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Orthopaedic Journal of Sports Medicine Nov 2021There is a paucity of data regarding osteochondral lesions of the tibial plafond (OLTPs), in part because they are far less common than osteochondral lesions of the... (Review)
Review
BACKGROUND
There is a paucity of data regarding osteochondral lesions of the tibial plafond (OLTPs), in part because they are far less common than osteochondral lesions of the talus.
PURPOSE
To evaluate the topographical characteristics of OLTPs and outcomes after surgical intervention, while analyzing the level of evidence (LOE) and quality of evidence (QOE) of the included studies.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting clinical data for OLTPs were included. The LOE and QOE of the included studies were evaluated using a 5-level grading system and the modified Coleman Methodology Score, respectively.
RESULTS
Included were 20 studies with 426 OLTPs; 4 studies were LOE 2 and 16 studies were LOE 4. Overall, 86.7% of OLTPs were associated with a traumatic history and/or previous ankle sprain. OLTPs were most commonly located in the centromedial region of the tibial plafond (30.4%), with the fewest number of OLTPs found in the anteromedial region of the tibial plafond (3.9%). In 17 of the studies, a total of 46.9% of OLTPs were associated with coexisting osteochondral lesions of the talus. The most frequently used surgical technique to treat OLTPs was microfracture, which resulted in good clinical outcomes at midterm follow-up.
CONCLUSION
The results of this systematic review indicated that OLTPs are frequently preceded by ankle trauma and are often associated with coexisting osteochondral lesions of the talus. Clinical outcomes after arthroscopic intervention appear to produce good results in the midterm, but the low LOE, poor QOE, marked heterogeneity, and underreporting of the data confound any recommendation based on this systematic review.
PubMed: 34778469
DOI: 10.1177/23259671211029208 -
Arthroscopy, Sports Medicine, and... Oct 2020The purpose of this study is to identify and summarize the current utility of intraoperative ultrasound (US) during hip arthroscopy. (Review)
Review
PURPOSE
The purpose of this study is to identify and summarize the current utility of intraoperative ultrasound (US) during hip arthroscopy.
METHODS
A systematic database query of the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, EMBASE, PubMed (1980 to 2019), and Ovid MEDLINE (1980 to 2019) was performed. After article identification, descriptions of the surgical procedure, use of intraoperative US, procedural complications, and conclusions from each article were recorded and summarized.
RESULTS
Five studies met inclusion criteria, all of which were surgical techniques or technical notes. Four of the 5 studies described US used for placement of arthroscopic portals, and 1 described the use of an intraarticular US catheter for the assessment of an osteochondritis dissecans (OCD) lesion. Of the 4 studies using US for portal placement, 3 were performed supine and 1 was performed in the lateral decubitus position. All studies recognized the need for additional US training or the required assistance of a radiologist to incorporate US into a surgical practice.
CONCLUSION
Descriptions of intraoperative US during hip arthroscopy are limited in the literature. However, existing technique reports demonstrate the feasibility of US for both portal placement with superficial probes and limited evaluation of cartilage using intraarticular US catheters.
LEVEL OF EVIDENCE
V, systematic review.
PubMed: 33135007
DOI: 10.1016/j.asmr.2020.06.001 -
Arthroscopy, Sports Medicine, and... Apr 2021To analyze the available literature pertaining to the indications, outcomes, and complications of both microfracture (MFX) and simple debridement for capitellar... (Review)
Review
PURPOSE
To analyze the available literature pertaining to the indications, outcomes, and complications of both microfracture (MFX) and simple debridement for capitellar osteochondritis dissecans (OCD).
METHODS
A comprehensive literature review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Studies were included if they evaluated OCD of the capitellum that underwent either arthroscopic debridement (AD) or MFX. The risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) scale. Patient demographic characteristics, imaging findings, return-to-sport rates, patient-reported outcomes, range of motion (ROM), complications, failures, and reoperations were recorded.
RESULTS
Eleven studies with 327 patients (332 elbows) met the inclusion criteria. Methodological Index for Non-randomized Studies (MINORS) scores ranged from 63% to 75% and showed considerable heterogeneity. Both AD and MFX showed improvement in patient outcome scores, ROM, and return to play, although the data precluded relative conclusions. Improvement in motion after MFX ranged from 4.9° to 5° of flexion, 5° to 22.6° of extension, 1° to 2° of pronation, and 0.5° to 2° of supination, whereas after AD, it ranged from -4° to 6° of flexion and -0.4° to 14° of extension, with prono-supination noted in only 1 study. The rate of return to play at a similar level of preinjury athletic competition ranged from 55% to 75% after MFX and from 40% to 100% after AD. Lesion location was discussed in only 1 study. Postoperative imaging trended toward early degenerative changes, most commonly of the radial head. Complications were only reported in 1 MFX study; in all cases, the complication was transient ulnar nerve neurapraxia. Reoperation rates ranged from 0% to 10%, and reoperation was most commonly performed to address radial head enlargement. Five studies reported no reoperations.
