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The American Journal of Sports Medicine Jan 2024High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are...
BACKGROUND
High tibial osteotomy (HTO) is a well-recognized procedure for its effectiveness in treating symptomatic early knee arthritis and malalignment. Although there are numerous systematic reviews evaluating the management and outcomes after HTO, there are few investigations on complications of this procedure.
PURPOSE
To systematically review the literature to determine the incidence of intraoperative and postoperative complications associated with medial opening wedge and lateral closing wedge HTOs.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
The Cochrane Database of Systematic Reviews, PubMed, Embase, and MEDLINE databases were queried for studies reporting complications associated with HTO with or without concomitant procedures. Data including patient characteristics, procedure type, concomitant procedures, follow-up time, and postoperative imaging were extracted. Rates of intra- and postoperative complications, reoperations, and conversion to arthroplasty were recorded.
RESULTS
A total of 71 studies were included for analysis, comprising 7836 patients. The overall intraoperative complication rate during HTO was 5.5% (range, 0%-29.3%), and the overall postoperative complication rate was 6.9% (range, 0%-26.6%). The most common intraoperative complication was lateral hinge fracture (incidence, 9.1%; range, 0%-30.4%) in medially based HTOs and peroneal nerve injury in laterally based HTOs (incidence, 3.2%; range, 0%-8.7%). The overall incidence of neurovascular injury after medially or laterally based HTOs was 1.1% (range, 0%-18.9%). The most common postoperative complication was superficial infection (incidence, 2.2%; range, 0%-13%). Of the included studies, 62 included postoperative radiographic analysis, and among those, the incidence of nonunion was 1.9% (range, 0%-15.5%), loss of correction was 1.2% (range, 0%-34.3%), and implant failure was 1.0% (range, 0%-10.2%). Among studies reporting revision surgeries, the overall reoperation rate was 15.5% (range, 0%-70.7%), with the most common type of reoperation being hardware removal (incidence, 10.0%; range, 0%-60%).
CONCLUSION
Intraoperatively, medially based HTOs are associated with a 1 in 11 risk of lateral hinge fracture and laterally based HTOs with a 1 in 30 risk of peroneal nerve injury. Postoperative complication rates in the range of 10% to 15% can be expected, including infection (2.9%), loss of correction (1.2%), and nonunion (1.9%). Patients should also be counseled that the reoperation rate is approximately 15%, with hardware removal being the most common procedure.
Topics: Humans; Arthroplasty, Replacement, Knee; Fractures, Bone; Incidence; Intraoperative Complications; Knee Joint; Osteoarthritis, Knee; Osteotomy; Postoperative Complications; Reoperation; Systematic Reviews as Topic; Tibia; Treatment Outcome
PubMed: 36779579
DOI: 10.1177/03635465221142868 -
Orthopaedic Journal of Sports Medicine Jun 2021The incidence of concomitant injuries, including meniscal and cartilage injuries, has not been adequately reported in previous studies on multiligament knee injury... (Review)
Review
BACKGROUND
The incidence of concomitant injuries, including meniscal and cartilage injuries, has not been adequately reported in previous studies on multiligament knee injury (MLKI) because their primary focal points have been the degree of ligament injury, treatment strategy, involvement of other soft tissues, and neurovascular injury.
PURPOSE
To analyze the incidence of associated lesions in MLKIs, including medial and lateral meniscal injuries, cartilage lesions, and complications.
STUDY DESIGN
Systemic review; Level of evidence, 4.
METHODS
The PubMed, Embase, Cochrane Library, CINAHL, and Scopus databases were searched between inception and April 30, 2020. Studies were included if they reported the incidence rates of medial and/or lateral meniscal tears and cartilage injuries in cases of MLKIs. For the meta-analysis, data were extracted on clinical outcomes measured according to the number of medial and/or lateral meniscal tears, cartilage injuries, and complications.
