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Experimental and Clinical... Aug 2020In recent years, there have been rapid advances in the field of keratoconus. Penetrating keratoplasty and deep anterior lamellar keratoplasty are the standard surgical... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
In recent years, there have been rapid advances in the field of keratoconus. Penetrating keratoplasty and deep anterior lamellar keratoplasty are the standard surgical procedures. Nevertheless, controversy remains regarding the outcomes of both procedures in the treatment of keratoconus. Therefore, we conducted a meta-analysis comparing postoperative outcome measures of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus.
MATERIALS AND METHODS
We searched PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews for eligible studies comparing best-corrected visual acuity, spherical equivalent, refractive cylinder, topography cylinder, and graft rejection episodes and complications of penetrating keratoplasty and deep anterior lamellar keratoplasty. Seven risk domains from software Review Manager 5.3 (The Cochrane Collaboration, Oxford, UK) were applied as quality assessments for the eligible studies. A random-effects model was used for data synthesis.
RESULTS
Thirteen eligible studies were included in our meta-analysis, which encompassed 530 eyes that underwent penetrating keratoplasty and 568 eyes that underwent deep anterior lamellar keratoplasty. With regard to best-corrected visual acuity, refractive cylinder, and topography cylinder, we found no significant differences in results between the 2 procedures (P = .49 and .47, respectively). However, spherical equivalent results were significantly greater in the deep anterior lamellar keratoplasty group than in the penetrating keratoplasty group (P < .001). The risk of graft rejection episodes was more prominent in the penetrating keratoplasty than in the deep anterior lamellar keratoplasty group (odds ratio = 2.69; P = .001). The odds ratio for complications was 1.79 (P = .03). Three studies showed moderate risk of bias, and the other 10 showed high risk of bias.
CONCLUSIONS
Deep anterior lamellar keratoplasty is preferred over penetrating keratoplasty for the treatment of keratoconus because of its low risk of rejection and complications.
Topics: Adolescent; Adult; Aged; Corneal Transplantation; Female; Graft Rejection; Humans; Keratoconus; Keratoplasty, Penetrating; Male; Middle Aged; Recovery of Function; Refractive Errors; Risk Assessment; Risk Factors; Treatment Outcome; Visual Acuity; Young Adult
PubMed: 31724924
DOI: 10.6002/ect.2019.0123 -
World Neurosurgery Mar 2018To compare the clinical efficacy of anterior and posterior approaches for selective thoracic fusion (STF) and selective thoracolumbar/lumbar fusion (SLF) in treating... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the clinical efficacy of anterior and posterior approaches for selective thoracic fusion (STF) and selective thoracolumbar/lumbar fusion (SLF) in treating adolescent idiopathic scoliosis (AIS).
METHODS
English-language literature on selective fusion treatment of AIS published before September 2016 was retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Studies were manually selected for inclusion based on preset criteria. Relevant radiologic data were extracted, and a systematic review and meta-analysis were performed.
RESULTS
Thirty-five eligible studies were included. The Cobb angles of the main thoracic and minor thoracolumbar/lumbar curves at the final follow-up were significantly and similarly corrected in the anterior and posterior STF groups. Anterior but not posterior STF was effective in correcting thoracic and thoracolumbar junctional hypokyphosis and in promoting sagittal balance, as determined by the relative position of the C7 plumb line. Similarly, in both the anterior and posterior SLF groups, the final Cobb angles of main thoracolumbar/lumbar and minor thoracic curves were significantly reduced compared with angles before surgery (P < 0.05). In contrast, posterior but not anterior SLF was effective in correcting lumbar hypolordosis and thoracic hypokyphosis. Both anterior and posterior SLF promoted coronal balance, with no effects on sagittal balance.
CONCLUSIONS
Both anterior and posterior approaches are effective for treatment of AIS. Anterior is more effective than posterior STF in correcting thoracic and thoracolumbar junctional hypokyphosis and in restoring sagittal balance. Posterior is more effective than anterior SLF in correcting lumbar hypolordosis and thoracic hypokyphosis and in restoring the sagittal curvature.
Topics: Adolescent; Humans; Scoliosis; Spinal Fusion
PubMed: 29309975
DOI: 10.1016/j.wneu.2017.12.161 -
Frontiers in Surgery 2022This systematic review and meta-analysis was performed to summarize available evidence of anterior transposition of the ulnar nerve for patients with distal humerus... (Review)
Review
BACKGROUND
This systematic review and meta-analysis was performed to summarize available evidence of anterior transposition of the ulnar nerve for patients with distal humerus fractures.
