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Sports Medicine and Arthroscopy Review Jun 2021Rotator cuff tears are the most common cause of shoulder disability and can cause significant pain and dysfunction. This systematic review summarizes the latest research...
Rotator cuff tears are the most common cause of shoulder disability and can cause significant pain and dysfunction. This systematic review summarizes the latest research on rehabilitation following arthroscopic rotator cuff repair. Studies were eligible for inclusion if they pertained to postoperative rehabilitation following arthroscopic rotator cuff repair and were published between 2003 and 2019 with a level of evidence of 1 or 2. Two blinded reviewers screened, graded, and extracted data from articles and recommendations on various aspects of rehabilitation were summarized. A total of 4067 articles were retrieved from the database search and 22 studies were included for data extraction. We noted similar outcomes between early and delayed mobilization following surgery. Reviewed articles support the use of supervised physical therapy, bracing in 15 degrees external rotation, and adjunctive transcutaneous electrical nerve stimulation for pain management. Early isometric loading improved outcomes in 1 study. Evidence is lacking for exercise prescription parameters and postoperative rehabilitation of the subscapularis.
Topics: Braces; Combined Modality Therapy; Humans; Pain Management; Physical Therapy Modalities; Postoperative Care; Rotator Cuff Injuries
PubMed: 33972488
DOI: 10.1097/JSA.0000000000000310 -
European Review For Medical and... Mar 2020Analyzing the available evidence by comparing the role of arthroscopic surgery and conservative treatment in the management of degenerative meniscopathy.
OBJECTIVE
Analyzing the available evidence by comparing the role of arthroscopic surgery and conservative treatment in the management of degenerative meniscopathy.
MATERIALS AND METHODS
A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases in May 2019 to identify all the randomized controlled trials (RCTs) comparing arthroscopic surgery to conservative management of painful but stable degenerated menisci. The quality of the RCTs was assessed using the Cochrane Risk of Bias Assessment.
RESULTS
A total of 10 studies, including 1525 patients and dealing with conservative treatment vs. arthroscopic surgery were included in this review. In eight studies the effectiveness of exercise therapy was compared to surgery; in one study the effectiveness of intra-articular steroid injection was compared to surgery; in one study the effectiveness of placebo surgery was compared to partial meniscectomy. In all studies, no significant inter-group difference in terms of knee pain and knee function were observed at any follow-up evaluation.
CONCLUSIONS
Degenerative meniscal tears, without symptoms of locking and catching, can be successfully managed by a proper regimen of physical therapy as a first line treatment. Surgical approach might be considered in case of poor response after conservative treatment.
Topics: Arthroscopy; Humans; Meniscectomy; Randomized Controlled Trials as Topic; Steroids; Tibial Meniscus Injuries
PubMed: 32271405
DOI: 10.26355/eurrev_202003_20651 -
Journal of Orthopaedic Surgery and... Jun 2022FAI (femoroacetabular impingement syndrome) is a common cause of hip pain, resulting in a decreased life quality. This study aims to compare the postoperative clinical... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
FAI (femoroacetabular impingement syndrome) is a common cause of hip pain, resulting in a decreased life quality. This study aims to compare the postoperative clinical outcome between arthroscopic surgery (AT) and conservative treatment (CT).
METHOD
The six studies were selected from PubMed, Embase and OVID database. The data were extracted and analyzed by RevMan5.3. Mean differences and 95% confidence intervals were calculated. RevMan5.3 was used to assess the risk of bias.
RESULT
Six observational studies were assessed. The methodological quality of the trials indicated five of six studies had a low risk of bias and one article had a high risk of bias. The differences were statistically significant between AT and CT for HOS (follow-up for 6 months), iHOT-33 (follow-up for 6 months) improvement, iHOT-33 (follow-up for 12 months) improvement, iHOT-33 (follow-up for 12 months), EQ-5D-5L index score (follow-up for 12 months) and AT showed higher benefits than CT. Meanwhile no statistically significant were found in iHOT-33 (follow-up for 6 months), EQ-5D-5L index score (follow-up for 6 months), EQ5D-VAS (follow-up for 6 months) and EQ5D-VAS (follow-up for 12 months).
CONCLUSION
AT and CT both can have clinical effects when facing FAI. In our meta-analysis, hip arthroscopy is statistically superior to conservative treatment in both long-term and short-term effects.
