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Indian Journal of Orthopaedics Oct 2022Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical... (Review)
Review
BACKGROUND
Anterior cruciate ligament (ACL) tear is considered as one of the most common sport-related musculoskeletal injuries. Double bundle (DB) and single bundle (SB) surgical techniques has been widely adopted for ACL reconstruction. This systematic review aimed to provide updated evidence by comparing the short-term, mid-term, and long-term knee stability and functional outcomes of DB and SB reconstruction techniques.
METHODS
We searched Medline, Web of Science, and CENTRAL. We have selected randomized controlled trials (RCTs) that compared DB and SB ACL reconstruction techniques for primary isolated ACL tear. We have assessed the following outcomes: pivot shift test, Lachman test, KT-1000/2000 knee ligament arthrometer, Lysholm knee function score, Tegner activity score, and graft failure. We have used the standardized mean difference (SMD) was to summarize the continuous outcomes while risk ratio (RR) was used to summarize the dichotomous outcomes.
RESULTS
A total of 34 RCTs that enrolled 2,992 participants deemed eligible. Overall, DB showed significantly better outcomes in terms of pivot shift test (RR = 0.61, 95% confidence interval (CI) 0.49-0.75), Lachman test (RR = 0.77, 95% CI 0.62 to 0.95), and KT 1000/2000 arthrometer (SMD = - 0.21, 95% CI - 0.34 to - 0.08). No discernible difference was found between DB and SB techniques in the overall Lysholm score (SMD = 0.12, 95% CI - 0.03 to 0.27), Tegner score (SMD = 0.03, 95% CI - 0.17 to 0.24), or graft failure rate (RR = 0.78, 95% CI 0.33 to 1.85).
CONCLUSIONS
Our review suggests that DB ACL reconstruction technique shows significantly better knee stability and functional outcomes than SB at short-term follow-up. However, both techniques exhibit similar outcomes at mid-term and long-term follow-up.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-022-00718-0.
PubMed: 36187591
DOI: 10.1007/s43465-022-00718-0 -
Tomography (Ann Arbor, Mich.) Jul 2022The aim of this study was to investigate the features of partial anomalous left pulmonary artery (PALPA) and differences between cases with posterior versus anterior a... (Review)
Review
The aim of this study was to investigate the features of partial anomalous left pulmonary artery (PALPA) and differences between cases with posterior versus anterior a nomalous vessels in relation to the tracheobronchial tree. We hypothesized that statistical significance was dependent on the course of the anomalous vessel due to airway compression in the posterior type. This study included cases obtained from the literature ( = 33) and an institution teaching file ( = 2). Information collected: age, sex, medical history, additional anomalies, anomalous vessel course, and respiratory symptoms. Data were analyzed with independent samples -test and Fisher's exact test. PALPAs were more commonly anterior than posterior. Mean age: 5.3 years (SD = 12.4) for anterior and 6.8 years (SD = 18.5) for posterior ( = 0.77). Respiratory symptoms: 20% of anterior and 60% of posterior cases ( = 0.032). Tracheobronchial anomalies: 35% of anterior and 60% of posterior cases ( = 0.182). Non-cardiac and non-tracheobronchial anomalies: 30% of anterior and 47% of posterior cases ( = 0.511). Kabuki syndrome: 25% of anterior and 6.7% of posterior cases ( = 0.207). In conclusion, respiratory symptoms were the only significant difference between anterior and posterior PALPA types.
Topics: Abnormalities, Multiple; Child, Preschool; Heart Defects, Congenital; Humans; Pulmonary Artery; Vascular Malformations; Vestibular Diseases
PubMed: 36006061
DOI: 10.3390/tomography8040163 -
Knee Surgery, Sports Traumatology,... Feb 2023Given the paucity of literature on the re-revision of ACL, the current study was undertaken. The purpose of this systematic review was to synthesise and qualitatively... (Review)
Review
PURPOSE
Given the paucity of literature on the re-revision of ACL, the current study was undertaken. The purpose of this systematic review was to synthesise and qualitatively assess the currently available evidence in the literature regarding the re-revision of ACL reconstruction (rrACLR).
