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bling del traductor

she's simply over him

Last Update: 2013-06-09
Subject: General
Usage Frequency: 1
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bing traductor

wanna about talking that

Last Update: 2014-08-05
Subject: General
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Bling-bling

Bling-bling

Last Update: 2014-08-07
Usage Frequency: 36
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Reference: Wikipedia

Bling-bling

Step 1 research and discuss

Last Update: 2014-06-12
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traductor Kızı

A Systematic Review of Anterior Cruciate Ligament Reconstruction Rehabilitation Part I: Continuous Passive Motion, Early Weight Bearing, Postoperative Bracing, and Home-Based Rehabilitation Rick W. Wright, MD Emily Preston, PT Braden C. Fleming, PhD Annunziato Amendola, MD Jack T. Andrish, MD John A. Bergfeld, MD Warren R. Dunn, MPH, MD Chris Kaeding, MD John E. Kuhn, MD Robert G. Marx, MD Eric C. McCarty, MD Richard C. Parker, MD Kurt P. Spindler, MD Michelle Wolcott, MD Brian R. Wolf, MD Glenn N. Williams, PhD, PT, ATC ABSTRACT: Anterior cruciate ligament (ACL) recon- struction is a common surgical knee procedure that requires intensive postoperative rehabilitation by the patient. A variety of randomized controlled trials have investigated aspects of ACL reconstruction rehabilita- tion. A systematic review of English language level 1 and 2 studies identified 54 appropriate randomized controlled trials of ACL rehabilitation. Topics dis- cussed in this part of the article include continuous passive motion, early weight bearing in motion, post- operative bracing, and home-based rehabilitation. [J Knee Surg. 2008;21:217-224.] IntroductIon Anterior cruciate ligament (ACL) reconstruction is a common procedure to allow patients to return to their for- mer active lifestyle. Rehabilitation of the reconstructed knee is critical for the successful return to risky cutting and jumping activities. Although many of the individual aspects of ACL rehabilitation have been evaluated using randomized trials, few reviews have used an evidence- based approach to create an overall protocol for ACL rehabilitation. Previous systematic reviews were not in- clusive of all possible aspects of rehabilitation (ie, brac- ing) and did not encompass many recently published studies.19,22 The goal of this systematic review was to assemble the available randomized controlled trials in ACL re- habilitation to facilitate the development of evidence- based rehabilitation protocols. This article is the first in a 2-part series systematically reviewing the level 1 and 2 evidence regarding ACL reconstruction rehabili- tation. Dr Wright is from the Department of Orthopedic Surgery, Washing- ton University School of Medicine at Barnes-Jewish Hospital, St Louis, Mo; Ms Preston and Drs Dunn, Kuhn, and Spindler are from the Van- derbilt Sports Medicine Center, Nashville, Tenn; Dr Fleming is from the Department of Orthopedic Surgery, Brown Medical School, Provi- dence, RI; Drs Amendola, Wolf, and Williams are from the University of Iowa Hospitals and Clinics, Iowa City, Iowa; Drs Andrish, Bergfeld, and Parker are from the Cleveland Clinic Foundation, Cleveland, and Dr Kaeding is from the Ohio State Sports Medicine Center, Columbus, Ohio; Dr Marx is from the Hospital for Special Surgery, New York, NY; and Drs McCarty and Wolcott are from the Department of Orthopedic Surgery, University of Colorado School of Medicine, Denver, Colo. Correspondence: Rick W. Wright, MD, 1 Barnes-Jewish Plaza, Ste 11300, St Louis, MO 63110. 218 THE JOURNAL OF KNEE SURGERY July 2008 / Vol 21 No 3 Methods PubMed 1966-2005, Embase 1980-2005, and the Co- chrane Controlled Trials Register were searched for arti- cles appropriate to this study. Bibliographies of identified studies also were searched, and a hand review of the past 6 months of appropriate journals was performed. For the database search, terms included anterior cruciate ligament, ACL, rehabilitation, randomized trials, and clinical trials. This search identified 82 potential studies for inclusion. Inclusion criteria included English-language randomized clinical trials involving ACL reconstruction rehabilita- tion. Exclusion criteria included non-English language, no true randomization, and subject matter not pertaining to ACL reconstruction rehabilitation. This resulted in 54 studies included in this systematic review. Studies under- went worksheet appraisal for methodologic quality with emphasis on identifying biases present in each study. All studies were level 1 or 2 evidence. Topics included in this review are continuous passive motion (CPM), rehabilita- tive bracing, neuromuscular electrical stimulation, early weight bearing, home versus supervised physical therapy, open versus closed chain kinetic exercise programs, and accelerated rehabilitation, as well as a variety of miscel- laneous topics assessed by only 1 randomized trial. contInuous PassIve MotIon Six randomized controlled trials have been performed assessing the efficacy of CPM in the rehabilitation of ACL reconstructions. In a 1991 study, Richmond et al17 com- pared short-term versus longer-term CPM use. Twenty pa- tients were randomly