MATERIALS AND METHODS
The databases were searched from PubMed, Cochrane, Embase, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to June 2022. The clinical outcome included operation time, fracture healing time, hospital stays, elbow joint function, and ulnar neuritis rate. Statistical analysis was performed with Review Manager 5.3 (Cochrane Collaboration).
RESULTS
A total of 17 studies were included (8 RCTs and 9 retrospective studies), and 1280 patients were analyzed. The results of this meta-analysis showed anterior transposition group had longer operation time (MD = 20.35 min, 95%CI: 12.56-28.14, < 0.00001). There was no significant difference in fracture healing time (SMD = -0.50, 95%CI: -1.50-0.50, = 0.33), hospital stays (MD = -1.23 days, 95%CI: -2.72--0.27, = 0.11), blood loss (MD = 2.66 ml, 95%CI: -2.45-7.76, = 0.31), and ulnar neuritis rate (OR = 1.23, 95%CI: 0.63-2.42, = 0.54) between two groups. Finally, elbow joint motion, elbow joint function, fracture nonunion, and post-operative infection ( > 0.05) between two groups were not significantly statistic difference.
CONCLUSION
This meta-analysis showed that anterior transposition group is not superior to non-transposition group for patients with distal humerus fractures without ulnar nerve injury. On the contrary, non-transposition group have shorter operation time than that of anterior transposition group. Non-transposition group did not increase the post-operative ulnar neuritis rate. Therefore, both anterior transposition group and non- transposition group are the treatment options for patients with distal humerus fractures without ulnar nerve injury. Besides, these findings need to be further verified by multi-center, double-blind, and large sample RCTs.
PubMed: 36684340
DOI: 10.3389/fsurg.2022.1005200 -
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 -
Cureus Jun 2023Growth disturbances after transphyseal paediatric anterior cruciate ligament (ACL) reconstruction have led to the development of physeal-sparing techniques. The aim of... (Review)
Review
Growth disturbances after transphyseal paediatric anterior cruciate ligament (ACL) reconstruction have led to the development of physeal-sparing techniques. The aim of this study is to investigate growth disturbances following paediatric ACL reconstruction and identify associated risk factors. A systematic search on PubMed, Scopus and Web of Science databases was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify case series reporting paediatric ACL reconstructions. Of 518 articles, 78 met the inclusion criteria, and data related to growth disturbances and graft failures were extracted. A total of 2,693 paediatric ACL reconstructions resulted in 70 growth disturbances (2.6%): 17 were varus, 26 were valgus, 13 were shortening, 14 were lengthening and five patients had reduced tibial slope. Some patients showed deformities in more than one plane. Coronal plane deformities were seen more frequently with eccentric physeal arrest and lengthening with intraepiphyseal tunnelling. Shortening and reduced tibial slope were related to large central physeal arrest and anterior tibial physeal arrest, respectively. Sixty-two studies documented 166 graft failures in 2,120 reconstructions (7.8%). The extraphyseal technique was least likely to result in growth disturbances and graft failure. Paediatric ACL reconstruction is a safe and effective treatment of rupture. Growth disturbances are least likely following extraphyseal tunnelling, and those resulting from transphyseal techniques can be minimised by reducing drill size, drilling steep and avoiding the physeal periphery. The insertion of hardware, synthetic material, or a bone plug through the drilled physis should be avoided. There is a greater need for robust long-term data collection, such as national ligament registries, to standardise practice and evaluate the risk of growth disturbance and re-ruptures in this treatment.
PubMed: 37456432
DOI: 10.7759/cureus.40455 -
The Bone & Joint Journal Aug 2017Different methods of anterior cruciate ligament (ACL) reconstruction have been described for skeletally immature patients before closure of the growth plates. However,... (Review)
Review
AIMS
Different methods of anterior cruciate ligament (ACL) reconstruction have been described for skeletally immature patients before closure of the growth plates. However, the outcome and complications following this treatment remain unclear. The aim of this systematic review was to analyse the outcome and complications of different techniques which may be used for reconstruction of the ACL in these patients.
MATERIALS AND METHODS
We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This involved a comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using the following combinations of keywords, "knee", "anterior cruciate ligament", "reconstruction", "injury", "children", "adolescent", "skeletally immature", "open physis" and "surgery".
