. MEASUREMENTS AND MAIN RESULTS The onset time of surgical block was 13 +/- 5 minutes in Group 4 and 10 +/- 4 minutes in Group 6 (p = 0.006), and 9 +/- 4 minutes in Group 8 (p = 0.002). The maximum level of sensory block on the operative and nonoperative sides was, respectively, T(10) (T(12)-T(6)) and / (/-L(2)) in Group 4 (p = 0.0005), T(8) (T(12)-T(6)) and / (/-L(5)) in Group 6 (p = 0.0005), and T(7) (T(12)-T(5)) and / (/-T(10)) in Group 8 (p = 0.0005). A strictly unilateral sensory block was observed in 27 Group 4 patients (90%), 28 Group 6 patients (93%) and 23 Group 8 patients (77%) (p = 0.28). Complete unilateral motor block was observed in 29 Group 4 patients (97%), 28 Group 6 patients (93%), and 28 Group 8 patients (93%) (p = 0.80). No failed blocks were reported. Complete regression of spinal anesthesia required 71 +/- 20 minutes in Group 4 (range: 40 to 110 min), 82 +/- 25 minutes in Group 6 (range: 30 to 160 min), and 97 +/- 37 minutes in Group 8 (range: 50 to 120 min) (p = 0.003). CONCLUSIONS Hyperbaric bupivacaine 4 mg injected slowly through pencil-point directional needles in patients who are maintained in the lateral decubitus position for 15 minutes provided a surgical block that was mostly restricted to the operative side and adequate to perform knee arthroscopy, with a faster recovery profile than when a 6 mg or 8 mg dose was used.
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Tissue absorption and distribution of ketoprofen after patch application in subjects undergoing knee arthroscopy or endoscopic carpal ligament release.
Osterwalder, A, Reiner, V, Reiner, G, Lualdi, P
Arzneimittel-Forschung. 2002;(11):822-7
Abstract
The diffusion into the target tissues of ketoprofen (CAS 22071-15-4), a widely used nonsteroidal anti-inflammatory drug, from a new topical patch has been studied after repeated patch application in comparison with its plasma level. Ten patients (5 women and 5 men) with a mean age of 45.0 +/- 12.3 years (mean +/- SD), scheduled for arthroscopic meniscectomy (5 subjects) or endoscopic carpal tunnel decompression (5 subjects), were asked to apply one patch with 100 mg ketoprofen on the affected body site once a day during the 6 days before the scheduled surgery. The last patch was kept for 6 h, and removed just a few minutes before surgery, when venous blood was drawn. Biopsies of the synovial tissue of the medial compartment and of the anterior fat pad (Hoffa's tissue) or of the ulnar bursa were taken during knee arthroscopy or endoscopic carpal tunnel release, respectively. An average plasma value of 52.8 +/- 30.1 (SD) ng/ml of ketoprofen was obtained in the 10 patients. The tissue concentrations of ketoprofen in the 5 subjects undergoing knee arthroscopy were 27.9 +/- 26.1 ng/g (range 7.2-67.1 ng/g) in the anterior fat pad and 239.0 +/- 163.0 ng/g (range 20.0-430.5 ng/g) in the synovial tissue. Drug concentrations up to 1000 times higher were found in the tendon sheath tissue of the ulnar bursa of the five patients undergoing endoscopic carpal tunnel release: average values of 20,107 +/- 7359 ng/g (range 13,004-32,578 ng/g) were obtained in this tissue. Data observed in this trial are consistent with those previously published by other authors, and demonstrate that ketoprofen applied on the skin is able to enter the subcutaneous and intra-articular tissues, reaching concentrations markedly higher than in plasma, and is further able to produce the desired pharmacological activity in situ, whereas plasma concentrations are too low to produce any systemic activity or side effect.
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A prospective, randomized comparison of dexketoprofen, ketoprofen or paracetamol for postoperative analgesia after outpatient knee arthroscopy.
Berti, M, Albertin, A, Casati, A, Palmisano, S, Municino, G, da Gama Malcher, M, De Ponti, A
Minerva anestesiologica. 2000;(7-8):549-54
Abstract
BACKGROUND This prospective, randomized study was conducted to evaluate the quality of postoperative pain relief when using dexketoprofen, ketoprofen, or paracetamol after outpatient knee arthroscopy. METHODS Without premedication, 45 ASA physical status I-II patients undergoing elective outpatient knee arthroscopy with combined sciatic-femoral nerve block, were randomly allocated to receive either 25 mg oral dexketoprofen (n = 15), 50 mg oral ketoprofen (n = 15), or 500 mg oral paracetamol (n = 15) before block placement. After completion of surgery the same pain medication was given according to standard protocols, while 50 mg oral tramadol were allowed as rescue analgesic if required by the patient. After standard discharge criteria had been fulfilled, patients were discharged from the day-surgery unit, while a telephone follow-up was performed the day after surgery using standard questionnaires evaluating the quality of pain relief during the first 24 hours after surgery. Total consumption of rescue tramadol, maximum pain complained of after hospital discharge, as well as the visual analogue scale of pain measured at hospital discharge were assessed by an independent trained observer. RESULTS No differences in anthropometric variables, duration of surgical procedure, and fulfillment of discharge criteria were observed between the three groups. The degree of pain measured at rest at hospital discharge was similar in the three groups, while the VAS measured during motion was higher in patients receiving paracetamol (24 +/- 2.5 mm) than in those patients treated with dexketoprofen (13 +/- 6 mm) or ketoprofen (17 +/- 5 mm) (p = 0.016). Two patients (one in ketoprofen group and one in paracetamol group) required rescue tramadol after hospital discharge; however, no differences in maximum pain complained of after surgery or patient acceptance were observed between groups. CONCLUSIONS This prospective, randomized study demonstrated that in outpatients receiving arthroscopic knee surgery, the use of 75 mg/day dexketoprofen was as effective and safe as 150 mg/day racemate ketoprofen, with a better pain relief during motion compared to 2 g/day paracetamol when patients were discharged from the day-surgery unit.