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Indian Journal of Orthopaedics Jun 2022The aim of this meta-analysis was to evaluate differences in functional outcomes between simultaneous bi-unicompartmental knee arthroplasty (Bi-UKA) and total knee... (Review)
Review
Outcomes of Bi-unicompartmental Versus Total Knee Arthroplasty for the Treatment of Medial and Lateral Knee Osteoarthritis: A Systematic Review and Meta-analysis of Comparative Studies.
PURPOSE
The aim of this meta-analysis was to evaluate differences in functional outcomes between simultaneous bi-unicompartmental knee arthroplasty (Bi-UKA) and total knee arthroplasty (TKA) for the treatment of medial and lateral knee osteoarthritis.
MATERIAL AND METHODS
According to the PRISMA statement, a comprehensive search was conducted to identify studies reporting comparative results of the Bi-UKA versus the TKA. Of 953 titles, 6 studies met the inclusion criteria.
RESULTS
A total of 286 patients were identified, of which 137 underwent Bi-UKA and 149 TKA. TKA reported a mean hip-knee-ankle (HKA) angle of 179.4 ± 2.4 compared to that in Bi-UKA measuring 177.2 ± 2.7 ( = 0.0001, 95% CI - 3.02 to - 1.38). No difference was found in the Western Ontario and McMaster Universities (WOMAC) pain (4 ± 1.6 and 4.2 ± 1.3 for Bi-UKA and TKA, respectively; = 0.4996, 95% CI - 0.86 to 0.43). Bi-UKA was favorable in terms of WOMAC function (7.5 ± 1.9 and 9 ± 1.9 for Bi-UKA and TKA, respectively; = 0.001, 95% CI - 2.29 to - 0.61) and WOMAC stiffness (1.6 ± 1 and 2.4 ± 0.7 for Bi-UKA and TKA, respectively; = 0.0001, 95% CI - 1.18 to - 0.42). Bi-UKA showed a better Knee Society Score (KSS) in comparison to TKA (79.7 ± 7.8 and 75.4 ± 10.5 for Bi-UKA and TKA, respectively; = 0.0021, 95% CI 1.58-7.02). The differences in postoperative outcomes scores between Bi-UKA and TKA were lower than their respective minimum clinically important differences.
CONCLUSIONS
When Bi-UKA and TKA are compared for the treatment of medial and lateral knee osteoarthritis, Bi-UKA are favorable in terms of WOMAC and KSS even though these values are lower than the minimum clinically important differences; moreover, similar postoperative hip-knee-ankle angle can be expected 3 years after Bi-UKA and TKA.
PubMed: 35669030
DOI: 10.1007/s43465-022-00628-1 -
Archives of Orthopaedic and Trauma... Dec 2022The primary aim of this investigation was to systematically review relevant literature of various imaging modalities (magnetic resonance imaging (MRI), stress...
INTRODUCTION
The primary aim of this investigation was to systematically review relevant literature of various imaging modalities (magnetic resonance imaging (MRI), stress radiography and ultrasonography) in the assessment of patients with a medial collateral ligament (MCL) injury.
MATERIALS AND METHODS
A systematic literature review of articles indexed in PubMed and Cochrane library was performed. Original research reporting data associated with medial gapping, surgical, and clinical findings associated with MCL injuries were considered for inclusion. The methodological quality of each inclusion was also assessed using a verified tool.
RESULTS
Twenty-three imaging studies (magnetic resonance imaging (MRI) n = 14; ultrasonography n = 6; radiography n = 3) were ultimately included into the review. A total of 808 injured, and 294 control, knees were assessed. Interobserver reliabilities were reported in radiographic and ultrasonographic investigations with almost perfect agreement. MRI studies demonstrated agreement ranging between substantial to almost perfect. Intraobserver reliability was only reported in radiographic studies pertinent to medial gapping and was found to be almost perfect. Correlation of MRI with clinical findings was moderate to strong (65-92%). Additionally, MRI imaging was more sensitive in the detection of MCL lesions when compared to clinical examination. However, when compared to surgical findings, MRI underestimated the grade of instability in up to 21% of cases. Furthermore, MRI showed relatively inferior performance in the identification of the exact MCL-lesion location when compared to surgical findings. Interestingly, preoperative clinical examination was slightly inferior to stress radiography in the detection of MCL lesions. However, clinical testing under general anaesthesia performed similar to stress radiography. The methodological quality analysis showed a low risk of bias regarding patient selection and index testing in each imaging modality.
