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European Journal of Medical Research Jul 2023Shoulder is vulnerable to dislocation owing to its anatomical structure and the increasing popularity of contact sports in young population. The management of first-time... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Shoulder is vulnerable to dislocation owing to its anatomical structure and the increasing popularity of contact sports in young population. The management of first-time anterior shoulder dislocation in this group is still controversial and the prognosis are varied. This review aimed to compare the results of arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young active patients.
METHODS
Databases were searched till November 2021, and comparative studies between arthroscopic Bankart repair and conservative management for first-time traumatic anterior shoulder dislocation in young population were selected. Methodological quality of the studies was assessed according to the Cochrane Back Review Group 12-item scale. Outcome measures included recurrence of instability, return to play, subsequent instability surgery, and shoulder functional scores.
RESULTS
The search returned 12 eligible trials with 786 participants. All the trials were of prospective design. After arthroscopic Bankart repair, patients experienced significantly less re-dislocation (7.5% vs. 53.0%, p < 0.00001, I = 0%), subluxation (3.1% vs. 24.2%, p < 0.0001, I = 0%), positive apprehension test (7.3% vs. 25.8%, p = 0.002, I = 11%), and subsequent surgical treatment for instability (5.6% vs. 37.8%, p < 0.00001, I = 0%) when compared with those underwent conservative management. And more patients returned to play (83.5% vs. 66.0%, p = 0.03, I = 81%) after arthroscopic Bankart repair. Outcomes regarding the functional scores did not reach a significant difference between the two cohorts.
CONCLUSIONS
Arthroscopic Bankart repair showed superiority over conservative management in terms of recurrence, return to play, and subsequent instability surgery during the follow-up in young active patients that encountered first episode of dislocation. As long-term prognosis is comparable, an immediate surgical stabilization might not be suitable for everyone.
Topics: Humans; Shoulder Dislocation; Shoulder; Shoulder Joint; Conservative Treatment; Joint Instability; Arthroscopy; Recurrence; Retrospective Studies
PubMed: 37501089
DOI: 10.1186/s40001-023-01160-0 -
Orthopaedic Journal of Sports Medicine Aug 2023The optimal immobilization position of the shoulder after rotator cuff repair is controversial. (Review)
Review
BACKGROUND
The optimal immobilization position of the shoulder after rotator cuff repair is controversial.
PURPOSE
To compare the clinical outcomes and incidence of retears after arthroscopic rotator cuff repair between patients who used an abduction brace versus a sling for postoperative shoulder immobilization.
STUDY DESIGN
Systematic review; Level of evidence, 1.
METHODS
This systematic review and meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, MEDLINE, and Embase electronic databases for randomized controlled trials (RCTs) that compared abduction brace and sling immobilization after arthroscopic rotator cuff repair using single-row, double-row, or suture-bridge fixation. Clinical scores, pain severity, and retear rates were compared between patients with abduction brace versus sling immobilization.
RESULTS
Of 1572 retrieved studies, 4 RCTs with a total of 224 patients (112 patients with abduction brace and 112 patients with sling) were included in the qualitative analysis, and 3 of the RCTs were included in the quantitative analysis (meta-analysis). There were no significant differences between the abduction brace and sling immobilization groups in the Constant-Murley score at 3 months (weighted mean difference [WMD], 0.26 [95% CI, -1.30 to 1.83]; = .74; = 84%), 6 months (WMD, 1.91 [95% CI, -0.17 to 4.00]; = .07; = 85%), and 12 months (WMD, 0.55 [95% CI, -1.37 to 2.47]; = .57; = 0%); the visual analog scale score for pain at 1 week (WMD, 0.10 [95% CI, -0.20 to 0.41]; = .51; = 0%), 3 weeks (WMD, -0.12 [95% CI, -0.34 to 1.00]; = .29; = 0%), 6 weeks (WMD, -0.12 [95% CI, -0.30 to 0.06]; = .20; = 0%), and 12 weeks (WMD, -0.13 [95% CI, -0.27 to 0.02]; = .09; = 18%); or the retear rate at 3 months (risk ratio, 0.63 [95% CI, 0.09 to 4.23]; = .64; = 0.47%) postoperatively.
