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International Orthopaedics Dec 2022The use of metallic implants for the treatment of patella fractures often involves complications related to the hardware. As a result, there has been a considerable... (Meta-Analysis)
Meta-Analysis Review
Fixation of patella fractures with metallic implants is associated with a significantly higher risk of complications and re-operations than non-metallic implants: a systematic review and meta-analysis.
PURPOSE
The use of metallic implants for the treatment of patella fractures often involves complications related to the hardware. As a result, there has been a considerable focus on the use of non-metallic implants. The aim of this study was to determine the differences in clinical outcomes, including the rates of complications and re-operations following the surgical management of patellar fractures with metallic versus non-metallic implants.
METHODS
The systematic review was conducted in accordance with PRISMA guidelines. Two investigators independently applied the search strategy to PubMed, SCOPUS, Google Scholar, and Cochrane databases, limited to publications between 1st January 2000 to 30st September 2021. The search strategy identified studies in which there was a comparison between the clinical outcome of the metallic and non-metallic fixation. Meta-analysis was conducted according to the Cochrane Collaboration and Quality of Reporting of Meta-Analysis (QUORUM) guidelines.
RESULTS
A total of 19 studies were selected for the systematic review and seven studies for the meta-analysis. Two hundred ninety-sixt patients formed the pooled study population for the meta-analysis. The outcomes evaluated in the meta-analysis were range of motion (ROM), complications, and re-operation rates. There was no significant difference between groups regarding ROM, but the risk ratio (RR) of re-operation (RR 0.19, 95% CI [0.09-0.41]) and complications (RR 0.30, 95% CI [0.17-0.55]) was significantly in favor of fixation with non-metallic implants.
CONCLUSION
The use of non-metallic implants for fixation of patella fractures was associated with significantly lower risk of complications and re-operations than fixation with metallic implants, without any difference between groups with respect to the final range of motion or functional outcome measures.
Topics: Humans; Patella; Fractures, Bone; Fracture Fixation, Internal; Reoperation; Knee Injuries; Treatment Outcome
PubMed: 36208340
DOI: 10.1007/s00264-022-05565-0 -
Arthroscopy : the Journal of... Jul 2022The purpose of this study is to compare the biomechanical properties between traditional transosseous tunnel and suture anchor technique repair for extensor mechanism... (Review)
Review
PURPOSE
The purpose of this study is to compare the biomechanical properties between traditional transosseous tunnel and suture anchor technique repair for extensor mechanism ruptures and assess for differences in the mechanism of failure of both techniques.
METHODS
A multi-database search (PubMed, EMBASE, and Medline) was performed according to PRISMA guidelines on November 14, 2021. All articles comparing biomechanical properties of transpatellar and suture anchor technique for extensor mechanism ruptures were included. Abstracts, reviews, case reports, studies without biomechanical analysis, conference proceedings, and non-English language studies were excluded. Outcomes pursued included gap formation, load to failure, and mechanism of failure. Relevant data from studies meeting inclusion criteria were extracted and analyzed. Study methodology was assessed using the Methodological Index for Non-Randomized Studies score.
RESULTS
A total of 212 knees were biomechanically assessed, including 98 patella and 114 quadricep tendon ruptures. Five patellar tendon studies were included, and all of them reported significantly smaller gap formation in suture anchor group. Gap formation for suture anchors ranged from .9 mm to 4.1 mm, while that of transpatellar group ranged from 2.9 mm to 10.3 mm. One study reported a significantly higher load to failure in the suture anchor group, while the remaining four studies reported no significant difference. Load to failure for suture anchor ranged from 259 N to 779 N, while that of the transpatellar group ranged from 287 N to 763 N. The most common mechanism of failure was anchor pullout in suture anchor and knot failure in the transpatellar group. Five quadriceps tendon studies were included, and three studies reported statistically significant smaller gap formation in the suture anchor group. Gap formation for suture anchor ranged from 1.5 mm to 5.0 mm, while that of transpatellar group ranged from 3.1 mm to 33.3 mm. Two studies reported a significantly higher load to failure in the suture anchor group, while one study reported a higher load to failure in the transpatellar repair group. Load to failure for suture anchor ranged from 286 N to 740 N, while that of transpatellar group ranged from 251 N to 691 N. The most common mechanism of failure was suture failure in the suture anchor and knot failure in the transpatellar group.
CONCLUSION
Suture anchor fixation displays a better biomechanical profile than traditional transpatellar techniques in terms of smaller gap formations in the repair of both patella and quadriceps tendon injuries. Anchor pullout in suture anchor fixation was present mainly with the use of titanium anchors.
