Jay Cherniak

Children who received diphenhydramine or ranitidine after undergoing surgery for perforated appendicitis had a significantly higher risk of a postoperative abscess than did children who received neither drug, according to a review of 98 patients at a single center.

Patients given either drug had a 70%–80% greater risk of an abscess 5 days after appendectomy, regardless of antibiotic regimen, and patients given both drugs had a fourfold greater risk of an abscess, investigators reported. Diphenhydramine blocks the H₁ receptor and is often given after appendectomy to induce sleep or to relieve pruritus caused by narcotics. Ranitidine blocks the H₂ receptor and is given to prevent gastritis caused by ketorolac, an NSAID analgesic.

Dr. Shawn D. St. Peter and his colleagues at Children's Mercy Hospital, Kansas City, Mo., reviewed the records of all 98 children (mean age, about 8.6 years) who had surgery for perforated appendicitis at the hospital between April 2005 and November 2006.

During postoperative care, providers ordered medications from a standardized list that included ranitidine and diphenhydramine. Ranitidine was ordered by someone other than the surgeon—either a resident or nurse practitioner—and when it was ordered, it was given within 24 hours following surgery. Diphenhydramine could be ordered on an as-needed basis. Narcotics were given to every patient, and ketorolac and ondansetron also could be ordered.

A total of 24 children received ranitidine, 17 were given diphenhydramine, 16 were administered both medications, and 41 received neither. “No differences existed in patient or operative variables in those given [ranitidine or diphenhydramine], compared with those receiving no doses,” the authors said.

The results showed that children given only ranitidine or diphenhydramine had abscess rates of 17% and 18%, whereas those not given either drug had a 10% rate. The differences were significant for both medications, reported Dr. St. Peter and his colleagues (Arch. Surg. 2010;145:143–6). Patients who received both drugs had an abscess rate of 44%.

There were no significant differences in other outcomes, including hospital stay and wound infections. No correlations were found between abscess rates and the administration of ketorolac, naloxone, or ondansetron.

“These data represent the first clinical evidence, to our knowledge, that both H₁- and H₂-receptor antagonism may adversely affect postoperative abscess formation,” the researchers wrote.

In an interview, Dr. St. Peter said that they felt these data were “real because we could find nothing about the patients that justified use of ranitidine or diphenhydramine that would correlate with the patient being sicker and thus this is why they had the higher abscess rate.”

In an invited critique, Dr. Stephanie F. Heller and Dr. Michael G. Sarr wrote that the study shows the two drugs “have adverse effects that presumably attenuate several aspects of the inflammatory response. This concept has been unappreciated previously but is argued convincingly by [Dr.] St. Peter and colleagues” (Arch. Surg. 2010;145:147).

“What have we gleaned from this study? We should (1) not use 'prophylactic' H₂-receptor antagonists; [and] (2) use another sleeping pill, but only if absolutely needed,” wrote Dr. Heller and Dr. Sarr, who are both with the surgery department of the Mayo Clinic, Rochester, Minn.

Disclosures: Dr. St. Peter and his colleagues, as well as Dr. Heller and Dr. Sarr, disclosed no financial conflicts of interest.

Children who received diphenhydramine or ranitidine after undergoing surgery for perforated appendicitis had a significantly higher risk of a postoperative abscess than did children who received neither drug, according to a review of 98 patients at a single center.

Patients given either drug had a 70%–80% greater risk of an abscess 5 days after appendectomy, regardless of antibiotic regimen, and patients given both drugs had a fourfold greater risk of an abscess, investigators reported. Diphenhydramine blocks the H₁ receptor and is often given after appendectomy to induce sleep or to relieve pruritus caused by narcotics. Ranitidine blocks the H₂ receptor and is given to prevent gastritis caused by ketorolac, an NSAID analgesic.

Dr. Shawn D. St. Peter and his colleagues at Children's Mercy Hospital, Kansas City, Mo., reviewed the records of all 98 children (mean age, about 8.6 years) who had surgery for perforated appendicitis at the hospital between April 2005 and November 2006.

During postoperative care, providers ordered medications from a standardized list that included ranitidine and diphenhydramine. Ranitidine was ordered by someone other than the surgeon—either a resident or nurse practitioner—and when it was ordered, it was given within 24 hours following surgery. Diphenhydramine could be ordered on an as-needed basis. Narcotics were given to every patient, and ketorolac and ondansetron also could be ordered.

A total of 24 children received ranitidine, 17 were given diphenhydramine, 16 were administered both medications, and 41 received neither. “No differences existed in patient or operative variables in those given [ranitidine or diphenhydramine], compared with those receiving no doses,” the authors said.