RESULTS
A total of 53 studies met the inclusion criteria and were included for analysis. The overall rate of disturbance of growth after ACL reconstruction was 2.6%, with no statistical difference between transphyseal and physeal-sparing techniques. Physeal-sparing techniques had a lower rate of post-operative complications compared with transphyseal techniques (p = 0.0045). Outcomes assessed were Lysholm score, International Knee Documentation Committee (IKDC) score, the IKDC grade, the Tegner score and the KT-1000. Both techniques had similar clinical outcomes.
CONCLUSIONS
This review reveals low rates of disturbance of growth after ACL reconstruction in skeletally immature patients. Although limited, the available evidence did not support any particular surgical technique when considering disturbance of growth or clinical outcome. Further randomised controlled trials are needed to investigate the efficacy of differing surgical techniques on outcomes in skeletally immature patients. Cite this article: 2017;99-B:1053-60.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Arthroscopy; Humans; Knee Joint; Recovery of Function; Tendons; Transplantation, Autologous; Treatment Outcome
PubMed: 28768782
DOI: 10.1302/0301-620X.99B8.BJJ-2016-1150.R1 -
Orthopaedic Journal of Sports Medicine May 2021The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults. (Review)
Review
BACKGROUND
The glenohumeral joint is one of the most frequently dislocated joints in the body, particularly in young, active adults.
PURPOSE
To conduct a systematic review and meta-analysis to evaluate and compare outcomes between anterior versus posterior shoulder instability.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review was performed using the PubMed, Cochrane Library, and MEDLINE databases (from inception to September 2019) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were published in the English language, contained outcomes after anterior or posterior shoulder instability, had at least 1 year of follow-up, and included arthroscopic soft tissue labral repair of either anterior or posterior instability. Outcomes including return-to-sport (RTS) rate, postoperative instability rate, and pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores were recorded and analyzed.
RESULTS
Overall, 39 studies were included (2077 patients; 1716 male patients and 361 female patients). Patients with anterior instability had a mean age of 23.45 ± 5.40 years (range, 11-72 years), while patients with posterior instability had a mean age of 23.08 ± 8.41 years (range, 13-61 years). The percentage of male patients with anterior instability was significantly higher than that of female patients (odds ratio [OR], 1.36; 95% CI, 1.04-1.77; = .021). Compared with patients with posterior instability, those with anterior instability were significantly more likely to RTS (OR, 2.31; 95% CI, 1.76-3.04; < .001), and they were significantly more likely to have postoperative instability (OR, 1.53; 95% CI, 1.07-2.23; = .018). Patients with anterior instability also had significantly higher ASES scores than those with posterior instability (difference in means, 6.74; 95% CI, 4.71-8.77; < .001). There were no significant differences found in postoperative complications between the anterior group (11 complications; 1.8%) and the posterior group (3 complications; 1.6%) (OR, 1.12; 95% CI, 0.29-6.30; = .999).
CONCLUSION
Patients with anterior shoulder instability had higher RTS rates but were more likely to have postoperative instability compared with posterior instability patients. Overall, male patients were significantly more likely to have anterior shoulder instability, while female patients were significantly more likely to have posterior shoulder instability.
PubMed: 34104660
DOI: 10.1177/23259671211006437 -
Journal of Orthopaedic Surgery and... Aug 2021The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of osteoarthritis. However, due to the structural limitations of the human body, it is not possible to perform ACLR with conventional sutures. To restore normal functioning of the anterior cruciate ligament (ACL), a new ligament must be reconstructed in the position of the previous ACL.
OBJECTIVE
To compare autografts and synthetic grafts in terms of postoperative knee stability and function SEARCH METHODS: The protocol for this study was registered with PROSPERO (CRD42021243451). Two reviewers independently searched the PubMed, Embase, and the Cochrane Library databases from database inception though February 10, 2021. The following search method was used: ((Autograft) OR (Autologous) OR (Autotransplant)) OR Artificial Ligament AND (Anterior Cruciate Ligament Injury [MeSH Terms]) AND (Randomized controlled trial [MeSH Terms]). Methodological quality was assessed by the Cochrane risk of bias tool.
SELECTION CRITERIA
We only included randomized controlled trials (level I) that compared autograft and synthetic graft interventions in participants with ACL injury. We included trials that evaluated ACLR using at least one outcome (Lachman test, pivot shift test, IKDC grades, or complications).
