-
PloS One 2023Arthroscopically assisted reduction and internal fixation (ARIF) allows for the assessment of joint congruity following anatomic reduction, identification of occult... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Arthroscopically assisted reduction and internal fixation (ARIF) allows for the assessment of joint congruity following anatomic reduction, identification of occult intra-articular lesions, and treatment of traumatic intra-articular pathologies. The aim of this systematic review and meta-analysis was to provide evidence on whether ARIF is an alternative treatment protocol for ankle fractures.
METHODS
The PubMed, Embase, and Cochrane Library databases were searched independently by two investigators from the inception dates to October 9, 2022, for comparative studies. The risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials and the methodological index for non-randomized studies (MINORS) were used for assessing the methodological quality. Outcomes were evaluated in terms of the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, post-operative complications, arthroscopic findings, Visual Analogue Scale (VAS) score, and operation time. Cochrane Review Manager Software 5.4 was used to perform the statistical analysis.
RESULTS
A total of 10 trials involving 755 patients were included in this meta-analysis. The results revealed that ARIF for ankle fractures was superior regarding functional outcomes and VAS scores when compared with open reduction and internal fixation (ORIF). No significant difference was noted in the post-operative complication rate and the operation time between the ARIF and ORIF groups. A high incidence of chondral or osteochondral lesions (OCLs), ligamentous injuries, and loose bodies with ankle fractures was found by ankle arthroscopy.
CONCLUSIONS
ARIF for ankle fractures might be beneficial to offer superior functional outcomes and VAS score than ORIF. Orthopedic surgeons should take a high incidence of OCLs and ligamentous injuries into consideration for the treatment of acute ankle fractures. We believe that with the increase in surgical experience, the occurrence of post-operative complications and the extension of operation time will no longer be a potential concern for surgeons.
Topics: Humans; Ankle Fractures; Fracture Fixation, Internal; Ankle Joint; Arthroscopy; Foot; Postoperative Complications; Treatment Outcome; Retrospective Studies
PubMed: 37540648
DOI: 10.1371/journal.pone.0289554 -
Cartilage Dec 2021A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A systematic review and meta-analysis of Autologous Matrix-Induced Chondrogenesis (AMIC®) outcomes for grade III/IV chondral and osteochondral lesions of the knee treated with Chondro-Gide®.
DESIGN
Studies with a minimum follow-up of 1 year providing clinical results of AMIC repair in the knee were included based on PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Methodological quality was assessed by the modified Coleman Methodology Score (mCMS). The meta-analysis was comparing pain VAS (Visual Analog Scale), Lysholm score, and IKDC score (International Knee Documentation Committee) between baseline and follow-up after 1 or 2 years and after >3 years.
RESULTS
Twelve studies (375 patients) were included. The mCMS demonstrated a suboptimal study design (ranking between 52 and 80). The mean age was 36.2 years (14-70 years). The mean defect size was 4.24 cm (0.8-22 cm). The results from the random effects model indicated a clinically significant ( < 0.05) improvement of pain VAS from baseline to follow-up at year 1 to 2 of -4.02(confidence interval -4.37; -3.67), still significant after 3 years. Lysholm score at year 1 or 2 improved significantly and remained highly significant after 3 years. IKDC score showed highly significant improvement of 32.61 between 1 and 2 years versus baseline values maintained after 3 years.
CONCLUSIONS
The AMIC procedure significantly improved the clinical status and functional scoring versus preoperative values. Evidence was obtained in a non-selected patient population, corresponding to real-life treatment of knee chondral and osteochondral defects. The evidence is sufficient to recommend AMIC in this indication.
