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World Journal of Clinical Cases Jul 2023The medial patellofemoral ligament (MPFL), along with the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament, aid in the stabilization of the...
BACKGROUND
The medial patellofemoral ligament (MPFL), along with the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament, aid in the stabilization of the patellofemoral joint. Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter, this ligament is critical in maintaining joint stability. There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.
AIM
To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.
METHODS
By May 8, 2022, four electronic databases were searched: Medline (PubMed), Scopus, Web of Science, and Google Scholar. General keywords such as "patellar instability," "patellar dislocation," "MPFL," "medial patellofemoral ligament," "MPTL," and "medial patellotibial ligament" were co-searched to increase the sensitivity of the search.
RESULTS
The pooled effects of combined MPFL and MPTL reconstruction for Kujala score (12-mo follow-up) and Kujala score (24-mo follow-up) were positive and incremental, according to the findings of this meta-analysis. The mean difference between the Cincinnati scores was also positive, but not statistically significant. The combination of the two surgeries reduces pain. According to cumulative meta-analysis, the trend of pain reduction in various studies is declining over time.
CONCLUSION
The combined MPFL and MPTL reconstruction has good clinical results in knee function and, in addition to providing good control to maintain patellofemoral joint balance, the patient's pain level decreases over time, making it a valid surgical method for patella stabilization.
PubMed: 37469731
DOI: 10.12998/wjcc.v11.i19.4625 -
Journal of Orthopaedic Trauma Feb 2024To compare, in a systematic review, Krakow transosseous (KT) suturing and separate vertical wiring (VW) fixation methods in inferior pole fractures of the patella and to... (Meta-Analysis)
Meta-Analysis
Comparison of Fixation Methods Between Transosseous Pull-Out Suture and Separate Vertical Wiring for Inferior Pole Fracture of Patella: A Systematic Review and Meta-Analysis.
OBJECTIVES
To compare, in a systematic review, Krakow transosseous (KT) suturing and separate vertical wiring (VW) fixation methods in inferior pole fractures of the patella and to evaluate whether the supplementary fixation affected bone union.
DATA SOURCES
The MEDLINE, Embase, and Cochrane databases were searched from inception to January 15, 2023. The keywords were "patella inferior pole fracture", "patella distal pole fracture", "transosseous", "pull-out suture", "reattachment", and "vertical wiring".
STUDY SELECTION
All clinical studies describing KT or VW techniques for inferior pole fracture of the patella and reporting bone union-related complications were included.
DATA EXTRACTION
This meta-analysis included 16 studies with 274 patellae. Demographic data, surgical techniques, clinical outcomes, and complication rates were recorded. The Methodological Index for Non-Randomized Studies criteria were used to assess their quality.
DATA SYNTHESIS
A meta-analysis was performed using random-effects models and meta-regression. The meta-analytic estimate of bone union-related complications was 3.8% (95% CI, 1.6%-6.0%) for either PO or VW techniques in inferior pole fractures of the patella. The bone union-related complication rates did not differ significantly between the two techniques (KT, 5.7%; VW, 3.0%; P = .277). Meanwhile, supplementation fixation was significantly associated with decrease in bone union-related complication rates ( p = .013).
CONCLUSIONS
Fixation of inferior pole fractures of the patella using either KT or VW techniques provided satisfactory and similar clinical results with minimal bone union-related complications. Supplementary fixation has a positive impact on reducing bone union-related complications in inferior pole fractures of the patella following KT and VW techniques.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Knee Injuries; Patella; Sutures; Treatment Outcome
PubMed: 38031280
DOI: 10.1097/BOT.0000000000002725 -
European Journal of Trauma and... Apr 2024The application of the suprapatellar (SP) approach has challenged the traditional infrapatellar (IP) approach in the surgery treatment of tibial shaft fractures, yet the... (Meta-Analysis)
Meta-Analysis Comparative Study Review
BACKGROUND
The application of the suprapatellar (SP) approach has challenged the traditional infrapatellar (IP) approach in the surgery treatment of tibial shaft fractures, yet the advantages and disadvantages still remain controversial. We included more high-quality studies for this meta-analysis and systematic review to evaluate the clinical outcomes and prognosis of both approaches and thus to provide new ideas for surgeons.
