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Sports Medicine (Auckland, N.Z.) Feb 2021Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neuromuscular deficits are common following knee injuries and may contribute to early-onset post-traumatic osteoarthritis, likely mediated through quadriceps dysfunction.
OBJECTIVE
To identify how peri-articular neuromuscular function changes over time after knee injury and surgery.
DESIGN
Systematic review with meta-analyses.
DATA SOURCES
PubMed, Web of Science, Embase, Scopus, CENTRAL (Trials).
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Moderate and high-quality studies comparing neuromuscular function of muscles crossing the knee joint between a knee-injured population (ligamentous, meniscal, osteochondral lesions) and healthy controls. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and other torque related outcomes.
RESULTS
A total of 46 studies of anterior cruciate ligament (ACL) and five of meniscal injury were included. For ACL injury, strength and voluntary activation deficits were evident (moderate to strong evidence). Cortical excitability was not affected at < 6 months (moderate evidence) but decreased at 24+ months (moderate evidence). Spinal-reflex excitability did not change at < 6 months (moderate evidence) but increased at 24+ months (strong evidence). We also found deficits in torque variability, rate of torque development, and electromechanical delay (very limited to moderate evidence). For meniscus injury, strength deficits were evident only in the short-term. No studies reported gastrocnemius, soleus or popliteus muscle outcomes for either injury. No studies were found for other ligamentous or chondral injuries.
CONCLUSIONS
Neuromuscular deficits persist for years post-injury/surgery, though the majority of evidence is from ACL injured populations. Muscle strength deficits are accompanied by neural alterations and changes in control and timing of muscle force, but more studies are needed to fill the evidence gaps we have identified. Better characterisation and therapeutic strategies addressing these deficits could improve rehabilitation outcomes, and potentially prevent PTOA.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42019141850.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Knee Injuries; Knee Joint; Muscle Strength
PubMed: 33247378
DOI: 10.1007/s40279-020-01386-6 -
Orthopaedics & Traumatology, Surgery &... Oct 2019Knee brace has been commonly used as a device to protect the graft after reconstruction of anterior cruciate ligament (ACL). Studies have focused on the effects of... (Meta-Analysis)
Meta-Analysis
The effect of knee bracing on the knee function and stability following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Knee brace has been commonly used as a device to protect the graft after reconstruction of anterior cruciate ligament (ACL). Studies have focused on the effects of braces after ACL reconstruction, and controversial results were reported. The current meta-analysis was conducted to identify whether knee braces could provide superior clinical outcomes on knee functional scores and stability evaluations.
HYPOTHESIS
Knee braces could not provide superior clinical outcomes on knee functional scores and stability evaluations.
MATERIALS AND METHODS
Two reviewers independently retrieved the literature on PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Data related to the knee functional scores and stability evaluations, including International Knee Documentation Committee (IKDC) evaluation, Lachman test, manual anterior drawer test, single leg hop test, pivot shift test, side-to-side difference, Lysholm score and Tegner score, were extracted and pooled using meta-analysis with fixed or random- effect models when applicable.
RESULTS
A total of 7 studies with 440 participants were finally included. The IKDC objective score was pooled using the odds ratio (OR) as effect size, which was demonstrated to be non-significantly different between the brace and no brace groups. All of the other clinical outcomes, including Lysholm score, Tegner score, side-to-side difference, single-leg hop test and VAS pain score, were pooled using the standard mean difference (SMD) as effect size. At final follow up, the aforementioned clinical outcomes were demonstrated to be similar between the brace and non-brace groups.
DISCUSSION
Knee bracing does not appear to improve the clinical outcomes on the function and stability for ACL-reconstructed knees. Thus, bracing for patients treated with ACL reconstruction should not be recommended routinely.
LEVEL OF EVIDENCE
I, Meta-analysis.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Braces; Humans; Knee Joint; Randomized Controlled Trials as Topic; Range of Motion, Articular
PubMed: 31279767
DOI: 10.1016/j.otsr.2019.04.015 -
Experimental Gerontology May 2022An association between osteoarthritis (OA) and atherosclerosis (AT) has been proposed, but evidence is controverted, with recent meta-analysis showing disparate results.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
An association between osteoarthritis (OA) and atherosclerosis (AT) has been proposed, but evidence is controverted, with recent meta-analysis showing disparate results. To better refine this possible association, we performed a systematic review and meta-analysis subdividing OA by joint, i.e., hip and knee, hands, and OA in general, and stratified the results by subclinical AT, manifest cardiovascular (CV) disease, and CV death. Separation by sex, whenever this information was available, was also accounted.
