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Journal of Orthopaedic Surgery (Hong... 2022To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) reduces rotational laxity of the knee,... (Meta-Analysis)
Meta-Analysis
Anterior cruciate ligament reconstruction with lateral extra-articular tenodesis reduces knee rotation laxity and graft failure rate: A systematic review and meta-analysis.
PURPOSE
To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) reduces rotational laxity of the knee, and to compare the clinical results of this treatment with those of ACLR alone.
METHODS
PubMed, Embase, and Cochrane Library were searched by two researchers for clinical studies comparing ACLR with and without LET. Studies with only evidence levels I and II and studies in which anterior lateral ligament reconstruction was performed with grafts were excluded. The risk of bias of the studies was assessed using the Cochrane risk-of-bias and modified Downs & Black tools. The outcomes included (1) functional outcomes; (2) knee laxity measures; (3) knee injury osteoarthritis and outcome score; and (4) complications. The outcomes of the two groups were extracted, summarized and compared.
RESULTS
A total of 234 studies were retrieved and 223 were excluded. Eleven clinical studies with 1745 patients were included in our meta-analysis. Compared to the patients who underwent ACLR alone, the patients who underwent ACLR with LET had reduced pivot-shift (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.31 to 0.74, = 0.0009), and lower graft failure rate (OR 0.34, 95% CI 0.20 to 0.55, < 0.0001).
CONCLUSION
Compared with ACLR only, ACLR combined with LET can effectively reduce rotation laxity of the knee joint, and reduce the graft failure rate in high-risk patients. However, the effects on the function and activity level of patients cannot be confirmed.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Joint Instability; Knee Joint; Osteoarthritis, Knee; Tenodesis
PubMed: 35465765
DOI: 10.1177/10225536221095969 -
Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review.Journal of Orthopaedics and... Sep 2015The benefits of acromioplasty in treating rotator cuff disease have been debated. We systematically reviewed the literature regarding whether acromioplasty with... (Review)
Review
BACKGROUND
The benefits of acromioplasty in treating rotator cuff disease have been debated. We systematically reviewed the literature regarding whether acromioplasty with concomitant coracoacromial (CA) release is necessary for the successful treatment of full-thickness rotator cuff tears.
MATERIALS AND METHODS
We identified randomized controlled trials that reported on patients who underwent rotator cuff repair with or without acromioplasty and used descriptive statistics to summarize the findings.
RESULTS
Four studies fulfilled the inclusion criteria. They reported on 354 patients (mean age, 59 years; range 3-81 years) with a mean follow-up of 22 months (range 12-24 months). There were two level-I and two level-II studies. Two studies compared rotator cuff repair with versus without acromioplasty, and two studies compared rotator cuff repair with versus without subacromial decompression (acromioplasty, CA ligament resection, and bursectomy). The procedures were performed arthroscopically, and the CA ligament was released in all four studies. There were no statistically significant differences in clinical outcomes between patients treated with acromioplasty compared with those treated without acromioplasty.
CONCLUSIONS
This systematic review of the literature does not support the routine use of partial acromioplasty or CA ligament release in the surgical treatment of rotator cuff disease. In some instances, partial acromioplasty and release of the CA ligament can result in anterior escape and worsening symptoms. Further research is needed to determine the optimum method for the operative treatment of full-thickness rotator cuff tears.
LEVEL OF EVIDENCE
Level I, systematic review of level I and II studies.
Topics: Acromion; Arthroplasty; Humans; Ligaments, Articular; Rotator Cuff Injuries; Tendon Injuries
PubMed: 26003837
DOI: 10.1007/s10195-015-0353-z -
Journal of Experimental Orthopaedics Aug 2021The purpose of this investigation was to systematically review the contemporary literature to determine if a lateral augmentation (LA) added to an Anterior Cruciate... (Review)
Review
PURPOSE
The purpose of this investigation was to systematically review the contemporary literature to determine if a lateral augmentation (LA) added to an Anterior Cruciate Ligament Reconstruction (ACLR) provides better clinical and patient reported outcomes compared to an isolated ACLR.