CONCLUSION
MRI can reliably diagnose an MCL lesion but demonstrates limitations in its ability to predict the specific lesion location or grade of MCL instability. Ultrasonography is a widely available, radiation free modality, but is rarely used in clinical practice for detecting MCL lesions and clinical or surgical correlates are scarce. Stress radiography findings correlate with surgical findings but clinical correlations are missing in the literature.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Reproducibility of Results; Knee Joint; Joint Instability; Radiography; Magnetic Resonance Imaging; Collateral Ligaments; Medial Collateral Ligament, Knee
PubMed: 34628563
DOI: 10.1007/s00402-021-04200-8 -
The Journal of Hand Surgery, European... Nov 2017The aim of this study was to review the literature of decompression of the cubital tunnel with medial epicondylectomy and to assess outcomes and complications.... (Review)
Review
UNLABELLED
The aim of this study was to review the literature of decompression of the cubital tunnel with medial epicondylectomy and to assess outcomes and complications. Twenty-one case series reported on 886 medial epicondylectomies. The mean percentage of patients obtaining improvement of one or more McGowan grade was 79%. The mean percentage obtaining a good/excellent Wilson Krout grade of outcome was 83%. Of six comparative studies, two showed no significant differences in outcomes between medial epicondylectomy and transposition procedures, and three reported better outcomes with medial epicondylectomy. One reported similar outcomes with medial epicondylectomy and simple decompression. The existing literature on medial epicondylectomy is of limited methodological quality and does not allow for firm conclusions to be drawn regarding its efficacy compared with other surgical techniques. Further studies should aim for high methodological quality, randomized comparison with simple decompression or anterior transposition and should utilize standardized outcome measures.
LEVEL OF EVIDENCE
II.
Topics: Cubital Tunnel Syndrome; Decompression, Surgical; Epiphyses; Humans; Humerus; Osteotomy
PubMed: 28856934
DOI: 10.1177/1753193417724351 -
The American Journal of Sports Medicine Jan 2022Patellar instability is frequently encountered in the athletic population. Medial patellofemoral ligament (MPFL) reconstruction is a common strategy to treat recurrent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patellar instability is frequently encountered in the athletic population. Medial patellofemoral ligament (MPFL) reconstruction is a common strategy to treat recurrent patellar dislocation and demonstrates good clinical outcomes.
PURPOSE/HYPOTHESIS
The purpose was to examine return to sport after MPFL reconstruction for patellar instability. We hypothesized that patients would resume athletic activity at a high rate and that a large proportion would return to their preoperative level of performance.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A systematic review of the literature was conducted using PubMed and Cochrane Library databases to identify articles reporting return to sport after MPFL reconstruction for recurrent patellar dislocation. Athletes were defined as those reporting a preoperative sport. A random-effects model was used to evaluate return to sport rates, subsequent level, and rate of instability recurrence. Meta-regression was used to compare return to sport rates in patients undergoing MPFL reconstruction without osteotomy compared with those treated with simultaneous tibial tubercle osteotomy or trochleoplasty.
RESULTS
In total, 23 articles met inclusion criteria after full-text review. A total of 930 patients were analyzed, including 786 athletes. Women represented 61.3% of all patients. The overall mean age was 21.1 years (range, 9.5-60.0 years), with a mean follow-up time of 3.0 years (range, 0.8-8.5 years). The return to sport rate was 92.8% (95% CI, 86.4-97.6). Patients returned to or surpassed their preoperative level of activity in 71.3% (95% CI, 63.7-78.4) of cases. An osteotomy was performed on 10.5% of athletes. Return to sport did not differ significantly in patients undergoing MPFL reconstruction without osteotomy versus those receiving additional osteotomy (95.4% vs 86.9%; = .22). Patients returned to sport at a mean of 6.7 months (range, 3.0-6.4 months) postoperatively. Osteotomy did not affect return time. Complications occurred at an overall rate of 8.8%. The most common complication was recurrence of instability (1.9%; 95% CI, 0.4-4.0). The Kujala score was reported by 13 studies, with pre- and postoperative combined means of 60.3 and 90.0, respectively.