The results showed that children given only ranitidine or diphenhydramine had abscess rates of 17% and 18%, whereas those not given either drug had a 10% rate. The differences were significant for both medications, reported Dr. St. Peter and his colleagues (Arch. Surg. 2010;145:143–6). Patients who received both drugs had an abscess rate of 44%.

There were no significant differences in other outcomes, including hospital stay and wound infections. No correlations were found between abscess rates and the administration of ketorolac, naloxone, or ondansetron.

“These data represent the first clinical evidence, to our knowledge, that both H₁- and H₂-receptor antagonism may adversely affect postoperative abscess formation,” the researchers wrote.

In an interview, Dr. St. Peter said that they felt these data were “real because we could find nothing about the patients that justified use of ranitidine or diphenhydramine that would correlate with the patient being sicker and thus this is why they had the higher abscess rate.”

In an invited critique, Dr. Stephanie F. Heller and Dr. Michael G. Sarr wrote that the study shows the two drugs “have adverse effects that presumably attenuate several aspects of the inflammatory response. This concept has been unappreciated previously but is argued convincingly by [Dr.] St. Peter and colleagues” (Arch. Surg. 2010;145:147).

“What have we gleaned from this study? We should (1) not use 'prophylactic' H₂-receptor antagonists; [and] (2) use another sleeping pill, but only if absolutely needed,” wrote Dr. Heller and Dr. Sarr, who are both with the surgery department of the Mayo Clinic, Rochester, Minn.

Disclosures: Dr. St. Peter and his colleagues, as well as Dr. Heller and Dr. Sarr, disclosed no financial conflicts of interest.

Children who received diphenhydramine or ranitidine after undergoing surgery for perforated appendicitis had a significantly higher risk of a postoperative abscess than did children who received neither drug, according to a review of 98 patients at a single center.

Patients given either drug had a 70%–80% greater risk of an abscess 5 days after appendectomy, regardless of antibiotic regimen, and patients given both drugs had a fourfold greater risk of an abscess, investigators reported. Diphenhydramine blocks the H₁ receptor and is often given after appendectomy to induce sleep or to relieve pruritus caused by narcotics. Ranitidine blocks the H₂ receptor and is given to prevent gastritis caused by ketorolac, an NSAID analgesic.

Dr. Shawn D. St. Peter and his colleagues at Children's Mercy Hospital, Kansas City, Mo., reviewed the records of all 98 children (mean age, about 8.6 years) who had surgery for perforated appendicitis at the hospital between April 2005 and November 2006.

During postoperative care, providers ordered medications from a standardized list that included ranitidine and diphenhydramine. Ranitidine was ordered by someone other than the surgeon—either a resident or nurse practitioner—and when it was ordered, it was given within 24 hours following surgery. Diphenhydramine could be ordered on an as-needed basis. Narcotics were given to every patient, and ketorolac and ondansetron also could be ordered.

A total of 24 children received ranitidine, 17 were given diphenhydramine, 16 were administered both medications, and 41 received neither. “No differences existed in patient or operative variables in those given [ranitidine or diphenhydramine], compared with those receiving no doses,” the authors said.

The results showed that children given only ranitidine or diphenhydramine had abscess rates of 17% and 18%, whereas those not given either drug had a 10% rate. The differences were significant for both medications, reported Dr. St. Peter and his colleagues (Arch. Surg. 2010;145:143–6). Patients who received both drugs had an abscess rate of 44%.

There were no significant differences in other outcomes, including hospital stay and wound infections. No correlations were found between abscess rates and the administration of ketorolac, naloxone, or ondansetron.

“These data represent the first clinical evidence, to our knowledge, that both H₁- and H₂-receptor antagonism may adversely affect postoperative abscess formation,” the researchers wrote.

In an interview, Dr. St. Peter said that they felt these data were “real because we could find nothing about the patients that justified use of ranitidine or diphenhydramine that would correlate with the patient being sicker and thus this is why they had the higher abscess rate.”

In an invited critique, Dr. Stephanie F. Heller and Dr. Michael G. Sarr wrote that the study shows the two drugs “have adverse effects that presumably attenuate several aspects of the inflammatory response. This concept has been unappreciated previously but is argued convincingly by [Dr.] St. Peter and colleagues” (Arch. Surg. 2010;145:147).

“What have we gleaned from this study? We should (1) not use 'prophylactic' H₂-receptor antagonists; [and] (2) use another sleeping pill, but only if absolutely needed,” wrote Dr. Heller and Dr. Sarr, who are both with the surgery department of the Mayo Clinic, Rochester, Minn.