METHOD
We searched literatures from PubMed, Cochrane Library, Web of Science, and EMBASE databases from January 2000 to December 2022. We extracted general information including sample size, gender, proportion of open fracture, follow-up time, and outcome indicators including entrance accuracy, fluoroscopy time, operation time, intraoperative blood loss, Lysholm score, VAS pain score, range of motion (ROM) function score, reposition accuracy, and revision cases. Cochrane Collaboration's tool and the Newcastle-Ottawa Scale were used to evaluate literature qualities. Meta-analysis was performed using RevMan 5.4 software.
RESULTS
A total of 23 studies were generated that qualified for inclusion, 17 of which were used for meta-analysis. This study found statistically significant differences in coronal plane entrance accuracy, fluoroscopy time, Lysholm score, and VAS pain score.
CONCLUSION
The results of our meta-analysis showed that the SP approach was significantly better than the IP approach in angle and distance entrance accuracy of coronal plane, angle entrance accuracy of sagittal plane, fluoroscopy time, Lysholm score, and VAS pain score. There were no significant differences in sagittal angle accuracy, operative time, intraoperative blood loss, and ROM score.
Topics: Humans; Fracture Fixation, Intramedullary; Tibial Fractures; Range of Motion, Articular; Operative Time; Patella
PubMed: 37989960
DOI: 10.1007/s00068-023-02384-9 -
The Journal of Orthopaedic and Sports... Jan 2024It is unclear if clinical trials of treatments for lower-limb tendinopathies include clinically homogeneous participant populations (an assumption for pooling in... (Meta-Analysis)
Meta-Analysis Review
It is unclear if clinical trials of treatments for lower-limb tendinopathies include clinically homogeneous participant populations (an assumption for pooling in meta-analyses). We assessed the recruitment setting and participant characteristics used in randomized controlled trials (RCTs) that were investigating any treatment for lower-limb tendinopathies. Scoping review. We conducted a systematic literature search in the PubMed, Embase, Cochrane CENTRAL, and Web of Science databases. All RCTs that were investigating treatments for lower-limb tendinopathies in an adult population (≥18 years) were eligible for inclusion. At least 2 authors conducted independent screening and selection of full-text papers, and extracted data from included studies. Of 18 341 records, 342 RCTs (21 897 participants) were eligible for inclusion and data extraction. The most common diagnoses were plantar fasciopathy (n = 195, 57%), Achilles tendinopathy (n = 82, 24%), and patellar tendinopathy (n = 41, 12%). Secondary care (n = 144, 42%) was the most reported recruitment setting, followed by an open setting (n = 44, 13%). In 93 (27%) RCTs, the recruitment setting was not described. We found high heterogeneity in participant characteristics (eg, symptom duration, age, body mass index, and the Victorian Institute of Sport Assessment [VISA] questionnaire score) within and between recruitment settings. Our results question whether clinical homogeneity can be adequately assumed in clinical trials of lower-limb tendinopathies due to the lack of clear reporting of the recruitment setting and the variability within and between recruitment settings of key participant characteristics. These findings threaten assumptions for meta-analyses in lower-limb tendinopathies. .
Topics: Adult; Humans; Exercise Therapy; Lower Extremity; Patella; Sports; Tendinopathy
PubMed: 38051676
DOI: 10.2519/jospt.2023.11722 -
Journal of Orthopaedics Aug 2023Patellar instability can arise from a traumatic event with anatomical predisposing factors increasing the risk of dislocation. Accurate diagnosis is required to initiate... (Review)
Review
INTRODUCTION
Patellar instability can arise from a traumatic event with anatomical predisposing factors increasing the risk of dislocation. Accurate diagnosis is required to initiate appropriate treatment. We aimed to evaluate the patella apprehension test (PAT) as a method to diagnose patellar instability.
METHODS
The PRISMA diagnostic test accuracy checklist was followed. The review protocol was registered on PROSPERO with registration number CRD42022357898. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. A narrative synthesis evaluated the validity of the PAT as a method of diagnosing patellar instability.
RESULTS
A total of 4867 records were screened in the initial search. Of these, 34 articles satisfied the inclusion criteria, assessing 1139 knees of 1046 patients. The PAT was found to have a high sensitivity and specificity. Its intra and inter-rater reliability was highly variable among studies. Studies reporting patellar instability correction following surgery also found a decrease in the number of patients exhibiting a positive PAT.