Topics: Activities of Daily Living; Arthroscopy; Conservative Treatment; Femoracetabular Impingement; Hip Joint; Humans; Postoperative Period; Quality of Life; Treatment Outcome
PubMed: 35659016
DOI: 10.1186/s13018-022-03187-1 -
Archives of Orthopaedic and Trauma... May 2022Aim of this systematic review was to analyze long-term results after meniscus refixation. (Review)
Review
PURPOSE
Aim of this systematic review was to analyze long-term results after meniscus refixation.
METHODS
A systematic literature search was carried out in various databases on studies on long-term results after meniscus refixation with a minimum follow-up of 7 years. Primary outcome criterion was the failure rate. Secondary outcome criteria were radiological signs of osteoarthritis (OA) and clinical scores.
RESULTS
A total of 12 retrospective case series (level 4 evidence) were identified that reported about failure rates of more than 7 years follow-up. There was no statistical difference in the failure rates between open repair, arthroscopic inside-out with posterior incisions and arthroscopic all-inside repair with flexible non-resorbable implants. In long-term studies that examined meniscal repair in children and adolescents, failure rates were significantly higher than in studies that examined adults. Six studies have shown minor radiological degenerative changes that differ little from the opposite side. The reported clinical scores at follow-up were good to very good.
CONCLUSION
This systematic review demonstrates that good long-term outcomes can be obtained in patients after isolated meniscal repair and in combination with ACL reconstruction. With regard to the chondroprotective effect of meniscus repair, the long-term failure rate is acceptable.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Adult; Anterior Cruciate Ligament Injuries; Arthroscopy; Child; Humans; Menisci, Tibial; Meniscus; Retrospective Studies; Tibial Meniscus Injuries
PubMed: 33913009
DOI: 10.1007/s00402-021-03906-z -
Physical Therapy in Sport : Official... Sep 2020The purpose of this study was to review the current literature on rehabilitation protocols following arthroscopic meniscus repair.
OBJECTIVES
The purpose of this study was to review the current literature on rehabilitation protocols following arthroscopic meniscus repair.
METHODS
A systematic literature review was performed of Medline, Scopus, and Web of Science databases to identify relevant articles from January 1990 to April 2019. Search terms were (meniscus OR meniscal repair) AND (repaired OR repair) AND (rehabilitation OR physiotherapy OR physical therapy). Each study was independently scored for methodological research quality level using the Modified Coleman Methodology Score (MCMS). The following variables were extracted from each study: publication year, study type, evidence level, subject demographics, injury mechanism, meniscus tear type, surgical procedure, rehabilitation program [immobilization, weight bearing, ROM progression, therapeutic exercises, length of follow-up, patient-reported outcome measurements, return to sport timing/criteria and failure rate/criteria.
RESULTS
Eighteen studies met the inclusion criteria. The overall MCMS was moderate 59.5 ± 11.7 (range = 42-90). The average MCMS score for postoperative rehabilitation was 4.7 ± 1.18. Only 1 (5.6%) study was a prospective randomized controlled trial and 14 studies (78%) had retrospective designs. Fourteen (78%) studies suggested that return to sports should occur between 3 and 6 months post-surgery. Early range of motion and immediate weight-bearing had no influence over patient-reported outcomes or failure rates for vertical meniscus tear repairs.
CONCLUSION
Low MCMS scores, primarily retrospective study designs and poorly described postoperative rehabilitation protocols made it difficult to design an evidence-based therapeutic rehabilitation program for patients following arthroscopic repair of an isolated meniscus tear. An arthroscopic isolated meniscal tear repair rehabilitation protocol is being attempted to present based on a synopsis of existing evidence.
Topics: Arthroscopy; Humans; Postoperative Care; Return to Sport; Tibial Meniscus Injuries
PubMed: 32688294
DOI: 10.1016/j.ptsp.2020.06.011 -
International Orthopaedics Jun 2022There is currently no consensus regarding the optimal treatment for stiffness following total knee arthroplasty (TKA). With the increased utilization of value-based... (Review)
Review
PURPOSE
There is currently no consensus regarding the optimal treatment for stiffness following total knee arthroplasty (TKA). With the increased utilization of value-based models, it is important to determine the most effective treatments that will reduce the need for further intervention and additional expenditure. A systematic review was performed to compare the outcomes of manipulation under anaesthesia (MUA), arthroscopic lysis of adhesions (aLOA), and revision TKA (rTKA) for arthrofibrosis and stiffness following TKA.