CONCLUSION
MPFL reconstruction is an effective and reliable treatment in the setting of patellofemoral instability. Surgeons can counsel their patients that they can expect a high rate of return to sport after MPFL reconstruction surgery alone or with concomitant osteotomy.
Topics: Adult; Female; Humans; Joint Instability; Ligaments, Articular; Patellar Dislocation; Patellofemoral Joint; Return to Sport; Young Adult
PubMed: 33720789
DOI: 10.1177/0363546521990004 -
The American Journal of Sports Medicine Feb 2024Combined injury of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) is a common injury pattern and accounts for 20% of all ligamentous knee... (Meta-Analysis)
Meta-Analysis
Nonoperative Management, Repair, or Reconstruction of the Medial Collateral Ligament in Combined Anterior Cruciate and Medial Collateral Ligament Injuries-Which Is Best? A Systematic Review and Meta-analysis.
BACKGROUND
Combined injury of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) is a common injury pattern and accounts for 20% of all ligamentous knee injuries. Despite advancements in surgical technique, there is no up-to-date consensus regarding the superiority of nonoperative versus operative management in higher-grade MCL tears of combined ACL-MCL injuries.
PURPOSE
To interpret recent literature on treatment options and to provide an updated evidence-based approach for management of combined ACL-MCL knee injuries.
STUDY DESIGN
Systematic review and meta-analysis; Level of evidence, 4.
METHODS
We performed a systematic review on outcomes following treatment of concomitant ACL and MCL injuries. A computerized search was conducted in PubMed, Embase.com, and Scopus.com. Authors independently assessed eligible studies and screened titles and abstracts. Articles reporting on patients with concomitant ACL and MCL injuries with or without concomitant procedures were included. Data regarding study design, sample size, patient age and sex, length of follow-up, timing of surgery, indications, surgical methods, concomitant procedures, outcomes, and complications were recorded. Patient-reported outcomes (PROs) and functional outcomes, including Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee scores, Lysholm and Tegner scores, and range of motion, were estimated via meta-analysis and compared statistically by surgical approach.
RESULTS
In total, 18 studies were included in the systematic review with level 1 to level 4 evidence, with a total of 1,534 cases, were included in the systematic review. Of these, 16 studies with sufficient statistical reporting including 997 cases with sufficient follow-up were included in meta-analysis. Three different approaches to combined ACL-MCL injuries were identified: ACL reconstruction with (1) nonoperative MCL, (2) MCL repair, and (3) MCL reconstruction. There was no statistical difference between nonoperative versus surgically managed MCL injuries for PROs, range of motion at final follow up, or quadriceps strength.
CONCLUSION
Reconstruction of combined injury in a delayed fashion facilitates return of range of motion and may allow time for low-grade MCL tears to heal. If residual valgus or anteromedial rotatory laxity remains after a period of rehabilitation, then concomitant surgical management of ACL and MCL injuries is warranted. Avulsion MCL injuries and Stener-type lesions may benefit from early repair techniques.
Topics: Humans; Medial Collateral Ligament, Knee; Treatment Outcome; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Knee Injuries; Knee Joint
PubMed: 36960920
DOI: 10.1177/03635465231153157 -
Arthroplasty (London, England) Mar 2023Total knee arthroplasty (TKA) is one of the most performed orthopedic procedures worldwide. While excellent efficacy has been reported, about 20% of patients are not... (Review)
Review
BACKGROUND
Total knee arthroplasty (TKA) is one of the most performed orthopedic procedures worldwide. While excellent efficacy has been reported, about 20% of patients are not satisfied with the result. A potential cause is the problematic reproduction of knee kinematics. This systematic review examines gait analysis studies in primary medial pivot (MP) and posterior stabilized (PS) TKAs to investigate the differences between the two prosthesis designs.