Disclosures: Dr. St. Peter and his colleagues, as well as Dr. Heller and Dr. Sarr, disclosed no financial conflicts of interest.

Participation in organized sports has long been considered good for one's health, but a large survey indicates that team sports don't always lead teenagers to engage in healthier behavior.

Questionnaires answered by more than 13,000 students revealed that males who participated in team sports during the previous 12 months were more likely to engage in physical fighting during that period and to consume alcohol than were males who did not participate. But the male participants were less likely to smoke or experience depression.

A different picture emerged for females: Sports participation lowered the likelihood of all types of risky behavior among white females but had no association with risky behavior in black females except for increased binge drinking.

These results were presented by Susan M. Connor, Ph.D., at the annual meeting of the American Public Health Association in Philadelphia.

“Sports team participation appears to have both protective and risk-enhancing associations” in males, Dr. Connor, a clinical psychologist, said in an interview. At the same time, it has strong positive associations for white females but not black females, she noted.

Dr. Connor and her colleagues at Rainbow Babies & Children's Hospital, Cleveland, analyzed results from a Youth Risk Behavior Survey administered to 14,041 high school students, of whom 13,411 (50% males, 50% females) responded.

The survey, which defined team sports participation as playing on one or more teams (school- or community-based) during the previous 12 months, sought information on the following health risks: physical fighting in the past 12 months; depression in the past 12 months; drinking, binge drinking, and cigarette or pot smoking in the past 30 days; and fasting, taking pills, or vomiting to lose weight in the past year.

The respondents, equally distributed across grades 9-12, were 42% white, 37% Hispanic, 21% black, 3% Asian, and 16% mixed race.

In all, 60.5% of the males and 48.0% of the females reported participating on one or more teams in the past year, Dr. Connor said in her presentation.

After the researchers controlled for grade and race, they found that males who participated in team sports had a higher risk of drinking (odds ratio 1.4) and binge drinking (OR 1.4) than did males who did not participate. Females, however, showed no association between participation and drinking or binge drinking, said Dr. Connor, injury prevention research manager at Rainbow Babies & Children's Hospital.

Males who participated in team sports had a greater risk of fighting than did males who did not participate (OR 1.3), but a lower risk of smoking (OR 0.8). Overall, females who participated had lower risks than did non-participating females for fighting (OR 0.9), smoking (0.5), marijuana use (OR 0.7), and unhealthy weight loss practices (OR 0.9). Both boys and girls participating in sports had a lower risk of depression (OR 0.7 for both).

A comparison of white males and black males showed similar risks for fighting (OR 1.3 for whites vs. 1.4 for blacks), drinking (OR 1.4 for both), binge drinking (OR 1.3 vs. 1.6, respectively), and depression (OR 0.61 vs. 0.75).

When responses from white females were analyzed, the white participants showed lower risks than did white nonparticipants for fighting (OR 0.67), depression (OR 0.62), smoking (OR 0.47), marijuana use (OR 0.58), and unhealthy weight loss practices (OR 0.75). In comparison, black female sports participants showed no association with risky behaviors other than binge drinking (OR 1.4).

Limitations of the study included the fact that team sports participation was gauged by a single question on the survey and that the survey did not allow for analysis by socioeconomic status. Dr. Connor also noted that the study examined associations and does not imply cause/effect relationships between sports team participation and any behaviors.

Disclosures: Dr. Connor declared no financial relationships with commercial interests relevant to her presentation.

Participation in organized sports has long been considered good for one's health, but a large survey indicates that team sports don't always lead teenagers to engage in healthier behavior.

Questionnaires answered by more than 13,000 students revealed that males who participated in team sports during the previous 12 months were more likely to engage in physical fighting during that period and to consume alcohol than were males who did not participate. But the male participants were less likely to smoke or experience depression.

A different picture emerged for females: Sports participation lowered the likelihood of all types of risky behavior among white females but had no association with risky behavior in black females except for increased binge drinking.

These results were presented by Susan M. Connor, Ph.D., at the annual meeting of the American Public Health Association in Philadelphia.

“Sports team participation appears to have both protective and risk-enhancing associations” in males, Dr. Connor, a clinical psychologist, said in an interview. At the same time, it has strong positive associations for white females but not black females, she noted.

Dr. Connor and her colleagues at Rainbow Babies & Children's Hospital, Cleveland, analyzed results from a Youth Risk Behavior Survey administered to 14,041 high school students, of whom 13,411 (50% males, 50% females) responded.

