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Knee Surgery, Sports Traumatology,... Aug 2023To systematically review and evaluate the current meta-analyses for the treatment of acute Achilles tendon rupture (AATR). This study can provide clinicians with a clear... (Review)
Review
Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute achilles tendon ruptures: a systematic review of overlapping meta-analyses.
PURPOSE
To systematically review and evaluate the current meta-analyses for the treatment of acute Achilles tendon rupture (AATR). This study can provide clinicians with a clear overview of the current literature to aid clinical decision-making and the optimal formulation of treatment plans for AATR.
METHODS
Two independent reviewers searched PubMed and Embase on June 2, 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Assessment of evidence was twofold: level of evidence (LoE) and quality of evidence (QoE). LoE was evaluated using published criteria by The Journal of Bone and Joint Surgery and the QoE by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) scale. Pooled complication rates were highlighted for significance in favour of one treatment arm or no significance.
RESULTS
There were 34 meta-analyses that met the eligibility criteria, with 28 studies of LoE 1, and the mean QoE was 9.8 ± 1.2. Significantly lower re-rupture rates were reported with surgical (2.3-5%) versus conservative treatment (3.9-13%), but conservative treatment was favoured in terms of lower complication rates. The re-rupture rates were not significantly different between percutaneous repair or minimally invasive surgery (MIS) compared to open repair, but MIS was favoured in terms of lower complication rates (7.5-10.4%). When comparing rehabilitation protocols following open repair (four studies), conservative treatment (nine studies), or combined (three studies), there was no significant difference in terms of re-rupture or obvious advantage in terms of lower complication rates between early versus later rehabilitation.
CONCLUSION
This systematic review found that surgical treatment was significantly favoured over conservative treatment for re-rupture, but conservative treatment had lower complication rates other than re-rupture, notably for infections and sural nerve injury. Open repair had similar re-rupture rates to MIS, but lower complication rates; however, the rate of sural nerve injuries was lower in open repair. When comparing earlier versus later rehabilitation, there was no difference in re-rupture rates or obvious advantage in complications between open repair, conservative treatment, or when combined. The findings of this study will allow clinicians to effectively counsel their patients on the postoperative outcomes and complications associated with different treatment approaches for AATR.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Conservative Treatment; Achilles Tendon; Minimally Invasive Surgical Procedures; Orthopedic Procedures; Rupture; Tendon Injuries; Acute Disease; Ankle Injuries; Treatment Outcome
PubMed: 37115231
DOI: 10.1007/s00167-023-07411-1 -
Journal of Shoulder and Elbow Surgery Nov 2023Although tranexamic acid (TXA) is being increasingly used in orthopedic arthroplasty and lower-extremity arthroscopic procedures, its use in arthroscopic rotator cuff... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Although tranexamic acid (TXA) is being increasingly used in orthopedic arthroplasty and lower-extremity arthroscopic procedures, its use in arthroscopic rotator cuff repair (ARCR) is less widely reported. The aim of this study was to evaluate the clinical effectiveness and safety of TXA administration in ARCR.
METHODS
A systematic review and meta-analysis of randomized controlled trials was performed to compare clinical outcomes in patients who underwent ARCR with or without TXA. Literature was retrieved using the Cochrane Library, MEDLINE, PubMed, and Embase electronic databases. The primary outcome of this study was visual clarity. Secondary outcomes contained total operative time, postoperative pain score, amount of blood loss, shoulder swelling (change in shoulder circumference), volume of irrigation fluid, number of adjustments of the pump pressure for irrigation, and adverse cardiovascular events.
RESULTS
Seven studies (3 and 4 with level I and II evidence, respectively), which included 272 and 265 patients who underwent arthroscopy with and without TXA, respectively, met the eligibility criteria. Pooled analysis showed significant improvements in visual clarity (mean difference, 9.10%; 95% CI, 4.05-14.15; P = .0004) and total operative time (mean difference, -11.24 minute; 95% CI, -19.90 to -2.57) associated with perioperative TXA application. None of the trials reported adverse events and complications associated with TXA.
CONCLUSION
The best available evidence indicates that TXA administration could significantly improve arthroscopic visual clarity and effectively save operative time in ARCR without increasing the incidence of adverse events. Furthermore, the optimal dose, route, and timing of TXA application in ARCR surgery remains to be validated by future high-level evidence studies.