CONCLUSION
Our systematic review demonstrated a lack of significant differences between the abduction brace and sling immobilization groups regarding postoperative clinical scores, pain severity, and tendon healing.
PubMed: 37538535
DOI: 10.1177/23259671231185368 -
Scientific Reports Oct 2023This study aimed to compare the efficacy and safety of arthroscopy with physiotherapy or joint lavage in patients with femoroacetabular impingement (FAI). A... (Meta-Analysis)
Meta-Analysis
This study aimed to compare the efficacy and safety of arthroscopy with physiotherapy or joint lavage in patients with femoroacetabular impingement (FAI). A meta-analysis using PubMed, Embase, Scopus, and the Cochrane Collaboration Library databases was performed in September 2022. We included studies focusing on patients with FAI who underwent arthroscopic surgery versus those who underwent physiotherapy or arthroscopic lavage. The outcomes were functional scores (iHOT-33 and HOS ADL) and adverse events. Randomized clinical trials were included in the study. The risk of bias in each study was assessed according to Cochrane guidelines for clinical trials. The data were combined using Review Manager version 5.4. (PROSPERO CRD42022375273). Six RCTs were included, from a pool of 839 patients (407 females). The iHOT-33 and HOS ADL scales showed significant differences at 12 months in favor of the arthroscopy group (MD, 10.65; 95% CI 6.54-4.76) and (MD, 8.09; 95% CI 3.11-13.07). MCID was not achieved through arthroscopy in functional variables. The rates of osteoarthritis (OR, 6.18; 95% CI 1.06-36.00) and numbness (OR, 73.73; 95% CI 10.00-43.92) were significantly higher in the arthroscopy group. Arthroscopic surgery showed statistical superiority over the control group without exceeding the MCID in most studies; however, the results might have been influenced by secondary variables. Finally, arthroscopic surgery results in a high rate of conversion to osteoarthritis.
Topics: Female; Humans; Femoracetabular Impingement; Hip Joint; Arthroscopy; Treatment Outcome; Activities of Daily Living; Randomized Controlled Trials as Topic
PubMed: 37779117
DOI: 10.1038/s41598-023-43441-y -
Revista Espanola de Cirugia Ortopedica... Sep 2023Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy... (Review)
Review
INTRODUCTION
Although conservative treatment of calcific tendinopathy has a high success rate, arthroscopic excision of the calcific deposit is occasionally necessary. Controversy exists as to whether the remaining rotator cuff defect can be left in situ or should be repaired to achieve better functional outcomes. This study aimed to compare the results of debridement versus debridement combined with suturing in arthroscopic surgery for calcific tendinopathy.
METHODOLOGY
MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched from inception to February 2023 for articles on arthroscopic treatment of calcific tendinopathy. Functional outcomes (VAS, ASES, UCLA, and Constant) and the number of complications were analyzed. The effect size was calculated using Cohen's d-index.
RESULTS
Twenty-one studies were included, including a total of 1172 patients aged between 44.7 and 55 years. The mean follow-up time was 24.7 months. The combined ES estimates for the total score of the VAS, ASES, UCLA, and Constant scales were very strong (>1.0) for both debridement and combined debridement with suture. The ES estimates for the number of total complications were 1.75 (95% CI: 0.08-3.43, I = 0%) for debridement and 9.07 (95% CI: -0.03-18.17, I = 50.4%) for combined debridement with suture.
CONCLUSIONS
Both arthroscopic procedures improve the total score significantly on the EVA, ASES, UCLA, and Constant scales. However, a higher proportion of complications was observed in the group that performed suturing. In this regard, we must consider whether it is really necessary to repair all partial tears after the calcified deposits removal.
PubMed: 37573942
DOI: 10.1016/j.recot.2023.08.015 -
Children (Basel, Switzerland) Aug 2023Tibial eminence fractures (TEF) of Meyers-McKeever type II-III-IV usually require surgical management. No consensus in the literature has been achieved regarding the... (Review)
Review
BACKGROUND
Tibial eminence fractures (TEF) of Meyers-McKeever type II-III-IV usually require surgical management. No consensus in the literature has been achieved regarding the best treatment option. The aims of the present systematic review were (1) to analyze the current literature and describe the outcomes of surgical treatment for TEF; and (2) to compare the outcomes of different surgical options using arthroscopic reduction and internal fixation (ARIF) with sutures or screws and open reduction and internal fixation (ORIF).