RESULTS
A total of 45 studies were included in the MLKI analysis (3391 patients). The pooled rate of medial meniscal tears was 30.4% (95% CI, 24.1%-37.1%; < .0001; = 85.8%). The pooled rate of lateral meniscal tears was 27.5% (95% CI, 20.3%-35.3%; < .0001; = 89.6%). The pooled rate of cartilage injuries was 27.5% (95% CI, 22.1%-33.3%; < .0001; = 86.8%). The pooled rates of peroneal nerve injuries, vascular injuries, and arthrofibrosis were 19.2% (95% CI, 14.2%-24.7%; < .001; = 81.3%), 18.4% (95% CI, 13.2%-24.3%; < .0001; = 81.0%), and 11.2% (95% CI, 8.1%-14.7%; = .0018; = 54.0%), respectively.
CONCLUSION
The pooled rates of meniscal tears and cartilage injuries concomitant with MLKIs were high, ranging from 27% to 30%, and the pooled rates of peroneal nerve injury, vascular injury, and arthrofibrosis were considerable, ranging from 11% to 19%. The influence of these associated lesions on clinical results should be evaluated in future clinical studies.
PubMed: 34368374
DOI: 10.1177/23259671211010409 -
Arthroscopy : the Journal of... Feb 2022To determine whether the use of suture tape augmentation (ST) would lead to improved clinical outcomes, increased stability, shorter postoperative immobilization, and... (Review)
Review
PURPOSE
To determine whether the use of suture tape augmentation (ST) would lead to improved clinical outcomes, increased stability, shorter postoperative immobilization, and earlier return to activity and sports compared with Broström repair (BR) in surgical treatment of chronic lateral ankle instability (CLAI).
METHODS
A systematic literature search was performed using Pubmed and Embase according to PRISMA guidelines. The following search terms were used: ankle instability, suture tape, fiber tape, and internal brace. Full-text articles in English that directly compared BR and ST cohorts were included, with a minimum cohort size of 40 patients. Exclusion criteria were former systematic reviews, biomechanical studies, and case reports.
RESULTS
Ultimately, 7 clinical trials were included in this systematic review. Regarding the clinical and radiologic outcomes and complication rates, no major differences were detected between groups. Recurrence of instability and revision surgeries tended to occur more often after BR, whereas irritation of the peroneal nerve and tendons seemed to occur more frequently after ST. Postoperative rehabilitation protocols were either the same for both groups or more aggressive in the ST groups. When both techniques were performed with arthroscopic assistance, return to sports was significantly faster in the ST groups.
CONCLUSIONS
In conclusion, suture tape augmentation showed excellent results and is a safe technique comparable to traditional Broström repair. No major differences regarding clinical and radiologic outcomes or complications were found.
LEVEL OF EVIDENCE
III, systematic review of level I, II, and III studies.
Topics: Ankle; Ankle Joint; Arthroscopy; Humans; Joint Instability; Lateral Ligament, Ankle; Sutures
PubMed: 34252562
DOI: 10.1016/j.arthro.2021.06.028 -
Frontiers in Pharmacology 2023The objective of this systematic review and meta-analysis is to assess the effectiveness and security of Chinese herbal medicine (CHM) in the therapy of painful...
The objective of this systematic review and meta-analysis is to assess the effectiveness and security of Chinese herbal medicine (CHM) in the therapy of painful diabetic neuropathy (PDN). We searched databases for randomized controlled trials (RCTs) of CHM in the treatment of PDN. Outcome indicators included nerve conduction velocity, clinical efficiency, pain score, TCM syndrome score, and adverse events. Stata 16.0 was used to carry out the Meta-analysis. A total of 21 RCTs with 1,737 participants were included. This meta-analysis found that using CHM as adjuvant treatment or as monotherapy for PDN can improve SCV of median nerve [mean difference (MD) = 3.56, 95% Confidence interval (CI) (2.19, 4.92) ], MCV of median nerve [ MD = 3.82, 95% CI (2.51, 5.12) ], SCV of common peroneal nerve [ MD = 4.16, 95% CI (1.62, 6.70) ], MCV of common peroneal nerve [ MD = 4.37, 95% CI (1.82, 6.93) ], SCV of gastrocnemius nerve [ MD = 4.95, 95% CI (3.52, 6.37) ], SCV of tibial nerve [ MD = 3.17, 95% CI (-2.64, 8.99) ], MCV of tibial nerve [MD = 6.30, 95%CI (5.00, 7.60)] and clinical effective rate [ odds ratio (OR) = 4.00, 95% CI (2.89, 5.52) ] and reduce pain score [standardized mean difference (SMD) = -2.23, 95% CI (-3.04, -1.41) ], TCM syndrome score [ MD = -4.70, 95% CI (-6.61, -2.80) ]. In addition, compared to the control group, adverse events of Chinese medicine intervention occurred less. CHM as adjuvant therapy or single treatment has a good curative effect and is safe for patients with PDN, which is worthy of clinical promotion and use, however; higher quality clinical studies are still needed to prove. https://www.crd.york.ac.uk/, identifier CRD42022327967.