METHODS
A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on February 6, 2021 for level I-III randomized controlled trials (RCT) and prospective cohort studies without randomization, published after 2012 and with a minimum of two year follow-up. Publications were included when they reported on the objective knee stability examination, patient reported outcome scores, return to sports or graft rupture rate of any type of primary, isolated ACLR compared to ACLR combined with any type of LA.
RESULTS
A total of 11 studies that reported on a combined total of 1892 unique patients were eligible for data extraction, including five RCTs and six prospective cohort studies. In 6 studies, an Anterolateral Ligament reconstruction (ALLR) was the LA of choice, while the 5 other publications used different types of Lateral Extra-articular Tenodesis (LET). A significant reduction in graft ruptures was found in patients treated with ACLR + LA (3%) compared to isolated ACLR (12%). Rotational laxity was significantly higher in isolated ACLR (14%) compared to ACLR + LA (6%). Addition of a LA reduced anterior translation when assessed via instrumented laxity testing. No significant difference was found in the patient reported outcome scores (IKDC and Tegner) between both patient groups, except for the Lysholm Score which was significant in favour of the ACLR + LA group.
CONCLUSION
Combination of a primary ACLR with a LA can significantly reduce the risk of graft rupture and provide better rotatory stability, without jeopardizing patient reported outcomes.
LEVEL OF EVIDENCE
Level III, Systematic Review of Level I, II and III studies.
PubMed: 34383156
DOI: 10.1186/s40634-021-00368-5 -
Acta Orthopaedica Apr 2015To retain or to sacrifice the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) remains a matter of discussion. In this systematic review, we wanted to... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND AND PURPOSE
To retain or to sacrifice the posterior cruciate ligament (PCL) in total knee arthroplasty (TKA) remains a matter of discussion. In this systematic review, we wanted to find differences in functional and clinical outcome between the 2 methods.
METHODS
We conducted a systematic review and meta-analysis including all randomized controlled trials (RCTs) and quasi-RCTs that have compared PCL retention with PCL sacrifice in TKA with a minimum of 1-year follow-up. Primary outcome was range of motion. Secondary outcomes were knee pain and clinical scoring systems that were preferably validated. Quality of evidence was graded using the GRADE approach. All outcomes available for data pooling were used for meta-analysis.
RESULTS
20 studies involving 1,877 patients and 2,347 knees were included. In meta-analysis, the postoperative flexion angle had a mean difference of 2 degrees (95% CI: 0.23-4.0; p = 0.03) and the KSS functional score was 2.4 points higher in favor of PCL sacrifice (95% CI: 0.41-4.3; p = 0.02). There were no statistically significant differences regarding other measured clinical outcomes such as WOMAC, KSS pain, clinical and overall score, HSS score, SF-12, radiolucencies, femoro-tibial angle, and tibial slope. The quality of the studies varied considerably. Risk of bias in most studies was unclear; 5 were judged to have a low risk of bias and 5 to have a high risk of bias.
INTERPRETATION
We found no clinically relevant differences between retention and sacrifice of the PCL in TKA, in terms of functional and clinical outcomes. The quality of the studies ranged from moderate to low. Based on the current evidence, no recommendation can be made as to whether to retain or to sacrifice the PCL.
Topics: Arthroplasty, Replacement, Knee; Humans; Organ Sparing Treatments; Posterior Cruciate Ligament; Range of Motion, Articular; Treatment Outcome
PubMed: 25323799
DOI: 10.3109/17453674.2014.973329 -
The Journal of the American Academy of... Jun 2023Management of Anterior Cruciate Ligament Injuries : Evidence-based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of...
Management of Anterior Cruciate Ligament Injuries : Evidence-based Clinical Practice Guideline is based on a systematic review of published studies for the treatment of anterior cruciate ligament injurie in both skeletally mature and immature patients. This guideline contains eight recommendations and seven options to assist orthopaedic surgeons and all qualified physicians managing patients with ACL injuries based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.