METHODS
PubMed and MEDLINE databases were reviewed for articles published through October 2020. Studies were included if they reported patient-reported outcome measures (PROMs) following MUA, aLOA, or rTKA. The primary endpoint was PROMs, while secondary outcomes included range of motion and the percentage of patients who pursued further treatment for stiffness.
RESULTS
A total of 40 studies were included: 21 on rTKA, 7 on aLOA, and 14 on MUA. The mean or median post-operative arc ROM was > 90° in 6/20 (30%) rTKA, 5/7 (71%) aLOA, and 7/10 (70%) MUA studies. Post-operative Knee Society (KSS) clinical and functional scores were the greatest in patients who underwent MUA and aLOA. As many as 43% of rTKA patients required further care compared to 25% of aLOA and 17% of MUA patients.
CONCLUSION
Stiffness following TKA remains a challenging condition to treat. Nonetheless, current evidence suggests that patients who undergo rTKA have poorer clinical outcomes and a greater need for further treatment compared to patients who undergo MUA or aLOA.
Topics: Arthroplasty, Replacement, Knee; Humans; Joint Diseases; Knee Joint; Range of Motion, Articular; Retrospective Studies; Treatment Outcome
PubMed: 35301559
DOI: 10.1007/s00264-022-05344-x -
Journal of Shoulder and Elbow Surgery Mar 2022There is ongoing controversy regarding optimal treatment for full-thickness rotator cuff tears. Given that the evidence surrounding the use of various treatment options... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is ongoing controversy regarding optimal treatment for full-thickness rotator cuff tears. Given that the evidence surrounding the use of various treatment options has expanded, an overall assessment is required.
OBJECTIVES
The following were compared to determine which resulted in improved patient-reported function, pain, and reoperation rates for each: (1) double-row (DR) fixation and single-row (SR) fixation in arthroscopic cuff repair; (2) latissimus dorsi transfer (LDT) with lower trapezius transfer (LTT), partial rotator cuff repair, and superior capsular reconstruction (SCR); and (3) early and late surgical intervention.
METHODS
Medline, Embase, and Cochrane were searched through to April 20, 2021. Additional studies were identified from reviews. The following were included: (1) All English-language randomized controlled trials (RCTs) in patients ≥18 years of age comparing SR and DR fixation, (2) observational studies comparing LDT with LTT, partial repair, and SCR, and (3) observational studies comparing early vs. late treatment of full-thickness rotator cuff tears.
RESULTS
A total of 15 RCTs (n = 1096 randomized patients) were included in the meta-analysis of SR vs. DR fixation. No significant standardized mean differences in function (0.08, 95% confidence interval [CI] -0.09, 0.24) or pain (-0.01, 95% CI -0.52, 0.49) were observed. There was a difference in retear rates in favor of DR compared with SR fixation (RR 1.56, 95% CI 1.06, 2.29). Four studies were included in the systematic review of LDT compared with a surgical control. LDT and partial repair did not reveal any differences in function (-1.12, 95% CI -4.02, 1.78) on comparison. A single study compared arthroscopically assisted LDT to LTT and observed a nonstatistical difference in the Constant score of 14.7 (95% CI -4.06, 33.46). A single RCT compared LDT with SCR and revealed a trend toward superiority for the Constant score with SCR with a mean difference of -9.6 (95% CI -19.82, 0.62). Comparison of early vs. late treatment revealed a paucity of comparative studies with varying definitions of "early" and "late" treatment, which made meaningful interpretation of the results difficult.
CONCLUSION
DR fixation leads to similar improvement in function and pain compared with SR fixation and results in a higher healing rate. LDT transfer yields results similar to those from partial repair, LTT, and SCR in functional outcomes. Further study is required to determine the optimal timing of treatment and to increase confidence in these findings. Future trials of high methodologic quality comparing LDT with LTT and SCR are required.
Topics: Arthroscopy; Humans; Rotator Cuff; Rotator Cuff Injuries; Superficial Back Muscles; Treatment Outcome
PubMed: 34906681
DOI: 10.1016/j.jse.2021.11.002 -
Journal of Clinical Medicine Oct 2022Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating... (Review)
Review
Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating FAI, although the best standard of care is not established yet. Our aim is to provide a comprehensive review of the best treatment for FAI syndrome evaluating differences in outcomes between surgical and non-operative management. A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases, using the following keywords: "femoroacetabular impingement", "FAI", in association with "surgery", "arthroscopy", "surgical" and "conservative", "physiotherapy", "physical therapy", "rehabilitation", "exercise". Only Level I RCTs were included. Four articles were selected for this systematic review. Our analysis showed different therapeutic protocols, follow-up periods, and outcomes; however, three out of the four studies included favored surgery. Our study demonstrates beneficial effects for both arthroscopic treatment and a proper regimen of physical therapy, nevertheless a surgical approach seemed to offer superior short-term results when compared to conservative care only. Further trials with larger sample sizes and longer follow-ups are needed to assess the definitive approach to the FAI condition.