The survey, which defined team sports participation as playing on one or more teams (school- or community-based) during the previous 12 months, sought information on the following health risks: physical fighting in the past 12 months; depression in the past 12 months; drinking, binge drinking, and cigarette or pot smoking in the past 30 days; and fasting, taking pills, or vomiting to lose weight in the past year.

The respondents, equally distributed across grades 9-12, were 42% white, 37% Hispanic, 21% black, 3% Asian, and 16% mixed race.

In all, 60.5% of the males and 48.0% of the females reported participating on one or more teams in the past year, Dr. Connor said in her presentation.

After the researchers controlled for grade and race, they found that males who participated in team sports had a higher risk of drinking (odds ratio 1.4) and binge drinking (OR 1.4) than did males who did not participate. Females, however, showed no association between participation and drinking or binge drinking, said Dr. Connor, injury prevention research manager at Rainbow Babies & Children's Hospital.

Males who participated in team sports had a greater risk of fighting than did males who did not participate (OR 1.3), but a lower risk of smoking (OR 0.8). Overall, females who participated had lower risks than did non-participating females for fighting (OR 0.9), smoking (0.5), marijuana use (OR 0.7), and unhealthy weight loss practices (OR 0.9). Both boys and girls participating in sports had a lower risk of depression (OR 0.7 for both).

A comparison of white males and black males showed similar risks for fighting (OR 1.3 for whites vs. 1.4 for blacks), drinking (OR 1.4 for both), binge drinking (OR 1.3 vs. 1.6, respectively), and depression (OR 0.61 vs. 0.75).

When responses from white females were analyzed, the white participants showed lower risks than did white nonparticipants for fighting (OR 0.67), depression (OR 0.62), smoking (OR 0.47), marijuana use (OR 0.58), and unhealthy weight loss practices (OR 0.75). In comparison, black female sports participants showed no association with risky behaviors other than binge drinking (OR 1.4).

Limitations of the study included the fact that team sports participation was gauged by a single question on the survey and that the survey did not allow for analysis by socioeconomic status. Dr. Connor also noted that the study examined associations and does not imply cause/effect relationships between sports team participation and any behaviors.

Disclosures: Dr. Connor declared no financial relationships with commercial interests relevant to her presentation.

Participation in organized sports has long been considered good for one's health, but a large survey indicates that team sports don't always lead teenagers to engage in healthier behavior.

Questionnaires answered by more than 13,000 students revealed that males who participated in team sports during the previous 12 months were more likely to engage in physical fighting during that period and to consume alcohol than were males who did not participate. But the male participants were less likely to smoke or experience depression.

A different picture emerged for females: Sports participation lowered the likelihood of all types of risky behavior among white females but had no association with risky behavior in black females except for increased binge drinking.

These results were presented by Susan M. Connor, Ph.D., at the annual meeting of the American Public Health Association in Philadelphia.

“Sports team participation appears to have both protective and risk-enhancing associations” in males, Dr. Connor, a clinical psychologist, said in an interview. At the same time, it has strong positive associations for white females but not black females, she noted.

Dr. Connor and her colleagues at Rainbow Babies & Children's Hospital, Cleveland, analyzed results from a Youth Risk Behavior Survey administered to 14,041 high school students, of whom 13,411 (50% males, 50% females) responded.

The survey, which defined team sports participation as playing on one or more teams (school- or community-based) during the previous 12 months, sought information on the following health risks: physical fighting in the past 12 months; depression in the past 12 months; drinking, binge drinking, and cigarette or pot smoking in the past 30 days; and fasting, taking pills, or vomiting to lose weight in the past year.

The respondents, equally distributed across grades 9-12, were 42% white, 37% Hispanic, 21% black, 3% Asian, and 16% mixed race.

In all, 60.5% of the males and 48.0% of the females reported participating on one or more teams in the past year, Dr. Connor said in her presentation.

After the researchers controlled for grade and race, they found that males who participated in team sports had a higher risk of drinking (odds ratio 1.4) and binge drinking (OR 1.4) than did males who did not participate. Females, however, showed no association between participation and drinking or binge drinking, said Dr. Connor, injury prevention research manager at Rainbow Babies & Children's Hospital.

Males who participated in team sports had a greater risk of fighting than did males who did not participate (OR 1.3), but a lower risk of smoking (OR 0.8). Overall, females who participated had lower risks than did non-participating females for fighting (OR 0.9), smoking (0.5), marijuana use (OR 0.7), and unhealthy weight loss practices (OR 0.9). Both boys and girls participating in sports had a lower risk of depression (OR 0.7 for both).