CLINICAL RELEVANCE
These findings above may result in better retention of tendon approximation in patella and quadriceps tendon fixation postoperatively, which may result in earlier recovery. Further randomized controlled clinical trials to compare these techniques are required.
Topics: Biomechanical Phenomena; Cadaver; Humans; Patella; Rupture; Suture Anchors; Suture Techniques; Sutures; Tendon Injuries; Tendons
PubMed: 35066110
DOI: 10.1016/j.arthro.2022.01.012 -
The Surgeon : Journal of the Royal... Aug 2022Evidence concerning the influence gender, age, and the time elapsed from the first dislocation to surgery in the outcomes of Medial Patella Femoral Ligament (MPFL)... (Review)
Review
BACKGROUND
Evidence concerning the influence gender, age, and the time elapsed from the first dislocation to surgery in the outcomes of Medial Patella Femoral Ligament (MPFL) reconstruction are lacking. This systematic review was conducted to investigate whether patient characteristics have an influence in the clinical outcomes of MPFL reconstruction for patients with patellofemoral instability.
MATERIAL AND METHODS
This study followed the PRISMA guidelines. The main databases were accessed in February 2021. All the studies reporting outcomes of primary MPFL reconstruction in patients with recurrent patellofemoral instability were considered for inclusion. A multivariate analysis diagnostic tool was used to analyse the association between age, gender and time from injury to surgery and the surgical outcomes at last follow-up.
RESULTS
A total of 50 articles (2037 procedures) were included. The mean follow-up was 40.90 ± 24.8 months. The mean age was 23.6 ± 3.9 years. 64.3% (1309 of 2037 patients) were female. The mean time from injury to surgery was 64.5 ± 48.9 months. Women showed no statistically significant association with the Kujala score or complications. Older patients had a reduced risk to incur re-dislocations (P = 0.01) and revisions (P = 0.01). Longer time from injury to surgery was associated with greater risk to incur re-dislocations (P = 0.01), and with lower Kujala score (P < 0.0001). No other statistically significant association was evidenced.
CONCLUSION
The time span from the first patellar dislocation to the surgical reconstruction was a negative prognostic factor, while sex had no influence on surgical outcomes. The role of patients age on surgical outcomes remains unclear.
Topics: Adult; Female; Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Male; Patellar Dislocation; Patellofemoral Joint; Prognosis; Young Adult
PubMed: 33962891
DOI: 10.1016/j.surge.2021.03.003 -
Knee Surgery & Related Research Feb 2022The optimal practice of patellar management in total knee arthroplasty (TKA) remains controversial. This systematic review was conducted to compare patella-related (1)... (Review)
Review
Is the patient aware of the difference between resurfaced and nonresurfaced patella after bilateral total knee arthroplasty? A systematic review of simultaneous bilateral randomized trials.
PURPOSE
The optimal practice of patellar management in total knee arthroplasty (TKA) remains controversial. This systematic review was conducted to compare patella-related (1) patient-reported outcome measures (PROMs), (2) clinical outcomes, and (3) reoperation rates after TKA with patellar resurfacing (PR) and nonresurfacing (NPR) in single patients undergoing bilateral patellar procedures during simultaneous bilateral TKA.
METHODS
This review included prospective bilateral randomized trials investigating patella-related PROMs, clinical outcomes, and reoperation (secondary resurfacing and patellar component revision) and other patella-related complications in single patients undergoing randomly assigned PR and NPR during bilateral TKA.
RESULTS
Six studies were included. There was no difference in PROMs between PR and NPR in five studies, whereas PR was found to be superior to NPR in one study. Five studies reported similar functional outcomes and complication rates between PR and NPR, while one study found better clinical outcomes and a lower complication rate in PR. Between-group secondary resurfacing and patellar revision rates were similar in all studies.
CONCLUSIONS
The majority of patients who underwent bilateral patellar procedures could not tell the difference between PR and NPR following bilateral TKA. There were no differences in clinical outcomes or reoperation and complication rates between PR and NPR. No evidence was found to support routine PR.
LEVEL OF EVIDENCE
Therapeutic Level 1.
PubMed: 35164884
DOI: 10.1186/s43019-022-00133-7 -
Knee Surgery, Sports Traumatology,... Dec 2017The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the... (Review)
Review
PURPOSE
The medial patellofemoral ligament (MPFL) is the major medial soft-tissue stabiliser of the patella, originating from the medial femoral condyle and inserting onto the medial patella. The exact position reported in the literature varies. Understanding the true anatomical origin and insertion of the MPFL is critical to successful reconstruction. The purpose of this systematic review was to determine these locations.