CONCLUSION
Current evidence suggests that the PAT has a high sensitivity and specificity. The intra- and inter-rater validities of the PAT are widely variable due to its subjective nature. Thus, though the PAT can be used to provide a provisional clinical diagnosis of patellar instability, formal functional assessment and imaging should be performed to confirm the diagnosis. Further research should explore the association between a positive PAT and anatomical parameters. In addition, studies comparing the accuracy of the PAT and radiological investigations should be performed.
PubMed: 37483643
DOI: 10.1016/j.jor.2023.07.005 -
Orthopaedic Journal of Sports Medicine Jan 2024Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the...
BACKGROUND
Osteochondral injuries (OCIs) are common in patients with acute lateral patellar dislocation, which can produce both short- and long-;term adverse effects. However, the pattern of these injuries warrants further analysis, especially in relation to patient age.
PURPOSE
To determine the overall prevalence of concomitant OCIs as well as the prevalence differences based on location and age after acute lateral patellar dislocations.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to July 20, 2022. All articles reporting the prevalence of OCI were included. The sample characteristics such as age, study design, magnetic resonance imaging diagnostic data, and the number of patients with OCI were extracted. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. The overall and per-;site injury rates were calculated, and the prevalence was stratified by age-;group (≤16 and >16 years) and compared.
RESULTS
The systematic review included 39 studies involving 3354 patients. MINORS scores were 11.94 ± 1.98 and 16 ± 3.46 in the noncomparative and comparative studies, respectively. The overall prevalence of bone bruises and OCI was 89.6% (95% CI, 77.4%-97.7%) and 48.8% (95% CI, 39.0%-58.7%), respectively. In both overall and >16-year-old patients, the lateral femoral condyle (LFC) was the most common site of bone bruise (90.5% [95% CI, 84.0%-95.6%] and 91.5% [95% CI, 84.3%-96.9%], respectively); however, the medial patellar bruise was more common in patients ≤16 years (89.2% [95% CI, 82.9%-94.4%]). Among the pooled sites of OCI, the medial patella accounted for the largest proportion (36.9% [95% CI, 28.0%-46.3%]). OCIs were more common in patients >16 years (52.6% [95% CI, 39.4%-65.6%]) than in patients ≤16 years (46.6% [95% CI, 33.2%-60.3%]).
CONCLUSION
Bone bruises on the LFC were most prevalent overall and in patients >16 years, whereas bone bruises on the medial patella were more prevalent in patients ≤16 years. OCIs were frequently seen in patients >16 years, with the most common site being the medial patella.
PubMed: 38274015
DOI: 10.1177/23259671231220904 -
Knee Surgery, Sports Traumatology,... Dec 2023The purpose of this systematic review was to critically assess the quality of papers that report on the intra- and inter-observer repeatability of the Dejour... (Review)
Review
PURPOSE
The purpose of this systematic review was to critically assess the quality of papers that report on the intra- and inter-observer repeatability of the Dejour classification for trochlear dysplasia, and to identify the possible causes for poor repeatability.
METHODS
Two authors independently conducted an electronic search (four databases) on 8 February 2023 for studies (English or French) that assessed trochlear dysplasia classifications on imaging of skeletally mature participants. Exclusion criteria were reviews of clinical studies, conference proceedings, or editorials. After title, abstract, and full-text screening, characteristics of eligible studies were tabulated (author, year, journal, study design, cohort characteristics, and intra- and/or inter-observer agreement coefficients). The methodological quality of studies was assessed using the Joanna Briggs Institute (JBI) checklist for analytical cross-sectional studies. Authors analysed three components of the included studies: (1) classifications based on true lateral radiographs and slice imaging; (2) dysplasia graded into Type A vs B vs C vs D and 3) coefficients of intra- and/or inter-observer agreement.
RESULTS
The electronic search returned 3,178 references, and after removal of duplicates and irrelevant studies, ten were eligible for data extraction. A second search (31 July 2023) yielded one additional study. Eight studies did not include lateral radiographs, two studies did not explicitly state if radiographs were true lateral views, and one used true lateral radiographs in isolation. Classification of trochlear dysplasia into A vs B vs C vs D using different imaging modalities resulted in moderate to near-perfect intra-observer agreement, and slight to near-perfect inter-observer agreement. Studies distinguished between moderate and severe dysplasia using a variety of combinations: A vs B/C/D, A/B vs C/D and A/C vs B/D.