METHODS
A search was carried out with Pubmed, Medline, and Cochrane. Key terms were used "tibial" AND "eminence" or "spine" or "intercondylar" AND "paediatric" or "children" AND "fracture" or "avulsion" AND "treatment". Twelve articles met the inclusion criteria. Demographic data, clinical outcomes, and complication rates were evaluated for each study. Means/standard deviation and sum/percentage were used for continuous and categorical variables, respectively. Chi-square or t-student tests were applied. A -value < 0.05 was considered statistically significant.
RESULTS
ORIF showed superior clinical outcomes (Tegner ( < 0.05) and Lysholm ( < 0.001) scores) relative to ARIF and a lower incidence of arthrofibrosis ( < 0.05) and implant removal ( < 0.01). The Tegner, IKDC, and Lysholm scores showed statistically significant superior results following arthroscopic sutures compared to arthroscopic screws ( < 0.001). The incidence of arthrofibrosis was higher after arthroscopic sutures ( < 0.05), the implant removal was higher after screw fixation ( < 0.001) Conclusions: Better clinical results with low complication rates were achieved with ORIF surgery rather than ARIF; arthroscopic suture fixation resulted in higher clinical results compared to arthroscopic screw fixation and reduced the incidence of postoperative complications.
PubMed: 37628378
DOI: 10.3390/children10081379 -
Arthroscopy : the Journal of... Feb 2024To further clarify the role of tranexamic acid (TXA) in arthroscopic rotator cuff repair (ARCR), especially visual field clarity and operation time. (Meta-Analysis)
Meta-Analysis Review
Intravenous Tranexamic Acid Significantly Improved Visualization and Shortened the Operation Time in Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis of Level I and II Studies.
PURPOSE
To further clarify the role of tranexamic acid (TXA) in arthroscopic rotator cuff repair (ARCR), especially visual field clarity and operation time.
METHODS
We searched the PubMed, Cochrane Library, and Embase databases to find prospective randomized controlled clinical trials (RCTs) examining the use of TXA in ARCR. All included RCTs were evaluated for methodological quality using the Cochrane Collaboration's risk of bias tool. We used Review Manager 5.3 for meta-analysis and calculated the weighted mean difference (WMD) and 95% confidence interval (CI) of the related outcome indicators. The GRADE system was used to evaluate the strength of the clinical evidence provided by the included studies.
RESULTS
Six RCTs (3 Level I, 3 Level II) from four countries or regions were included in this study: 2 studies used intra-articular (IA) TXA, and 4 studies used intravenous TXA. A total of 451 patients underwent ARCR, including 227 patients in the TXA group and 224 patients in the non-TXA group. In 2 RCTs evaluating good visualization, intravenous TXA achieved a better surgical field of view in ARCR compared to the control group (P =.036; P = .045). Meta-analysis showed that compared with non-TXA, intravenous TXA shortened the operation time (WMD = -12.87 min, 95% CI: -18.81 to -6.93). These two RCTs did not reveal a statistically significant difference in the impact of intravenous TXA and non-TXA on mean arterial pressure (MAP) (P = .306; P = .549). Compared with epinephrine (EPN), IA TXA had no significant effects on improving the visual field clarity under arthroscopy, shortening the operation time or reducing the total amount of irrigation fluid (P > .05). Compared with saline irrigation, IA TXA improved the surgical field of vision and shortened the operation time (P < .001). No adverse events were reported for either intravenous TXA or IA TXA.
CONCLUSIONS
Intravenous TXA can shorten the operation time of ARCR, and the conclusions of existing RCTs suggest that intravenous TXA can improve visual field clarity during ARCR, thus supporting the application of intravenous TXA in ARCR. Compared with EPN, IA TXA was not better at improving the visual field clarity under arthroscopy and shortening the operation time, but it was better than saline irrigation.
