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British Journal of Sports Medicine Nov 2022Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Compare the effectiveness of primarily surgical versus primarily rehabilitative management for anterior cruciate ligament (ACL) rupture.
DESIGN
Living systematic review and meta-analysis.
DATA SOURCES
Six databases, six trial registries and prior systematic reviews. Forward and backward citation tracking was employed.
ELIGIBILITY CRITERIA
Randomised controlled trials that compared primary reconstructive surgery and primary rehabilitative treatment with or without optional reconstructive surgery.
DATA SYNTHESIS
Bayesian random effects meta-analysis with empirical priors for the OR and standardised mean difference and 95% credible intervals (CrI), Cochrane RoB2, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence.
RESULTS
Of 9514 records, 9 reports of three studies (320 participants in total) were included. No clinically important differences were observed at any follow-up for self-reported knee function (low to very low certainty of evidence). For radiological knee osteoarthritis, we found no effect at very low certainty of evidence in the long term (OR (95% CrI): 1.45 (0.30 to 5.17), two studies). Meniscal damage showed no effect at low certainty of evidence (OR: 0.85 (95% CI 0.45 to 1.62); one study) in the long term. No differences were observed between treatments for any other secondary outcome. Three ongoing randomised controlled trials were identified.
CONCLUSIONS
There is low to very low certainty of evidence that primary rehabilitation with optional surgical reconstruction results in similar outcome measures as early surgical reconstruction for ACL rupture. The findings challenge a historical paradigm that anatomic instability should be addressed with primary surgical stabilisation to provide optimal outcomes.
PROSPERO REGISTRATION NUMBER
CRD42021256537.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Bayes Theorem; Humans; Knee Joint; Osteoarthritis, Knee
PubMed: 36038357
DOI: 10.1136/bjsports-2021-105359 -
PloS One 2020Systematic review.
STUDY DESIGN
Systematic review.
BACKGROUND AND OBJECTIVES
Preoperative neuromuscular function is predictive for knee function and return to sports (RTS) after reconstruction of the anterior cruciate ligament (ACL). The aim of this review was to examine the potential benefits of prehabilitation on pre-/postoperative objective, self-reported and RTS-specific outcomes.
METHODS
A systematic search was conducted within three databases. From the 1.071 studies screened, two randomized control trials (RCTs), two control trials (CTs) and two cohort studies (CS) met the inclusion criteria. Methodological quality rating adopted the PEDro- (RCT, CT) or Newcastle-Ottawa-Scale (CS).
RESULTS AND CONCLUSIONS
Methodological quality of the included studies was moderate (PEDro score: 6.5 ± 1.7; range 4 to 9). Two studies reported higher increases of the maximal quadriceps torque from baseline to pre-reconstruction: one study in the limb symmetry index (LSI), and one in both legs of the prehabilitation group compared to the controls. At 12-weeks post-reconstruction, one study (from two) indicated that the prehabilitation group had a lesser post-operative decline in the single-leg-hop for distance LSI (clinically meaningful). Similar findings were found in terms of quadriceps strength LSI (one study). At both pre-reconstruction (three studies) and two-year post-surgery (two studies), the prehabilitation groups reached significantly higher self-reported knee function (clinically meaningful) than the controls. RTS tended to be faster (one study). At two years post-surgery, RTS rates (one study) were higher in the prehabilitation groups. The results provide evidence for the relevance of prehabilitation prior to ACL-reconstruction to improve neuromuscular and self-reported knee function as well as RTS. More high quality confirmatory RCTs are warranted.
REGISTRATION NUMBER
PROSPERO 2017: CRD42017065491.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Clinical Trials as Topic; Female; Humans; Male; Postoperative Complications; Preoperative Period; Plastic Surgery Procedures; Recovery of Function; Return to Sport
PubMed: 33112865
DOI: 10.1371/journal.pone.0240192 -
BMC Musculoskeletal Disorders Oct 2020To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament...
BACKGROUND
To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR).
METHOD
A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence.
RESULTS
The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored 'high' risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p < 0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR, compared to no PreHab. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes.
CONCLUSION
Very low quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR compared with no PreHab. There is no consensus on the optimum PreHab programme content, frequency and length. Further research is needed to develop PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness and return to sport.
TRIAL REGISTRATION
PROSPERO trial registration number. CRD42020162754 .
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Preoperative Exercise; Return to Sport
PubMed: 33010802
DOI: 10.1186/s12891-020-03676-6 -
International Journal of Environmental... Jun 2022This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon... (Meta-Analysis)
Meta-Analysis Review
A Systematic Review and Meta-Analysis of Strength Recovery Measured by Isokinetic Dynamometer Technology after Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Autografts vs. Hamstring Tendon Autografts or Patellar Tendon Autografts.
BACKGROUND
This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon autografts (HTAs) or patellar tendon autografts (PTAs) after anterior cruciate ligament (ACL) reconstruction by determining the isokinetic angular velocity and follow-up time points. The functional outcomes and knee stability at the same time points were also compared using isokinetic technology.
