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Medicine Sep 2018With conflicting results in the literature, it remains unclear whether a higher field strength automatically increases the sensitivity and specificity of magnetic... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
With conflicting results in the literature, it remains unclear whether a higher field strength automatically increases the sensitivity and specificity of magnetic resonance imaging (MRI) for detecting pathological lesions in the knee. Therefore, we performed a systematic review and meta-analysis of studies comparing the diagnostic accuracy of 1.5- and 3.0-T MRI for lesions within the knee.
METHODS
Sixteen studies were included in the meta-analysis of the diagnostic accuracy of MRI for lesions of the knee joint, and areas under the curve (AUC) derived from the summary receiver operating characteristic curve analysis were determined for comparison of the diagnostic accuracy with differing magnetic field strength as well as for lesions in different tissues of the knee. Separate meta-analyses were performed for the diagnosis of lesions within articular cartilage, ligaments, and meniscus.
RESULTS
For lesions within the articular cartilage, the AUC for 1.5-T MRI differed significantly from that for 3.0-T MRI (Z = 3.4, P < .05). However, for lesions within the ligaments and meniscus, the AUC values for 1.5-T MRI did not differ significantly from those for 3.0-T MRI (Z = 0.32, P > .05, and Z = 0.33, P > .05, respectively).
CONCLUSION
Our results indicate that both 1.5-T and 3.0-T MRI offer high diagnostic accuracy and clinical relevance for knee injuries involving the meniscus or a ligament. However, the present meta-analysis indicates that 3.0-T MRI does offer greater diagnostic accuracy than 1.5-T MRI for articular cartilage lesions.
Topics: Bone Diseases; Cartilage, Articular; Humans; Joint Diseases; Knee; Knee Joint; Magnetic Resonance Imaging; Predictive Value of Tests; Sensitivity and Specificity
PubMed: 30235710
DOI: 10.1097/MD.0000000000012401 -
Journal of the American Academy of... Dec 2022Thumb carpometacarpal (CMC) joint dislocations are rare with minimal agreement on surgical management. The dorsoradial ligament (DRL) is the primary joint stabilizer but...
INTRODUCTION
Thumb carpometacarpal (CMC) joint dislocations are rare with minimal agreement on surgical management. The dorsoradial ligament (DRL) is the primary joint stabilizer but has not historically been reconstructed. We hypothesize that the reported reconstruction of first CMC joint dislocations primarily uses the flexor carpi radialis (FCR) without collective agreement on a surgical technique.
METHODS
A systematic review of the PubMed database from 1996 to 2022 was done. Keywords were "thumb dislocation," "thumb carpometacarpal dislocation," and "carpometacarpal joint ligament repair." Inclusion criteria included isolated, unstable thumb CMC dislocations with reconstruction. The Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were used.
RESULTS
Four hundred thirty-seven records were identified, and nine met inclusion criteria. Two articles were cohort studies, and seven were case reports. Thirty-seven patients were included, and 26 patients had reconstruction with tendonous autograft. Twenty-five (96.2%) used the FCR and 1 (3.9%) from the palmaris longus. Three patients had reconstruction with a suture anchor. Surgical techniques varied between studies.
DISCUSSION
The recommendation of the authors recreates the DRL during autograft repair. Current repair techniques that recreate the DRL use the FCR, but quantitative comparisons of tendonous autografts or suture anchors have not been done.
Topics: Humans; Carpometacarpal Joints; Thumb; Joint Dislocations; Plastic Surgery Procedures; Ligaments, Articular
PubMed: 36732303
DOI: 10.5435/JAAOSGlobal-D-22-00103 -
Spine Jul 2018Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF).
SUMMARY OF BACKGROUND DATA
OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF.
METHODS
A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model.
RESULTS
A total of 137 patients were included. The pooled pre- and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70-7.47; I = 98%) and 8.29 (95% CI, 7.73-8.85; I = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08-4.98; I = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6-26.1; I = 0%), 12.1% (95% CI, 6.6-21.2; I = 0%), 5.8% (95% CI, 2.1-15.4; I = 0%), and 5.7% (95% CI, 2.2-14.3; I = 0%), respectively.
CONCLUSION
Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF.
LEVEL OF EVIDENCE
3.
Topics: Humans; Laminectomy; Ligamentum Flavum; Ossification, Heterotopic; Postoperative Complications; Spinal Cord Diseases; Thoracic Vertebrae; Treatment Outcome
PubMed: 29940604
DOI: 10.1097/BRS.0000000000002563 -
Orthopaedic Journal of Sports Medicine Sep 2021Residual rotational instability after isolated anterior cruciate ligament reconstruction (ACLR) has been a challenge for many years. Anterolateral extra-articular... (Review)
Review
Clinical Outcomes of Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis Combined With Primary ACL Reconstruction: A Systematic Review With Meta-analysis.