PubMed: 36950007
DOI: 10.3389/fphar.2023.1072991 -
Evidence-based Complementary and... 2018The role of traditional Chinese medicine injections (TCMIs) in diabetic foot (DF) has not been well estimated. (Review)
Review
CONTEXT
The role of traditional Chinese medicine injections (TCMIs) in diabetic foot (DF) has not been well estimated.
OBJECTIVE
To evaluate the clinical effective rate, safety, and the financial cost of TCMIs in treating DF and ulcer wound healing.
METHODS
We searched PubMed, Embase, CENTRAL, China National Knowledge Infrastructure (CNKI), VIP database, and Wanfang database from inception to May 2018 to find all randomized control trials (RCTs) related to TCMIs in DF treatment. The search items were "Traditional Chinese Medicine Injection" AND "Diabetic foot or Diabetic foot ulcer" AND "random".
STUDY SELECTION AND SYNTHESIS
Only RCTs of TCMIs combined conventional therapies versus conventional therapies and that can be quantitatively synthesized were included. Finally, 17 studies and 1294 participants were included after extraction. Two investigators independently extracted and analyzed the data using RevMan5.3 software.
RESULTS
The overall clinical effective rate of TCMI groups is higher than that of control groups [RR=1.27, 95CI % (1.20, 1.34), P<0.00001] based on fixed effect model analysis. Regarding motor nerve conduction velocity of median nerve and peroneal nerve, TCMI group showed a significant improvement (MD=3.84[2.28, 5.41], P<0.00001; MD=2.89[0.63, 5.15], P=0.01). Regarding plasma viscosity TCMI group showed a statistically difference (MD=0.27[0.04, 0.49], P=0.02). In terms of blood viscosity at high shear rate, there was an improvement of TCMI group (MD=0.36[0.05, 0.67], P=0.02). However, sensory nerve conduction velocity of peroneal nerve and median nerve showed a contradiction to motor nerve conduction velocity, respectively (MD=2.59[-1.69, 6.87], p=0.24; MD=2.73[-0.96, 6.43], P=0.15).
CONCLUSION
The data of this study shows that TCMIs can bring benefits to patients with diabetic foot. However, due to low methodological quality of included RCTs, more rigorous designed RCTs with large sample size are recommended to provide more high-quality evidence.
PubMed: 30402123
DOI: 10.1155/2018/4730896 -
Frontiers in Pharmacology 2022Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse reaction of chemotherapy. Many studies have confirmed that traditional Chinese medicine (TCM) has... (Review)
Review
Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse reaction of chemotherapy. Many studies have confirmed that traditional Chinese medicine (TCM) has unique advantages for treating CIPN. However, there is no standard TCM prescription in clinical practice or objective outcome index, and similar efficacy varies. Therefore, in this study, a systematic review of randomized controlled trials (RCTs) was performed to evaluate the clinical efficacy of external treatment with Chinese herbal medicine (CHM) for CIPN. This analysis provides evidence-based medical support for the use of CHM for external treatment of CIPN. Relevant RCTs assessing CHM external treatment of CIPN were searched in nine electronic databases, including the China National Knowledge Infrastructure Database, China Biology Medicine Disc, China Science and Technology Journal Database, Wanfang Database, PubMed, Cochrane Library, MEDLINE, Web of Science, and OVID, from inception to July 2021. A meta-analysis was performed on these studies using RevMan5.3 software. Based on the inclusion and exclusion criteria, 33 clinical studies were included, while 1,354 studies were screened out. There were 2,356 patients in total, including 1,208 in the treatment group and 1,148 in the control group. In the treatment group, peripheral neurotoxicity rate, total effect rate, KPS score, TCM syndrome score and efficacy, pain NRS score, and pain relief rate were significantly improved compared with those of the control group ( < 0.01). Furthermore, the peroneal and median nerve conduction velocities were also improved compared with those in the control group ( < 0.05). By creating a funnel plot for the incidence of peripheral neurotoxicity and the total effect rate, we showed that the left and right sides were symmetrical, and that the publication bias was low. CHM external treatment was found to be an effective method for treating CIPN as it significantly improved clinical symptoms and quality of life in patients with CIPN. identifier ChiCTR1900024617.