METHODS
Two independent reviewers searched the Medline (via PubMed search engine), Scopus, Web of Science and Cochrane Library databases to include full text comparative studies that assessed isokinetic strength test following ACL reconstruction. The DerSimonian and Laird method was used.
RESULTS
In total, ten studies were included; seven compared studies QTAs vs. HTAs, and three compared QTAs vs. PTAs. Five studies were included in the meta-analysis. Isokinetic strength data were reported 3, 6, 12 and 24 months after ACL reconstruction.
CONCLUSIONS
The QTAs showed better and significant results with knee flexion compared with HTAs, similar results to PTAs at 6 and 12 months. While HTAs showed better and significant results with knee extension at 6 months and similar results at 12 months compared to QTAs. Furthermore, a standardized isokinetic strength test must be followed to achieve a more specific conclusion and better clinical comparison among participants.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Hamstring Tendons; Humans; Patellar Ligament; Technology; Tendons
PubMed: 35682357
DOI: 10.3390/ijerph19116764 -
International Journal of Sports... Sep 2019Dynamic balance is often an important criterion used during lower extremity musculoskeletal injury prediction, prevention, and rehabilitation processes. Methods to...
BACKGROUND
Dynamic balance is often an important criterion used during lower extremity musculoskeletal injury prediction, prevention, and rehabilitation processes. Methods to assess lower extremity dynamic balance include the Star Excursion Balance Test (SEBT) and Lower Quarter Y-Balance Test (YBT). Due to the importance of dynamic balance it is imperative to establish reliable quantification techniques.
PURPOSE
To conduct a systematic review to assess the reliability and responsiveness of the SEBT/YBT.
STUDY DESIGN
Systematic Review.
METHODS
Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to August 2018. Included studies examined the intra- and inter-rater reliability of the SEBT/YBT in healthy adults. Two investigators independently assessed methodological quality, level of evidence and strength of recommendation with the Qualtiy Appraisal of Reliability Studies (QAREL) scale. Relative intra and inter-rater reliability was examined through intraclass correlation coefficients (ICC) and responsiveness was evaluated through minimal detectable change (MDC). Data was analyzed based on reach direction (Anterior, Posteromedial, and Posterolateral) and normalization (normalized and non-normalized). Additionally, data were then synthesized using the strength of recommendation taxonomy to provide a grade of recommendation.
RESULTS
A total of nine studies were included in this review. Six studies examined the inter-rater reliability and seven assessed intra-rater reliability. The included studies had a median QAREL score of 66.89% (range = 55.56% to 75.00%) and 59.03% (range = 33.33 to 66.67%) for inter and intra-rater reliability respectively. Median ICC values for inter-rater reliability were 0.88 (Range = 0.83 - 0.96), 0.87 (range = 0.80 - 1.00), and 0.88 (range = 0.73 - 1.00) for the anterior, posteromedial, and posterolateral directions respectively. Median ICC values for intra-rater reliability were 0.88 (Range = 0.84 - 0.93), 0.88 (Range = 0.85 - 0.94), and 0.90 (Range = 0.68 - 0.94) for the anterior, posteromedial, and posterolateral directions, respectively.
CONCLUSIONS
There is grade A evidence to support that the SEBT/YBT have excellent inter and intra-rater reliability when used in healthy adults. Furthermore, minimal detectable change values have been provided that can be used in practice to aid clinical decision making. Future research is needed to assess the reliability, responsiveness, and validity of the SEBT/YBT in pathologic populations.
LEVEL OF EVIDENCE
1a.
PubMed: 31598406
DOI: No ID Found -
Knee Surgery, Sports Traumatology,... Oct 2022The diagnostic accuracy of clinical tests for anterior cruciate ligament injury has been reported in previous systematic reviews. Numerous studies in these reviews... (Meta-Analysis)
Meta-Analysis
The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis.
PURPOSE
The diagnostic accuracy of clinical tests for anterior cruciate ligament injury has been reported in previous systematic reviews. Numerous studies in these reviews include subjects with additional knee ligament injury, which could affect the sensitivity of the tests. Meta-analyses have also been performed using methods that do not account for the non-independence of sensitivity and specificity, potentially overestimating diagnostic accuracy. The aim of this study was to report the diagnostic accuracy of clinical tests for anterior cruciate ligament tears (partial and complete) without concomitant knee ligament injury.
METHODS
A systematic review with meta-analysis was performed according to the PRISMA guidelines. Meta-analyses included studies reporting the specificity and/or sensitivity of tests with or without concomitant meniscal injury. Where possible, pooled diagnostic estimates were calculated with bivariate random-effects modelling to determine the most accurate effect sizes. Diagnostic accuracy values are presented for the anterior drawer, Lachman, Lever sign and pivot shift tests overall and in acute or post-acute presentations.
