-
Sports Medicine (Auckland, N.Z.) Aug 2017Studies have shown a familial predisposition for anterior cruciate ligament (ACL) rupture and have been followed by genetic-association studies on polymorphisms in... (Review)
Review
BACKGROUND
Studies have shown a familial predisposition for anterior cruciate ligament (ACL) rupture and have been followed by genetic-association studies on polymorphisms in candidate genes in recent years. To date, no systematic review with a best-evidence synthesis has evaluated the influence of genetics on this devastating knee injury.
OBJECTIVE
Our objective was to evaluate the association between genetic variants and ACL rupture.
METHODS
We performed an extensive search in Embase, MEDLINE, Web of Science, Scopus, PubMed Publisher, Cochrane Register of Clinical Trials, and Google scholar up to 24 August 2015. Studies were eligible if they met the following inclusion criteria: (1) design was a case-control study, retrospective or prospective follow-up study, or a randomized controlled trial (RCT); (2) the study examined the association between a genetic variant and ACL rupture in both an ACL and a control group. We determined the risk of bias for all included studies.
RESULTS
We included a total of 16 studies (eight at high risk of bias and eight with an unclear risk) that examined 33 different DNA variants. Conflicting evidence was found for the COL1A1 rs1800012 and COL3A1 rs1800255 variants, whereas limited evidence was found for no association of the COL5A1 rs12722 and rs13946 and COL12A1 rs970547 variants (all encoding collagen). Evidence was insufficient to draw conclusions as to whether any other genetic variant identified in this review had any association with ACL rupture.
CONCLUSIONS
More research is needed to support a clear association between ACL rupture and genetic variants. Genome-wide studies are recommended for exploring more potential genetic variants. Moreover, large prospective studies are needed to draw robust conclusions.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Reconstruction; Genetic Predisposition to Disease; Genetic Variation; Humans; Knee Injuries; Rupture
PubMed: 28102489
DOI: 10.1007/s40279-017-0678-2 -
Medicine Jun 2022: Current guidelines recommend per-oral endoscopic myotomy (POEM) and laparoscopic Heller's myotomy (LHM) as first-line treatment of idiopathic achalasia, but the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
: Current guidelines recommend per-oral endoscopic myotomy (POEM) and laparoscopic Heller's myotomy (LHM) as first-line treatment of idiopathic achalasia, but the optimum choice between different endoscopic and surgical modalities remains inconclusive. We conducted a network meta-analysis to compare the efficacy of 8 treatments for idiopathic achalasia.
MATERIALS AND METHODS
: Three major bibliographic databases were reviewed for enrollment of randomized controlled trials between January 2000 and June 2021. We included adults with idiopathic achalasia and compared two or more of eight interventions including botulinum toxin injection (BTI), pneumatic dilation (PD), BTI + PD, LHM without fundoplication, LHM followed with Dor or Toupet fundoplication, and POEM using either the anterior or posterior approach. Our focus was on clinical success rate, postsurgical acid reflux, and moderate-to-severe adverse events.
RESULTS
: Twenty-four studies involved a total of 1987 participants for analysis. When compared with PD, POEM with anterior approach, POEM with posterior approach, LHM + Toupet, and LHM + Dor were all significantly superior to the other regimens in short-term efficacy, with POEM with anterior approach and LHM + Dor showing better improvement in mid-term efficacy. BTI showed a significantly lower efficacy than PD in both periods. Regarding safety, only LHM without fundoplication was significantly associated with higher acid reflux than PD, while LHM + Toupet, LHM without fundoplication, and LHM + Dor showed a non-significant increase in moderate-to-severe adverse events.
CONCLUSIONS
: For idiopathic achalasia, we suggest that POEM with an anterior or posterior approach and LHM with Dor or Toupet fundoplication be initially recommended. On the contrary, both LHM without fundoplication and BTI are not recommended as definitive therapy.
Topics: Adult; Botulinum Toxins; Dilatation; Esophageal Achalasia; Fundoplication; Gastroesophageal Reflux; Heller Myotomy; Humans; Laparoscopy; Network Meta-Analysis; Treatment Outcome
PubMed: 35713453
DOI: 10.1097/MD.0000000000029441 -
European Journal of Medical Research Jul 2023Shoulder is vulnerable to dislocation owing to its anatomical structure and the increasing popularity of contact sports in young population. The management of first-time... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Shoulder is vulnerable to dislocation owing to its anatomical structure and the increasing popularity of contact sports in young population. The management of first-time anterior shoulder dislocation in this group is still controversial and the prognosis are varied. This review aimed to compare the results of arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young active patients.
METHODS
Databases were searched till November 2021, and comparative studies between arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young population were selected. Methodological quality of the studies was assessed according to the Cochrane Back Review Group 12-item scale. Outcome measures included recurrence of instability, return to play, subsequent instability surgery, and shoulder functional scores.
