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Archives of Orthopaedic and Trauma... Jun 2016The purpose of this study was to conduct a systematic review to address the stability outcome from reconstruction and conservative treatments. (Review)
Review
INTRODUCTION
The purpose of this study was to conduct a systematic review to address the stability outcome from reconstruction and conservative treatments.
MATERIALS AND METHODS
Inclusion criteria were as follows: (1) English language, (2) human subject, (3) measures of stability outcomes, and (4) patients with isolated PCL injuries. We did not limit the type of study design (interventional or non-interventional study) and included all published systematic reviews. The following data were extracted: the number of study populations, year of publication, baseline characteristics of patients, follow-up period, and outcome data. The primary outcome variable was side-to-side difference (STSD).
RESULTS
In the conservative treatment, the average STSD ranged from 3.5 to 5.3 mm on Telos™ (range 0.7-12.0 mm) and from 3.0 to 5.2 mm on KT-1000™ (range 0.5-10 mm). Among reconstructive treatment, the average STSD ranged from 2.0 to 3.7 mm on Telos™ (range 0-7 mm) and 0.7-5.9 mm on KT-1000™ (range -1 to 11.8 mm). In the conservative treatment, the estimated weighted mean STSD difference was 3.49 [95 % confidence interval (CI): 0.95-6.03] on Telos™ and 2.64 (95 % CI 0.76-4.51) on KT-1000™. On the other hand, in the reconstructive treatment, the estimated mean STSD difference was 8.09 (95 % CI 7.11-9.07) on Telos™ and 8.45 (95 % CI 6.44-10.47) on KT-1000™.
CONCLUSIONS
This systematic review noted more satisfactory and consistent stability in the reconstructive treatment group. However, more complications and small differences of stability between groups should be also considered.
Topics: Braces; Casts, Surgical; Conservative Treatment; Humans; Joint Instability; Knee Joint; Physical Therapy Modalities; Posterior Cruciate Ligament; Posterior Cruciate Ligament Reconstruction
PubMed: 27084513
DOI: 10.1007/s00402-016-2454-4 -
International Orthopaedics Feb 2023This study aims to describe and assess the current stage of the artificial intelligence (AI) technology integration in preventive orthopaedics of the knee and hip joints. (Review)
Review
PURPOSE
This study aims to describe and assess the current stage of the artificial intelligence (AI) technology integration in preventive orthopaedics of the knee and hip joints.
MATERIALS AND METHODS
The study was conducted in strict compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Literature databases were searched for articles describing the development and validation of AI models aimed at diagnosing knee or hip joint pathologies or predicting their development or course in patients. The quality of the included articles was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and QUADAS-AI tools.
RESULTS
56 articles were found that meet all the inclusion criteria. We identified two problems that block the full integration of AI into the routine of an orthopaedic physician. The first of them is related to the insufficient amount, variety and quality of data for training, and validation and testing of AI models. The second problem is the rarity of rational evaluation of models, which is why their real quality cannot always be evaluated.
CONCLUSION
The vastness and relevance of the studied topic are beyond doubt. Qualitative and optimally validated models exist in all four scopes considered. Additional optimization and confirmation of the models' quality on various datasets are the last technical stumbling blocks for creating usable software and integrating them into the routine of an orthopaedic physician.
Topics: Humans; Artificial Intelligence; Hip Joint; Orthopedic Procedures; Orthopedics; Software
PubMed: 36369394
DOI: 10.1007/s00264-022-05628-2 -
Arthritis Research & Therapy Aug 2015Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional... (Review)
Review
INTRODUCTION
Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and joint replacement in peripheral joint OA.
METHODS
A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring.
RESULTS
In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively.
CONCLUSION
Subchondral bone features have independent associations with structural progression, pain and joint replacement in peripheral OA in the hip and hand but especially in the knee. For peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target.
SYSTEMATIC REVIEW
PROSPERO registration number: CRD 42013005009.
Topics: Arthralgia; Bone Density; Bone and Bones; Cartilage, Articular; Cross-Sectional Studies; Diagnostic Imaging; Humans; Joints; Osteoarthritis; Osteophyte
PubMed: 26303219
DOI: 10.1186/s13075-015-0735-x -
Arthroscopy : the Journal of... Jan 2016To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically... (Review)
Review
PURPOSE
To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically review each subcategory, beginning with ACL anatomy.
METHODS
After searching for "anterior cruciate ligament" OR "ACL" in Arthroscopy and The American Journal of Sports Medicine from January 2012 through December 2014, we excluded articles more pertinent to ACL augmentation; open growth plates; and meniscal, chondral, or multiligamentous pathology. Studies were subcategorized for data extraction.