PubMed: 36233719
DOI: 10.3390/jcm11195852 -
BMC Musculoskeletal Disorders Dec 2021The septic arthritis of the hip is a complex condition characterized by a variety of clinical presentations, a challenging diagnosis and different surgical treatment... (Review)
Review
BACKGROUND
The septic arthritis of the hip is a complex condition characterized by a variety of clinical presentations, a challenging diagnosis and different surgical treatment options, including arthroscopy, resection arthroplasty and one and two-stage total hip replacement. Each technique reports variable results in terms of infection eradication rate. The aim of this systematic review is to compare the most relevant studies available in current literature and to assess if a better treatment outcome can be predicted based on the microbiology, history, and type of infection (active vs quiescent) of each case.
METHODS
A systematic review of the literature was performed in accordance with the PRISMA guidelines, including the studies dealing with the treatment of hip septic arthritis in adult patients. Electronic databases, namely the MEDLINE, Scopus, and Web of Science, were reviewed using a combination of following keywords "septic arthritis" AND "hip joint" OR "hip" AND "adult".
RESULTS
The total number of patients included in this review was 1236 (45% of which females), for 1238 hips. The most common pathogen isolated was Staphylococcus aureus in its Methicillin-sensitive variant ranging from 2 to 37% of cases. Negative cultures were the second most common finding. It was also differentiated the type of infection of the hip, 809 and 417 patients with active and quiescent hip infection, respectively, were analyzed. Eradication rates for two-stage revision arthroplasty ranged between 85 and 100%, for one-stage approach between 94 and 100%, while for arthroscopic debridement/lavage between 89 and 100%.
CONCLUSION
Staphylococcus aureus is the most common microorganism isolated followed by culture negative infections. Arthroscopic, one and two stage procedures can be effective in the treatment of hip septic arthritis when the indication is consistent with the type of infection retrieved.
LEVEL OF EVIDENCE
IV, therapeutic study.
Topics: Arthritis, Infectious; Arthroplasty, Replacement, Hip; Arthroscopy; Debridement; Female; Hip Joint; Humans; Retrospective Studies; Staphylococcal Infections; Treatment Outcome
PubMed: 34856966
DOI: 10.1186/s12891-021-04843-z -
The Cochrane Database of Systematic... Mar 2022Arthroscopic knee surgery remains a common treatment for symptomatic knee osteoarthritis, including for degenerative meniscal tears, despite guidelines strongly... (Review)
Review
BACKGROUND
Arthroscopic knee surgery remains a common treatment for symptomatic knee osteoarthritis, including for degenerative meniscal tears, despite guidelines strongly recommending against its use. This Cochrane Review is an update of a non-Cochrane systematic review published in 2017.
OBJECTIVES
To assess the benefits and harms of arthroscopic surgery, including debridement, partial menisectomy or both, compared with placebo surgery or non-surgical treatment in people with degenerative knee disease (osteoarthritis, degenerative meniscal tears, or both).
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and two trials registers up to 16 April 2021, unrestricted by language.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), or trials using quasi-randomised methods of participant allocation, comparing arthroscopic surgery with placebo surgery or non-surgical interventions (e.g. exercise, injections, non-arthroscopic lavage/irrigation, drug therapy, and supplements and complementary therapies) in people with symptomatic degenerative knee disease (osteoarthritis or degenerative meniscal tears or both). Major outcomes were pain, function, participant-reported treatment success, knee-specific quality of life, serious adverse events, total adverse events and knee surgery (replacement or osteotomy).
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and the certainty of evidence using GRADE. The primary comparison was arthroscopic surgery compared to placebo surgery for outcomes that measured benefits of surgery, but we combined data from all control groups to assess harms and knee surgery (replacement or osteotomy).