Topics: Adolescent; Adult; Aged; Arthroplasty, Subchondral; Cartilage, Articular; Chondrogenesis; Collagen; Female; Fractures, Stress; Guided Tissue Regeneration; Humans; Intra-Articular Fractures; Knee Injuries; Male; Middle Aged; Patellofemoral Joint; Patient Satisfaction; Transplantation, Autologous; Treatment Outcome
PubMed: 31508990
DOI: 10.1177/1947603519870846 -
The American Journal of Sports Medicine Jun 2020Many surgical options for treating patellofemoral (PF) cartilage lesions are available but with limited evidence comparing their results. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many surgical options for treating patellofemoral (PF) cartilage lesions are available but with limited evidence comparing their results.
PURPOSE
To determine and compare outcomes of PF cartilage restoration techniques.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were followed by utilizing the PubMed, EMBASE, and Cochrane Library databases. Inclusion criteria were clinical studies in the English language, patient-reported outcomes after PF cartilage restoration surgery, and >12 months' follow-up. Quality assessment was performed with the Coleman Methodology Score. Techniques were grouped as osteochondral allograft transplantation (OCA), osteochondral autograft transfer (OAT), chondrocyte cell-based therapy, bone marrow-based therapy, and scaffolds.
RESULTS
A total of 59 articles were included. The mean Coleman Methodology Score was 71.8. There were 1937 lesions (1077 patellar, 390 trochlear, and 172 bipolar; 298 unspecified). The frequency of the procedures was as follows, in descending order: chondrocyte cell-based therapy (65.7%), bone marrow-based therapy (17.2%), OAT (8%), OCA (6.6%), and scaffolds (2.2%). When compared with the overall pooled lesion size (3.9 cm; 95% CI, 3.5-4.3 cm), scaffold (2.2 cm; 95% CI, 1.8-2.5 cm) and OAT (1.5 cm; 95% CI, 1.1-1.9 cm) lesions were smaller ( < .001), while chondrocyte cell-based therapy lesions were larger (4.7 cm; 95% CI, 4.1-5.3 cm; = .039). Overall, the instability pool was 11.9%, and the anatomic risk factors pool was 32.1%. Statistically significant improvement was observed on at least 1 patient-reported outcome in chondrocyte cell-based therapy (83%), OAT (78%), OCA (71%), bone marrow-based therapy (64%), and scaffolds (50%). There were no significant differences between any group and the overall pooled change in International Knee Documentation Committee score (30.2; 95% CI, 27.4-32.9) and Lysholm score (25.2; 95% CI, 16.9-33.5). There were no significant differences between any group and the overall pooled rate in minor complication rate (7.6%; 95% CI, 4.7%-11.9%) and major complication rate (8.3%; 95% CI, 5.7%-12.0%); however, OCA had a significantly greater failure rate (22.7%; 95% CI, 14.6%-33.4%) as compared with the overall rate (6.8%; 95% CI, 4.7%-9.5%).
CONCLUSION
PF cartilage restoration leads to improved clinical outcomes, with low rates of minor and major complications. There was no difference among techniques; however, failures were higher with OCA.
Topics: Bone Marrow; Cartilage; Cartilage Diseases; Cartilage, Articular; Chondrocytes; Humans; Orthopedic Procedures; Patellofemoral Joint; Patient Reported Outcome Measures; Tissue Scaffolds; Transplantation, Autologous; Transplantation, Homologous
PubMed: 31899868
DOI: 10.1177/0363546519886853 -
Orthopaedics & Traumatology, Surgery &... Feb 2024Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others... (Review)
Review
BACKGROUND
Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes debridement and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage.
PATIENTS AND METHODS
A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).
RESULTS
Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.
DISCUSSION
Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.
LEVEL OF EVIDENCE
IV.
PubMed: 38340961
DOI: 10.1016/j.otsr.2024.103834 -
Foot and Ankle Surgery : Official... Apr 2022Ankle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in... (Review)
Review
BACKGROUND
Ankle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions.
METHODS
A systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis.
RESULTS
SH1 fractures were found in 0-57.5% of the cases in all series and 0-3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2-80% and an osteochondral avulsion of the distal fibula in 6-28.1%. The most recent series report 76-80% and 62% for ATFL injury and osteochondral avulsion respectively.