divided into 2 groups. Group 1 used CPM 6 hours per day for 4 days during hospitalization. Group 2 used CPM 6 hours per day for the first 14 days postoperatively. Both groups underwent additional reha- bilitative activities. The study was prospective, but the randomization method was not discussed. Some selection bias was pres- ent by exclusion of patients whose insurance would not pay for a CPM machine. Otherwise, the 2 groups were similar. Reconstruction methods were identical for both groups. Swelling, atrophy, range of motion, and instrumented laxity were assessed postoperatively. Swelling, atrophy, and range of motion were assessed at 2, 7, 14, 28, and 42 days. No significant difference was noted in any of these values at these time points. A statistically significant difference was noted on KT-1000 89 N testing at 42 days. The 14-day CPM group had statistically significant less anterior translation compared with the 4-day CPM group (0.4 mm versus 2.4 mm, P = .04). The authors concluded longer-term CPM use, given its higher cost, was not ben- eficial and also did not increase the risk of laxity in the knee. Rosen et al,20 in a 1992 study, compared early active motion versus CPM in patients undergoing autograft pa- tellar tendon reconstruction. Seventy-five patients were randomly divided into 3 groups: group A patients under- went early active motion during hospitalization followed by outpatient physical therapy (PT) 3 times per week, group B patients used a CPM machine 20 hours per day during hospitalization (mean, 2.9 days) followed by CPM use 6 hours per day for 4 weeks and outpatient PT 3 times per week, and group C patients performed early active motion during hospitalization and followed the group B CPM protocol but did not participate in outpatient physi- cal therapy for the first month. The study was prospective, and randomization was performed by a lottery. In general, there was minimal selection bias, with the groups equiva- lent except for gender. Group B had 42% women versus 24% and 20% in groups A and C, respectively. Exclusion criteria included extracapsular procedures and meniscal repairs. Range of motion and instrumented knee laxity were the most important determinants of outcome for the study. Range of motion was determined at hospital discharge, 1 week postoperatively, and then monthly for the first 6 months. No statistically significant differences were noted in any of the groups at any time. KT-1000 data were ob- tained at completion of the surgical procedure and at 2 and 6 months postoperatively. No difference in stability was noted between any group at any time point. In addition, no difference was noted in analgesic use, hemovac drainage, or length of hospital stay. The authors concluded the use of CPM in the first 30 days after ACL reconstruction re- sulted in similar results as early active motion. The CPM added an additional cost to treatment. In another 1992 study, Yates et al26 evaluated the ef- fects of 2 weeks of CPM following patellar tendon au- tograft ACL reconstruction. Using random sampling, 30 patients were randomized to either CPM 16 hours per day for the first 3 postoperative days followed by 6 hours per day for a total of 14 days use or an identical rehabilita- tion protocol without CPM. The authors concluded there was decreased hemarthrosis, decreased narcotic use, and decreased swelling in the CPM group. Active and passive flexion was noted to be improved at days 3 and 7 in the CPM group. McCarthy et al,11 in a 1993 study, assessed the effects of CPM on anterior laxity following ACL reconstruction. Twenty patients who underwent patellar tendon autograft ACL reconstruction were randomized to either CPM 16 hours per day for the first 3 days followed by 6 hours per day until postoperative day 14 or an identical rehabilita- tion protocol without CPM. KT-1000 testing at 12 months 219 ACL Reconstruction Rehabilitation: Part I www.JournalofKneeSurgery.com postoperatively demonstrated an identical average side-to- side difference of 0.4 mm in both groups, and all patients had side-to-side differences <3 mm. The authors con- cluded CPM did not result in increased anterior laxity. In another 1993 study, McCarthy et al12 compared 3 days of CPM versus no CPM on pain and narcotic re- quirements. Thirty patients who underwent bone-patellar tendon-bone ACL reconstruction were randomized to 2 groups: group 1 began physical therapy on postoperative day 1 and group 2 began using a CPM machine immedi- ately postoperatively and continued its use for 16 hours per day for 3 days in addition to routine physical therapy similar to group 1. The randomization methods were not discussed. Patient-controlled analgesia use during the first 24 hours postoperatively, oral narcotic use on postoperative days 2 and 3, and graphic pain scales were used to assess results. The 2 groups were similar but no narcotic dose correc- tion for patient body weight was performed to standard- ize results. Total narcotic dose and the number of times the patient-controlled analgesia button was pushed were significantly increased in the non-CPM group (P , .05). Oral narcotic use on postoperative days 2 and 3 was sig- nificantly increased in the non-CPM group. Graphic pain scales were similar in all groups at all time