METHODS
A systematic search of published (AMED, CINAHL, MEDLINE, EMBASE, PubMed and Cochrane Library) and unpublished literature databases was conducted from their inception to the 3 February 2016. All papers investigating the anatomy of the MPFL were eligible. Methodological quality was assessed using a modified CASP tool. A narrative analysis approach was adopted to synthesise the findings.
RESULTS
After screening and review of 2045 papers, a total of 67 studies investigating the relevant anatomy were included. From this, the origin appears to be from an area rather than (as previously reported) a single point on the medial femoral condyle. The weighted average length was 56 mm with an 'hourglass' shape, fanning out at both ligament ends.
CONCLUSION
The MPFL is an hourglass-shaped structure running from a triangular space between the adductor tubercle, medial femoral epicondyle and gastrocnemius tubercle and inserts onto the superomedial aspect of the patella. Awareness of anatomy is critical for assessment, anatomical repair and successful surgical patellar stabilisation.
LEVEL OF EVIDENCE
Systematic review of anatomical dissections and imaging studies, Level IV.
Topics: Databases, Factual; Female; Humans; Knee Joint; Male; Patellar Ligament; Patellofemoral Joint
PubMed: 27631645
DOI: 10.1007/s00167-016-4272-1 -
Arthroplasty (London, England) Jun 2023Difficulty kneeling following total knee arthroplasty (TKA) remains highly prevalent, and has cultural, social, and occupational implications. With no clear evidence of... (Review)
Review
BACKGROUND
Difficulty kneeling following total knee arthroplasty (TKA) remains highly prevalent, and has cultural, social, and occupational implications. With no clear evidence of superiority, whether or not to resurface the patella remains debatable. This systematic review examined whether resurfacing the patella (PR) or not (NPR) influences kneeling ability following TKA.
METHODS
This systematic review was conducted by following PRISMA guidelines. Three electronic databases were searched utilizing a search strategy developed with the aid of a department librarian. Study quality was assessed using MINROS criteria. Article screening, methodological quality assessment and data extraction were performed by two independent authors, and a third senior author was consulted if consensus was not reached.
RESULTS
A total of 459 records were identified, with eight studies included in the final analysis, and all deemed to be level III evidence. The average MINORS score was 16.5 for comparative studies and 10.5 for non-comparative studies. The total number of patients was 24,342, with a mean age of 67.6 years. Kneeling ability was predominantly measured as a patient-reported outcome measure (PROM), with two studies also including an objective assessment. Two studies demonstrated a statistically significant link between PR and kneeling, with one demonstrating improved kneeling ability with PR and the other reporting the opposite. Other potential factors associated with kneeling included gender, postoperative flexion, and body mass index (BMI). Re-operation rates were significantly higher in the NPR cohort whereas PR cohorts had higher Feller scores, patient-reported limp and patellar apprehension.
CONCLUSION
Despite its importance to patients, kneeling remains not only under-reported but also ill-defined in the literature, with no clear consensus regarding the optimum outcome assessment tool. Conflicting evidence remains as to whether PR influences kneeling ability, and to clarify the situation, large prospective randomized studies are required.
PubMed: 37268994
DOI: 10.1186/s42836-023-00184-5 -
Osteoarthritis and Cartilage Jul 2022This systematic review investigated whether people with patellofemoral osteoarthritis (PFOA) have muscle strength, volume, and activation around the hip and knee that is... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review investigated whether people with patellofemoral osteoarthritis (PFOA) have muscle strength, volume, and activation around the hip and knee that is different from asymptomatic controls.
METHODS
Searches were carried out in five electronic databases, with terms related to PFOA, including muscle strength, volume and activation. Only studies with at least one group with symptomatic PFOA and one asymptomatic group were included. The methodological quality of the studies was assessed using the Downs and Black checklist. Certainty of evidence was assessed using the GRADE methodology. Using the random effects model, a meta-analysis was performed when there were at least two studies reporting the same domain.
RESULTS
Eight studies (250 participants) met the inclusion criteria. Subjects with PFOA had weaker hip abduction (SMD -0.96; 95%CI = -1.34 to -0.57), hip external rotation (-0.55;-1.07 to -0.03), hip extension (-0.72;-1.16 to -0.28), and knee extension (-0.97;-1.41 to -0.53) when compared to asymptomatic controls. People with PFOA also presented with smaller volumes of the gluteus medius, gluteus minimus, tensor fascia lata, vastus medialis (VM), vastus lateralis (VL) and rectus femoris when compared to asymptomatic controls. Also, people with PFOA presented with changes in muscle activation for the VL, VM and gluteus maximus (GMax) when compared to asymptomatic controls.