METHODS
A systematic review was conducted by following PRISMA guidelines. Five databases (PubMed, Medline, Embase, Scopus and the Cochrane Database of Systematic Reviews) were analyzed, and eligible articles were evaluated in terms of the levels of evidence. The methodological quality of the articles was assessed by using the MINORS scoring. This review was registered in PROSPERO.
RESULTS
Nine studies were included. Gait analysis was performed in 197 MP TKA and 192 PS TKA patients. PS TKA cases showed (P < 0.05) a significantly higher peak of knee flexion angle during the swing phase, greater knee flexion angle at toe-off, an increased knee adduction angle, higher knee flexion and extension moment, increased anterior femoral roll during knee flexion and anterior translation on medial and lateral condyle during knee flexion compared to MP TKA. MP TKA showed statistically significant (P < 0.05) higher knee rotational moment and greater tibiofemoral external rotation motion during knee flexion than PS TKA. No statistically significant difference (P > 0.05) was reported regarding gait spatial-temporal parameters. The Forgotten Joint Score (FJS) and Western Ontario and McMaster Universities Comparison in terms of Arthritis Index (WOMAC) score (mean stiffness) showed that MP TKA yielded significantly better results than PS TKA.
CONCLUSIONS
This systematic review revealed significant kinematic and kinetic differences between MP and PS TKA at all gait analysis phases. Furthermore, the considerable difference between TKA design and the kinematics of healthy knee were highlighted in this study.
LEVEL OF EVIDENCE
III.
PubMed: 36927464
DOI: 10.1186/s42836-023-00165-8 -
Journal of Orthopaedic Surgery (Hong... 2023Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Complete meniscus root tear is associated with meniscus extrusion; this causes a loss of meniscus function and accelerated osteoarthritis of the knee. Existing small-scale retrospective case-control studies suggested that the outcomes were different between medial and lateral meniscus root repair. This meta-analysis aims to study whether such discrepancies exist via a systematic review of the available evidence in the literature.
METHODS
Studies evaluating the outcomes of surgical repair of posterior meniscus root tears, with reassessment MRI or second-look arthroscopy, were identified through a systematic search of PubMed, Embase, and Cochrane Library. The degree of meniscus extrusion, healing status of the repaired meniscus root, and functional outcome scores after repair were the outcomes of interest.
RESULTS
Among the 732 studies identified, 20 studies were included in this systematic review. 624 knees and 122 knees underwent MMPRT and LMPRT repair, respectively. The amount of meniscus extrusion following MMPRT repair was 3.8 ± 1.7 mm, which was significantly larger than the 0.9 ± 1.2 mm observed after LMPRT repair ( < 0.001). Significantly better healing outcomes were observed on reassessment MRI after LMPRT repair ( < 0.001). The postoperative Lysholm score and IKDC score was also significantly better after LMPRT than MMPRT repair ( < 0.001).
CONCLUSIONS
LMPRT repairs resulted in significantly less meniscus extrusion, substantially better healing outcomes on MRI, and superior Lysholm/IKDC scores, when compared to MMPRT repair. This is the first meta-analysis we are aware of that systematically reviews the differences in the clinical, radiographic, and arthroscopic results of MMPRT and LMPRT repair.