RESULTS
Pooled estimates using a bivariate model for overall sensitivity and specificity respectively were as follows: anterior drawer test 83% [95% CI, 77-88] and 85% [95% CI, 64-95]; Lachman test 81% [95% CI, 73-87] and 85% [95% CI, 73-92]; pivot shift test 55% [95% CI, 47-62] and 94% [95% CI, 88-97]; Lever sign test 83% [95% CI, 68-92] and 91% [95% CI, 83-95]. For specific presentations, the sensitivity and specificity of the Lachman test, respectively, were: complete tears 68% [95% CI, 54-79] and 79% [95% CI, 51-93]; post-acute injuries 70% [95% CI, 57-80] and 77% [95% CI, 53-91].
CONCLUSIONS
The pivot shift and Lever sign were the best tests overall for ruling in or ruling out an anterior cruciate ligament tear, respectively. The diagnostic accuracy of the Lachman test, particularly in post-acute presentations and for complete tears, is lower than previously reported. Further research is required to establish more accurate estimates for the Lachman test in acute presentations and partial ligament tears using bivariate analysis.
LEVEL OF EVIDENCE
III.
Topics: Anterior Cruciate Ligament Injuries; Humans; Knee Injuries; Meniscus; Physical Examination; Rupture
PubMed: 35150292
DOI: 10.1007/s00167-022-06898-4 -
Journal of Spine Surgery (Hong Kong) Mar 2020The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential... (Review)
Review
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
PubMed: 32309668
DOI: 10.21037/jss.2020.01.14 -
European Journal of Paediatric Dentistry Dec 2021The cause-effect relationship between anterior open bite and atypical swallowing, two frequently associated conditions, is currently not completely understood. These...
AIM
The cause-effect relationship between anterior open bite and atypical swallowing, two frequently associated conditions, is currently not completely understood. These conditions are often accompanied by speech disorders and represent a problem for both young patients and untreated adult patients. Treatment of these complex cases may be orthodontic, logopedic therapy or both. The purpose of this review is to compare the various types of treatment to determine their effectiveness in improving skeletal condition, normalisation of muscle activity, and temporal stability.
METHODS
The present systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA) guidelines. In order to find the most appropriate articles for inclusion, an electronic and manual search was performed using PubMed and The Cochrane Library on May 23, 2021. No language restrictions or time limits were applied. Only human studies describing cases of patients in the developmental stage of dentition, i.e., deciduous dentition or mixed dentition with an anterior open bite related to a type of swallowing with tongue interposition between the arches, undergoing three different types of treatment (orthodontic only, myofunctional/logopedic only, combined) were included.
CONCLUSION
The most effective treatment in cases of anterior open bite associated with atypical swallowing is a combination of the traditional orthodontic therapy and myofunctional therapy. Further studies are needed to devise an effective and universal logopaedic protocol to be followed in these cases.
Topics: Deglutition; Humans; Malocclusion; Myofunctional Therapy; Open Bite; Speech Therapy
PubMed: 35034464
DOI: 10.23804/ejpd.2021.22.04.5 -
International Journal of Environmental... Dec 2021Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based...
Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review.
Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.
Topics: Adult; Female; Humans; Male; Anterior Cruciate Ligament Injuries; Athletic Injuries; Core Stability; Incidence; Reproducibility of Results; Risk Factors; Soccer
PubMed: 34948963
DOI: 10.3390/ijerph182413351 -
Acta Orthopaedica Et Traumatologica... 2016The purpose of this study was to evaluate the sensitivity and specificity of 3 tests for assessing anterior cruciate ligament (ACL) ruptures. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this study was to evaluate the sensitivity and specificity of 3 tests for assessing anterior cruciate ligament (ACL) ruptures.
METHODS
MEDLINE, EMBASE, Cochrane Library, and CBM (Chinese Biomedical Literature Database) searches were performed. Studies selected for data extraction were those that addressed the accuracy of at least 1 physical diagnostic test for ACL rupture in comparison with a clinical reference standard such as arthroscopy, arthrotomy, or magnetic resonance imaging (MRI). The references of the included studies were also reviewed. Searches were limited to English and Chinese languages.
RESULTS
Sixteen studies that assessed the accuracy of the 3 tests for diagnosing ACL ruptures met the inclusion criteria. Study results were, however, heterogeneous. The Lachman test is the most sensitive test to determine ACL tears, showing a pooled sensitivity of 87.1% (95% confidence interval [CI] 0.84-0.90). The pivot shift test is the most specific test, showing a pooled specificity of 97.5% (95% CI 0.95-0.99); additionally, it has the highest positive likelihood ratios (LR+) of 16.00 (95% CI 7.34-34.87). The Lachman test has the lowest negative likelihood ratios (LR-) of 0.17 (95% CI 0.11-0.25).
CONCLUSION
In cases of suspected ACL injury, it is recommended to perform the pivot shift test, as it is highly specific and has greater likelihood and discrimination of accurately diagnosing ACL rupture. The Lachman test has great efficacy in ruling out a diagnosis of ACL rupture because of the lowest negative likelihood ratios.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Arthroscopy; Comparative Effectiveness Research; Dimensional Measurement Accuracy; Humans; Magnetic Resonance Imaging; Sensitivity and Specificity
PubMed: 26854045
DOI: 10.3944/AOTT.2016.14.0283