BACKGROUND
Residual rotational instability after isolated anterior cruciate ligament reconstruction (ACLR) has been a challenge for many years. Anterolateral extra-articular procedures (AEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET), are performed as a surgical option for additional rotational stability, but clear evidence for their usefulness is lacking.
PURPOSE
To conduct a systematic review and meta-analysis of the literature regarding the efficacy of AEAP in primary ACLR.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
A literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. MEDLINE, EMBASE, and the Cochrane Library were searched in April 2020, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 3444 studies were screened, and 20 studies (11 randomized controlled trials and 9 nonrandomized studies) were evaluated. Functional outcomes, stability, and complications were compared between patients who underwent primary ACLR with AEAP and those who underwent isolated primary ACLR. For subgroup analysis, outcomes were compared according to AEAP technique (ALLR vs LET) and time from injury to surgery (≤12 vs >12 months). The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool, Jadad scale, and Newcastle-Ottawa Scale.
RESULTS
Compared with isolated ACLR, combined ACLR with AEAP led to improved pivot-shift grades and graft failure rates, regardless of the AEAP technique or of time from injury to surgery. A limited, marginal improvement in subjective function score was observed in patients who underwent AEAP combined with ACLR. In contrast to ALLR, patients who underwent LET combined with ACLR had an increased risk of knee stiffness and adverse events.
CONCLUSION
Our review suggests that when there is a need to improve rotational stability and subjective function, AEAP combined with primary ACLR can be considered regardless of time from injury. ALLR appeared to be a better option for improving rotational stability compared with LET.
PubMed: 34541008
DOI: 10.1177/23259671211023099 -
Journal of Orthopaedics and... Apr 2022Our aim was to evaluate the literature investigating proprioception improvement after anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that ACL...
AIM
Our aim was to evaluate the literature investigating proprioception improvement after anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that ACL tibial remnant-preserving reconstruction (ACLR-R) is more beneficial than standard technique (ACLR-S) in terms of postoperative proprioceptive function with various reported tests, including joint position sense (JPS) and threshold to detect passive motion (TTDPM).
METHODS
An online search was performed in Embase, MEDLINE/PubMed, Cochrane, SPORTDiscus, and Web of Science databases before 5 October 2020, on the basis of the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Key terms [('ACLR' or 'ACL-R' or 'anterior cruciate ligament reconstruction') AND ('remnant' or 'stump') AND ('proprioception' or 'proprioceptive')] were used. The Oxford Centre for Evidence-Based Medicine and The McMaster Critical Review Form for Quantitative Studies were used for quality assessment. In total, four articles comparing proprioceptive functions between ACLR-R and ACLR-S were included, two of which were randomized clinical trials rated as level of evidence II, and two were retrospective cohort studies rated as level of evidence III. The outcomes were then compared. Evaluation of proprioception involved joint position sense (JPS) [reproduction of active positioning (RAP) and reproduction of passive positioning (RPP)] and threshold to detect passive motion (TTDPM) tests.
RESULTS
Only four studies were included, with a total of 234 patients (119 ACLR-R patients and 115 ACLR-S patients). High heterogeneity in characteristics and outcome measurements was observed among the studies. Three studies performed sparing technique, and one performed tensioning technique. One study tested RAP and reported better results at an average of 7 months follow-up in ACLR-R (P < 0.05). Three studies tested RPP, one of which measured RPP within 12 months after surgery and reported better results in ACLR-R than in ACLR-S (P < 0.05). The other two studies reported similar results; however, the findings of one study were statistically insignificant. TTDPM was tested in one study, with no statistically significant difference found.
CONCLUSION
The current literature, although limited, reported proprioception improvement after ACLR-R (compared with ACLR-S) in terms of JPS. However, owing to the heterogeneity of the relevant studies, further research is required to determine remnant preservation effect on knee proprioceptive restoration.
LEVEL OF EVIDENCE
Level III, systematic review of Level II and III studies.
Topics: Anterior Cruciate Ligament Reconstruction; Humans; Knee Joint; Proprioception; Range of Motion, Articular; Retrospective Studies
PubMed: 35478294
DOI: 10.1186/s10195-022-00641-y -
Knee Surgery, Sports Traumatology,... Dec 2022Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories:... (Review)
Review
PURPOSE
Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle.
METHODS
A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient's subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures.
RESULTS
Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes.
