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Orthopaedic Journal of Sports Medicine Mar 2021Although studies are available on high-energy Lisfranc injuries, the evidence for increasingly reported low-energy Lisfranc injuries in active individuals, including... (Review)
Review
BACKGROUND
Although studies are available on high-energy Lisfranc injuries, the evidence for increasingly reported low-energy Lisfranc injuries in active individuals, including athletes and military personnel, remains scarce and mostly retrospective.
PURPOSE
This meta-analysis aimed to review the return-to-play (RTP) and return-to-duty (RTD) rates with regard to the anatomic type and the management of low-energy Lisfranc injuries in a high-demand, active population.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the MEDLINE (PubMed), EMBASE, Google Scholar, and Cochrane databases through June 2019 to identify studies on low-energy Lisfranc injuries in athletes and military personnel. The primary outcomes were RTP/RTD rates and time to RTP/RTD, and the secondary outcomes were time missed from practice, games missed, time to full recovery, midfoot arthritis rate, and reoperation rate.
RESULTS
Overall, 15 studies (N = 441 patients) were included in the meta-analysis. Of these, 6 studies were of level 3 evidence, 8 studies were level 4 (case series), and 1 study was level 5. Of the 441 subjects, 380 (86.17%) were able to RTP and RTD. There was no statistically significant difference in RTP rates for operative versus nonoperative treatment, ORIF versus PA, or bony versus ligamentous injuries. The mean time missed from practice/duty for operative versus nonoperative treatment was 58.02 days (95% CI, 13.6-102.4 days; = 98.03%) and 116.4 days (95% CI, 62.4-170.4 days; = 99.45%), respectively. The mean time missed from practice/duty for bony versus ligamentous injury was 98.9 days (95% CI, 6.1-191.7 days; = 99.82%) and 76.5 days (95% CI, 37.9-115.02 days; = 99.83%), respectively, with no statistically significant differences (standardized mean difference = 3.62 days [95% CI: -5.7 to 13 days]; = 83.17%).
CONCLUSION
This review indicated an overall excellent RTP/RTD rate for low-energy Lisfranc injuries in high-demand individuals. The time missed from athletic participation/military duty was not affected by injury treatment type, the bony versus ligamentous nature of the injury, or athlete player position. However, the low evidence levels and significant heterogeneity of the included studies precludes making conclusions regarding length of time missed or optimal management. Higher-quality studies on low-energy Lisfranc injuries are needed.
PubMed: 33763497
DOI: 10.1177/2325967120988158 -
Journal of Hand Surgery Global Online Jul 2023To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease.
PURPOSE
To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease.
METHODS
This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate.
RESULTS
The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively.
CONCLUSIONS
Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results.
CLINICAL RELEVANCE
Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.
PubMed: 37521555
DOI: 10.1016/j.jhsg.2023.03.014 -
BMC Surgery Nov 2023To comprehensively compare and assess the effects of different lumbar fusion techniques in patients with lumbar spinal stenosis (LSS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To comprehensively compare and assess the effects of different lumbar fusion techniques in patients with lumbar spinal stenosis (LSS).
METHODS
PubMed, Embase, Cochrane Library, and Web of Science databases were systematically searched up to December 24, 2022 in this network meta-analysis. Outcomes were pain (pain, low back pain, and leg pain), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), complications, reoperation, and fusion. Network plots illustrated the direct and indirect comparisons of different fusion techniques for the outcomes. League tables showed the comparisons of any two fusion techniques, based on both direct and indirect evidence. The efficacy of each fusion technique for LSS was ranked by rank probabilities.
RESULTS
Totally 29 studies involving 2,379 patients were eligible. For pain, percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) was most likely to be the best technique, followed by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), extreme lateral interbody fusion (XLIF), and transforaminal lumbar interbody fusion (TLIF). Percutaneous endoscopic posterior lumbar interbody fusion (Endo-PLIF) had the greatest likelihood to be the optimal technique for low back pain, followed sequentially by MIS-TLIF, minimally invasive posterior lumbar interbody fusion (MIS-PLIF), XLIF, Endo-TLIF, TLIF, oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), and posterolateral lumbar fusion (PLF). MIS-PLIF was ranked the most effective technique concerning leg pain, followed by Endo-TLIF, MIS-TLIF, TLIF, Endo-PLIF, PLIF, OLIF, PLF, and XLIF. As regards JOA scores, Endo-TLIF had the maximum probability to be the best technique, followed by MIS-TLIF and TLIF. Endo-PLIF had the greatest likelihood to be the optimum technique for complications, followed by TLIF, MIS-TLIF, Endo-TLIF, OLIF, and XLIF.