Topics: Humans; United States; Anterior Cruciate Ligament Injuries; Knee Injuries; Orthopedic Surgeons; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament
PubMed: 36727995
DOI: 10.5435/JAAOS-D-22-01020 -
Orthopaedic Surgery May 2018Instead of extensive dissection of soft tissue around the fracture site, percutaneous techniques have unique advantages in managing displaced fragments, including... (Review)
Review
Instead of extensive dissection of soft tissue around the fracture site, percutaneous techniques have unique advantages in managing displaced fragments, including preservation of soft tissues, less blood loss, lower risk of complications, and earlier functional rehabilitation. However, there are few systematic reviews on the effects of percutaneous reduction and internal fixation (PRIF) for tibial plateau fractures. A systematic search of Cochrane, EMBASE, and MEDLINE databases was performed for all publicly available data in March 2017 regarding the use of PRIF in treating monocondylar tibial plateau fractures. Basic information of included articles, surgical information, clinical outcomes, and concomitant soft tissue injuries were collected for analysis. Finally, a total of 20 articles including 561 patients were retrieved. Traffic accident was the most common cause of injury. Percutaneous techniques using bone tamp reduction were described in all studies. The majority (≥85%) of patients were classified as excellent or good according to clinical and radiological Rasmussen scores. The overall complication rate was 6.6%, with loss of reduction the most frequent complication with an incidence of 2.4%. This systematic review indicated that PRIF was an optimal alternative that physicians should consider for the treatment of monocondylar tibial plateau fractures.
Topics: Fracture Fixation, Internal; Humans; Knee Injuries; Ligaments, Articular; Postoperative Complications; Radiography; Tibial Fractures
PubMed: 29770577
DOI: 10.1111/os.12372 -
Orthopaedic Journal of Sports Medicine Jun 2022Sufficient intra-articular graft ligamentization enhances the biomechanical and biological properties of the femur-graft-tibia complex to ensure knee stability after... (Review)
Review
BACKGROUND
Sufficient intra-articular graft ligamentization enhances the biomechanical and biological properties of the femur-graft-tibia complex to ensure knee stability after anterior cruciate ligament (ACL) reconstruction using a tendon graft. It remains unclear whether stem cell therapy promotes tendon graft ligamentization.
PURPOSE/HYPOTHESIS
The purpose of this study was to compare tendon graft ligamentization after primary ACL reconstruction with versus without stem cell therapy. It was hypothesized was that stem cell therapy would promote tendon graft ligamentization by enhancing the biomechanical and histological properties of the tendon graft after ACL reconstruction.
STUDY DESIGN
Systematic review.
METHODS
A systematic review was performed according to the guidelines outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to identify controlled animal studies that compared tendon graft ligamentization outcomes after primary ACL reconstruction in groups with and without stem cell therapy. Biomechanical and histological outcomes were assessed.
RESULTS
A total of 4 studies met the eligibility criteria and were included in this review. Bone marrow-derived mesenchymal stem cells were used in 3 studies, while tendon-derived stem cells were used in 1 study. An intra-articular injection was used to deliver conditioned medium and stem cells in 2 studies, while around-graft application was used to deliver bone marrow-derived mesenchymal stem cells in 2 studies. Stem cell therapy enhanced the biomechanical and histological properties of the tendon graft after ACL reconstruction.
CONCLUSION
This review revealed that stem cell therapy is a promising technique that promotes graft ligamentization by enhancing the biomechanical and histological properties of the tendon graft after ACL reconstruction in animal models. There is a need for future preclinical studies aimed at evaluating the effect of stem cells on graft ligamentization and identifying the optimal method of intra-articular stem cell delivery.
PubMed: 35706553
DOI: 10.1177/23259671221098363 -
PloS One 2022The ligaments in the knee are prone to injury especially during dynamic activities. The resulting instability can have a profound impact on a patient's daily activities...