METHODS
A systematic review was conducted based on the PRISMA guidelines. The following search terms were used in the title, abstract and keywords fields: "ACL" or "anterior cruciate ligament" AND "revision" or "multiple" or "repeat". The outcome data extracted from the studies were the Lysholm score, Subjective IKDC, Marx Score, Tegner, Marx Score, KOOS score, radiological changes and the rate of return to sports. Complications, failures and/or revision surgery were also analysed.
RESULTS
The cohort consisted of 295 patients [191 (64.7%) men and 104 (35.3%) women] with a mean age of 29.9 ± 2.8 years (range 14-58 years) from 10 studies. The mean postoperative follow-up (reported in all studies except one) was 66.9 ± 44.7 months (range 13-230.4 months). Associated injuries were 103 (34.9%) medial meniscus tears, 57 (19.3%) lateral meniscus tears, 14 (4.7%) combined medial plus lateral meniscus tears, 11 (3.7%) meniscal tears (not specified), 252 (85.4%) cartilage lesions, 6 (2.0%) medial collateral ligament injury and 2 (0.7%) lateral collateral ligament injuries. In 47 (15.9%) patients an extra-articular plasty was performed for the anterolateral ligament. In all studies that reported pre- and post-operative IKDC (subjective and objective) and Lysholm score, there was a significant improvement compared to the pre-operative value (p < 0.05). At the final follow-up, laxity measured with KT-1000 was found to be 2.2 ± 0.6 mm. 31 (10.5%) out of 295 patients returned to their pre-injury activity level. A total of 19 (6.4%) re-ruptures were found, while only 4 (1.4%) complications (all minors) were reported, out of which 2 (0.7%) were superficial infections, 1 (0.3%) cyclops lesion and 1 (0.3%) flexion loss.
CONCLUSION
Multiple revisions of anterior cruciate ligament reconstruction allow acceptable clinical results and a good degree of knee stability with a low rate of subsequent new re-ruptures but the possibility of regaining pre-injury sports activity is poor; whenever possible, it is preferred to revise the ligament in one stage. This surgery remains a challenge for orthopaedic surgeons and many doubts persist regarding the ideal grafts, additional extra-articular procedures and techniques to use.
LEVEL OF EVIDENCE
IV.
STUDY REGISTRATION
PROSPERO-CRD42022352164 ( https://www.crd.york.ac.uk/prospero/ ).
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Knee Joint; Knee Injuries; Anterior Cruciate Ligament Reconstruction; Reoperation; Follow-Up Studies
PubMed: 36224291
DOI: 10.1007/s00167-022-07197-8 -
Cureus Aug 2023Anterior cruciate ligament (ACL) rupture is a common and debilitating knee injury that can significantly impair knee function and stability. The optimal management of... (Review)
Review
Anterior cruciate ligament (ACL) rupture is a common and debilitating knee injury that can significantly impair knee function and stability. The optimal management of ACL injuries remains a topic of ongoing debate, with two primary treatment approaches being surgical reconstruction and adequate rehabilitation. The aim of this study is to compare the knee function and stability outcomes between these two treatment modalities, shedding light on their respective effectiveness. We utilized Scopus, PubMed, Cochrane Database, MEDLINE, and Web of Science from inception until April 20, 2022. We utilized the Cochrane risk of bias tool for quality assessment. The following outcomes were assessed: Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee score, Lysholm score, the occurrence of the knee giving way, Tegner score, KT1000, Lachman test, pivot shift test, SF-36 score to assess the quality of life, and incidence of reinjury and reoperation. We included a total of six trials with a population sample size of 691 patients, which were divided into surgical versus non-surgical groups, accounting for 348 and 343 patients, respectively. The pooled estimate demonstrated that the surgical reconstruction was associated with a significant increase in the IKDC score (MD = 7.49 [2.04, 12.94], (P = 0.007)), and KOOS score was significant in the reconstruction cohort (MD = 5.87 [1.64, 10.09], (P = 0.007)). The incidences of reoperation (RR = 0.43 [0.20, 0.91], (P = 0.03)), reinjury (RR = 0.49 [0.27, 0.88], (P = 0.02)), and occurrence of the knee giving way (RR = 0.19 [0.08, 0.49], (P = 0.005)) were significantly decreased in the surgical cohort. There is no significant difference between both cohorts regarding the Lysholm score (1.27 [-1.39, 3.93], (P = 0.35)). The findings of this comprehensive analysis indicate that early reconstruction does not demonstrate clear superiority over rehabilitation alone in terms of knee function, Lysholm score, and Tegner score among patients with ACL rupture. However, early reconstruction does exhibit a substantial reduction in the incidence of reinjury, reoperation, and knee giving way, suggesting potential benefits in terms of stability outcomes. These results underscore the importance of considering individual patient characteristics and preferences in treatment decision-making.