CONCLUSIONS
Both AD and MFX for capitellar OCD appear to yield excellent improvements in pain, ROM, patient outcome scores, and return to sport. Given that comparable mid-term outcomes can be achieved with debridement alone, without the use of MFX, similarly to recent prospective studies in the knee, AD alone may be a reasonable approach to relatively small OCD defects.
LEVEL OF EVIDENCE
Level IV, systematic review of studies, all Level IV evidence.
PubMed: 34027472
DOI: 10.1016/j.asmr.2020.10.002 -
Arthroscopy : the Journal of... Oct 2022The purpose of this study was to evaluate the impact of patient sex on outcomes after treatment of osteochondritis dissecans (OCD) lesions of the knee through a... (Review)
Review
PURPOSE
The purpose of this study was to evaluate the impact of patient sex on outcomes after treatment of osteochondritis dissecans (OCD) lesions of the knee through a systematic review of current evidence.
METHODS
This review was conducted according to the PRISMA guidelines using the PubMed, PubMed Central, Embase, Ovid Medline, Cochrane Libraries, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Relevant outcomes included functional (e.g., International Knee Documentation Committee and Subjective Knee Evaluation, Lysholm Knee Score) and clinical outcomes (e.g., symptom/pain resolution, reoperation rates) for males and females after operative or nonoperative treatment of knee OCD lesions.
RESULTS
Ten articles with a total of 691 (73%) males and 260 (27%) females were included. Mean age ranged from 11.3 ± 2.1 years to 34.5 ± 10.3 years, and follow-up ranged from 6 months to 16.3 years. In four studies reporting functional outcomes, no significant differences were found between males and females in any metric assessed (all P > .05). Seven studies reported clinical outcomes after treatment of knee OCD lesions. One study determined males were more likely to have a successful nonoperative outcome than females (OR: 1.85, 95% CI: 1.00-3.40). Another study found males had a lower risk of developing symptomatic knee pain following operative or nonoperative treatment at a mean 14-year follow-up (HR: 0.24; 95% CI: 0.07-0.81). The remaining 5 studies reported statistically comparable clinical outcomes between males and females (all P > .05).
CONCLUSION
The present systematic review found mostly comparable clinical and functional outcomes between males and females following treatment of knee OCD lesions. Despite sex-related differences in the prevalence of these lesions and limited evidence of differences in clinical outcomes, these data suggest that sex does not independently predict outcomes after treatment.
LEVEL OF EVIDENCE
III, systematic review of Level II and III studies.
Topics: Female; Humans; Infant; Knee; Knee Joint; Male; Osteochondritis Dissecans; Pain; Second-Look Surgery
PubMed: 35337959
DOI: 10.1016/j.arthro.2022.03.015 -
Medicine Dec 2023Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur.
BACKGROUND
Accomplish a thorough review on the existing biomechanical and clinical studies about coronal plane fractures of the distal femur.
METHODS
We performed an electronic search of PubMed/MEDLINE database from April to June, 2023. The terms for the database search included "Hoffa fractures," OR "Busch-Hoffa fractures" OR "coronal plane fractures of the distal femur."
RESULTS
The search identified 277 potentially eligible studies. After application of inclusion and exclusion criteria, 113 articles were analyzed in terms of the most important topics related to coronal plane fractures of the distal femur.
CONCLUSION
Lateral coronal plane fractures of the distal femur are more frequent than medial, present a more vertical fracture line, and usually concentrate on the weight bearing zone of the condyle. The Letenneur system is the most used classification method for this fracture pattern. Posterior-to-anterior fixation using isolated lag screws (for osteochondral fragments-Letenneur type 2) or associated with a posterior buttressing plate (when the fracture pattern is amenable for plate fixation-Letenneur types 1 and 3) is biomechanically more efficient than anterior-to-posterior fixation. Anterior-to-posterior fixation using lag screws complemented or not by a plate remains a widely used treatment option due to the surgeons' familiarity with the anterior approaches and lower risk of iatrogenic neurovascular injuries. There is no consensus in the literature regarding diameter and number of screws for fixation of coronal plane fractures of the distal femur.
Topics: Humans; Femoral Fractures; Hoffa Fracture; Fracture Fixation, Internal; Bone Screws; Femur; Bone Plates
PubMed: 38050206
DOI: 10.1097/MD.0000000000036161 -
International Orthopaedics Feb 2021To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus (OLT) to osteoarthritis (OA).