PubMed: 35250555
DOI: 10.3389/fphar.2022.764473 -
Evidence-based Complementary and... 2018The injection of the traditional Chinese patent medicine puerarin has been widely used in the treatment of various diseases such as angina pectoris or ischemic stroke.... (Review)
Review
Efficacy and Safety of the Injection of the Traditional Chinese Medicine Puerarin for the Treatment of Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis of 53 Randomized Controlled Trials.
OBJECTIVE
The injection of the traditional Chinese patent medicine puerarin has been widely used in the treatment of various diseases such as angina pectoris or ischemic stroke. We aim to evaluate the efficacy and safety of puerarin injection for the treatment of diabetic peripheral neuropathy (DPN).
METHODS
A systematic literature search was performed in seven medical databases from their inception until June 2017. 53 studies with RCTs, totaling 3284 patients, were included in this meta-analysis. The included studies were assessed by the Cochrane risk of bias and analyzed by Review Manager 5.3 software.
RESULTS
The meta-analysis showed that puerarin injection for the treatment of DPN was significantly better compared with the control group in terms of the total effective rate. The result showed that puerarin injection for the treatment of DPN can significantly increase the probability of sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of the median and peroneal nerves.
CONCLUSIONS
This meta-analysis demonstrated that puerarin injection may be more effective and safe for the treatment of DPN. However, further and higher quality RCTs are required to prove its efficacy and provide meaningful evidence for clinical treatment due to the poor methodological quality.
PubMed: 29619066
DOI: 10.1155/2018/2834650 -
American Journal of Physical Medicine &... Aug 2015The purpose of this systematic review was to summarize the effect of daily use of single-channel foot drop stimulation among persons with stroke. Randomized controlled... (Review)
Review
The purpose of this systematic review was to summarize the effect of daily use of single-channel foot drop stimulation among persons with stroke. Randomized controlled trials were searched using electronic databases through May 2014. Six randomized controlled trials were included, involving 820 participants. Gait speed was the most common outcome measured. Other common outcomes included Timed Up and Go, modified Emory Functional Ambulation Profile, Berg Balance Scale, Physiologic Cost Index, Six-Minute Walk Test, quality-of-life, and lower extremity Fugl-Meyer. In summary, foot drop stimulation and ankle foot orthoses seem effective and "equivalent" for increasing gait speed. Other outcomes that consistently improved in both groups were the Timed Up and Go and Six-Minute Walk Test. Foot drop stimulation was more effective compared with ankle foot orthosis for decreasing Physiologic Cost Index and seemed to be preferred by participants. Physical therapy may facilitate improvement in both foot drop stimulation and ankle foot orthosis groups.
Topics: Disability Evaluation; Electric Stimulation Therapy; Exercise Test; Gait Disorders, Neurologic; Humans; Patient Preference; Peroneal Nerve; Quality of Life; Randomized Controlled Trials as Topic; Stroke
PubMed: 26035725
DOI: 10.1097/PHM.0000000000000308 -
Frontiers in Pharmacology 2022In recent years, people pay more and more attention to diabetic peripheral neuropathy (DPN). As a neurotrophic agent, mecobalamin is able to repaire nerves, which has...
The efficacy and safety of mecobalamin combined with Chinese medicine injections in the treatment of diabetic peripheral neuropathy: A systematic review and Bayesian network meta-analysis of randomized controlled trials.