BACKGROUND
The ligaments in the knee are prone to injury especially during dynamic activities. The resulting instability can have a profound impact on a patient's daily activities and functional capacity. Musculoskeletal knee modelling provides a non-invasive tool for investigating ligament force-strain behaviour in various dynamic scenarios, as well as potentially complementing existing pre-planning tools to optimise surgical reconstructions. However, despite the development and validation of many musculoskeletal knee models, the effect of modelling parameters on ligament mechanics has not yet been systematically reviewed.
OBJECTIVES
This systematic review aimed to investigate the results of the most recent studies using musculoskeletal modelling techniques to create models of the native knee joint, focusing on ligament mechanics and modelling parameters in various simulated movements.
DATA SOURCES
PubMed, ScienceDirect, Google Scholar, and IEEE Xplore.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Databases were searched for articles containing any numerical ligament strain or force data on the intact, ACL-deficient, PCL-deficient, or lateral extra-articular reconstructed (LER) knee joints. The studies had to derive these results from musculoskeletal modelling methods. The dates of the publications were between 1 January 1995 and 30 November 2021.
METHOD
A customised data extraction form was created to extract each selected study's critical musculoskeletal model development parameters. Specific parameters of the musculoskeletal knee model development used in each eligible study were independently extracted, including the (1) musculoskeletal model definition (i.e., software used for modelling, knee type, source of geometry, the inclusion of cartilage and menisci, and articulating joints and joint boundary conditions (i.e., number of degrees of freedom (DoF), subjects, type of activity, collected data and type of simulation)), (2) specifically ligaments modelling techniques (i.e., ligament bundles, attachment points, pathway, wrapping surfaces and ligament material properties such as stiffness and reference length), (3) sensitivity analysis, (4) validation approaches, (5) predicted ligament mechanics (i.e., force, length or strain) and (6) clinical applications if available. The eligible papers were then discussed quantitatively and qualitatively with respect to the above parameters.
RESULTS AND DISCUSSION
From the 1004 articles retrieved by the initial electronic search, only 25 met all inclusion criteria. The results obtained by aggregating data reported in the eligible studies indicate that considerable variability in the predicted ligament mechanics is caused by differences in geometry, boundary conditions and ligament modelling parameters.
CONCLUSION
This systematic review revealed that there is currently a lack of consensus on knee ligament mechanics. Despite this lack of consensus, some papers highlight the potential of developing translational tools using musculoskeletal modelling. Greater consistency in model design, incorporation of sensitivity assessment of the model outcomes and more rigorous validation methods should lead to better agreement in predictions for ligament mechanics between studies. The resulting confidence in the musculoskeletal model outputs may lead to the development of clinical tools that could be used for patient-specific treatments.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; Computer Simulation; Humans; Knee Joint; Mechanical Phenomena
PubMed: 35085320
DOI: 10.1371/journal.pone.0262684 -
Journal of Neuroengineering and... Mar 2017The development of interactive rehabilitation technologies which rely on wearable-sensing for upper body rehabilitation is attracting increasing research interest. This... (Review)
Review
BACKGROUND
The development of interactive rehabilitation technologies which rely on wearable-sensing for upper body rehabilitation is attracting increasing research interest. This paper reviews related research with the aim: 1) To inventory and classify interactive wearable systems for movement and posture monitoring during upper body rehabilitation, regarding the sensing technology, system measurements and feedback conditions; 2) To gauge the wearability of the wearable systems; 3) To inventory the availability of clinical evidence supporting the effectiveness of related technologies.
METHOD
A systematic literature search was conducted in the following search engines: PubMed, ACM, Scopus and IEEE (January 2010-April 2016).
