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December 28, 1940


Author Affiliations

Instructor in Orthopedic Surgery, Johns Hopkins University School of Medicine BALTIMORE

JAMA. 1940;115(26):2243-2246. doi:10.1001/jama.1940.02810520005002

Fifteen years ago I was impressed with difficulties attendant on internal derangements of the knee. Principles of diagnosis were not as clearly defined as at present. Operation often resulted in many weeks or several months of disability and too often produced a joint lacking full free motion. Convalescence was frequently long and painful and the entire procedure costly. In 1927 I1 began aspirating joints and injecting air before and after operation as a matter of routine. This experience indicated hemorrhage as probably the greatest disturbing factor. Much blood in the joint before or after operation may result in irritation, infiltration, swelling and thickening of the synovial membrane and ballooning of the joint capsule. Formation of fibrin and its absorption or organization often results in adhesions within the joint. This train of events prolongs immobility. Hence a study was undertaken with a view to keeping free blood out of the

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