METHODS
We searched PubMed, Web of Science, LILACS, and SciELO from inception until September 2021, using the MeSH search terms "osteoarthritis", "aorta", "carotid", "intima-media thickness", "coronary artery disease", "atherosclerosis", "cardiovascular disease", and "death". To appraise the quality of the studies, we applied the NewCastle-Ottawa scale. To assess for heterogeneity, I was used. A random-fixed effect model was adopted, and outliers were excluded when detected. Publication bias was ascertained by funnel plot and Egger regression test.
RESULTS
A total of 49 studies, comprising 552,857 individuals with OA and 688,820 controls, were included on the narrative synthesis, and 33 on the meta-analysis. All but five studies were deemed as of fair or good quality. Hip and knee OA increased the risk for both subclinical AT (OR 1.15, 95% CI 1.01-1.31), and CV disease (OR 1.13, 95% CI 1.05-1.22), but not for CV death (OR 1.08, 95% CI 0.99-1.19). Hands OA was associated with subclinical AT (OR 1.18, 95% CI 1.02-1.36), but not with CV disease (OR 1.49, 95% CI 0.90-2.46) or CV death (OR 1.02, 95% CI 0.73-1.44).
CONCLUSIONS
Having OA was associated with subclinical AT for all joints evaluated, but with CV disease only for weight-bearing joints. Even though there was a trend in favor of a positive association between OA and CV death, it did not reach statistical significance.
Topics: Atherosclerosis; Carotid Arteries; Hand; Humans; Knee Joint; Osteoarthritis, Hip; Osteoarthritis, Knee
PubMed: 35151784
DOI: 10.1016/j.exger.2022.111734 -
The Knee Oct 2023Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Treatment of patellar instability remains up for debate, and a combination of tibial tubercle osteotomy and medial patellofemoral ligament reconstruction (MPFLr) of the medial patellofemoral ligament (MPFL) has become the mainstay treatment for recurrent lateral patellar dislocation. Due to limited small studies, there remains a variety of surgical techniques still being practiced. The use of MPFL reconstruction, in isolation, has demonstrated promise.
PURPOSE
The purpose of this systematic review and meta-analysis is to investigate if isolated medial patellofemoral ligament reconstruction (iMPFLr) can safely and efficaciously restore knee stability and to present the patient demographics, surgical techniques, graft choices, clinical outcomes, and complications after iMPFLr for recurrent patellar dislocation (RPD).
METHODS
A review of the current literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, yielded 299 abstracts. Twenty-seven articles met the inclusion/exclusion criteria accounting for 1200 patients. Data was pooled and analyzed focusing on patient demographics, graft type used, Kujala, International Knee Documentation Committee (IKDC), Lysholm, Tegner, and complications.
RESULTS
Across all studies the weighted mean age was found to be an average of 24.5 years, BMI was 24.9 kg/m, follow-up was 47.3 months, as 67% were female, TT-TG distance was 15.3 mm, and Caton Deschamps index 1.11. The pooled effect size difference of pre versus post assessment of Kujala was -2.8, IKDC was -4.5, Lysholm was -6.4, and Tegner was -0.74. The pooled complication rate was found to be 8% across all included studies. A subgroup analysis was also performed, specifically looking at how single bundle, double bundle, gracilis, semitendinosus and knee angle during fixation effect outcome data.
CONCLUSION
This systematic review and meta-analysis demonstrates that isolated MPFL reconstruction is a safe and effective treatment for recurrent patellar dislocations. Given the efficacy of isolated MPFL reconstruction, future investigations should aim to uncover the exact TT-TG distance, trochlear dysplasia, and patella alta grade for selecting patients to undergo this procedure. Furthermore, more primary research needs to be conducted on this topic due to the overall lack of published data from randomized controlled studies and no broad standardization of outcome measurements.
LEVEL OF EVIDENCE
(4) Systematic Review and Meta-Analysis.
Topics: Humans; Female; Young Adult; Adult; Male; Patellar Dislocation; Patellofemoral Joint; Joint Instability; Knee Joint; Joint Dislocations; Ligaments, Articular; Patella
PubMed: 37531844
DOI: 10.1016/j.knee.2023.07.003 -
The Journal of Hand Surgery Aug 2022The first carpometacarpal (CMC) joint is a frequent location of osteoarthritis in the hand. The denervation of the first CMC joint has gained traction as a viable...
PURPOSE
The first carpometacarpal (CMC) joint is a frequent location of osteoarthritis in the hand. The denervation of the first CMC joint has gained traction as a viable treatment for CMC arthritis. This study reviewed literature on CMC denervation for first CMC arthritis.
METHODS
A systematic review of papers and abstracts was conducted. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Articles including the results of CMC denervation were included. We compiled data on patient demographics, preoperative testing, intraoperative technique, and postoperative outcomes. Anatomic literature was also reviewed to assess agreement on the innervation of the first CMC joint.