CONCLUSION
Minimally invasive fusion techniques may be effective in the treatment of LSS, compared with traditional techniques. Minimally invasive techniques were likely non-inferior with regards to postoperative complications.
Topics: Humans; Low Back Pain; Lumbar Vertebrae; Spinal Stenosis; Bayes Theorem; Network Meta-Analysis; Treatment Outcome; Minimally Invasive Surgical Procedures; Spinal Fusion; Retrospective Studies
PubMed: 37968633
DOI: 10.1186/s12893-023-02242-w -
Neurosurgical Review Apr 2023This meta-analysis compared the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the... (Meta-Analysis)
Meta-Analysis
Oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative disease of the lumbar spine: a systematic review and meta-analysis.
This meta-analysis compared the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases. A computer search for the published literature on OLIF and MIS-TLIF for the treatment of lumbar degenerative diseases in the PubMed, Web of Science, Embase, CINAHL, MEDLINE, Cochrane Library, and other databases was performed, from which 522 related articles were retrieved and 13 were finally included. Two reviewers independently extracted data from the included studies and analyzed them using RevMan 5.4. The quality of the studies was assessed using the Cochrane systematic analysis and the Newcastle-Ottawa scale. Meta-analysis showed that the blood loss [95% confidence intervals (CI) (- 121.01, - 54.56), [Formula: see text]], hospital stay [95% CI (- 1.98, - 0.85), [Formula: see text]], postoperative fusion rate [95%CI (1.04, 3.60), [Formula: see text]], postoperative disc height [95% CI (0.50, 3.63), [Formula: see text]], and postoperative foraminal height [95% CI (0.96, 4.13), [Formula: see text]] were all better in the OLIF group; however, the complication rates were significantly lower in the MIS-TLIF group [95% CI (1.01, 2.06), [Formula: see text]]. However, there were no significant differences between the two in terms of surgery time, patient satisfaction, or postoperative functional scores. The OLIF group had the advantages of lower blood loss, a shorter hospital stay, a higher postoperative fusion rate, and better recovery of the disc and foraminal heights, whereas MIS-TLIF had a relatively lower complication rate.
Topics: Humans; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Spinal Fusion; Patient Satisfaction; Lumbosacral Region; Treatment Outcome; Retrospective Studies
PubMed: 37119422
DOI: 10.1007/s10143-023-02009-0 -
Orthopedic Reviews Jun 2020The Charcot foot is a condition characterized by a progressive derangement of the foot. The type of deformity and patient clinical conditions will lead to the proper...
The Charcot foot is a condition characterized by a progressive derangement of the foot. The type of deformity and patient clinical conditions will lead to the proper surgical approach among exostectomy, arthrodesis (through external and/or internal fixation) and amputation. Many authors report good clinical outcomes performing the arthrodesis in Charcot foot; however, the choice of the most appropriate hardware is still an issue. The aim of this study is to analyze the outcomes of different hardware in midfoot and hindfoot Charcot arthrodesis.
PubMed: 32913602
DOI: 10.4081/or.2020.8670 -
Indian Journal of Orthopaedics Mar 2023Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip... (Review)
Review
INTRODUCTION
Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip arthroplasty (THA) in patients with advanced arthritis offers a painless and mobile joint with good functional outcome but some aspects of THA in TB hip have been controversial in the past due to the concerns of disease reactivation, especially when disease activity is factored in. Various factors like timing of surgery, Antitubercular therapy (ATT) initiation timing, reactivation, complications etc needs to be evaluated very carefully before planning for such cases.