RESULTS
Forty-five papers were included and discussed in a new cuboid taxonomy which consists of 3 dimensions: sensing technology, feedback modalities and system measurements. Wearable sensor systems were developed for persons in: 1) Neuro-rehabilitation: stroke (n = 21), spinal cord injury (n = 1), cerebral palsy (n = 2), Alzheimer (n = 1); 2) Musculoskeletal impairment: ligament rehabilitation (n = 1), arthritis (n = 1), frozen shoulder (n = 1), bones trauma (n = 1); 3) Others: chronic pulmonary obstructive disease (n = 1), chronic pain rehabilitation (n = 1) and other general rehabilitation (n = 14). Accelerometers and inertial measurement units (IMU) are the most frequently used technologies (84% of the papers). They are mostly used in multiple sensor configurations to measure upper limb kinematics and/or trunk posture. Sensors are placed mostly on the trunk, upper arm, the forearm, the wrist, and the finger. Typically sensors are attachable rather than embedded in wearable devices and garments; although studies that embed and integrate sensors are increasing in the last 4 years. 16 studies applied knowledge of result (KR) feedback, 14 studies applied knowledge of performance (KP) feedback and 15 studies applied both in various modalities. 16 studies have conducted their evaluation with patients and reported usability tests, while only three of them conducted clinical trials including one randomized clinical trial.
CONCLUSIONS
This review has shown that wearable systems are used mostly for the monitoring and provision of feedback on posture and upper extremity movements in stroke rehabilitation. The results indicated that accelerometers and IMUs are the most frequently used sensors, in most cases attached to the body through ad hoc contraptions for the purpose of improving range of motion and movement performance during upper body rehabilitation. Systems featuring sensors embedded in wearable appliances or garments are only beginning to emerge. Similarly, clinical evaluations are scarce and are further needed to provide evidence on effectiveness and pave the path towards implementation in clinical settings.
Topics: Accelerometry; Biomechanical Phenomena; Clothing; Humans; Movement; Posture; Range of Motion, Articular; Rehabilitation
PubMed: 28284228
DOI: 10.1186/s12984-017-0229-y -
Sports Health 2022Although anterior cruciate ligament (ACL) tears are relatively common in athletic populations, few studies have systematically reviewed graft choice in young women.
CONTEXT
Although anterior cruciate ligament (ACL) tears are relatively common in athletic populations, few studies have systematically reviewed graft choice in young women.
OBJECTIVE
To quantitatively and qualitatively examine reported outcomes for graft choice in women aged 25 years and younger undergoing primary ACL reconstruction.
DATA SOURCE
A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search in the PubMed (includes MEDLINE) and EMBASE databases was completed using a combination of key terms.
STUDY SELECTION
Studies were included if they reported graft choice outcomes in women aged 25 years and younger.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
The following information was extracted: title, author, year of publication, number of female patients and age, graft type, follow-up, and patient-reported outcome measures. The following outcome scores were identified as being reported or not reported by each study: graft failure, contralateral ACL (CACL) rupture, IKDC (International Knee Documentation Committee), graft survival (Kaplan-Meier), Lysholm, Tegner, KT-1000, kneeling pain, return to sport, and Lachman.
RESULTS
Of 1170 identified articles, 16 met inclusion criteria, reporting on 1385 female patients aged 25 years and younger. Comparison of 655 bone-patellar tendon-bone (BPTB) versus 525 hamstring tendon (HT) autografts showed significant differences in mean failure rate between BPTB autografts (6.13% ± 2.58%) and HT autografts (17.35% ± 8.19%), = 0.001. No statistically significant differences in CACL failure rates were found between BPTB autografts and HT autografts ( = 0.25). Pooled results for IKDC were possible in 3 of the HT autograft studies, showing a mean score of 88.31 (95% CI 83.53-93.08). Pooled Lysholm score results were possible in 2 of the HT autograft studies, showing a mean score of 93.46 (95% CI 91.90-95.01).
CONCLUSION
In female patients aged 25 years and younger, BPTB autografts showed significantly less graft failure compared with HT autografts. However, BPTB autografts had comparable patient-reported outcomes compared with HT autografts with the available data. The overall state of evidence for graft choice in female patients aged 25 years and younger is low. Future studies should report statistics by age and sex to allow for further analysis of graft choice for this specific population that is known to be more vulnerable to ACL injury.
Topics: Female; Humans; Bone-Patellar Tendon-Bone Grafting; Anterior Cruciate Ligament Reconstruction; Anterior Cruciate Ligament Injuries; Hamstring Tendons; Patellar Ligament; Transplantation, Autologous
PubMed: 35343326
DOI: 10.1177/19417381221079632