PubMed: 37700946
DOI: 10.7759/cureus.43370 -
Medicine Jun 2022: Current guidelines recommend per-oral endoscopic myotomy (POEM) and laparoscopic Heller's myotomy (LHM) as first-line treatment of idiopathic achalasia, but the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
: Current guidelines recommend per-oral endoscopic myotomy (POEM) and laparoscopic Heller's myotomy (LHM) as first-line treatment of idiopathic achalasia, but the optimum choice between different endoscopic and surgical modalities remains inconclusive. We conducted a network meta-analysis to compare the efficacy of 8 treatments for idiopathic achalasia.
MATERIALS AND METHODS
: Three major bibliographic databases were reviewed for enrollment of randomized controlled trials between January 2000 and June 2021. We included adults with idiopathic achalasia and compared two or more of eight interventions including botulinum toxin injection (BTI), pneumatic dilation (PD), BTI + PD, LHM without fundoplication, LHM followed with Dor or Toupet fundoplication, and POEM using either the anterior or posterior approach. Our focus was on clinical success rate, postsurgical acid reflux, and moderate-to-severe adverse events.
RESULTS
: Twenty-four studies involved a total of 1987 participants for analysis. When compared with PD, POEM with anterior approach, POEM with posterior approach, LHM + Toupet, and LHM + Dor were all significantly superior to the other regimens in short-term efficacy, with POEM with anterior approach and LHM + Dor showing better improvement in mid-term efficacy. BTI showed a significantly lower efficacy than PD in both periods. Regarding safety, only LHM without fundoplication was significantly associated with higher acid reflux than PD, while LHM + Toupet, LHM without fundoplication, and LHM + Dor showed a non-significant increase in moderate-to-severe adverse events.
CONCLUSIONS
: For idiopathic achalasia, we suggest that POEM with an anterior or posterior approach and LHM with Dor or Toupet fundoplication be initially recommended. On the contrary, both LHM without fundoplication and BTI are not recommended as definitive therapy.
Topics: Adult; Botulinum Toxins; Dilatation; Esophageal Achalasia; Fundoplication; Gastroesophageal Reflux; Heller Myotomy; Humans; Laparoscopy; Network Meta-Analysis; Treatment Outcome
PubMed: 35713453
DOI: 10.1097/MD.0000000000029441 -
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 -
Cureus Jul 2023The purpose of this review is to examine the literature on combined pelvic ring and acetabular fractures. We hope to further define the classifications, severities (ISS... (Review)
Review
The purpose of this review is to examine the literature on combined pelvic ring and acetabular fractures. We hope to further define the classifications, severities (ISS & Mortality), healing, radiographic parameters, and functional outcomes of such injuries to report all potential recommendations based on findings. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and a systematic search on PubMed and Google Scholar was performed. Articles included were in the English Language or through English translation, between the years 1996 and 2022. Articles that had met the inclusion criteria were systematically assessed for the relevance of their content. Eleven articles were identified with a total of 985 patients. All eleven were retrospective case series and the presence of both an injury within the pelvic ring and another injury within the acetabulum, either ipsilateral or contralateral, was the indication of a combination injury. The overall mortality rate averaged over all studies was 7.9% and the Injury Severity Score (ISS) of 22.98. When considering the higher mortality rate seen in pelvic ring injuries compared to the isolated acetabulum, there appears to be survivability beyond reductive means as a reason for reducing and fixing the pelvic ring first. However, accurate reduction of the acetabulum has a greater weight in overall patient recovery compared to the reduction of the pelvic ring and thus surgical emphasis on the anatomic reduction of the acetabulum may be paramount. Despite this good to excellent outcomes can be achieved with careful preoperative planning and surgical execution in patients with fractures of the pelvic ring and acetabulum. Further research as well as uniform radiographic scoring system and outcomes scores should be required to better evaluate and treat these injuries.