Topics: Humans; Menisci, Tibial; Retrospective Studies; Knee Joint; Osteoarthritis; Magnetic Resonance Imaging; Arthroscopy; Rupture
PubMed: 37173149
DOI: 10.1177/10225536231175233 -
Cureus Jul 2023Ramp lesions are a common occurrence in patients with anterior cruciate ligament (ACL) tears. These lesions can be difficult to diagnose due to their concealed nature,... (Review)
Review
Ramp lesions are a common occurrence in patients with anterior cruciate ligament (ACL) tears. These lesions can be difficult to diagnose due to their concealed nature, and their treatment is crucial due to the stabilizing function of the medial meniscocapsular region. The optimal treatment option for ramp lesions varies depending on the size and stability of the lesion. The purpose of this study was to evaluate the best treatment option for ramp lesions based on the stability of the lesion, including no treatment, biological treatment, and arthroscopic repair. We hypothesize that stable lesions have a favorable prognosis with techniques that do not require the use of meniscal sutures. In contrast, unstable lesions require appropriate fixation, either through an anterior or posteromedial portal. This study is a systematic review and meta-analysis with a level of evidence IV. The study used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for a systematic review of clinical studies reporting outcomes of ramp lesion treatment. The PubMed/MEDLINE database was searched using Mesh and non-Mesh terms related to ramp lesions, medial meniscus ramp lesions, and meniscocapsular injuries. The inclusion criteria encompassed clinical studies in English or Spanish that reported the treatment of ramp meniscal lesions, with a follow-up of at least six months and inclusion of functional results, clinical stability tests, radiological evaluation, or arthroscopic second look. The analysis included 13 studies with 1614 patients. Five studies distinguished between stable and unstable ramp lesions using different criteria (displacement or size) for assessment. Of the stable lesions, 90 cases received no treatment, 64 cases were treated biologically (debridement, edge-curettage, or trephination), and 728 lesions were repaired. There were 221 repaired unstable lesions. All different methods of repair were registered. In stable lesions, three studies were included in a network meta-analysis. The best-estimated treatment for stable lesions was biological (SUCRA 0.9), followed by repair (SUCRA 0.6), and no treatment (SUCRA 0). In unstable lesions, seven studies using International Knee Documentation Committee Subjective Knee Form (IKDC) and 10 studies using Lysholm for functional outcomes showed significant improvement from preoperative to postoperative scores after repair, with no differences between repairing methods. We recommend simplifying the classification of ramp lesions as stable or unstable to determine treatment. Biological treatment is preferred for stable lesions rather than leaving them in situ. Unstable lesions, on the other hand, require repair, which has been associated with excellent functional outcomes and healing rates.
PubMed: 37435014
DOI: 10.7759/cureus.41651 -
Sports Health Nov 2014The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have...
CONTEXT
The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described.
OBJECTIVE
A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures.
DATA SOURCES
OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013.
STUDY SELECTION
Included studies mentioned treatment and outcomes of medial malleolus stress fractures.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis.
RESULTS
Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation.
CONCLUSION
Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play.
PubMed: 25364485
DOI: 10.1177/1941738114546089 -
The American Journal of Sports Medicine Mar 2024Medial meniscus posterior root (MMPR) tears are recognized as a substantial cause of disability and morbidity. However, meniscus root repair, regardless of technique, is...
BACKGROUND
Medial meniscus posterior root (MMPR) tears are recognized as a substantial cause of disability and morbidity. However, meniscus root repair, regardless of technique, is not without potential complications.
PURPOSE
To evaluate the reported incidence of complications and adverse events after isolated MMPR repair.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using Embase, PubMed, and Scopus databases with the following search terms combined with Boolean operators: "meniscus,""root," and "repair." Inclusion criteria consisted of level 1 to 4 human clinical studies in English or English-language translation reporting complications and adverse events after isolated posterior medial meniscus root repairs. The overall incidence of specific complications was estimated from the pooled sample of the included studies.
RESULTS
Eleven studies with a total pooled sample of 442 patients were identified. The mean patient age was 58.1 years, while the mean final follow-up time was 37.2 months (range, 12-84.8 months). The overall incidence of complications was 9.7% (n = 43/442), with the most commonly reported complication being progressive degenerative changes within the knee (10.4%; n = 25/240; n = 5 studies). A total of 1.25% (n = 3/240) of patients who experienced degenerative changes required conversion to total knee arthroplasty. Repair failures were reported in 3.1% (n = 10/327; n = 8 studies) of patients.
CONCLUSION
Repairing MMPR tears is critical in preventing accelerated progression of knee osteoarthritis in patients without significant knee osteoarthritis preoperatively. While this repair is still recommended and necessary in appropriate patients, this review found that the incidence of complications after isolated posterior medial meniscus root repair was 9.7%, primarily involving the presence of progressive degeneration, while repair failure was reported in 3% of patients.
Topics: Humans; Infant; Child, Preschool; Child; Menisci, Tibial; Osteoarthritis, Knee; Knee Injuries; Tibial Meniscus Injuries; Knee Joint; Meniscus; Retrospective Studies; Arthroscopy
PubMed: 37129097
DOI: 10.1177/03635465231157758