RESULTS
We included 212 studies that were classified into 8 categories: anatomy; basic science and biomechanics; tunnel position; graft selection; graft fixation; injury risk and rehabilitation; practice patterns and outcomes; and complications. Anatomic risk factors for ACL injury and post-reconstruction graft failure include a narrow intercondylar notch, low native ACL volume, and increased posterior slope. Regarding anatomic footprints, the femoral attachment is 43% of the proximal-to-distal lateral femoral condylar length whereas the posterior border of the tendon is 2.5 mm from the articular margin. The tibial attachment of the ACL is two-fifths of the medial-to-lateral interspinous distance and 15 mm anterior to the posterior cruciate ligament. Anatomic research using radiology and computed tomography to evaluate ACL graft placement shows poor interobserver and intraobserver reliability.
CONCLUSIONS
With a mind to improving outcomes, surgeons should be aware of anatomic risk factors (stenotic femoral notch, low ligament volume, and increased posterior slope) for ACL graft failure, have a precise understanding of arthroscopic landmarks identifying femoral and tibial footprint locations, and understand that imaging to evaluate graft placement is unreliable.
LEVEL OF EVIDENCE
Level III, systematic review of Level III evidence.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Femur; Humans; Knee Injuries; Knee Joint; Posterior Cruciate Ligament; Reproducibility of Results; Risk Factors; Tendons; Tibia; Tomography, X-Ray Computed; Transplants
PubMed: 26743422
DOI: 10.1016/j.arthro.2015.10.009 -
Sensors (Basel, Switzerland) Mar 2019Motion capture systems are recognized as the gold standard for joint angle calculation. However, studies using these systems are restricted to laboratory settings for... (Meta-Analysis)
Meta-Analysis
Motion capture systems are recognized as the gold standard for joint angle calculation. However, studies using these systems are restricted to laboratory settings for technical reasons, which may lead to findings that are not representative of real-life context. Recently developed commercial and home-made inertial measurement sensors (M/IMU) are potentially good alternatives to the laboratory-based systems, and recent technology improvements required a synthesis of the current evidence. The aim of this systematic review was to determine the criterion validity and reliability of M/IMU for each body joint and for tasks of different levels of complexity. Five different databases were screened (Pubmed, Cinhal, Embase, Ergonomic abstract, and Compendex). Two evaluators performed independent selection, quality assessment (consensus-based standards for the selection of health measurement instruments [COSMIN] and quality appraisal tools), and data extraction. Forty-two studies were included. Reported validity varied according to task complexity (higher validity for simple tasks) and the joint evaluated (better validity for lower limb joints). More studies on reliability are needed to make stronger conclusions, as the number of studies addressing this psychometric property was limited. M/IMU should be considered as a valid tool to assess whole body range of motion, but further studies are needed to standardize technical procedures to obtain more accurate data.
Topics: Accelerometry; Databases, Factual; Humans; Joints; Movement; Range of Motion, Articular; Reproducibility of Results; Wearable Electronic Devices
PubMed: 30935116
DOI: 10.3390/s19071555 -
Clinical Rheumatology Sep 2023C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA.
MATERIALS AND METHODS
A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models.
RESULTS
Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS.
CONCLUSIONS
In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
Topics: Humans; C-Reactive Protein; Spondylarthritis; Inflammation; Sacroiliac Joint; Magnetic Resonance Imaging; Axial Spondyloarthritis
PubMed: 37336841
DOI: 10.1007/s10067-023-06658-w -
The Journal of Foot and Ankle Surgery :... 2016Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. Although treatment of associated lateral and medial structures is... (Review)
Review
Posterior malleolar fractures are relatively common and usually result from rotational ankle injuries. Although treatment of associated lateral and medial structures is well established, several controversies exist in the management of posterior malleolus fractures. We performed a systematic review of the current published data with regard to the diagnosis, management, and prognosis of posterior malleolus fractures. A total of 33 studies (8 biomechanical and 25 clinical) with >950 patients were reviewed. The outcome of ankle fractures with posterior malleolar involvement was poor; however, the evidence was not enough to prove that the size of the posterior malleolus affects the outcome. Significant heterogeneity was noted in the cutoff size of the posterior malleolar fragment in determining management. The outcome was related to other factors, such as fracture displacement, congruency of the articular surface, and residual tibiotalar subluxation. Indirect evidence showed that large fracture fragments were associated with fracture dislocations and ankle instability and, thus, might require surgical fixation. We have concluded that the evidence to prove that the size of the posterior malleolar affects the outcome of ankle fractures is not enough, and the decision to treat these fractures should be determined by other factors, as stated previously.