METHODS
Electronic databases like MEDLINE, EMBASE, Cochrane library, Clinicaltrials gov and OpenGrey were searched. The key words used were "Tuberculosis", "Tuberculosis of hip", Hip tuberculosis, "TB", "THR", "total hip replacement", "total hip arthroplasty","THA", "ankylosed hip", "fused hip", "arthrodesis" along with boolean operators "AND" and "OR". Out of a total of 1634 articles, 38 were selected for full text review and 22 articles were finally included in the study.
RESULTS
For the timing of surgery most authors relied on the inflammatory markers to settle down with ATT before performing THA. 15 authors advocated use of pre-operative ATT with 6 studies recommending at least 2 weeks and 3 studies advocating atleast 3 months of ATT pre surgery.Single stage THA was performed in most studies(214 hips vs 18 hips) as opposed to 2 or 3 stage surgery. In the active disease 72.8% of the hips had uncemented prosthesis, 25.6% hips underwent cemented and 1.5% hips had hybrid THA fixation. Overall reactivation of the infection was seen in 2.47% cases. All authors reported excellent clinical improvement (mean HHS improvement 37.17 to 88.62).
PubMed: 36825271
DOI: 10.1007/s43465-023-00817-6 -
Journal of Clinical Medicine May 2023Although open surgery is the conventional option for ankle arthritis, there are some reports in the literature regarding the use of the arthroscopy procedure with... (Review)
Review
Although open surgery is the conventional option for ankle arthritis, there are some reports in the literature regarding the use of the arthroscopy procedure with outstanding results. The primary purpose of this systematic review and meta-analysis was to analyze the effect of the surgery technique (open-ankle arthrodesis vs. arthroscopy) in patients with ankle osteoarthritis. Three electronic databases (PubMed, Web of Science, and Scopus) were searched until 10 April 2023. The Cochrane Collaboration's risk-of-bias tool was used to assess the risk of bias and grading of the recommendations assessment, development, and evaluation system for each outcome. The between-study variance was estimated using a random-effects model. A total of 13 studies (including = 994 participants) met the inclusion criteria. The meta-analysis results revealed a nom-significant ( = 0.072) odds ratio (OR) of 0.54 (0.28-1.07) for the fusion rate. Regarding operation time, a non-significant difference ( = 0.573) among both surgical techniques was found (mean differences (MD) = 3.40 min [-11.08 to 17.88]). However, hospital length stay and overall complications revealed significant differences (MD = 2.29 days [0.63 to 3.95], = 0.017 and OR = 0.47 [0.26 to 0.83], = 0.016), respectively. Our findings showed a non-statistically significant fusion rate. On the other hand, operation time was similar among both surgical techniques, without significant differences. Nevertheless, lower hospital stay was found in patients that were operated on with arthroscopy. Finally, for the outcome of overall complications, the ankle arthroscopy technique was a protective factor in comparison with open surgery.
PubMed: 37240680
DOI: 10.3390/jcm12103574 -
Shoulder & Elbow Feb 2020Severe glenohumeral arthritis in the young/active patient remains challenging. Historically, glenohumeral arthrodesis was recommended with limited return of function.... (Review)
Review
BACKGROUND
Severe glenohumeral arthritis in the young/active patient remains challenging. Historically, glenohumeral arthrodesis was recommended with limited return of function. Total shoulder arthroplasty has shown increasing survivorship at 15 years; however it is still not ideal for young patients. Biologic resurfacing of the glenoid with humeral head replacement has shown promising results.
METHODS
The PubMed and Embase databases were queried for studies evaluating outcomes of glenoid biologic resurfacing with autograft or allograft. Two independent reviewers performed a systematic review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.
RESULTS
Eleven studies (268 shoulders, 264 patients) were included. Minimum follow-up was 24 months in all but one study; patient age ranged from 14 to 75 years. Glenoid grafts used included 44.3% lateral meniscus allografts, 25.4% human acellular dermal matrix, 14.2% Achilles tendon allografts, 11.6% shoulder joint capsules, and 4.5% fascia lata autografts. Studies reported significantly improved American Shoulder and Elbow Surgeons, Visual Analog Scale, and Simple Shoulder Test scores postoperatively; 43.3% were failures (Neer's evaluation of unsatisfactory or requiring revision). Infection occurred in 12/235.