CONCLUSIONS
There is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities.
Topics: Adolescent; Ankle Injuries; Ankle Joint; Child; Fibula; Fractures, Bone; Humans; Lateral Ligament, Ankle; Sprains and Strains
PubMed: 33965308
DOI: 10.1016/j.fas.2021.04.010 -
International Orthopaedics Mar 2018We present a systematic review of the recent literatures regarding the arthroscopic and open technique in fragment fixation for osteochondritis dissecans (OCD) of the... (Meta-Analysis)
Meta-Analysis
PURPOSE
We present a systematic review of the recent literatures regarding the arthroscopic and open technique in fragment fixation for osteochondritis dissecans (OCD) of the humeral capitellum and an analysis of the subjective and objective outcomes between these two procedures.
METHODS
PubMed and EMBASE were reviewed for suitable articles relating to fragment fixation for OCD, both open and arthroscopic. We included all studies reporting on the clinical outcomes of these two procedures that were published in the English language. Data extracted from each study included level of evidence, number of patients, surgical techniques, length of follow-up, clinical outcome measures including outcome scores, range of motion (ROM), return to sports, osseous union and complications. We analyzed each study to determine the primary outcome measurement.
RESULTS
A total of ten studies met our inclusion criteria. Among all studies, 35 arthroscopic procedures and 107 open procedures were performed. After the procedure, 70 patients (86.4%) in the open group returned to their sports, and 32 patients (91.4%) in the arthroscopic group returned to their sports. In the arthroscopic group, patients gained 14.1 degrees of flexion and 9.5 degrees of extension after surgery. In the open group, patients gained 8 degrees of flexion and 5.7 degrees of extension. Five patients (4.7%) had complications in the open group. No complication was found in the arthroscopic group.
CONCLUSIONS
Both open and arthroscopic lesion debridement with fragment fixation are successful in treating unstable OCD. The arthroscopic technique may be a better choice than the open procedure, but we need high-level evidence to determine the superiority of the open or arthroscopic techniques in treating elbow OCD.
LEVEL OF EVIDENCE
Level III.
Topics: Adolescent; Arthroscopy; Debridement; Elbow Joint; Female; Fracture Fixation, Internal; Humans; Humerus; Male; Osteochondritis Dissecans; Postoperative Complications; Range of Motion, Articular; Return to Sport; Treatment Outcome
PubMed: 29349503
DOI: 10.1007/s00264-018-3768-3 -
Knee Surgery, Sports Traumatology,... Jul 2017To determine the rate of donor-site morbidity after osteochondral autologous transplantation (OATS) for capitellar osteochondritis dissecans. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine the rate of donor-site morbidity after osteochondral autologous transplantation (OATS) for capitellar osteochondritis dissecans.
METHODS
A literature search was performed in PubMed/MEDLINE, Embase, and Cochrane Library to identify studies up to November 6, 2016. Criteria for inclusion were OATS for capitellar osteochondritis dissecans, reported outcomes related to donor sites, ≥10 patients, ≥1 year follow-up, and written in English. Donor-site morbidity was defined as persistent symptoms (≥1 year) or cases that required subsequent intervention. Patient and harvest characteristics were described, as well as the rate of donor-site morbidity. A random effects model was used to calculate and compare weighted group proportions.
RESULTS
Eleven studies including 190 patients were included. In eight studies, grafts were harvested from the femoral condyle, in three studies, from either the 5th or 6th costal-osteochondral junction. The average number of grafts was 2 (1-5); graft diameter ranged from 2.6 to 11 mm. In the knee-to-elbow group, donor-site morbidity was reported in 10 of 128 patients (7.8%), knee pain during activity (7.0%) and locking sensations (0.8%). In the rib-to-elbow group, one of 62 cases (1.6%) was complicated, a pneumothorax. The proportion in the knee-to-elbow group was 0.04 (95% CI 0.0-0.15), and the proportion in the rib-to-elbow group was 0.01 (95% CI 0.00-0.06). There were no significant differences between both harvest techniques (n.s.).