A comparison of white males and black males showed similar risks for fighting (OR 1.3 for whites vs. 1.4 for blacks), drinking (OR 1.4 for both), binge drinking (OR 1.3 vs. 1.6, respectively), and depression (OR 0.61 vs. 0.75).

When responses from white females were analyzed, the white participants showed lower risks than did white nonparticipants for fighting (OR 0.67), depression (OR 0.62), smoking (OR 0.47), marijuana use (OR 0.58), and unhealthy weight loss practices (OR 0.75). In comparison, black female sports participants showed no association with risky behaviors other than binge drinking (OR 1.4).

Limitations of the study included the fact that team sports participation was gauged by a single question on the survey and that the survey did not allow for analysis by socioeconomic status. Dr. Connor also noted that the study examined associations and does not imply cause/effect relationships between sports team participation and any behaviors.

Disclosures: Dr. Connor declared no financial relationships with commercial interests relevant to her presentation.

Patients with osteoarthritis of the knee who undergo arthroscopic meniscectomy have better outcomes at 6 weeks' follow-up if they receive a steroid injection in the knee joint after surgery, according to the results of a randomized, controlled trial.

The meniscectomy patients who received an intra-articular steroid/lidocaine injection reported significantly less pain and better function at 6 weeks' follow-up than did patients who received a saline/lidocaine injection, sinvestigators reported.

The difference between groups disappeared by 6 months after the operation, however.

The study cohort consisted of 58 patients (59 knees) with a meniscal tear who were treated with arthroscopic surgery at Rush University Medical Center, Chicago, between December 2004 and January 2007. All patients had confirmed chondromalacia (modified Outerbridge grade 2 or higher) in the ipsilateral knee. Exclusion criteria included a steroid injection in the 2 months prior to surgery and inadequate follow-up data. A single surgeon performed all the operations.

Before surgery, patients were randomized in a double-blinded manner to receive a postoperative injection of lidocaine plus either 1 mL (40 mg) of methylprednisolone (Depo-Medrol) or 1 mL of 0.9% normal saline. The injection was administered into the knee after the arthroscopic portals were closed.

The steroid group (19 men, 10 women) had a mean age of 49 years, and the saline group (22 men, 8 women) had a mean age of 52 years.

Before surgery and at follow-up times of 6 weeks and 6, 9, and 12 months, patients had an exam and completed a subjective function survey. The investigators calculated function scores using several systems, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and Short Form-12. There were no significant differences in preoperative scores between groups.

At 6 weeks' follow-up, the steroid group had significantly better scores than did the saline group on the KOOS sport scale, KOOS qQuality of life scale, and IKDC and treatment satisfaction scales, according to the investigators, led by Dr. Loukas Koyonos (Am. J. Sports Med. 2009;37:1077–82).

At 6, 9, and 12 months, “score differences between the steroid and saline groups had disappeared,” the investigators wrote. At these time points, both groups showed significant improvements over their preoperative scores on all scales except the SF-12. By 12 months' follow-up, 86% of the steroid group and 69% of the saline group were “completely or mostly satisfied” with the surgery.

“The addition of a postoperative corticosteroid injection resulted in improved pain and function at an early time point; however, it provided no lasting difference compared with only local anesthetic injection,” the researchers concluded. Additional trials “are necessary to further characterize the benefits, indications, and durability of intra-articular corticosteroid injections” in the setting of OA.

Limitations included the fact that “the study was underpowered to detect a significant difference in the distribution of chondromalacia and meniscectomies,” they wrote.

In addition, “the saline group had a higher prevalence of tricompartmental arthritis and bilateral meniscectomies, suggestive of a more advanced disease state, which may contribute to the lower scores observed in these patients.”

The authors reported that this research was supported by a grant from Pfizer Inc.

Patients with osteoarthritis of the knee who undergo arthroscopic meniscectomy have better outcomes at 6 weeks' follow-up if they receive a steroid injection in the knee joint after surgery, according to the results of a randomized, controlled trial.

The meniscectomy patients who received an intra-articular steroid/lidocaine injection reported significantly less pain and better function at 6 weeks' follow-up than did patients who received a saline/lidocaine injection, sinvestigators reported.

The difference between groups disappeared by 6 months after the operation, however.

The study cohort consisted of 58 patients (59 knees) with a meniscal tear who were treated with arthroscopic surgery at Rush University Medical Center, Chicago, between December 2004 and January 2007. All patients had confirmed chondromalacia (modified Outerbridge grade 2 or higher) in the ipsilateral knee. Exclusion criteria included a steroid injection in the 2 months prior to surgery and inadequate follow-up data. A single surgeon performed all the operations.

