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Anterior cruciate ligament (ACL) reconstruction is becoming increasingly popular in active middle-aged patients with symptomatic instability. The purpose of this study was to retrospectively evaluate the results of ACL reconstruction in patients over the age of 40. Twenty-one patients with a median age of 44 (range 40-56) who had arthroscopically assisted reconstruction using four-stranded hamstring autograft were reviewed. RCI titanium interference screw fixation was used in the tibia, and Endobutton CL fixation in the femur. The clinical results were assessed at a mean follow-up of 2 years. The median value for the Lysholm knee score was 92 (range 74-100), and the median value for the International Knee Documentation Committee score was 83 (range 53-97). For the Tegner activity scale, the median value was 6 (range 4-8) at follow-up. The median side-to-side difference using the KT-1000 arthrometer was 2 mm (range 0-3.5 mm). Hamstring ACL reconstruction in appropriately selected middle-aged patients can yield successful and satisfactory results.

This study was carried out to assess the hypotensive effect of low dose dexmedetomidine (DEX) infusion during middle ear surgery. 42 ASA grades I and II patients of either sex aged 18-45 years undergoing elective middle ear surgery were randomly divided into two groups of 21 each. Group I received placebo bolus and infusion of saline at a rate similar to DEX in Group II. Group II received 10-15 min prior to induction of anesthesia 1 μg/kg IV bolus DEX diluted in 10 ml of normal saline over 10 min. Immediately thereafter an infusion of 0.4 μg/kg/hr of DEX commenced. Standard anesthetic technique was used. Halothane was titrated to achieve a mean arterial pressure 30% below the control value (value taken just after premedication). We observed that a statistically signifi cant reduction in the percentage of halothane required to reduce MAP 30% below control value occurred in patients receiving DEX infusion (1.3 ± 0.4%) in comparison to those receiving placebo (3.1 ± 0.3%). Patients receiving DEX infusion had a better surgical fi eld. The mean awakening time was signifi cantly reduced in patients of Group II (9.1 ± 2.7 min) when compared to patients of Group I (12.8 ± 2.2 min).We conclude that DEX can be safely used to provide hypotensive anesthesia during middle ear surgery.

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