CONCLUSION
This systematic review revealed that the Dejour classification remains the most widely used to assess trochlear dysplasia and that the majority of studies that assessed the reliability of the Dejour classification, reported moderate to near-perfect inter-observer agreement; however, pooling of results for comparison among the included studies was inappropriate due to substantial variation in imaging protocols and non-standardised criteria to distinguish severe from moderate dysplasia.
LEVEL OF EVIDENCE
Level IV.
TRIAL REGISTRY
The PROSPERO registration number is CRD42023386731.
Topics: Humans; Magnetic Resonance Imaging; Reproducibility of Results; Cross-Sectional Studies; Joint Instability; Radiography; Patellofemoral Joint
PubMed: 37919443
DOI: 10.1007/s00167-023-07612-8 -
Journal of ISAKOS : Joint Disorders &... Jun 2024Patellofemoral instability (PFI) has multiple predisposing anatomic factors, including ligamentous hyperlaxity, coronal and axial malalignment, patella alta, trochlea... (Review)
Review
Femoral internal torsion greater than twenty-five degrees and/or external tibial torsion greater than thirty degrees as measured by computed tomography are threshold values for axial alignment correction in patellofemoral instability.
OBJECTIVES
Patellofemoral instability (PFI) has multiple predisposing anatomic factors, including ligamentous hyperlaxity, coronal and axial malalignment, patella alta, trochlea dysplasia, excessive lateral patellar tilt, and excessive lateral Q vector. Yet, few studies have analyzed surgical thresholds for performing axial alignment corrective osteotomies in the treatment of PFI and patella maltracking. The objective of this systematic literature review was to determine if there is a threshold for axial plane alignment that triggers surgical correction for the treatment of patellar instability in the published literature.
METHODS
Using a predetermined search strategy, a systematic literature search of 10 major databases and gray literature resources was completed. Only studies reporting on patellar instability and outcomes were included. Radiologic indications, additional procedures, outcomes, and complications were reported. Titles and abstracts were screened, and full-text manuscripts were then selected and extracted. Variables related to radiographic and clinical parameters, patient demographics, surgery performed, surgical correction, complications, and reoperations were recorded preoperatively and postoperatively.
RESULTS
A total of 1132 abstracts and titles were screened by two reviewers, yielding 15 eligible studies. The reported threshold identified in our study for axial plane alignment that triggers surgical correction in most of the published literature when discussing PFI was either tibial torsion greater than 30° and/or femoral anteversion greater than 25°. Following rotational osteotomy of one or both long bones, one study (7%) reported improvements in tubercle-sulcus angle, two studies (13%) reported improvements in femoral-tibial angle, and four studies (27%) reported decreases in tibial torsion. For patient-reported outcomes, seven studies (47%) reported improvement in the Kujala score, five studies (33%) reported postoperative improvement in Lysholm, and four studies (27%) reported improvement in the International Knee Documentation Committee (IKDC) score. Nine studies (60%) reported preoperative femoral anteversion; however, only two studies compared pre- and post-operative values (one study reported a decrease in anteversion and another study reported an increase in anteversion).
CONCLUSION
When treating PFI, the reported threshold for axial plane alignment that triggers surgical correction in most of the published literature was tibial torsion greater than 30° and/or femoral anteversion greater than 25° as measured by CT. However, there is no consensus on the axial alignment measurement technique.
LEVEL OF EVIDENCE
III.
Topics: Humans; Joint Instability; Patellofemoral Joint; Femur; Tibia; Osteotomy; Tomography, X-Ray Computed; Patella; Female; Male
PubMed: 38365167
DOI: 10.1016/j.jisako.2024.02.002 -
Knee Surgery, Sports Traumatology,... Dec 2023To evaluate the clinical outcomes of primary or revision ACL reconstruction (ACLR) after contralateral hamstring autografts versus ipsilateral hamstring autograft... (Review)
Review
Contralateral hamstring autografts do not provide benefit compared to ipsilateral hamstring autografts in primary or revision anterior cruciate ligament reconstruction: a systematic review.