Before surgery, patients were randomized in a double-blinded manner to receive a postoperative injection of lidocaine plus either 1 mL (40 mg) of methylprednisolone (Depo-Medrol) or 1 mL of 0.9% normal saline. The injection was administered into the knee after the arthroscopic portals were closed.

The steroid group (19 men, 10 women) had a mean age of 49 years, and the saline group (22 men, 8 women) had a mean age of 52 years.

Before surgery and at follow-up times of 6 weeks and 6, 9, and 12 months, patients had an exam and completed a subjective function survey. The investigators calculated function scores using several systems, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and Short Form-12. There were no significant differences in preoperative scores between groups.

At 6 weeks' follow-up, the steroid group had significantly better scores than did the saline group on the KOOS sport scale, KOOS qQuality of life scale, and IKDC and treatment satisfaction scales, according to the investigators, led by Dr. Loukas Koyonos (Am. J. Sports Med. 2009;37:1077–82).

At 6, 9, and 12 months, “score differences between the steroid and saline groups had disappeared,” the investigators wrote. At these time points, both groups showed significant improvements over their preoperative scores on all scales except the SF-12. By 12 months' follow-up, 86% of the steroid group and 69% of the saline group were “completely or mostly satisfied” with the surgery.

“The addition of a postoperative corticosteroid injection resulted in improved pain and function at an early time point; however, it provided no lasting difference compared with only local anesthetic injection,” the researchers concluded. Additional trials “are necessary to further characterize the benefits, indications, and durability of intra-articular corticosteroid injections” in the setting of OA.

Limitations included the fact that “the study was underpowered to detect a significant difference in the distribution of chondromalacia and meniscectomies,” they wrote.

In addition, “the saline group had a higher prevalence of tricompartmental arthritis and bilateral meniscectomies, suggestive of a more advanced disease state, which may contribute to the lower scores observed in these patients.”

The authors reported that this research was supported by a grant from Pfizer Inc.

Patients with osteoarthritis of the knee who undergo arthroscopic meniscectomy have better outcomes at 6 weeks' follow-up if they receive a steroid injection in the knee joint after surgery, according to the results of a randomized, controlled trial.

The meniscectomy patients who received an intra-articular steroid/lidocaine injection reported significantly less pain and better function at 6 weeks' follow-up than did patients who received a saline/lidocaine injection, sinvestigators reported.

The difference between groups disappeared by 6 months after the operation, however.

The study cohort consisted of 58 patients (59 knees) with a meniscal tear who were treated with arthroscopic surgery at Rush University Medical Center, Chicago, between December 2004 and January 2007. All patients had confirmed chondromalacia (modified Outerbridge grade 2 or higher) in the ipsilateral knee. Exclusion criteria included a steroid injection in the 2 months prior to surgery and inadequate follow-up data. A single surgeon performed all the operations.

Before surgery, patients were randomized in a double-blinded manner to receive a postoperative injection of lidocaine plus either 1 mL (40 mg) of methylprednisolone (Depo-Medrol) or 1 mL of 0.9% normal saline. The injection was administered into the knee after the arthroscopic portals were closed.

The steroid group (19 men, 10 women) had a mean age of 49 years, and the saline group (22 men, 8 women) had a mean age of 52 years.

Before surgery and at follow-up times of 6 weeks and 6, 9, and 12 months, patients had an exam and completed a subjective function survey. The investigators calculated function scores using several systems, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and Short Form-12. There were no significant differences in preoperative scores between groups.

At 6 weeks' follow-up, the steroid group had significantly better scores than did the saline group on the KOOS sport scale, KOOS qQuality of life scale, and IKDC and treatment satisfaction scales, according to the investigators, led by Dr. Loukas Koyonos (Am. J. Sports Med. 2009;37:1077–82).

At 6, 9, and 12 months, “score differences between the steroid and saline groups had disappeared,” the investigators wrote. At these time points, both groups showed significant improvements over their preoperative scores on all scales except the SF-12. By 12 months' follow-up, 86% of the steroid group and 69% of the saline group were “completely or mostly satisfied” with the surgery.

“The addition of a postoperative corticosteroid injection resulted in improved pain and function at an early time point; however, it provided no lasting difference compared with only local anesthetic injection,” the researchers concluded. Additional trials “are necessary to further characterize the benefits, indications, and durability of intra-articular corticosteroid injections” in the setting of OA.

Limitations included the fact that “the study was underpowered to detect a significant difference in the distribution of chondromalacia and meniscectomies,” they wrote.