RESULTS
A total of 748 studies were identified in the initial literature search, and seven studies that examined only bone-patellar tendon-bone (BPTB) grafts compared with artificial grafts met the predetermined inclusion criteria. The results showed that BPTB grafts were associated with significantly better pivot shift test and Lachman test results and better IKDC grades and lower complication rates than synthetic grafts.
CONCLUSIONS
This review indicates that for adults, BPTB grafts perform more favorably than synthetic grafts in ACLR in terms of knee stability, function, and complication. More research is needed to compare autologous tendons and allogeneic tendons with artificial ligaments, especially in elderly individuals.
LEVEL OF EVIDENCE
Level I, systematic review and meta-analysis.
Topics: Adult; Aged; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Humans; Knee Joint; Patellar Ligament; Tendons; Transplantation, Autologous
PubMed: 34348750
DOI: 10.1186/s13018-021-02624-x -
Cureus Nov 2023Autonomic responses elicited by myocardial infarction vary depending on the site of injury, but accurate assessment using heart rate variability during the acute phase... (Review)
Review
Autonomic responses elicited by myocardial infarction vary depending on the site of injury, but accurate assessment using heart rate variability during the acute phase is limited. We systematically searched PubMed without language restrictions throughout July 2023. We reviewed studies reporting autonomic indices separately for anterior and inferior infarcts, followed by a meta-analysis of those reporting the standard deviation of the inter-beat interval between normal sinus beats during the initial 24 hours after the onset of symptoms. Six studies were included, comprising 341 patients (165 anterior, 176 inferior infarcts), all with satisfactory scores on the Newcastle-Ottawa quality scale. The estimated average of the standardized mean difference (based on the random-effects model) was -0.722 (95% confidence intervals: -0.943 to -0.501), which differed from zero (z=-6.416, p<0.0001). This finding indicates sympathetic and vagal dominance during acute anterior and inferior infarcts, respectively, with excessive responses likely contributing to early arrhythmogenesis. Despite the amelioration of autonomic dysfunction by revascularization, infarct location should be considered when commencing β-adrenergic receptor blockade, especially after delayed procedures.
PubMed: 38106761
DOI: 10.7759/cureus.48893 -
Orthopaedic Journal of Sports Medicine Dec 2023While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding... (Review)
Review
BACKGROUND
While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding indications and outcomes of proximal tibia anterior closing-wedge osteotomy (ACWO) with concomitant ACL reconstruction in patients with ACL tears.
PURPOSE
To assess clinical outcomes after combined ACL reconstruction and proximal tibia ACWO.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, we performed a systematic review of the existing literature on ACWO and ACL reconstruction using PubMed (MEDLINE), Cochrane Library, Scopus, and Embase. The search phrases included "anterior closing wedge osteotomy,""anterior closing wedge tibial osteotomy,""anterior closing wedge proximal tibial osteotomy,""anterior cruciate ligament," and "revision anterior cruciate ligament." Non-English publications and single-patient case reports were excluded. Extracted data included study details, patient demographics, patient-reported outcomes (PROs), clinical outcomes, radiographic outcomes, complications, and return-to-sport (RTS) rates.
RESULTS
A total of 6 studies with 110 patients (110 knees) were included. Two-stage ACWO and ACL reconstruction was reported in 2 studies of 78 patients (71%), while a single-stage technique was reported in 4 studies of 32 patients (29%). ACWO was performed in the setting of primary ACL tear in 23 patients (21%) and in recurrent ACL tear in 87 patients (79%). Patients demonstrated postoperative improvements in Lysholm, pivot-shift test, and side-to-side difference in anterior tibial translation. After ACWO, all studies reported mean postoperative PTS of <10° (range, 4.4°-9.2°). Of patients with available RTS data (n = 43), the same-level RTS rate ranged from 65% to 100%. A two-stage procedure reported in 1 study had a lower RTS rate (n = 13 of 20 [65%]) than that of 2 studies with single-stage procedure (n = 4 of 5 [80%] and n = 18 of 18 [100%]). The overall complication rate was 0.9% to 1.3%, and there were no reported ACL retears.
CONCLUSION
The current evidence, which is constrained by the quantity and quality of studies, showed that ACWO with single- or two-stage ACL reconstruction in patients with ACL insufficiency and increased PTS was associated with significant improvements in PROs and high RTS rates.
PubMed: 38107842
DOI: 10.1177/23259671231210549