RESULTS
Six anatomic studies and 9 clinical studies were included in this systematic review. Pinch strength, grip strength, and Kapandji scores increased on average in patients. Pain relief was noted on average in patients in 5 studies that reported pain outcomes. In studies that reported postoperative complications, the most frequent complications were radial paresthesias, hypoesthesia dorsal and/or distal to the surgical site, and wound infection.
CONCLUSIONS
The innervation of the CMC joint is controversial. This is reflected in clinical practice, wherein varied surgical approaches are used. Carpometacarpal denervation shows promise as an option to treat patients with CMC arthritis without joint instability, but its results vary. Additional clinical studies with longer-term follow-up and control groups are necessary to better determine its longevity and efficacy.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic V.
Topics: Carpometacarpal Joints; Denervation; Humans; Osteoarthritis; Pain; Thumb
PubMed: 34509313
DOI: 10.1016/j.jhsa.2021.07.020 -
Experimental Gerontology Sep 2017Age-related gait changes may play a critical role in functional limitations of older adults. Despite sizable interest in determining how age alters walking mechanics,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Age-related gait changes may play a critical role in functional limitations of older adults. Despite sizable interest in determining how age alters walking mechanics, small sample sizes and varied outcome measures have precluded a comprehensive understanding of the impact of age on lower extremity joint kinematics and kinetics.
OBJECTIVE
The aim of this study was to perform a systematic review and meta-analysis of the aging gait mechanics literature.
METHODS
The overall standardized effect of age on walking mechanics was computed for 29 studies (200 standardized effects). To account for variation in reported outcome variables, analyses were carried out for comparisons between young and older adult results using all discrete kinematic or kinetic variables reported for the ankle, knee, or hip. Different variables reported for a given joint were then analyzed as separate categorical moderators.
RESULTS
The overall standardized effect of age was large for ground reaction forces, moderate for ankle and small for knee and hip kinematics and ankle and hip kinetics. When the analysis was restricted to studies with similar or matched walking speed, the standardized effects of age remained similar except for hip power generation and knee kinematic variables.
CONCLUSIONS
The results of this meta-analysis provide evidence to support moderate standardized effects, with and without consideration of walking speeds, for changes in lower extremity kinematics, joint moments and powers at the ankle, and ground reaction forces. The standardized effects of age for knee mechanics are less conclusive and would benefit from further research.
Topics: Adult; Age Factors; Aged; Aging; Ankle Joint; Biomechanical Phenomena; Gait; Hip Joint; Humans; Joints; Knee Joint; Muscle Strength; Muscle, Skeletal; Range of Motion, Articular; Walking
PubMed: 28499954
DOI: 10.1016/j.exger.2017.05.005 -
Effects of joint stabilizers on proprioception and stability: A systematic review and meta-analysis.Physical Therapy in Sport : Official... May 2017The current review and meta-analysis systematically investigated the effect of joint stabilizers on proprioception, postural stability, and neurological activity. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The current review and meta-analysis systematically investigated the effect of joint stabilizers on proprioception, postural stability, and neurological activity.
METHODS
Systematic identification of published literature was performed on online databases; Scopus, PEDro, SportDiscus, and EMBASE, followed by a critical PEDro methodological quality appraisal. Data from the studies were extracted and summarized in a tabular format.
RESULTS
Of 2954 records, 50 studies, involving 1443 participants met our inclusion criteria. In the included studies, 60% of studies reported significant enhancements (p < 0.05), 19% of studies reported enhancements (p > 0.05) and 21% of studies reported no effects of joint stabilizers on proprioception and/or postural stability. Meta-analysis of pooled studies demonstrated beneficial effects of joint stabilizers on the knee (95% CI: 0.35°-0.61°) and ankle (at 10: 0.1°-0.65°) joint proprioception, and negligible effects on postural stability (-0.28°-0.19°).
CONCLUSION
The pooled evidence suggests that application of joint stabilizers enhances joint proprioception and stability by not merely altering the mechanical stability of the underlying musculoskeletal structures but by also causing subtle changes in cerebral haemodynamics and musculoskeletal activation. These findings support clinical implications of joint stabilizers as a prophylactic and rehabilitation measure in modern sports and rehabilitation settings.
Topics: Ankle Joint; Athletic Tape; Braces; Humans; Knee Joint; Postural Balance; Proprioception
PubMed: 28262354
DOI: 10.1016/j.ptsp.2016.05.006 -
Clinical Biomechanics (Bristol, Avon) May 2021Pelvic injuries that disrupt the sacroiliac joints often require surgical intervention to restore stability. Quantitative characterization of sacroiliac motion in... (Review)
Review
BACKGROUND
Pelvic injuries that disrupt the sacroiliac joints often require surgical intervention to restore stability. Quantitative characterization of sacroiliac motion in response to physiologic loading provides important metrics of adequate fixation in the evaluation of newly emerged fixation techniques. The objective of this study was to systematically review and evaluate biomechanical evidence on the motion of the sacroiliac joint in its normal, destabilized, and stabilized states.