In addition, “the saline group had a higher prevalence of tricompartmental arthritis and bilateral meniscectomies, suggestive of a more advanced disease state, which may contribute to the lower scores observed in these patients.”

The authors reported that this research was supported by a grant from Pfizer Inc.

Preoperative MRI scanning of the knee in some patients with joint line pain revealed more advanced degenerative disease than was suggested by clinical examination and plain x-rays, judging from findings from a large British series.

In the study of more than 600 patients presenting with knee symptoms, MRI assessment led to a change in the clinical management of 23% of the patients (141 of 618), study investigators reported.

In most of these patients (129 of 141), the scans revealed unexpected chondral surface lesions, unstable meniscal tears, and other pathologies. The purpose of the study was to determine if preoperative MRI assessment of knee pathology after a clinical examination and plain x-rays affects the surgical management of patients with knee pain.

The study had two parts. First, investigators assessed the accuracy of MRI scans for detecting knee cartilage lesions at their institution, Royal Free Hampstead National Health Service (NHS) Trust, London.

They performed MRI scans and arthroscopic exams on 100 randomly selected patients with knee pain. Using arthroscopy as the standard, the researchers found that the MRI scans had an overall sensitivity of 83% and an overall specificity of 94% for the detection of chondral lesions.

In the second part of the study, the researchers enrolled 618 patients with knee pain (316 women, mean age 55 years; 302 men, mean age 45 years).

All participants were initially examined by a clinician for evidence of arthritis or meniscal tears, and had plain x-rays. The clinician recorded the most probable cause of the pain and the likelihood of proceeding to arthroscopy. All the patients had an initial diagnosis of an arthroscopically treatable lesion.

After this initial consultation, the patients underwent an MRI scan.

The patients and their scans were then reviewed by one of two surgeons who specialized in knees.

The analysis showed that the MRI findings matched the clinical diagnosis in 477 (77%) of the 618 patients; the diagnosis was confirmed by subsequent arthroscopy. In the 141 patients whose MRI findings did not match the clinical diagnosis, 77 had chondral lesions that were not suggested by the clinical exam and plain x-rays, 22 had unexpected meniscal tears rather than chondral lesions, 30 had miscellaneous pathologies, and 12 had a normal MRI scan.

As a result of the MRI findings in these patients, the orthopedic surgeons altered their clinical management, wrote the investigators, led by Dr. Arthur Galea of the Royal Free Hampstead NHS Trust (Arthroscopy 2009;25:473-80).

MRI assessment allowed some patients to avoid “unnecessary arthroscopic intervention and improved the quality of life in a subset of patients who underwent an arthroplasty as a primary procedure,” the authors wrote.

“Preoperative MRI identifies a group of patients who have more advanced DJD [degenerative joint disease] than the clinical assessment and the plain radiographs suggest,” the researchers concluded. The use of MRI “would expedite definitive surgery in patients with advanced osteoarthritis on MRI scans,” they wrote.

“A potential source of bias in our study was that the orthopaedic specialist had the opportunity to view the MRI scans at the time of arthroscopy.

Ethical considerations meant that it was not acceptable to blind the knee specialist from viewing the MRI scan,” they wrote.

The authors reported no conflicts of interest.

Preoperative MRI scanning of the knee in some patients with joint line pain revealed more advanced degenerative disease than was suggested by clinical examination and plain x-rays, judging from findings from a large British series.

In the study of more than 600 patients presenting with knee symptoms, MRI assessment led to a change in the clinical management of 23% of the patients (141 of 618), study investigators reported.

In most of these patients (129 of 141), the scans revealed unexpected chondral surface lesions, unstable meniscal tears, and other pathologies. The purpose of the study was to determine if preoperative MRI assessment of knee pathology after a clinical examination and plain x-rays affects the surgical management of patients with knee pain.

The study had two parts. First, investigators assessed the accuracy of MRI scans for detecting knee cartilage lesions at their institution, Royal Free Hampstead National Health Service (NHS) Trust, London.

They performed MRI scans and arthroscopic exams on 100 randomly selected patients with knee pain. Using arthroscopy as the standard, the researchers found that the MRI scans had an overall sensitivity of 83% and an overall specificity of 94% for the detection of chondral lesions.

In the second part of the study, the researchers enrolled 618 patients with knee pain (316 women, mean age 55 years; 302 men, mean age 45 years).

All participants were initially examined by a clinician for evidence of arthritis or meniscal tears, and had plain x-rays. The clinician recorded the most probable cause of the pain and the likelihood of proceeding to arthroscopy. All the patients had an initial diagnosis of an arthroscopically treatable lesion.