In recent years, people pay more and more attention to diabetic peripheral neuropathy (DPN). As a neurotrophic agent, mecobalamin is able to repaire nerves, which has already become a consensus among experts. However, it has been found that mecobalamin has poor effect to increase nerve conduction velocity, which is an important indicator. Clinical data have shown that Chinese medicine injection, combined with mecobalamin injection, can significantly improve nerve conduction velocity of the limbs. Nevertheless, several kinds of Chinese medicine injections have been used to treat DPN. The effect of these Chinese medicine injections for DPN are various. Therefore, it is necessary to evaluate the effectiveness of Chinese medicine injections combined with mecobalamin in the treatment of DPN. All relevant articles published before 12 March 2022 were searched in eight electronic databases. Randomized controlled trials (RCTs) on Chinese medicine injections plus Mecobalamin for DPN were identified according to inclusion criteria, and were assessed using the revised Cochrane risk of bias tool (ROB2.0). R software and stata15 was used to create the ranking probabilities and network meta-analysis. A total of 80 RCTs involving 6,980 patients were included. The results showed that mecobalamin plus Dengzhanxixin injection (ME + DZXX) ranked first in overall response rate [RR = 1.64, 95% CI (1.26, 2.21)] and median motor nerve conduction velocity [MD = 9.46, 95% CI (5.67, 13.28)]. Then, mecobalamin plus Kudiezi Injection (ME + KDZ) had the best effect in median sensory nerve conduction velocity [MD = 10.41, 95% CI (-13.31, -7.52)], and mecobalamin plus Honghua injection (ME + HH) ranked highest in common peroneal motor nerve conduction velocity [MD = 6.8, 95% CI (4.13, 9.49)] and common peroneal sensory nerve conduction velocity [MD = -6.25, 95% CI (-8.85, -3.65)]. This study determined the efficacy of different Chinese medicine injections combined with mecobalamin. DZXX may be the best adjunctive Chinese medicine injection for DPN patients. However, due to potential risk of bias and limited RCTs, our results need to be treated with reservations.
PubMed: 36408262
DOI: 10.3389/fphar.2022.957483 -
Endocrine, Metabolic & Immune Disorders... 2023Diabetes mellitus (DM) is a metabolic disorder characterized by progressive β cell dysfunction. Sheng-Mai Injection (SMI), a Traditional Chinese medicine preparation,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diabetes mellitus (DM) is a metabolic disorder characterized by progressive β cell dysfunction. Sheng-Mai Injection (SMI), a Traditional Chinese medicine preparation, is widely used for DM and its related complications.
OBJECTIVE
This meta-analysis aimed to summarize the applications of SMI in DM and related complications.
METHODS
Eight databases were searched, and meta-analyses were performed.
RESULTS
Fifteen studies, including 1273 participants, were included. All studies and participants included were from China. Pooled effects showed that SMI might reduce glycated hemoglobin (MD -0.46%; 95% CI -0.89 to -0.03; P < 0.01), fasting blood glucose (MD -0.83 mmol/L; 95% CI -1.30 to -0.36; P < 0.01), two-hour postprandial glucose (MD -1.27 mmol/L; 95% CI -1.96 to -0.58; P < 0.01), 24-hour urinary protein (MD -0.28 mg; 95% CI -0.51 to -0.06; P = 0.01), blood urea nitrogen (MD -1.31 mg; 95% CI -2.08 to -0.54; P < 0.05), Scr (MD -2.60; 95% CI -3.43 to -1.77; P < 0.05), ulnar nerve motor nerve conduction velocity (MNCV) (MD 1.45; 95% CI 0.03 to 2.87; P < 0.05), and tibial nerve sensory nerve conduction velocity (SNCV) (MD 1.84; 95% CI 0.1 to 3.58; P < 0.05). There was no evidence of an effect on common peroneal nervous MNCV and SNCV, tibial nerve MNCV, median nerve MNCV, and SNCV. Adverse effects included less frequent gastrointestinal reactions, elevated transaminase, leucopenia, fever, and rash.
CONCLUSION
Combination use of SMI based on conventional hypoglycemic treatment can significantly improve HbA1c, FBG, and 2hPG in DM and reduce 24-hour urinary protein, Scr, and BUN in DM patients. SMI was found to have no effect on the neurological function of diabetic peripheral neuropathy.
Topics: Humans; Diabetic Neuropathies; Hypoglycemic Agents; Glycated Hemoglobin; Medicine, Chinese Traditional; China; Diabetes Mellitus
PubMed: 36705242
DOI: 10.2174/1871530323666230127121738