Topics: Humans; Tranexamic Acid; Rotator Cuff; Arthroscopy; Shoulder; Rotator Cuff Injuries; Arthroplasty; Treatment Outcome
PubMed: 37468032
DOI: 10.1016/j.jse.2023.06.013 -
Foot & Ankle Orthopaedics Oct 2023As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic review of the literature was performed to compare the different...
BACKGROUND
As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic review of the literature was performed to compare the different treatment options and recommend a literature-based algorithm.
METHODS
In June 2022, MEDLINE, Embase, and Cochrane Library databases were systematically reviewed based on the PRISMA guidelines. The level of evidence (LOE) and quality of evidence were evaluated, and statistics on clinical outcomes and complications were calculated.
RESULTS
Twenty-seven studies with 614 patients were included. Three studies were LOE III and 25 studies were LOE IV. The mean Achilles tendon rupture score improved from a preoperative weighted mean of 38.8 ± 12.4 to a postoperative score 90.6 ± 4.7. The overall complication rate was 11.4%. Single techniques were used in 23 studies and dual techniques were used in 5 studies. The FHL tendon transfer was the most frequently used technique. We devised an algorithmic approach based on time from injury to surgical intervention and the length of the gap between the tendon stumps: >3 months: FHL transfer; <3 months (a) gap <2 cm, end-to-end repair; (b) gap 2 to 5 cm, gastrocnemius transfer, (c) gap >5 cm, semitendinosus autograft.
CONCLUSION
Surgical management of CATR produced improvements in patient-reported outcome scores at midterm follow up, but a high complication rate (11.4%) was noted. Our proposed treatment algorithm may assist in shared decision making for this complex problem.
PubMed: 37810568
DOI: 10.1177/24730114231200491 -
Turkish Neurosurgery Jul 2023To evaluate the patients who underwent surgery for an anterior communicating artery (AcomA) aneurysm at our institution. We analyzed our case series and systematically...
AIM
To evaluate the patients who underwent surgery for an anterior communicating artery (AcomA) aneurysm at our institution. We analyzed our case series and systematically reviewed the literature to identify factors that could predict the rupture of an intracranial aneurysm in patients with AcomA aneurysms or any intracranial aneurysm.
MATERIAL AND METHODS
We conducted a cross-sectional analysis of prospectively collected data from patients who underwent surgery for AcomA aneurysms at a single institution between January 2014 and May 2023. Predictors for the rupture of intracranial aneurysm were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Pubmed and MEDLINE databases.
RESULTS
Younger age (odds ratio (OR): 0.957, 95% confidence interval (CI): 0.920-0.995, p = 0.028), presence of a daughter sac (OR: 3.209, 95% CI: 1.095-9.408, p = 0.034), and ever-smoking (OR: 0.357, 95% CI: 0.137-0.930, p = 0.035) were significant predictors of increased risk of rupture in patients with AcomA aneurysms. Several aneurysm- and patient-related risk factors for rupture of intracranial aneurysms were retrieved via the literature analysis.
CONCLUSION
Younger age, ever-smoking, and presence of a daughter sac increased the risk of AcomA aneurysm rupture. A systematic literature review revealed several more aneurysm- and patient-related risk factors for rupture of the intracranial aneurysms. Our results could aid neurosurgeons during their decision-making process when treating patients with unruptured intracranial aneurysms.
PubMed: 37528725
DOI: 10.5137/1019-5149.JTN.44866-23.2 -
Arthroscopy : the Journal of... Feb 2024To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a synthesis of randomized controlled trials (RCTs). We hypothesized that SB and ADB methods would lead to similar outcomes after reconstruction of ACL rupture.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist guided our reporting. To identify RCTs that compared SB and ADB reconstructions, a thorough literature search was conducted of PubMed, Embase, Cochrane library, and Web of Science. The methodologic quality of each included study was independently assessed by 2 authors using the Cochrane Collaboration's risk of bias tool. The Anatomic ACL Reconstruction Scoring Checklist (AARSC) was used to screen the eligibility of each study's operative approaches. Twelve clinical outcomes were investigated through pooled analyses conducted using Review Manager 5.3.