CONCLUSIONS
Biologic resurfacing of the glenoid with a metallic humeral component can provide a significant improvement in pain, motion, and standardized outcomes scores in the well-indicated situation. Appropriate counseling is required with an appreciated complication rate of over 36% and a revision rate of 34%.
PubMed: 32010227
DOI: 10.1177/1758573219849606 -
Indian Journal of Orthopaedics Sep 2022The purpose of this paper was to review the MRI features and treatment for idiopathic chondrolysis of the hip (ICH) in patients aged 18 years or less. (Review)
Review
BACKGROUND
The purpose of this paper was to review the MRI features and treatment for idiopathic chondrolysis of the hip (ICH) in patients aged 18 years or less.
METHODS
We included studies published in English up to August 2021. We accessed major electronic bibliographic databases on ICH that described MRI features, treatment, or both. We used the Joanna Briggs Institute (JBI) Critical appraisal checklist for case reports for Risk of bias assessment.
RESULTS
We pooled 136 hips (125 participants) from 35 studies with 11.6 ± 3.4 years mean age. We had 46, 8, and 106 hips to assess ICH's MRI, pharmacological, and operative interventions. Geometric marrow edema (GME) ( < 0.01), diffuse marrow edema (DME) ( < 0.05), diffuse cartilage loss (DCL) ( < 0.05), and joint effusion ( < 0.05), were significantly associated with time in first MRI reviews. GME ( < 0.01) and focal cartilage loss (FCL) ( < 0.01) decreased significantly between two MRI reviews at median time of 1.75 (IQR 0.93-4.25) and 12.5 (IQR 3.75-19.5) months. Diffuse cartilage loss ( < 0.01) and degenerative changes ( < 0.01) increased significantly between the two MRI reviews. Etanercept, Methotrexate, and Botulinum Neurotoxin A drugs were used by 3, 3, and 1 report to treat ICH. Capsulectomies, total hip arthroplasty, arthrodiastasis, arthrodesis, arthroscopy operations treated 45, 18, 5, 5, and 2 hips.
DISCUSSION
GME may be the most specific and early MRI feature in diagnosing ICH. GME and DME show an inverse relationship over time. So, it is with FCL and DCL. Despite reports on the efficacy of biologics, immunomodulators, and operations, early and late ICH management remains controversial due to poor quality studies.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-022-00684-7.
PubMed: 36052391
DOI: 10.1007/s43465-022-00684-7 -
Foot & Ankle Orthopaedics Jul 2022Central talar fractures are rare and often associated with impaired functional outcome. Despite recent advances in diagnosis and management of talus fractures,...
BACKGROUND
Central talar fractures are rare and often associated with impaired functional outcome. Despite recent advances in diagnosis and management of talus fractures, complications rates remain high and functional outcome is generally poor. This study aims to provide an overview of complication rates and functional outcome following operative treatment of talar neck and body fractures. This may help in clinical decision making by improving patients' expectation management and tailored treatment strategies.
METHODS
A systematic review of the literature was conducted of studies published from January 2000 to July 2021 reporting functional outcome and/or complications following operative treatment of talar neck, body, or combined neck and body fractures. Keywords used were (Talar fracture) or (Talus fracture). Data on complication rates and functional outcome was extracted from selected articles.
RESULTS
A total of 28 articles were included in our analysis reporting 1086 operative treated talar fractures (755 neck [70%], 227 body fractures [21%], and 104 combined body and neck fractures [9%]). The mean follow-up was 48 (range 4-192) months. Complications occurred frequently with; 6% surgical site infection, 8% nonunion, 29% avascular necrosis, 64% osteoarthritis, and in 16% a secondary arthrodesis was necessary. A wide variety in functional outcome was reported; however, there seems to be a correlation between fracture classification and postoperative complications.
CONCLUSION
Operative treatment of central talar fractures is associated with a high incidence of early and late complications and often leads to an impaired functional outcome. Standardization of talar fracture classification and scoring systems in combination with large sample-sized prospective studies are warranted to detect further predictive factors influencing tailormade treatment strategies and patient expectation management.
LEVEL OF EVIDENCE
Level III, Systematic review of case series and case-control studies.
PubMed: 36199382
DOI: 10.1177/24730114221127201