LEVEL OF EVIDENCE
Level II, systematic review and meta-analysis of Level I and II studies.
Topics: Humans; Tranexamic Acid; Antifibrinolytic Agents; Arthroscopy; Rotator Cuff; Arthroplasty; Epinephrine; Blood Loss, Surgical
PubMed: 37423470
DOI: 10.1016/j.arthro.2023.06.055 -
Clinics in Orthopedic Surgery Oct 2023The best course of action for massive irreparable rotator cuff tears (MIRCTs) is not universally agreed upon. Numerous surgical techniques have been discussed. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The best course of action for massive irreparable rotator cuff tears (MIRCTs) is not universally agreed upon. Numerous surgical techniques have been discussed. The implantation of a biodegradable spacer into the subacromial area has been documented since 2012 by several authors. The implantation method is touted as being simpler, repeatable, and less invasive than other solutions that are now available. The purpose of this systematic review and meta-analysis, being the first of its kind, was to evaluate the literature to see the efficacy of InSpace balloon (ISB) implantation in the management of MIRCTs.
METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and with 2 researchers assessing and analyzing each study separately, an extensive electronic search of the literature was conducted in the PubMed database from 1961 until July 27, 2022.
RESULTS
Fourteen studies were included in this systematic review and three in the meta-analysis. Eleven out of fourteen studies favored ISB use for MIRCTs, while only three were against its use. All spacers were arthroscopically implanted in the subacromial space. Three studies were included in the meta-analysis. The differences in the compared outcomes were statistically insignificant.
CONCLUSIONS
A controversy about the use of ISB remains in patients with MIRCTs. Both good and bad outcomes were reported. However, the majority of patients had good clinical outcomes across several grading scales, radiographic evidence of improved impingement, and self-report that they would redo the procedure in hindsight. To draw more solid conclusions and have statistically significant results in the meta-analysis, more randomized controlled trials and comparative studies comparing this device to other treatments are needed.
Topics: Humans; Rotator Cuff Injuries; Treatment Outcome
PubMed: 37811509
DOI: 10.4055/cios23032 -
Journal of Clinical Medicine Feb 2024: Ankle arthroscopy is indicated for both diagnosis and treatment of a large spectrum of common ankle disorders. It has certain advantages over the open procedure;... (Review)
Review
: Ankle arthroscopy is indicated for both diagnosis and treatment of a large spectrum of common ankle disorders. It has certain advantages over the open procedure; however, it is important to recognize that there are some complications associated with it. Infections after this procedure are quite uncommon, with an overall estimated incidence of 2%. Given the low incidence of infections after ankle arthroscopy, not a great deal of literature on the topic has been published. The present review aims to provide an overview of the incidence, diagnosis, and treatment of infections after ankle arthroscopy. : A systematic review of the literature indexed in the PubMed, MEDLINE, and Cochrane Library databases using search term "ankle arthroscopy infections" was performed in November 2023. No restrictions were applied concerning the date of publication. The Preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed. Among all surgical operations for the treatment of ankle and foot pathologies, we included articles with a described superficial or deep infection after ankle arthroscopy. The search resulted in 201 studies. Only 21 studies met our inclusion criteria, and they were included in this systematic review. We evaluated 1706 patients who underwent 1720 arthroscopic tibiotalar procedures at an average age of 42 years old. Out of the 1720 procedures, 41 (2%) were complicated by infection. We divided infectious complications into superficial (68%; 28/41) and deep (32%; 13/41) infections. The most common pathogen isolated was Staphylococcus aureus. Arthroscopic arthrodesis was found to be the most affected by deep infections. : Infection after ankle arthroscopy is an uncommon complication. Superficial infections were successfully treated with antibiotics, while surgical debridement, arthroscopic drainage, and intravenous antibiotics were necessary in cases of deep infections. Considering the amount of information on pathogens associated with knee and shoulder infections, there is still a lack of literature on pathogens associated with ankle infections, which makes their management difficulty.