PURPOSE
To evaluate the clinical outcomes of primary or revision ACL reconstruction (ACLR) after contralateral hamstring autografts versus ipsilateral hamstring autograft harvest.
METHODS
Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to April 27th, 2023 for studies investigating contralateral hamstring autografts in primary or revision ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, strength measures, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot-shift test and graft rupture were extracted. PROMs included Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores.
RESULTS
Nine studies comprising 371 patients were included in this review. In primary ACLR, there were no significant differences between contralateral and ipsilateral groups in isokinetic hamstring torque in the non-ACLR limb or isokinetic quadriceps torque in both limbs when tested at 60, 90, 120 or 180 degrees/second. Isokinetic hamstring torque in the non-ACLR limb was significantly weaker in the contralateral group at six months for primary ACLR; however, these deficits did not persist. There were no significant differences in postoperative median Tegner scores and Lysholm scores between contralateral and ipsilateral groups in primary ACLR. There were no significant differences in postoperative median Tegner, mean Lysholm and IKDC scores between groups in revision ACLR. There were no significant differences in positive Lachman, positive pivot-shift and rupture rates in primary ACLR between groups. Rates of positive Lachman and pivot-shift were slightly higher in the contralateral than ipsilateral group for revision ACLR.
CONCLUSION
Contralateral hamstring autografts results in comparable muscle strength to ipsilateral hamstring autografts, with the exception of weaker hamstring strengths in the early postoperative period. Patient-reported outcome measures were similar between the two groups across both primary and revision ACLR, with rates of instability and failure being similar between groups for primary ACLR. Contralateral hamstring grafts do not provide additional benefit when compared to ipsilateral options for either primary or revision ACLR, and should be used only in select circumstances including insufficient ipsilateral hamstring grafts or situations where quadriceps or patella autografts are not optimal.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Autografts; Anterior Cruciate Ligament Injuries; Hamstring Tendons; Transplantation, Autologous; Anterior Cruciate Ligament Reconstruction
PubMed: 37864773
DOI: 10.1007/s00167-023-07597-4 -
BMC Musculoskeletal Disorders Aug 2023Different types of grafts can be used for anterior cruciate ligament reconstruction (ACLR). There is little published data regarding skeletally immature patients. The...
Clinical outcomes of different autografts used for all-epiphyseal, partial epiphyseal or transphyseal anterior cruciate ligament reconstruction in skeletally immature patients - a systematic review.
BACKGROUND
Different types of grafts can be used for anterior cruciate ligament reconstruction (ACLR). There is little published data regarding skeletally immature patients. The purpose of this systematic review was to assess the clinical outcomes and complications for different autograft types used in all-epiphyseal, transphyseal and partial epiphyseal/hybrid ACLR in skeletally immature children and adolescents.
METHODS
PubMed, Embase and Cochrane databases were systematically searched for literature regarding ACLR using hamstrings, quadriceps or bone-patellar-tendon-bone (BPTB) autografts in skeletally immature patients. Studies were included if they examined at least one of the following outcomes: graft failure, return to sport(s), growth disturbance, arthrofibrosis or patient reported outcomes and had a minimum follow-up of 1 year. Case reports, conference abstracts and studies examining allografts and extra-articular or over-the-top ACL reconstruction techniques were excluded. Graft failure rates were pooled for each graft type using the quality effects model of MetaXL. A qualitative synthesis of secondary outcomes was performed.
RESULTS
The database search identified 242 studies. In total 31 studies were included in this review, comprising of 1358 patients. Most patients (81%) were treated using hamstring autograft. The most common used surgical technique was transphyseal. The weighted, pooled failure rate for each graft type was 12% for hamstring tendon autografts, 8% for quadriceps tendon autografts and 6% for BPTB autografts. Confidence intervals were overlapping. The variability in time to graft failure was high. The qualitative analysis of the secondary outcomes showed similar results with good clinical outcomes and low complication rates across all graft types.
CONCLUSIONS
Based on this review it is not possible to determine a superior graft type for ACLR in skeletally immature. Of the included studies, the most common graft type used was the hamstring tendon. Overall, graft failure rates are low, and most studies show good clinical outcomes with high return to sports rates.
Topics: Adolescent; Child; Humans; Autografts; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Transplantation, Autologous
PubMed: 37537529
DOI: 10.1186/s12891-023-06749-4