RESULTS
The search returned 12 eligible trials with 786 participants. All the trials were of prospective design. After arthroscopic Bankart repair, patients experienced significantly less re-dislocation (7.5% vs. 53.0%, p < 0.00001, I = 0%), subluxation (3.1% vs. 24.2%, p < 0.0001, I = 0%), positive apprehension test (7.3% vs. 25.8%, p = 0.002, I = 11%), and subsequent surgical treatment for instability (5.6% vs. 37.8%, p < 0.00001, I = 0%) when compared with those underwent conservative management. And more patients returned to play (83.5% vs. 66.0%, p = 0.03, I = 81%) after arthroscopic Bankart repair. Outcomes regarding the functional scores did not reach a significant difference between the two cohorts.
CONCLUSIONS
Arthroscopic Bankart repair showed superiority over conservative management in terms of recurrence, return to play, and subsequent instability surgery during the follow-up in young active patients that encountered first episode of dislocation. As long-term prognosis is comparable, an immediate surgical stabilization might not be suitable for everyone.
Topics: Humans; Shoulder Dislocation; Shoulder; Shoulder Joint; Conservative Treatment; Joint Instability; Arthroscopy; Recurrence; Retrospective Studies
PubMed: 37501089
DOI: 10.1186/s40001-023-01160-0 -
Cureus Jul 2023The purpose of this review is to examine the literature on combined pelvic ring and acetabular fractures. We hope to further define the classifications, severities (ISS... (Review)
Review
The purpose of this review is to examine the literature on combined pelvic ring and acetabular fractures. We hope to further define the classifications, severities (ISS & Mortality), healing, radiographic parameters, and functional outcomes of such injuries to report all potential recommendations based on findings. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and a systematic search on PubMed and Google Scholar was performed. Articles included were in the English Language or through English translation, between the years 1996 and 2022. Articles that had met the inclusion criteria were systematically assessed for the relevance of their content. Eleven articles were identified with a total of 985 patients. All eleven were retrospective case series and the presence of both an injury within the pelvic ring and another injury within the acetabulum, either ipsilateral or contralateral, was the indication of a combination injury. The overall mortality rate averaged over all studies was 7.9% and the Injury Severity Score (ISS) of 22.98. When considering the higher mortality rate seen in pelvic ring injuries compared to the isolated acetabulum, there appears to be survivability beyond reductive means as a reason for reducing and fixing the pelvic ring first. However, accurate reduction of the acetabulum has a greater weight in overall patient recovery compared to the reduction of the pelvic ring and thus surgical emphasis on the anatomic reduction of the acetabulum may be paramount. Despite this good to excellent outcomes can be achieved with careful preoperative planning and surgical execution in patients with fractures of the pelvic ring and acetabulum. Further research as well as uniform radiographic scoring system and outcomes scores should be required to better evaluate and treat these injuries.
PubMed: 37575857
DOI: 10.7759/cureus.41843 -
European Journal of Orthopaedic Surgery... Aug 2023This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial... (Meta-Analysis)
Meta-Analysis Review
Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis.
PURPOSE
This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR.
METHODS
A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant.
RESULTS
Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found.
CONCLUSION
ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Anterior Cruciate Ligament; Knee Joint; Anterior Cruciate Ligament Injuries; Tibia; Osteotomy; Anterior Cruciate Ligament Reconstruction; Retrospective Studies
PubMed: 36308547
DOI: 10.1007/s00590-022-03419-4 -
Acta Ophthalmologica May 2022Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative... (Review)
Review
Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st-generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle-based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post-implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology.
Topics: Glaucoma; Humans; Intraocular Pressure; Minimally Invasive Surgical Procedures; Stents; Tomography, Optical Coherence
PubMed: 34250742
DOI: 10.1111/aos.14962 -
JAMA Network Open Nov 2022The timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic.
OBJECTIVE
To synthesize up-to-date published data from randomized clinical trials (RCTs) comparing early vs elective delayed ACLR for patients with ACL deficiency, in terms of clinical outcomes and complications.
DATA SOURCES
The PubMed, Cochrane Library, and Web of Science databases were systematically searched until September 9, 2022.
STUDY SELECTION
All published RCTs comparing clinical and functional outcomes and complications associated with early ACLR vs elective delayed ACLR.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently extracted relevant data and assessed the methodological quality following the PRISMA guidelines.
MAIN OUTCOMES AND MEASURES
Due to the clinical heterogeneity, the random-effects model was preferred. The primary outcomes were functional outcomes and complications. The Mantel-Haenszel test was used to evaluate dichotomous variables and the inverse variance method was used to assess continuous variables.
RESULTS
This meta-analysis included 972 participants in 11 RCTs stratified by follow-up duration. The following factors did not differ between early and delayed ACLR: operative time (mean difference, 4.97; 95% CI, -0.68 to 10.61; P = .08), retear (OR, 1.52; 95% CI, 0.52-4.43; P = .44), and infection (OR, 3.80; 95% CI, 0.77-18.79; P = .10). There were also no differences between groups in range of motion, knee laxity, International Knee Documentation Committee (IKDC rating scale), and Tegner score. IKDC score (mean difference, 2.77; 95% CI, 1.89-3.66; P < .001), and Lysholm score at 2-year follow-up (mean difference, 2.61; 95% CI, 0.74-4.48; P = .006) significantly differed between early and delayed ACLR. In addition, the timing of surgery was redefined in the included RCTs and subgroup analyses were performed, which validated the robustness of the principal results.