PubMed: 38398296
DOI: 10.3390/jcm13040983 -
PloS One 2023Arthroscopically assisted reduction and internal fixation (ARIF) allows for the assessment of joint congruity following anatomic reduction, identification of occult... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Arthroscopically assisted reduction and internal fixation (ARIF) allows for the assessment of joint congruity following anatomic reduction, identification of occult intra-articular lesions, and treatment of traumatic intra-articular pathologies. The aim of this systematic review and meta-analysis was to provide evidence on whether ARIF is an alternative treatment protocol for ankle fractures.
METHODS
The PubMed, Embase, and Cochrane Library databases were searched independently by two investigators from the inception dates to October 9, 2022, for comparative studies. The risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials and the methodological index for non-randomized studies (MINORS) were used for assessing the methodological quality. Outcomes were evaluated in terms of the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, post-operative complications, arthroscopic findings, Visual Analogue Scale (VAS) score, and operation time. Cochrane Review Manager Software 5.4 was used to perform the statistical analysis.
RESULTS
A total of 10 trials involving 755 patients were included in this meta-analysis. The results revealed that ARIF for ankle fractures was superior regarding functional outcomes and VAS scores when compared with open reduction and internal fixation (ORIF). No significant difference was noted in the post-operative complication rate and the operation time between the ARIF and ORIF groups. A high incidence of chondral or osteochondral lesions (OCLs), ligamentous injuries, and loose bodies with ankle fractures was found by ankle arthroscopy.
CONCLUSIONS
ARIF for ankle fractures might be beneficial to offer superior functional outcomes and VAS score than ORIF. Orthopedic surgeons should take a high incidence of OCLs and ligamentous injuries into consideration for the treatment of acute ankle fractures. We believe that with the increase in surgical experience, the occurrence of post-operative complications and the extension of operation time will no longer be a potential concern for surgeons.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Ankle Joint; Arthroscopy; Foot; Postoperative Complications; Treatment Outcome; Retrospective Studies
PubMed: 37540648
DOI: 10.1371/journal.pone.0289554 -
Journal of ISAKOS : Joint Disorders &... Aug 2023Arthroscopic rotator cuff repairs (RCRs) are known to be associated with substantial pain and post-operative pain management is critical in overall patients' outcomes.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Arthroscopic rotator cuff repairs (RCRs) are known to be associated with substantial pain and post-operative pain management is critical in overall patients' outcomes. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used oral medications and can reduce opioid usage. However, controversies arise due to its postulated effect on postoperative tendon healing. As the evidence of safety and efficacy of NSAIDs remains unclear, this study aims to investigate the effect of NSAIDs on retear rates and clinical outcomes.
METHODS
A systematic search of four databases (PubMed, EMBASE, Scopus, and Cochrane Library) was conducted, identifying studies that compared cohorts with post-RCR NSAIDs use versus control groups without NSAID use. Meta-analysis was conducted for retear rate as well as pain and functional outcomes (Visual Analogue Scale and American Shoulder and Elbow Surgeons Shoulder score). Subgroup analysis was conducted for retear rates to determine the overall treatment effect of including selective COX-2 inhibitors.
RESULTS
Six studies were included in the meta-analysis. The total baseline cohort size was 916, with 443 (48.3%) patients in the NSAID group and 473 (51.6%) patients in the control group. There were no statistically significant differences in the baseline characteristics between the two groups. Meta-analysis between the two groups showed that there were no statistically significant differences in retear rates (p = 0.70), early and late post-operative Visual Analogue Scale score (p = 0.10 and p = 0.10, respectively) and latest American Shoulder and Elbow Surgeons Shoulder score (p = 0.31). However, subgroup analysis of retear rates revealed a statistically significant difference between the subgroup including COX-2 selective inhibitor versus non-selective COX inhibitor (p < 0.01).
CONCLUSION
NSAID use in post-arthroscopic RCR pain relief does not increase retear rates and can provide similar clinical outcomes compared to a non-NSAID regimen.
LEVEL OF EVIDENCE
Meta-analysis, level of evidence, 4.
Topics: Humans; Cyclooxygenase 2 Inhibitors; Pain; Rotator Cuff; Rotator Cuff Injuries; Treatment Outcome
PubMed: 37085034
DOI: 10.1016/j.jisako.2023.04.001