periods. The authors concluded CPM is beneficial following autog- enous bone-patellar tendon-bone ACL reconstruction to decrease narcotic use. Engström et al,3 in a 1995 study, compared CPM versus active motion in the early postoperative period. Thirty-four patients were randomized to 2 groups: group 1 started active motion on postoperative day 1 following ACL reconstruction and group 2 started CPM 6 hours per day for 6 days in addition to active motion beginning on postoperative day 1. The method of randomization was not discussed. Parameters evaluated included swelling, range of motion, and atrophy at 6 weeks postoperatively. Selection bias was present in the fact that the active mo- tion group had more acute ACL reconstructions (9 versus 3) and these patients had a much larger extension lag of 7.8° versus 0.8° in the CPM group. Otherwise, the groups were similar. There was no statistically significant difference at 6 weeks in range of motion or atrophy between the 2 groups. Midpatellar and base of patella circumference was increased in the active motion group at 6 weeks (P , .05). The authors attributed this difference to the fact that the active motion group contained more acute ACL recon- structions and had increased swelling preoperatively. The authors concluded there were no benefits of CPM after ACL reconstruction. All 6 of these studies included small numbers of pa- tients. Every study had at least 1 parameter that was de- termined not to be statistically different between groups. Selection bias by randomization method potentially ex- isted in all but the Rosen study.20 Blinding of examiners was not addressed in any study. Dropouts and compliance were not addressed in any study. None of the studies pre- sented power calculations to determine the size of group that would have been necessary to potentially demonstrate a difference if it did exist. Thus, these potentially have a type II error. Based on this review, there is no substantial advantage for CPM use except for a possible decrease in pain. Therefore, its use cannot be justified with its addi- tional insurance and patient costs. early WeIght bearIng and MotIon One randomized trial has been performed evaluating the efficacy of immediate weight bearing versus delayed weight bearing following ACL reconstruction. Tyler et al,24 in a 1998 study, compared immediate weight bearing as tolerated versus a delay of 2 weeks. Forty-nine patients were prospectively randomized following endoscopic au- tograft bone-patellar tendon-bone reconstructions. The randomization technique was not discussed. Independent examiners assessed the results, but blinding was not dis- cussed. Group 1 was instructed to discard their crutches as soon as possible and to bear as much weight as possible. Compliance with weight bearing was not determined. Group 2 was instructed to remain nonweight bearing for the first 2 weeks following reconstruction. They were in- structed to not wear a shoe to improve compliance. Two patients in each group were lost to follow-up. Parameters evaluated included range of motion, sta- bility, vastus medialis oblique electromyogram, Lysholm and Tegner scores, and anterior knee pain. KT-1000 test- ing demonstrated no difference at final follow-up, which ranged from 6 to 14 months. Range of motion showed no statistical difference at 2 weeks or final follow-up of 6 to 14 months (mean, 7.3 months). Vastus medialis oblique activity was significantly increased in the weight-bearing group at 2 weeks (P = .002); however, at final follow-up, vastus medialis oblique activity was equal in both groups. At final follow-up, a statistically significant difference in anterior knee pain was noted. Seven of 20 nonweight- bearing patients (35%) and 2 of 25 weight-bearing pa- tients (8%) reported pain (P = .03). Anterior knee pain was evaluated using questions from the Lysholm scale that described pain with routine exertion, stair climbing, or squatting. Lysholm scores demonstrated a significantly greater improvement from preoperatively in the weight- bearing group (P = .03). The authors concluded there were no deleterious ef- fects of early weight bearing on stability or function and anterior knee pain may be decreased by earlier recruit-

Last Update: 2013-10-28
Subject: Medical
Usage Frequency: 1
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Reference: Anonymous
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ibook traductor

casting

Last Update: 2014-02-14
Subject: General
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banar niños Bing traductor

traductor bingYOUR POSSIBLE PASTS

Last Update: 2014-07-20
Subject: General
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Bling traductor5-la serpiente de tierra caliente

underground

Last Update: 2013-07-13
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Bling traductor5-la serpiente de tierra caliente

Nueva Zelandia, el nuevo destino del cine mundial

Last Update: 2013-06-18
Subject: General
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Reference: Anonymous

Traductores

Translation

Last Update: 2013-08-27
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Reference: Wikipedia

Traductora

Translation

Last Update: 2013-07-23
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