MAIN RESULTS
Sixteen trials (2105 participants) met our inclusion criteria. The average age of participants ranged from 46 to 65 years, and 56% of participants were women. Four trials (380 participants) compared arthroscopic surgery to placebo surgery. For the remaining trials, arthroscopic surgery was compared to exercise (eight trials, 1371 participants), a single intra-articular glucocorticoid injection (one trial, 120 participants), non-arthroscopic lavage (one trial, 34 participants), non-steroidal anti-inflammatory drugs (one trial, 80 participants) and weekly hyaluronic acid injections for five weeks (one trial, 120 participants). The majority of trials without a placebo control were susceptible to bias: in particular, selection (56%), performance (75%), detection (75%), attrition (44%) and selective reporting (75%) biases. The placebo-controlled trials were less susceptible to bias and none were at risk of performance or detection bias. Here we limit reporting to the main comparison, arthroscopic surgery versus placebo surgery. High-certainty evidence indicates arthroscopic surgery leads to little or no difference in pain or function at three months after surgery, moderate-certainty evidence indicates there is probably little or no improvement in knee-specific quality of life three months after surgery, and low-certainty evidence indicates arthroscopic surgery may lead to little or no difference in participant-reported success at up to five years, compared with placebo surgery. Mean post-operative pain in the placebo group was 40.1 points on a 0 to 100 scale (where lower score indicates less pain) compared to 35.5 points in the arthroscopic surgery group, a difference of 4.6 points better (95% confidence interval (CI) 0.02 better to 9 better; I = 0%; 4 trials, 309 participants). Mean post-operative function in the placebo group was 75.9 points on a 0 to 100 rating scale (where higher score indicates better function) compared to 76 points in the arthroscopic surgery group, a difference of 0.1 points better (95% CI 3.2 worse to 3.4 better; I = 0%; 3 trials, 302 participants). Mean post-operative knee-specific health-related quality of life in the placebo group was 69.7 points on a 0 to 100 rating scale (where higher score indicates better quality of life) compared with 75.3 points in the arthroscopic surgery group, a difference of 5.6 points better (95% CI 0.36 better to 10.68 better; I = 0%; 2 trials, 188 participants). We downgraded this evidence to moderate certainty as the 95% confidence interval does not rule in or rule out a clinically important change. After surgery, 74 out of 100 people reported treatment success with placebo and 82 out of 100 people reported treatment success with arthroscopic surgery at up to five years (risk ratio (RR) 1.11, 95% CI 0.66 to 1.86; I = 53%; 3 trials, 189 participants). We downgraded this evidence to low certainty due to serious indirectness (diversity in definition and timing of outcome measurement) and serious imprecision (small number of events). We are less certain if the risk of serious or total adverse events increased with arthroscopic surgery compared to placebo or non-surgical interventions. Serious adverse events were reported in 6 out of 100 people in the control groups and 8 out of 100 people in the arthroscopy groups from eight trials (RR 1.35, 95% CI 0.64 to 2.83; I = 47%; 8 trials, 1206 participants). Fifteen out of 100 people reported adverse events with control interventions, and 17 out of 100 people with surgery at up to five years (RR 1.15, 95% CI 0.78 to 1.70; I = 48%; 9 trials, 1326 participants). The certainty of the evidence was low, downgraded twice due to serious imprecision (small number of events) and possible reporting bias (incomplete reporting of outcome across studies). Serious adverse events included death, pulmonary embolism, acute myocardial infarction, deep vein thrombosis and deep infection. Subsequent knee surgery (replacement or high tibial osteotomy) was reported in 2 out of 100 people in the control groups and 4 out of 100 people in the arthroscopy surgery groups at up to five years in four trials (RR 2.63, 95% CI 0.94 to 7.34; I = 11%; 4 trials, 864 participants). The certainty of the evidence was low, downgraded twice due to the small number of events.
AUTHORS' CONCLUSIONS
Arthroscopic surgery provides little or no clinically important benefit in pain or function, probably does not provide clinically important benefits in knee-specific quality of life, and may not improve treatment success compared with a placebo procedure. It may lead to little or no difference, or a slight increase, in serious and total adverse events compared to control, but the evidence is of low certainty. Whether or not arthroscopic surgery results in slightly more subsequent knee surgery (replacement or osteotomy) compared to control remains unresolved.
Topics: Aged; Arthroscopy; Female; Humans; Middle Aged; Osteoarthritis, Knee; Pain Measurement; Pain, Postoperative; Quality of Life
PubMed: 35238404
DOI: 10.1002/14651858.CD014328