METHODS
A systematic review and a meta-analysis were performed on PubMed, Embase, and Cochrane Library in March 2020. Safety was evaluated through the reported side effects and effectiveness through the scores used. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool and the Downs and Black checklist. For each outcome, the quality of evidence was graded according to GRADE guidelines.
RESULTS
Twenty-four studies (21 for OA, 3 for OLT) were included on hyaluronic acid (HA), platelet-rich plasma (PRP), saline, methylprednisolone, botulinum toxin type A (BoNT-A), mesenchymal stem cells (MSCs), and prolotherapy. No severe adverse events were reported. For OLT, a comparison was possible between HA and PRP showing no significant difference. For ankle OA, a significant difference favouring HA versus saline was documented at six months (p < 0.001). The GRADE level of evidence was very low.
CONCLUSION
This meta-analysis supports the safety of intra-articular treatment for ankle OA and OLT, while only a very low evidence supports the efficacy of HA in terms of better results versus placebo for the treatment of ankle OA, and other conclusions are hindered by the scarcity of the available literature. This urges further and stronger trials to specifically investigate potential and limitations of these different injective approaches for the treatment of OLT and ankle OA.
Topics: Ankle; Ankle Joint; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis; Osteoarthritis, Knee; Platelet-Rich Plasma; Treatment Outcome
PubMed: 32647968
DOI: 10.1007/s00264-020-04689-5 -
Frontiers in Surgery 2023Bone marrow stimulation (BMS) has been considered a well-established method for treating knee and ankle osteochondral lesions. Some studies have also shown that BMS can... (Review)
Review
Bone marrow stimulation in arthroscopic rotator cuff repair is a cost-effective and straightforward technique to reduce retear rates: A systematic review and meta-analysis.
BACKGROUND
Bone marrow stimulation (BMS) has been considered a well-established method for treating knee and ankle osteochondral lesions. Some studies have also shown that BMS can promote healing of the repaired tendon and enhance biomechanical properties during rotator cuff repair. Our purpose was to compare the clinical outcomes of arthroscopic repair rotator cuff (ARCR) with and without BMS.
METHODS
A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Embase, Web of Science, Google scholar, ScienceDirect, and the Cochrane Library were searched from inception to March 20, 2022. Data on retear rates, shoulder functional outcomes, visual analog score and range of motion were pooled and analyzed. Dichotomous variables were presented as odds ratios (OR), and continuous variables were presented as mean differences (MD). Meta-analyses were conducted with Review Manager 5.3.
RESULTS
Eight studies involving 674 patients were included, with mean follow-up period ranging from 12 to 36.8 months. Compared to ARCR alone, the intraoperative combination of the BMS resulted in lower retear rates ( < 0.0001), but showed similar results in Constant score ( = 0.10), University of California at Los Angeles (UCLA) score ( = 0.57), American Shoulder and Elbow Surgeons (ASES) score ( = 0.23), Disabilities of the Arm, Shoulder and Hand (DASH) score ( = 0.31), VAS (visual analog score) score ( = 0.34), and range of motion (ROM) (forward flexion, = 0.42; external rotation, = 0.21). After sensitivity analyses and subgroup analyses, no significant changes in statistical results were observed.
CONCLUSION
Compared to ARCR alone, the combination of intraoperative BMS can significantly reduce the retear rates, but showed similar short-term results in functional outcomes, ROM and pain. Better clinical outcomes are anticipated in the BMS group by improving structural integrity during long-term follow-up. Currently, BMS may be a viable option in ARCR based on its straightforward and cost-effective advantages.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier: CRD42022323379.
PubMed: 36896263
DOI: 10.3389/fsurg.2023.1047483 -
Journal of Orthopaedics Mar 2024Patella fractures in the pediatric age group often have a dilemma in their ease of diagnosis and treatment required. Indications for conservative management or surgical... (Review)
Review
BACKGROUND
Patella fractures in the pediatric age group often have a dilemma in their ease of diagnosis and treatment required. Indications for conservative management or surgical intervention in the pediatric population during growth phase are not clearly defined. The current systematic review aims to provide a consensus on the morphological types, treatment options, indications, the outcomes expected and complications and their management.
METHODS
The review was conducted as per the PRISMA guidelines. Inclusion criteria were (a).Articles published in English, (b) Age <18 years, (c) Patellar fractures including osteochondral fractures. Exclusion criteria includes articles with incomplete data, case reports, biomechanical studies, case series with sample size <2, biomechanical studies, reviews, letter to the editor, or editorials and Non-English language.