RESULTS
This meta-analysis synthesized 13 RCTs comparing postoperative outcomes between ADB and SB reconstructions of ACLs. After a minimum follow-up of 12 months, ADB and SB technique resulted in similar subjective clinical outcomes, including the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score sports subscale. Similarly, no statistically significant outcomes were found for objective outcomes such as International Knee Documentation Committee objective grade, pivot-shift test, Lachman test, side-to-side difference, extension deficit, flexion deficit, and osteoarthritis change. However, patients who underwent SB reconstruction had significantly greater complication rates than those that underwent ADB reconstruction.
CONCLUSIONS
When an ACLR approach meets a minimal total AARSC score of 8, ADB and SB techniques may result in similar subjective and objective outcomes, but the ADB technique may lead to lower complication rates following surgery. We recommend that surgeons favor ADB ACLR, as guided by the AARSC.
LEVEL OF EVIDENCE
Level I, systematic review and meta-analysis of Level I randomized controlled trials.
Topics: Adult; Humans; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Knee Joint; Knee Injuries; Osteoarthritis; Treatment Outcome
PubMed: 37230187
DOI: 10.1016/j.arthro.2023.05.017 -
International Immunopharmacology Oct 2023Intracerebral hemorrhage (ICH) is a stroke subtype characterized by non-traumatic rupture of blood vessels in the brain, resulting in blood pooling in the brain... (Review)
Review
Intracerebral hemorrhage (ICH) is a stroke subtype characterized by non-traumatic rupture of blood vessels in the brain, resulting in blood pooling in the brain parenchyma. Despite its lower incidence than ischemic stroke, ICH remains a significant contributor to stroke-related mortality, and most survivors experience poor outcomes that significantly impact their quality of life. ICH has been accompanied by various complex pathological damage, including mechanical damage of brain tissue, hematoma mass effect, and then leads to inflammatory response, thrombin activation, erythrocyte lysis, excitatory amino acid toxicity, complement activation, and other pathological changes. Accumulating evidence has demonstrated that activation of complement cascade occurs in the early stage of brain injury, and the excessive complement activation after ICH will affect the occurrence of secondary brain injury (SBI) through multiple complex pathological processes, aggravating brain edema, and pathological brain injury. Therefore, the review summarized the pathological mechanisms of brain injury after ICH, specifically the complement role in ICH, and its related pathological mechanisms, to comprehensively understand the specific mechanism of different complements at different stages after ICH. Furthermore, we systematically reviewed the current state of complement-targeted therapies for ICH, providing a reference and basis for future clinical transformation of complement-targeted therapy for ICH.
Topics: Humans; Quality of Life; Cerebral Hemorrhage; Brain; Stroke; Brain Injuries; Brain Edema; Complement System Proteins
PubMed: 37552908
DOI: 10.1016/j.intimp.2023.110744 -
Schizophrenia Research Dec 2023Schizophrenia is a severe mental illness that affects a significant proportion of the global population, particularly those of childbearing age. Several studies have... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Schizophrenia is a severe mental illness that affects a significant proportion of the global population, particularly those of childbearing age. Several studies have attempted to find an association between schizophrenia and obstetric complications, with varying results.
OBJECTIVE
The primary objective of this systematic review and meta-analyses was to summarize the relationship between maternal schizophrenia and perinatal pregnancy outcomes.
DATA SOURCES
PubMed, Web of Science and Ovid EMBASE were searched from January 2001 to September 2022 using keywords related to pregnancy, women, schizophrenia.
STUDY SELECTION
A total of 23 independent studies across 21,253 individuals with schizophrenia were identified and included in the analysis.
DATA EXTRACTION
The following data were extracted: author, year of publication, country/continent of data collection, study design, demographic characteristics, diagnoses criteria, related complications. Data were analyzed using random-effects pairwise meta-analysis and were reported as prevalence and odd ratios (OR). Statistical heterogeneity was quantified with the I statistic.