METHODS
We searched the PubMed database for studies available until June 2020 using keywords: sacroiliac, biomechanic*, and fixation. Publications of any in vivo or in vitro biomechanical study that included measurements of the range of motion at the sacroiliac joint were considered.
FINDINGS
We identified and screened 176 total records, and 13 articles of them met inclusion criteria and were used in this review. The average sacroiliac joint range of motion of the intact pelvis was 1.88° in flexion/extension, 0.85° in lateral bending, 1.26° in axial rotation. Of the 13 studies, four reported sacroiliac motion from a destabilized state, while seven reported the motion after stabilization. A forest plot of the stabilized data set in flexion/extension showed that while the heterogeneity was poor, the weighted effect size of the changes from the intact state to the stabilized state was 0.0%.
INTERPRETATION
Quantitative evidence on sacroiliac joint motion relating to pelvic injuries or fixation is limited. Our results indicate that the pooled intact range of motion from the literature may serve as a viable reference to quantify the effectiveness of new stabilization techniques.
LEVEL OF EVIDENCE
Level V, systematic review.
STUDY TYPE
Therapeutic- investigating the results of a treatment.
Topics: Biomechanical Phenomena; Bone Screws; Cadaver; Humans; Range of Motion, Articular; Rotation; Sacroiliac Joint
PubMed: 33940477
DOI: 10.1016/j.clinbiomech.2021.105368 -
Journal of Shoulder and Elbow Surgery Mar 2018Patient home-based self-assessments after shoulder surgery have the potential to aid clinicians in reducing clinic time and decreasing follow-up requirements. The... (Review)
Review
BACKGROUND
Patient home-based self-assessments after shoulder surgery have the potential to aid clinicians in reducing clinic time and decreasing follow-up requirements. The purpose of this systematic review was to determine the correlation between patient-based and physician-assessed outcome measures for range of motion (ROM), strength, and shoulder function.
METHODS
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched. All studies comparing patient-reported and clinician-based assessments of shoulder ROM, strength, and function were eligible for inclusion. Studies that included patient or clinician assessment only, description of shoulder diseases or treatments only, and animal- or cadaveric-based studies were excluded. More than 250 abstracts were searched, and 4 studies were found eligible.
RESULTS
Patients assessed their shoulder ROM, strength, and function with moderate-to-high accuracy compared with clinical assessment. There was less agreement between patients and clinicians regarding the symptomatic shoulder compared with the contralateral shoulder. There was less agreement between patients and clinicians on rotation than forward elevation. Patients who were less satisfied with their shoulder had less agreement with clinicians.
CONCLUSION
There is moderate-to-high agreement between patients and clinicians in the assessment of the shoulder after surgery. Methods of assessment of rotation could be reviewed to create a more exact self-assessment tool.
Topics: Arthroplasty, Replacement; Humans; Muscle Strength; Outcome Assessment, Health Care; Patient Outcome Assessment; Range of Motion, Articular; Self-Assessment; Shoulder Joint
PubMed: 29128374
DOI: 10.1016/j.jse.2017.09.008 -
Hand (New York, N.Y.) Nov 2022Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ... (Review)
Review
Vascularized joint transfer (VJT) from the proximal interphalangeal joint (PIPJ) of the toe is an attractive reconstructive option in cases of nonsalvageable finger PIPJ but is limited by equivocal functional outcomes. This systematic review aims to provide an update on vascularized toe-to-finger PIPJ transfers, examining functional outcomes, complications, and the latest refinements in operative technique. A systematic review of the available literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies examining vascularized toe-to-finger PIPJ transfer for post-traumatic indications were included for analysis. Outcomes assessed included postoperative active range of motion, extension lag, and complications. Thirteen studies examining 210 VJTs were analyzed. Five VJTs experienced microsurgical failure giving an overall survival rate of 97.6%. Average postoperative PIPJ active range of motion (ROM) was 40.3° ± 12.9°, with an average extensor lag of 29° ± 10.5° and mean flexion of 68.9° ± 10.9°. For studies reporting complication outcomes, 59/162 complications were seen. No significant differences were seen between studies published prior to 2013 and after 2013 when comparing digital ROM ( = .123), flexion ( = .602), and extensor lag ( = .280). Studies using a reconstructive algorithm based on prior assessment of the donor toe central slip and recipient finger anatomy had significantly improved ROM outcomes ( = .013). Although VJT provides a reliable option for autologous reconstruction in posttraumatic joints, it is limited by impaired postoperative ROM. Careful assessment of the donor toe and recipient finger anatomy followed by systematic and meticulous reconstruction may lead to improved functional outcomes.
Topics: Humans; Toe Joint; Finger Joint; Fingers; Range of Motion, Articular; Toes
PubMed: 33511878
DOI: 10.1177/1558944720988081