CONCLUSION
People with PFOA present with lower strength and volume of the hip and quadriceps muscles and altered muscle activation of the VM, VL and GMax during ascending and descending stairs when compared to asymptomatic controls. However, the certainty of these findings are very low.
TRIAL REGISTRATION NUMBER
PROSPERO systematic review protocol (ID = CRD42020197776).
Topics: Electromyography; Humans; Knee; Knee Joint; Muscle Strength; Muscle, Skeletal; Osteoarthritis, Knee; Quadriceps Muscle
PubMed: 35257862
DOI: 10.1016/j.joca.2022.01.013 -
ANZ Journal of Surgery Nov 2021Previous studies have reached mixed results regarding the effects of patellar denervation with electrocautery (PD) on total knee replacement (TKR). This systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous studies have reached mixed results regarding the effects of patellar denervation with electrocautery (PD) on total knee replacement (TKR). This systematic review and meta-analysis aimed to summarize all available literatures to investigate the influence of PD on postoperative anterior knee pain (AKP) and knee function after TKR.
METHODS
Electronic databases, including PubMed, Cochrane Library and Embase, were searched from their inception to March 2021. Randomized controlled trials (RCT) and quasi-randomized controlled trials (quasi-RCT) comparing PD and non-patellar denervation (NPD) in TKR were selected, and the Cochrane risk of bias tool was used to assess the quality of included trials. AKP prevalence was defined as the primary outcome.
RESULTS
A total of 12 RCTs and one quasi-RCT enrolled 1895 knees proved eligible. PD knees had significantly lower AKP prevalence than NPD knees (odds ratio [OR] = 0.54; 95% confidence intervals [95% CI], 0.36-0.81; p = 0.003). There was no difference between PD and NPD in terms of visual analogue scale for knee pain and range of motion, American knee society knee score, American knee society function score, patellar feller score, Oxford knee score for knee function. The results of subgroup analysis based on follow-up duration and patella resurfacing were in accordance with the results. PD knees were not associated with a higher risk of complication or revision.
CONCLUSION
PD can significantly reduce the AKP prevalence following TKR without increasing the risk of complication and revision. Although the pain relief effect of PD may not be associated with improved knee function after TKR, this procedure is preferred in both patella resurfacing and patella non-resurfacing TKR.
Topics: Arthroplasty, Replacement, Knee; Denervation; Humans; Knee Joint; Osteoarthritis, Knee; Pain, Postoperative; Patella; Treatment Outcome
PubMed: 34291537
DOI: 10.1111/ans.17078 -
The Journal of Arthroplasty Apr 2024Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing.
METHODS
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197).
RESULTS
An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%.
CONCLUSIONS
An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Retrospective Studies; Pain; Reoperation; Treatment Outcome; Knee Joint; Osteoarthritis, Knee; Knee Prosthesis
PubMed: 37871862
DOI: 10.1016/j.arth.2023.10.027 -
Osteoarthritis and Cartilage Feb 2016To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To review the association between patellofemoral joint (PFJ) imaging features and patellofemoral pain (PFP).
DESIGN
A systematic review of the literature from AMED, CiNAHL, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PEDro, EMBASE and SPORTDiscus was undertaken from their inception to September 2014. Studies were eligible if they used magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) or X-ray (XR) to compare PFJ features between a PFP group and an asymptomatic control group in people <45 years of age. A pooled meta-analysis was conducted and data was interpreted using a best evidence synthesis.
RESULTS
Forty studies (all moderate to high quality) describing 1043 people with PFP and 839 controls were included. Two features were deemed to have a large standardised mean difference (SMD) based on meta-analysis: an increased MRI bisect offset at 0° knee flexion under load (0.99; 95% CI: 0.49, 1.49) and an increased CT congruence angle at 15° knee flexion, both under load (1.40 95% CI: 0.04, 2.76) and without load (1.24; 95% CI: 0.37, 2.12). A medium SMD was identified for MRI patella tilt and patellofemoral contact area. Limited evidence was found to support the association of other imaging features with PFP. A sensitivity analysis showed an increase in the SMD for patella bisect offset at 0° knee flexion (1.91; 95% CI: 1.31, 2.52) and patella tilt at 0° knee flexion (0.99; 95% CI: 0.47, 1.52) under full weight bearing.
CONCLUSION
Certain PFJ imaging features were associated with PFP. Future interventional strategies may be targeted at these features.
PROSPERO REGISTRATION NUMBER
CRD 42014009503.
Topics: Humans; Magnetic Resonance Imaging; Patellofemoral Joint; Patellofemoral Pain Syndrome; Tomography, X-Ray Computed; Ultrasonography
PubMed: 26471209
DOI: 10.1016/j.joca.2015.09.004