RESULTS
The prevalence of adverse perinatal pregnancy outcomes was represented in descending order: cesarean section (26.0 %); labor induction (24.0 %); small for gestational age (10.5 %); gestational diabetes mellitus (9.2 %); preterm birth (9.1 %); low birth weight (7.8 %); preterm rupture of membranes (6.1 %); 1-Minute Apgar Score < 7 (5.6 %); large for gestational age (5.5 %); birth defect (5.4 %); antepartum hemorrhage (4.4 %);preeclampsia/eclampsia (4.8 %); postpartum hemorrhage (3.9 %); 5-Minute Apgar Score < 7 (3.6 %); gestational hypertension (3.3 %); placental abruption (1.0 %); placenta previa (0.6 %); thromboembolic disease (0.4 %); neonatal mortality (0.3 %) (P ≤ 0.05). There was a higher risk of adverse outcomes including gestational diabetes mellitus, preeclampsia/eclampsia, placental abruption, thromboembolic disease, preterm birth, birth defect, 1-Minute Apgar score < 7, small for gestational age, low birth weight and neonatal mortality compared with non-schizophrenia population (P ≤ 0.05).
CONCLUSIONS
Women with schizophrenia are at higher risk of adverse perinatal pregnancy outcomes. It is imperative that research efforts continue to focus on the reproductive safety of women with schizophrenia during their childbearing years.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Premature Birth; Diabetes, Gestational; Abruptio Placentae; Cesarean Section; Pre-Eclampsia; Eclampsia; Schizophrenia; Placenta
PubMed: 37979419
DOI: 10.1016/j.schres.2023.11.001 -
Journal of Sports Science & Medicine Dec 2023This study sought to provide a comprehensive assessment of the incidence of sports injuries among athletes participating in the Olympic Winter Games and to investigate... (Meta-Analysis)
Meta-Analysis Review
This study sought to provide a comprehensive assessment of the incidence of sports injuries among athletes participating in the Olympic Winter Games and to investigate contributing factors. We gathered injury data from athletes participating in the recent four Olympic Winter Games, incorporating details on the sports event, sex, injury location, and type. Through a meta-analysis, we calculated the injury incidence rates for each sport and examined the influence of sex and the type of sport on these incidence rates. Out of 11,197 registered athletes, we documented 1,304 sports injuries. The sports events with the highest injury rates were freestyle skiing, snowboarding, alpine skiing, bobsleigh, and ice hockey, with the most frequent injury locations being the knees, thoracic/lumbar/back regions, and the wrist/hand/fingers. Contusions, hematomas, and bruises were the most prevalent injuries, followed by strains (including muscle rupture, tearing, or tendon rupture) and sprains (covering dislocations, subluxations, and ligament ruptures). In the Olympic Winter Games, events such as freestyle skiing, snowboarding, alpine skiing, bobsleigh, and ice hockey pose a particularly high risk. Predominant injury sites include the knee, spine/back, and wrist and hand, with injuries ranging from contusions and hematomas to strains and sprains. For effective injury prevention, it is crucial to emphasize proper medical resource allocation, specialized training for medical personnel, and meticulous venue maintenance.
Topics: Humans; Athletic Injuries; Snow Sports; Athletes; Sprains and Strains; Contusions; Hematoma
PubMed: 38045742
DOI: 10.52082/jssm.2023.748 -
Journal of Clinical Medicine Sep 2023Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that... (Review)
Review
BACKGROUND
Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs.
MATERIALS AND METHODS
A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications.
RESULTS
We selected 129 studies reporting on 350 patients-185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)-24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, -value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair -6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (: 12) and 4.2% in the OSR group (: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups.
CONCLUSIONS
Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery.
PubMed: 37763025
DOI: 10.3390/jcm12186085 -
Cureus Jul 2023Triceps tendon avulsion is a rare but debilitating condition and the least frequent of all tendon injuries, but it is receiving increasing attention in the literature.... (Review)
Review
Triceps tendon avulsion is a rare but debilitating condition and the least frequent of all tendon injuries, but it is receiving increasing attention in the literature. The most common mechanism of injury is resisted extension, which is typically seen in a fall onto an extended hand. Such injuries are easily overlooked and should be considered a differential diagnosis in all patients who describe pain and swelling at the posterior aspect of the elbow following a traumatic event. Non-operative management is the general principle for partial rupture as opposed to a variety of surgical treatments for a complete avulsion. The goal of this meta-analysis is to analyse the current literature on triceps avulsion and provide a detailed overview of the occurrence, diagnosis, treatment options and outcomes, comparison of various repair techniques, and consequences of this injury.
PubMed: 37559858
DOI: 10.7759/cureus.41584