CONCLUSIONS
The systematic analysis of validated CAI outcome measures and the patient's subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient's subjective satisfaction.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Ankle; Allografts; Lateral Ligament, Ankle; Joint Instability; Ankle Joint; Autografts
PubMed: 35916928
DOI: 10.1007/s00167-022-07071-7 -
The American Journal of Sports Medicine Mar 2024Lateral extra-articular procedures are becoming increasingly popular in association with anterior cruciate ligament (ACL) reconstruction, especially in patients with... (Meta-Analysis)
Meta-Analysis
A Lateral Extra-articular Procedure Reduces the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Surgery Without Increasing Complications: A Systematic Review and Meta-analysis.
BACKGROUND
Lateral extra-articular procedures are becoming increasingly popular in association with anterior cruciate ligament (ACL) reconstruction, especially in patients with persistent rotatory instability and in a high-risk population. However, few studies have investigated the outcomes of the lateral extra-articular procedure as an associated procedure in an ACL revision (R-ACLR) setting and its benefit with respect to isolated intra-articular reconstruction.
HYPOTHESIS
Lateral extra-articular procedures reduce the failure rate of revision ACL reconstruction (R-ACLR).
PURPOSE
To compare subjective outcomes, knee stability, and failure and complication rates between patients who underwent ACL revision with and without an associated lateral extra-articular procedure.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 3.
METHODS
A systematic search of the PubMed, Cochrane, and OVID databases was performed on September 2022 in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies were trials directly comparing patients who had isolated ACL revision with patients who had ACL revision associated with lateral extra-articular procedures at a minimum follow-up of 2 years. A meta-analysis was performed, and bias and the quality of the evidence were rated according to the Newcastle-Ottawa Scale. The meta-analysis was conducted according to the PRISMA guidelines.
RESULTS
Eight studies were included: a total of 334 patients were treated with isolated revision (isolated (R-ACLR)) and 342 treated with combined revision and a lateral extra-articular procedure (combined (R-ACLR)). For the failure rate, the meta-analysis showed a significantly decreased relative risk reduction of 54% ( = .004) in patients with combined (R-ACLR) with respect to isolated R-ACL, whereas no difference in complication rate was observed. The combined (R-ACLR) group demonstrated a decreased risk ratio of 50% ( = .002) for having a positive pivot-shift test result and a relative risk reduction of 68% ( = .003) for having a grade 2-3 pivot shift when compared with the isolated (R-ACLR) group. Finally, no significant differences were observed among the lateral extra-articular procedures.
CONCLUSION
The addition of a lateral extra-articular procedure to revision ACL significantly reduced the failure rate and postoperative pivot shift without increasing the complication rate. Anterolateral ligament reconstruction and a lateral extra-articular procedure with iliotibial band were effective in improving the outcomes of revision ACL reconstruction. Further high-level studies could help to clarify which subgroup of patients could particularly benefit from an anterolateral procedure in the context of ACL revision.
Topics: Humans; Anterior Cruciate Ligament Injuries; Tenodesis; Joint Instability; Knee Joint; Anterior Cruciate Ligament Reconstruction
PubMed: 38294248
DOI: 10.1177/03635465231173698 -
European Journal of Orthopaedic Surgery... Aug 2023Clinical outcomes and potential complications associated with Bone-Patellar Tendon-Bone (BPTB) graft in skeletally immature ACL reconstruction (ACLR) are poorly defined.... (Review)
Review
BACKGROUND
Clinical outcomes and potential complications associated with Bone-Patellar Tendon-Bone (BPTB) graft in skeletally immature ACL reconstruction (ACLR) are poorly defined. Considering that in Tanner 1-2 patients this kind of graft is not recommended, we focused our systematic review on the evaluation of all the studies in the literature that reported clinical outcomes and rate of complications of the ACLR using BPTB graft in Tanner 3-4 patients.
METHODS
This review was conducted in accordance with the PRISMA statement. PubMed, Cochrane Library, EMBASE and Scopus were examined from 1965 to 2020 using different combinations of the following keywords: "ACL reconstruction", "skeletally immature", "young", "patellar tendon" and "BPTB". The database search yielded 742 studies, on which we performed a primary evaluation. After carrying out a full-text evaluation for the inclusion criteria, 4 studies were included in the final review and assessed using the Newcastle-Ottawa scale. Ninety-six cases with mean age of 14.2 years were reported.
RESULTS
Good stability and functional outcomes were reported with a mean follow-up of 49.5 months. Return to sport rate ranged from 91.7% to 100%. A KT-1000 side-to-side difference higher than 5 mm was observed in five patients (5.2%). No lower limb length discrepancy and angulation were reported. Graft rupture rate was 5.2%.
CONCLUSION
According to these results, BTPB graft could be a good choice in Tanner 3-4 patients who want to achieve their preinjury sport level with a low risk of growth disturbances and graft failure. Further investigations in a wider population are needed.