CONCLUSION AND RELEVANCE
This systematic review and meta-analysis found that early ACLR was not superior to delayed ACLR in terms of most factors analyzed, except for IKDC and Lysholm scores. This information should be available to patients with ACL deficiency and clinicians as part of the shared decision-making process of treatment selection.
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Knee Joint; Knee; Range of Motion, Articular
PubMed: 36394870
DOI: 10.1001/jamanetworkopen.2022.42742 -
Spine Surgery and Related Research 2022A thoracolumbar burst fracture (BF) is a severe type of compression fracture, which is the most common type of traumatic spine fractures. Generally, surgery is the... (Review)
Review
BACKGROUND
A thoracolumbar burst fracture (BF) is a severe type of compression fracture, which is the most common type of traumatic spine fractures. Generally, surgery is the preferred treatment, but whether the optimal approach is either an anterior or a posterior approach remains unclear. This study aims to determine whether either method provides an advantage.
METHODS
Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing anterior versus posterior surgical approaches in patients with thoracolumbar BFs. Data were analyzed using Review Manager 5.3. Seven studies were included.
RESULTS
An operative time of 87.97 min (53.91, 122.03; p<0.0001) and blood loss of 497.04 mL (281.8, 712.28; p<0.0001) were lower in the posterior approach. Length of hospital stay, complications, reintervention rate, neurological outcomes, postoperative kyphotic angle, and costs were similar between both groups.
CONCLUSIONS
Surgical intervention is usually selected to rehabilitate patients with BFs. The data obtained from this study suggest that a posterior approach represents a viable alternative to an anterior approach, with various advantages such as a shorter operative time and decreased bleeding.
PubMed: 35478987
DOI: 10.22603/ssrr.2021-0122 -
Cureus Jun 2023Growth disturbances after transphyseal paediatric anterior cruciate ligament (ACL) reconstruction have led to the development of physeal-sparing techniques. The aim of... (Review)
Review
Growth disturbances after transphyseal paediatric anterior cruciate ligament (ACL) reconstruction have led to the development of physeal-sparing techniques. The aim of this study is to investigate growth disturbances following paediatric ACL reconstruction and identify associated risk factors. A systematic search on PubMed, Scopus and Web of Science databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify case series reporting paediatric ACL reconstructions. Of 518 articles, 78 met the inclusion criteria, and data related to growth disturbances and graft failures were extracted. A total of 2,693 paediatric ACL reconstructions resulted in 70 growth disturbances (2.6%): 17 were varus, 26 were valgus, 13 were shortening, 14 were lengthening and five patients had reduced tibial slope. Some patients showed deformities in more than one plane. Coronal plane deformities were seen more frequently with eccentric physeal arrest and lengthening with intraepiphyseal tunnelling. Shortening and reduced tibial slope were related to large central physeal arrest and anterior tibial physeal arrest, respectively. Sixty-two studies documented 166 graft failures in 2,120 reconstructions (7.8%). The extraphyseal technique was least likely to result in growth disturbances and graft failure. Paediatric ACL reconstruction is a safe and effective treatment of rupture. Growth disturbances are least likely following extraphyseal tunnelling, and those resulting from transphyseal techniques can be minimised by reducing drill size, drilling steep and avoiding the physeal periphery. The insertion of hardware, synthetic material, or a bone plug through the drilled physis should be avoided. There is a greater need for robust long-term data collection, such as national ligament registries, to standardise practice and evaluate the risk of growth disturbance and re-ruptures in this treatment.
PubMed: 37456432
DOI: 10.7759/cureus.40455 -
World Journal of Gastroenterology Apr 2015To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse. (Review)
Review
AIM
To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.
METHODS
MEDLINE, PubMed, EMBASE, and other relevant database were searched to identify studies. Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.
RESULTS
Twelve non-randomized case series studies with 574 patients were included in the review. No surgical mortality was described. Conversion was needed in 17 cases (2.9%), most often due to difficult adhesiolysis. Twenty eight patients (4.8%) presented with major complications. Seven (1.2%) mesh-related complications were reported. Most frequent complications were urinary tract infection and urinary retention. Mean recurrence rate was 4.7% with a median follow-up of 23 mo. Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%. Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages. Evaluation of functional score was disparate between studies.
CONCLUSION
Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.
Topics: Constipation; Digestive System Surgical Procedures; Fecal Incontinence; Humans; Laparoscopy; Postoperative Complications; Recovery of Function; Rectal Prolapse; Recurrence; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25945021
DOI: 10.3748/wjg.v21.i16.5049