CONCLUSIONS
Donor-site morbidity after OATS for capitellar osteochondritis dissecans was reported in a considerable group of patients.
LEVEL OF EVIDENCE
Level IV, systematic review of level IV studies.
Topics: Arthralgia; Bone Transplantation; Elbow Joint; Femur; Humans; Knee Joint; Osteochondritis Dissecans; Postoperative Complications; Ribs; Transplant Donor Site; Transplantation, Autologous
PubMed: 28391550
DOI: 10.1007/s00167-017-4516-8 -
AJR. American Journal of Roentgenology Jul 2019The purpose of this study is to perform a systematic review and meta-analysis to estimate the clinical value of MRI in assessing the stability of osteochondritis...
The purpose of this study is to perform a systematic review and meta-analysis to estimate the clinical value of MRI in assessing the stability of osteochondritis dissecans (OCD) lesions. A systematic review of the literature published from January 1995 to July 2018 was performed by two independent reviewers using predefined search terms. The reference standard was established as arthroscopy or open surgery. True- and false-positive results as well as true- and false-negative results were counted. The quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooling of diagnostic accuracy, subgroup analysis, and identification of publication bias were included. Sixteen studies were included in the general data pooling. The pooled sensitivity and specificity were 0.92 (95% CI, 0.87-0.95; = 0.55) and 0.85 (95% CI, 0.64-0.95; = 0.88), respectively. The pooled sensitivity and specificity for juvenile OCD lesions were 0.93 (95% CI, 0.82-0.97) and 0.68 (95% CI, 0.41-0.86), respectively. Subgroup analysis showed that the staging system of Dipaola and colleagues and the criteria of De Smet and colleagues had a significant independent association with sensitivity. There was no evidence of publication bias ( = 0.57). The current meta-analysis suggested that MRI has a high diagnostic value for assessing the stability of OCD lesions. However, the MRI criteria applied for adult OCD lesions do not perform well in predicting stability of juvenile OCD lesions. Although some new juvenile OCD-specific MRI criteria yielding a satisfactory outcome have been proposed, further investigations are warranted.
PubMed: 30995094
DOI: 10.2214/AJR.18.20710 -
Knee Surgery, Sports Traumatology,... May 2023To assess the imaging modalities used for diagnosis, as well as the management decisions of patients with osteochondral fractures (OCF) and loose bodies following... (Review)
Review
MRI as the optimal imaging modality for assessment and management of osteochondral fractures and loose bodies following traumatic patellar dislocation: a systematic review.
PURPOSE
To assess the imaging modalities used for diagnosis, as well as the management decisions of patients with osteochondral fractures (OCF) and loose bodies following traumatic patellar dislocation.
METHODS
According to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA), MEDLINE, EMBASE, Web of Science, and PubMed were searched for results from January 1, 2000, to May 18, 2021, in two subsequent searches for English language studies that presented data on traumatic patellar dislocation. Quality of selected papers was assessed using the Methodological Index for Non-Randomised Studies (MINORS) and the Risk of Bias (RoB) 2.0 protocol. Results were qualitatively synthesised, and descriptive statistics were calculated.
RESULTS
Forty studies totalling 3074 patients (1407 females) were included for the analysis. The mean age was 18.9 years (range 0-69). The population included 2446 first-time dislocations. The imaging modalities used were: 71.1% MRI, 52.6% plain radiography, 12.1% CT, and 0.68% ultrasound. In the 25 studies that reported the number of OCF, a total of 38.3% of patients were found to have OCF. 43.3% of patients with a first-time dislocation, and 34.7% of patients with previous dislocations, had at least one OCF. In the included paediatric studies (maximum age ≤ 18), the presence of OCF was detected by plain radiography in 10.1% of patients, MRI in 76.6% of patients, and CT in 89.5% of patients. For management of an OCF, the surgical options include fixation for larger pieces, excision for smaller pieces, and conservative management on a case-by-case basis.