After this initial consultation, the patients underwent an MRI scan.

The patients and their scans were then reviewed by one of two surgeons who specialized in knees.

The analysis showed that the MRI findings matched the clinical diagnosis in 477 (77%) of the 618 patients; the diagnosis was confirmed by subsequent arthroscopy. In the 141 patients whose MRI findings did not match the clinical diagnosis, 77 had chondral lesions that were not suggested by the clinical exam and plain x-rays, 22 had unexpected meniscal tears rather than chondral lesions, 30 had miscellaneous pathologies, and 12 had a normal MRI scan.

As a result of the MRI findings in these patients, the orthopedic surgeons altered their clinical management, wrote the investigators, led by Dr. Arthur Galea of the Royal Free Hampstead NHS Trust (Arthroscopy 2009;25:473-80).

MRI assessment allowed some patients to avoid “unnecessary arthroscopic intervention and improved the quality of life in a subset of patients who underwent an arthroplasty as a primary procedure,” the authors wrote.

“Preoperative MRI identifies a group of patients who have more advanced DJD [degenerative joint disease] than the clinical assessment and the plain radiographs suggest,” the researchers concluded. The use of MRI “would expedite definitive surgery in patients with advanced osteoarthritis on MRI scans,” they wrote.

“A potential source of bias in our study was that the orthopaedic specialist had the opportunity to view the MRI scans at the time of arthroscopy.

Ethical considerations meant that it was not acceptable to blind the knee specialist from viewing the MRI scan,” they wrote.

The authors reported no conflicts of interest.

Preoperative MRI scanning of the knee in some patients with joint line pain revealed more advanced degenerative disease than was suggested by clinical examination and plain x-rays, judging from findings from a large British series.

In the study of more than 600 patients presenting with knee symptoms, MRI assessment led to a change in the clinical management of 23% of the patients (141 of 618), study investigators reported.

In most of these patients (129 of 141), the scans revealed unexpected chondral surface lesions, unstable meniscal tears, and other pathologies. The purpose of the study was to determine if preoperative MRI assessment of knee pathology after a clinical examination and plain x-rays affects the surgical management of patients with knee pain.

The study had two parts. First, investigators assessed the accuracy of MRI scans for detecting knee cartilage lesions at their institution, Royal Free Hampstead National Health Service (NHS) Trust, London.

They performed MRI scans and arthroscopic exams on 100 randomly selected patients with knee pain. Using arthroscopy as the standard, the researchers found that the MRI scans had an overall sensitivity of 83% and an overall specificity of 94% for the detection of chondral lesions.

In the second part of the study, the researchers enrolled 618 patients with knee pain (316 women, mean age 55 years; 302 men, mean age 45 years).

All participants were initially examined by a clinician for evidence of arthritis or meniscal tears, and had plain x-rays. The clinician recorded the most probable cause of the pain and the likelihood of proceeding to arthroscopy. All the patients had an initial diagnosis of an arthroscopically treatable lesion.

After this initial consultation, the patients underwent an MRI scan.

The patients and their scans were then reviewed by one of two surgeons who specialized in knees.

The analysis showed that the MRI findings matched the clinical diagnosis in 477 (77%) of the 618 patients; the diagnosis was confirmed by subsequent arthroscopy. In the 141 patients whose MRI findings did not match the clinical diagnosis, 77 had chondral lesions that were not suggested by the clinical exam and plain x-rays, 22 had unexpected meniscal tears rather than chondral lesions, 30 had miscellaneous pathologies, and 12 had a normal MRI scan.

As a result of the MRI findings in these patients, the orthopedic surgeons altered their clinical management, wrote the investigators, led by Dr. Arthur Galea of the Royal Free Hampstead NHS Trust (Arthroscopy 2009;25:473-80).

MRI assessment allowed some patients to avoid “unnecessary arthroscopic intervention and improved the quality of life in a subset of patients who underwent an arthroplasty as a primary procedure,” the authors wrote.

“Preoperative MRI identifies a group of patients who have more advanced DJD [degenerative joint disease] than the clinical assessment and the plain radiographs suggest,” the researchers concluded. The use of MRI “would expedite definitive surgery in patients with advanced osteoarthritis on MRI scans,” they wrote.

“A potential source of bias in our study was that the orthopaedic specialist had the opportunity to view the MRI scans at the time of arthroscopy.

Ethical considerations meant that it was not acceptable to blind the knee specialist from viewing the MRI scan,” they wrote.

The authors reported no conflicts of interest.