Topics: Ankle Fractures; Ankle Joint; Disease Management; Fracture Fixation; Humans; Radiography; Range of Motion, Articular
PubMed: 26100091
DOI: 10.1053/j.jfas.2015.04.001 -
The Journal of Hand Surgery... Oct 2023Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining... (Meta-Analysis)
Meta-Analysis
Literature investigating the long-term outcomes of prosthesis options for proximal interphalangeal (PIP) joint arthroplasty is scarce, with most reports combining indications and underlying pathologies in analyses. In this study, we aim to compare silicone, pyrocarbon and metal prostheses in PIP joint arthroplasty for primary degenerative osteoarthritis (OA). A review of scientific literature published between 1990 and 2021 was conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant studies were screened and the appropriate data was extracted. An evaluation of clinical outcomes (range of motion [ROM] and pain), complications (reoperation) and survival rates for each prosthesis was performed. Twelve studies were included for analysis with a total of 412 PIP joints. ROM was 66.6°, 55.8° and 46.4° for metal, silicone and pyrocarbon implants, respectively. Silicone implants had the best pain score on the visual analogue scale (1.2) followed by the pyrocarbon (2.6) and metal (3.9) groups. Complication rates were lowest in silicone implants (11.3%) compared to 18.5% in pyrocarbon and 22.4% in metal prostheses. Survival did not differ significantly amongst the three groups. Our findings suggest that for patients with primary degenerative OA, PIP joint arthroplasty using a silicone prosthesis can provide greater pain relief with lower complication rates compared to other implant options. Level III (Therapeutic).
Topics: Humans; Joint Prosthesis; Finger Joint; Arthroplasty, Replacement, Finger; Osteoarthritis; Arthroplasty; Silicones; Pain
PubMed: 37881822
DOI: 10.1142/S2424835523500571 -
The International Journal of Medical... Oct 2020Unicompartmental knee arthroplasty (UKA), which has many potential advantages compared with total knee arthroplasty, was widely used across the world in recent years.... (Review)
Review
Unicompartmental knee arthroplasty (UKA), which has many potential advantages compared with total knee arthroplasty, was widely used across the world in recent years. The introduction of the robot systems greatly makes up for the defects of the conventional UKA surgery such as higher complication rates and revision rates. MAKO system, a new image-guided robot system relies on a preoperative computed tomography scan to assist in preoperative mapping and planning, offers an opportunity to improve the outcome of UKA surgeries. In order to have a more comprehensive and in-depth understanding of MAKO-assisted UKA, the studies on MAKO-assisted UKA were summarized. MAKO-assisted UKA is better than conventional UKA surgery on implant accuracy, soft tissue balance, patient function scores and satisfaction, complications rates, and learning curve in short-term outcome; however, the mid-term and long-term outcomes of MAKO-assisted UKA need to be further studied.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Learning Curve; Osteoarthritis, Knee; Robotic Surgical Procedures; Treatment Outcome
PubMed: 32445224
DOI: 10.1002/rcs.2124 -
Clinical Neurology and Neurosurgery Oct 2017Although degenerative spondylolisthesis (DS) and lumber disc herniation (LDH) are common causes of back pain, the associations between the lumbar facet joint angle... (Meta-Analysis)
Meta-Analysis Review
Although degenerative spondylolisthesis (DS) and lumber disc herniation (LDH) are common causes of back pain, the associations between the lumbar facet joint angle orientation and tropism in these conditions are still contentious. The objective of the meta-analysis was to identify the role of facet joint orientation and tropism on the development of lumbar degenerative disease, including DS and LDH. Electronic searches of PubMed and Embase were conducted up to April 2017. P value<0.05 was regarded as significant. Seventeen studies were included in this meta-analysis. Depending on the analysis, patients with DS have more sagittal orientated facet joints compared with control subjects (weighted mean difference [WMD] -10.5, 95% confidence interval [CI] -11.71 to -8.60; P<0.00001). We also found that DS patients have more remarkable facet joint tropism (WMD 1.84, 95% CI 0.77-2.91; P=0.0007). No significant correlation was observed between facet joint angle with LDH. There is a possibility that morphological deformity of facet joints could be associated with accelerated degeneration of stabilizing structures and affect the progress of DS. Our conclusion did not support the correlation between LDH and abnormalities of the facet joint. We tend to assume that the mechanics related to biomechanical changes in LDH disease progress might be more sophisticated.
Topics: Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Spondylolisthesis; Zygapophyseal Joint
PubMed: 28843706
DOI: 10.1016/j.clineuro.2017.08.005