CONCLUSIONS
Based on the current available evidence, assessment and management of patellar dislocations and subsequent OCFs vary, with radiography and MRI as the main imaging modalities on presentation and particular benefit for MRI in the paediatric population. Findings from this study suggest the highest rate of OCF detection with MRI, and thus, surgeons should consider routinely ordering an MRI in patients with first-time patellar dislocation. Regarding management of OCFs, the main indication for fixation was large fragments, while smaller and poor-quality fragments are excised. Few studies choose conservative management of OCFs due to later requirements for surgical management. Future work should focus on large, high-quality studies, and implementation of randomised control trials to form guidelines for imaging patellar dislocations and management of OCFs.
LEVEL OF EVIDENCE
Level IV.
Topics: Female; Humans; Child; Infant, Newborn; Infant; Child, Preschool; Adolescent; Young Adult; Adult; Middle Aged; Aged; Patellar Dislocation; Joint Dislocations; Magnetic Resonance Imaging; Femoral Fractures; Radiography; Intra-Articular Fractures
PubMed: 35796753
DOI: 10.1007/s00167-022-07043-x -
Journal of Personalized Medicine Nov 2022Purpose: Approximately 60% of patients undergoing arthroscopy of the knee present with chondral defects. If left untreated, osteochondral lesions can trigger an early... (Review)
Review
Purpose: Approximately 60% of patients undergoing arthroscopy of the knee present with chondral defects. If left untreated, osteochondral lesions can trigger an early onset of osteoarthritis. Many cartilage repair techniques are mainly differentiated in techniques aiming for bone marrow stimulation, or cell-based methods. Cartilage repair can also be categorized in one- and two-stage procedures. Some two-stage procedures come with a high cost for scaffolds, extensive cell-processing, strict regulatory requirements, and limited logistical availability. Minced cartilage, however, is a one-stage procedure delivering promising results in short term follow-up, as noted in recent investigations. However, there is no available literature summarizing or synthesizing clinical data. The purpose of this study was to analyze and synthesize data from the latest literature in a meta-analysis of outcomes after the minced cartilage procedure and to compare its effectiveness to standard repair techniques. Methods: We conducted a systematic review searching the Cochrane, PubMed, and Ovid databases. Inclusion criteria were the modified Coleman methodology Score (mCMS) >60, cartilaginous knee-joint defects, and adult patients. Patient age < 18 years, biomechanical and animal studies were excluded. Relevant articles were reviewed independently by referring to title and abstract. In a systematic review, we compared three studies and 52 patients with a total of 63 lesions. Results: Analysis of Knee Injury and Osteoarthritis Outcome Score (KOOS) sub scores at 12 and 24 months showed a significant score increase in every sub score. Highest mean difference was seen in KOOS sport, lowest in KOOS symptoms (12 month: KOOS sport (Mean difference: 35.35 [28.16, 42.53]; p < 0.0001), lowest in KOOS symptoms (Mean difference: 20.12 [15.43, 24.80]; p < 0.0001)). A comparison of International Knee Documentation Committee (IKDC ) scores visualized a significant score increase for both time points too ((12 month: pooled total mean: 73.00 ± 14.65; Mean difference: 34.33 [26.84, 41.82]; p < 0.00001) (24 month: pooled total mean: 77.64 ± 14.46; mean difference: 35.20 [39.49, 40.92]; p < 0.00001)). Conclusion: Due to no need for separate cell-processing, and thanks to being a one-step procedure, minced cartilage is a promising method for cartilage repair in small defect sizes (mean 2.77 cm2, range 1.3−4.7 cm2). However, the most recent evidence is scarce, and takes only results two years post-surgery into account. Summarized, minced cartilage presents nearly equal short-term improvement of clinical scores (IKDC, KOOS) compared to standard cartilage repair techniques.
PubMed: 36422099
DOI: 10.3390/jpm12111923