PubMed: 37575857
DOI: 10.7759/cureus.41843 -
European Journal of Orthopaedic Surgery... Aug 2023This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial... (Meta-Analysis)
Meta-Analysis Review
Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis.
PURPOSE
This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR.
METHODS
A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant.
RESULTS
Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found.
CONCLUSION
ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Anterior Cruciate Ligament; Knee Joint; Anterior Cruciate Ligament Injuries; Tibia; Osteotomy; Anterior Cruciate Ligament Reconstruction; Retrospective Studies
PubMed: 36308547
DOI: 10.1007/s00590-022-03419-4 -
Acta Ophthalmologica May 2022Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative... (Review)
Review
Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st-generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle-based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post-implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology.
Topics: Glaucoma; Humans; Intraocular Pressure; Minimally Invasive Surgical Procedures; Stents; Tomography, Optical Coherence
PubMed: 34250742
DOI: 10.1111/aos.14962 -
JAMA Network Open Nov 2022The timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic.
OBJECTIVE
To synthesize up-to-date published data from randomized clinical trials (RCTs) comparing early vs elective delayed ACLR for patients with ACL deficiency, in terms of clinical outcomes and complications.
DATA SOURCES
The PubMed, Cochrane Library, and Web of Science databases were systematically searched until September 9, 2022.
STUDY SELECTION
All published RCTs comparing clinical and functional outcomes and complications associated with early ACLR vs elective delayed ACLR.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently extracted relevant data and assessed the methodological quality following the PRISMA guidelines.
MAIN OUTCOMES AND MEASURES
Due to the clinical heterogeneity, the random-effects model was preferred. The primary outcomes were functional outcomes and complications. The Mantel-Haenszel test was used to evaluate dichotomous variables and the inverse variance method was used to assess continuous variables.
RESULTS
This meta-analysis included 972 participants in 11 RCTs stratified by follow-up duration. The following factors did not differ between early and delayed ACLR: operative time (mean difference, 4.97; 95% CI, -0.68 to 10.61; P = .08), retear (OR, 1.52; 95% CI, 0.52-4.43; P = .44), and infection (OR, 3.80; 95% CI, 0.77-18.79; P = .10). There were also no differences between groups in range of motion, knee laxity, International Knee Documentation Committee (IKDC rating scale), and Tegner score. IKDC score (mean difference, 2.77; 95% CI, 1.89-3.66; P < .001), and Lysholm score at 2-year follow-up (mean difference, 2.61; 95% CI, 0.74-4.48; P = .006) significantly differed between early and delayed ACLR. In addition, the timing of surgery was redefined in the included RCTs and subgroup analyses were performed, which validated the robustness of the principal results.
CONCLUSION AND RELEVANCE
This systematic review and meta-analysis found that early ACLR was not superior to delayed ACLR in terms of most factors analyzed, except for IKDC and Lysholm scores. This information should be available to patients with ACL deficiency and clinicians as part of the shared decision-making process of treatment selection.
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Knee Joint; Knee; Range of Motion, Articular
PubMed: 36394870
DOI: 10.1001/jamanetworkopen.2022.42742