The effect of 20 mL of intraarticular bupivacaine (0.25%, with or without 1:200,000 epinephrine), morphine (0.03%, with or without 1:200,000 epinephrine), or normal saline on postoperative analgesia after arthroscopic knee surgery was studied in a randomized, prospective, double-blind trial in ASA I-III outpatients receiving general anesthesia (n = 112) or regional anesthesia (n = 27 [spinal (n = 25) or epidural (n = 2)]). The visual analogue pain scores in the postanesthesia care unit and 3, 6, 12, and 24 h after surgery, time to first analgesic use, and total 24-h analgesic requirements were recorded. In those who received general anesthesia, the visual analogue scores were significantly lower in the bupivacaine group compared with both the morphine- and placebo-treated patients (P less than 0.05). The time to first analgesic use was longer in both the bupivacaine and morphine groups when compared with the control group (P less than 0.05). No significant differences were detected in total 24-h analgesic requirements among the groups. Patients who had received regional anesthesia had lower visual analogue scores compared with patients who had received general anesthesia irrespective of the intraarticular treatment (P less than 0.05). Our results indicate that intraarticular injection of bupivacaine after arthroscopic knee surgery provides prolonged analgesia but that there is no significant prolonged analgesia provided by intraarticular morphine.

We report a series of ossific lesions of the posterior inferior glenoid in a group of elite baseball players. We hope to clarify the etiology, diagnosis, and treatment of the Bennett lesion. From August 1985 to August 1991, we identified six professional baseball pitchers and one college pitcher with evidence of ossification of the shoulder on plain radiographs, computed tomography, or magnetic resonance imaging. Arthroscopic examination was performed in all cases. All seven players had identifiable posterior labral injury on arthroscopic examination; six of these seven also had varying degrees of undersurface posterior rotator cuff damage. No anterior tissue damage, anterior instability, or subacromial impingement was noted. No ossification was identified arthroscopically. Intraarticular labral and rotator cuff tears were debrided arthroscopically and patients underwent rehabilitation for 4 to 6 months after surgery. Six of the seven athletes returned to preinjury performance levels; however, one pitcher is no longer playing competitive baseball. The Bennett lesion is an extraarticular posterior ossification associated with posterior labral injury and posterior undersurface rotator cuff damage. It is not, however, a result of traction stresses in the region of the triceps insertion. Recognition is important for identification and treatment of the lesion and associated pathologic damage.

The current study was done to determine whether an isolated, partial, or complete injury to the popliteus at the femur increases rotational knee laxity. The other aim was to determine how quadriceps loading affects internal and external rotation. Ten cadaver knee specimens with an intact posterolateral complex were held in a biomechanical testing rig at 0 degrees, 30 degrees, 60 degrees, and 90 degrees flexion. Movement of the tibia relative to the femur was measured while internal and external moments of 3 N-m were applied about the long axis of the tibia. Laxity was assessed for an intact specimen, and with partial and complete detachment of the popliteus femoral insertion. In five of the 10 specimens laxity additionally was assessed with sufficient quadriceps loading to resist 100 N vertical force at the hip. The results showed that partial and total release of the popliteus increased external laxity of the knee by as much as 6.6 degrees (90 degrees flexion) and by as much as 3.5 degrees (90 degrees flexion). Quadriceps loading reduced internal and external knee laxity significantly. Injury of the popliteus at the femoral insertion may be associated with increased rotational laxity of the knee. An increase in quadriceps force may be necessary to control increased external rotation of the tibia.

One hundred shoulders of 50 cadavers were dissected using the anterior approach. The normal appearance of the capsule, particularly the anterior superior, and the functions of the structures during passive motion were noted. There was a distinct capsular pattern with a Z formation which included the coracohumeral ligament and the superior, middle, and inferior glenohumeral ligaments. The middle and proximal capsular structures appeared to restrain external rotation. The coracohumeral ligament aided in restraint of external rotation at the lower range of abduction. The middle glenohumeral ligament was critical in restraining external rotation between 60 degrees and 90 degrees of abduction. It was readily identifiable except in a small percentage of individuals, who had a weak or absent ligament. The large capsular opening sometimes seen in shoulder repairs is due to an absent or attenuated middle glenohumeral ligament. Both the coracohumeral and middle glenohumeral ligaments were found to support the dependent arm.