RESULTS
The review search yielded a total of 18 articles. A total of 288 patients with patellar fractures were included in the review. The average age ranged from 9.6 years to 16 years. The follow-up period ranged from 3 months to 20 years In total, 49 individuals underwent immobilization with cast or brace application, 4 with spica cast application and 48 with cylindrical cast in extension. Overall, 83 patients in 13 studies underwent surgical fixation most of which underwent wiring.
CONCLUSION
Pediatric patella fracture/dislocations or Osteochondral fractures (OCF) although being a rare event, may be associated with a child with knee injury and swelling. Conservative management in terms of casting and immobilization may be an alternative but surgical intervention should be the primary mode of treatment in such cases.
PubMed: 38090603
DOI: 10.1016/j.jor.2023.11.049 -
Foot and Ankle Surgery : Official... Apr 2024Osteochondral lesions of the talus are common in patients suffering even minor trauma; timely diagnosis and treatment can prevent the development of early... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Osteochondral lesions of the talus are common in patients suffering even minor trauma; timely diagnosis and treatment can prevent the development of early osteoarthritis. The objectives of this systematic review and meta-analysis were to evaluate the effects of additional procedures on arthroscopic ankle microperforations for osteochondral lesions.
METHODS
A systematic literature search was conducted using PubMed-Medline, Cochrane Central, and Google Scholar to select clinical studies analyzing the efficacy of platelet-rich plasma (PRP), hyaluronic acid (HA), and bone marrow concentrate (BMC) procedures. Ten articles following PRISMA guidelines with a total of 464 patients were included in this review. Quality assessment using MINORS was performed, and all studies demonstrated high quality.
RESULTS
The results of the systematic review showed benefits in all patients undergoing infiltrative therapy with PRP, hyaluronic acid, and BMC. The best results in terms of AOFAS score and VAS scale were found in patients undergoing PRP injection. The meta-analysis showed improvements in pain relief and return to daily activities in patients undergoing arthroscopic microperforations and PRP, although not reporting statistically significant results (p = 0.42).
CONCLUSION
All treatment strategies reported better scores compared to the control groups. Among the various treatments analyzed, the addition of PRP appears to be the most valuable probably for the larger population receiving this treatment, showing excellent outcomes in pain reduction, clinical outcomes, and return to daily activities.
LEVEL OF EVIDENCE
II.
Topics: Humans; Fractures, Stress; Hyaluronic Acid; Cartilage, Articular; Talus; Pain; Arthroscopy; Treatment Outcome
PubMed: 38309989
DOI: 10.1016/j.fas.2023.12.005 -
BMC Musculoskeletal Disorders May 2023To systematically review the studies regarding to the safety, efficacy and application methods of PRP in promoting the talar cartilage repair. (Meta-Analysis)
Meta-Analysis
PURPOSE
To systematically review the studies regarding to the safety, efficacy and application methods of PRP in promoting the talar cartilage repair.
METHODS
A systematic review was performed by searching PubMed, Web of Science, OVID and EMBASE to identify studies that compared the clinical efficacy of PRP for talar cartilage repair. Main outcome was the American Orthopedic Foot and Ankle Society (AOFAS) score for function and Visual Analog Scale (VAS) for pain was the second outcome.
RESULTS
A total of 10 studies were included in this systematic review, including 4 randomized controlled trials, 1 controlled trial, 3 case series and 2 cohort studies. Four RCTs were analyzed using meta-analysis. For all outcomes, statistical results favored PRP group (AOFAS: MD = 7.84; 95% CI= [-0.13, 15.80], I = 83%, P < 0.01; VAS: MD = 1.86; 95% CI= [0.68, 3.04], I = 85%, P < 0.01). There were almost no reports of adverse events related to PRP intervention. Subgroup analysis showed that whether PRP was used alone or combined with other treatments could result in high heterogeneity but no more specific factors were identified to contribute to this.
CONCLUSION
PRP is safe and effective for talar cartilage repair. In addition to the standardization of PRP preparation and application, it is necessary to distinguish the effects of PRP used alone or in combination with other treatments. In PRP studies, surgical treatment of talar cartilage repair remains the mainstream. The regulation of PRP in surgical applications are worth exploring. The most relative component is the mesenchymal stem cell because it is the only exposed chondrocyte precursor in the articular cavity whether it is microfracture or cell transplantation.
TRIAL REGISTRATION
The study was registered in the PROSPERO International prospective register of systematic reviews (CRD42022360183).
Topics: Humans; Chondrocytes; Fractures, Stress; Joints; Platelet-Rich Plasma; Cartilage; Randomized Controlled Trials as Topic
PubMed: 37161527
DOI: 10.1186/s12891-023-06466-y