Topics: Humans; Adolescent; Bone-Patellar Tendon-Bone Grafting; Anterior Cruciate Ligament Reconstruction; Patellar Ligament; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Transplantation, Autologous
PubMed: 36307618
DOI: 10.1007/s00590-022-03402-z -
BMC Musculoskeletal Disorders Feb 2024Current treatment concepts for simple elbow dislocation involve conservative and surgical approaches. The aim of this systematic review was to identify the superiority...
BACKGROUND
Current treatment concepts for simple elbow dislocation involve conservative and surgical approaches. The aim of this systematic review was to identify the superiority of one treatment strategy over the other by a qualitative analysis in adult patients who suffered simple elbow luxation.
STUDY DESIGN
A systematic review in accordance with the PRISMA guidelines and following the suggestions for reporting on qualitative summaries was performed. A literature search was conducted using PubMed and Scopus, including variations and combinations of the following keywords: elbow, radiohumeral, ulnohumeral, radioulnar, luxation, and therapy. Seventeen studies that performed a randomized controlled trial to compare treatment strategies as conservative or surgical procedures were included. Reviews are not selected for further qualitative analysis. The following outcome parameters were compared: range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand outcome measure (Quick-DASH), recurrent instability, pain measured by visual analog scale (VAS) and time to return to work (RW).
RESULTS
Early mobilization after conservative treatment strategies showed improved ROM compared to immobilization for up to 3 weeks after surgery with less extension deficit in the early mobilization group (16° ± 13°. vs. 19.5° ± 3°, p < 0.05), as well as excellent clinical outcome scores. Surgical approaches showed similar results compared to conservative treatment, leading to improved ROM (115 vs. 118 ± 2.8) and MEPS: 95 ± 7 vs. 92 ± 4.
CONCLUSION
Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. The surgical procedure provides similar outcomes compared to conservative treatment regarding MEPS and ROM for patients with slight initial instability in physical examination and radiographs. People with red flags for persistent instability, such as severe bilateral ligament injuries and moderate to severe instability during initial physical examination, should be considered for a primary surgical approach to prevent recurrent posterolateral and valgus instability. Postoperative early mobilization and early mobilization for conservatively treated patients is beneficial to improve patient outcome and ROM.
Topics: Adult; Humans; Elbow; Elbow Injuries; Treatment Outcome; Range of Motion, Articular; Joint Dislocations; Elbow Joint; Joint Instability; Retrospective Studies; Randomized Controlled Trials as Topic
PubMed: 38365699
DOI: 10.1186/s12891-024-07260-0 -
PloS One 2016The posterior cruciate ligament (PCL) is the strongest ligament of the knee, serving as one of the major passive stabilizers of the tibio-femoral joint. However, despite... (Review)
Review
BACKGROUND
The posterior cruciate ligament (PCL) is the strongest ligament of the knee, serving as one of the major passive stabilizers of the tibio-femoral joint. However, despite a number of experimental and modelling approaches to understand the kinematics and kinetics of the ligament, the normal loading conditions of the PCL and its functional bundles are still controversially discussed.
OBJECTIVES
This study aimed to generate science-based evidence for understanding the functional loading of the PCL, including the anterolateral and posteromedial bundles, in the healthy knee joint through systematic review and statistical analysis of the literature.
DATA SOURCES
MEDLINE, EMBASE and CENTRAL.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Databases were searched for articles containing any numerical strain or force data on the healthy PCL and its functional bundles. Studied activities were as follows: passive flexion, flexion under 100N and 134N posterior tibial load, walking, stair ascent and descent, body-weight squatting and forward lunge.
METHOD
Statistical analysis was performed on the reported load data, which was weighted according to the number of knees tested to extract average strain and force trends of the PCL and identify deviations from the norms.
RESULTS
From the 3577 articles retrieved by the initial electronic search, only 66 met all inclusion criteria. The results obtained by aggregating data reported in the eligible studies indicate that the loading patterns of the PCL vary with activity type, knee flexion angle, but importantly also the technique used for assessment. Moreover, different fibres of the PCL exhibit different strain patterns during knee flexion, with higher strain magnitudes reported in the anterolateral bundle. While during passive flexion the posteromedial bundle is either lax or very slightly elongated, it experiences higher strain levels during forward lunge and has a synergetic relationship with the anterolateral bundle. The strain patterns obtained for virtual fibres that connect the origin and insertion of the bundles in a straight line show similar trends to those of the real bundles but with different magnitudes.
CONCLUSION
This review represents what is now the best available understanding of the biomechanics of the PCL, and may help to improve programs for injury prevention, diagnosis methods as well as reconstruction and rehabilitation techniques.
Topics: Humans; Knee Joint; Posterior Cruciate Ligament; Weight-Bearing
PubMed: 27880849
DOI: 10.1371/journal.pone.0167106