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Journal of Orthopaedic Surgery and... Dec 2019Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI.
METHODS
We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis.
RESULTS
After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84-90%), 96% (95% CI 95-97%), and 170.09 (95% CI 97.63-296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83-90%), 97% (95% CI 96-98%), and 158.18 (95% CI 74.26-336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively.
CONCLUSION
Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.
Topics: Carboxylic Ester Hydrolases; Hip Prosthesis; Humans; Knee Prosthesis; Prosthesis-Related Infections; Reproducibility of Results; Shoulder Prosthesis; Synovial Fluid; alpha-Defensins
PubMed: 31856885
DOI: 10.1186/s13018-019-1395-3 -
Clinics in Sports Medicine Jan 2020Meniscus injuries are among the most common athletic injuries and result in functional impairment in the knee. Repair is crucial for pain relief and prevention of...
Meniscus injuries are among the most common athletic injuries and result in functional impairment in the knee. Repair is crucial for pain relief and prevention of degenerative joint diseases like osteoarthritis. Current treatments, however, do not produce long-term improvements. Thus, recent research has been investigating new therapeutic options for regenerating injured meniscal tissue. This review comprehensively details the current methodologies being explored in the basic sciences to stimulate better meniscus injury repair. Furthermore, it describes how these preclinical strategies may improve current paradigms of how meniscal injuries are clinically treated through a unique and alternative perspective to traditional clinical methodology.
Topics: Adipose Tissue; Biomechanical Phenomena; Bone Marrow Cells; Cartilage; Chondrocytes; Humans; Intercellular Signaling Peptides and Proteins; Menisci, Tibial; Platelet-Rich Fibrin; Platelet-Rich Plasma; Regeneration; Stem Cell Transplantation; Synovial Membrane; Tibial Meniscus Injuries; Tissue Engineering; Tissue Scaffolds
PubMed: 31767102
DOI: 10.1016/j.csm.2019.08.003 -
EFORT Open Reviews Oct 2019Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and... (Review)
Review
Developmental dysplasia of the hip (DDH) is one of the most prevalent congenital malformations. It has a wide spectrum of anatomical abnormalities of the hip joint and is characterized by mild or incomplete formation of the acetabulum leading to laxity of the joint capsule, secondary deformity of the proximal femur and irreducible hip dislocation. It is the leading cause of early hip osteoarthritis in young individuals.Both genetic and environmental factors have been proposed to play an important role in the pathogenesis of DDH. A high prevalence is present in Asian, Caucasian, Mediterranean and American populations, with females being more frequently affected. We evaluated a variety of genetic studies indexed in the PubMed database.Several susceptive genes, including WISP3, PAPPA2, HOXB9, HOXD9, GDF5, TGF Beta 1, CX3CR1, UQCC, COL1A1, TbX4 and ASPN have been identified as being associated with the development of DDH. Moreover, genetic association has also been reported between hip dysplasia and other comorbidities. Even though genetic components are a crucial part in the aetiology of DDH, several DDH susceptibility genes need further investigation.The purpose of this review is to present current literature evidence regarding genes responsible for DDH development. Cite this article: 2019;4:595-601. DOI: 10.1302/2058-5241.4.190006.
PubMed: 31754465
DOI: 10.1302/2058-5241.4.190006 -
Orthopaedics & Traumatology, Surgery &... Dec 2019Irreparable rotator cuff tears in active patients provide a significant challenge and a consensus on the gold standard treatment is currently lacking. Superior capsule...
BACKGROUND
Irreparable rotator cuff tears in active patients provide a significant challenge and a consensus on the gold standard treatment is currently lacking. Superior capsule reconstruction (SCR) has recently been advocated and functions by providing a passive biological constraint to superior humeral head migration. The aim of this study is to systematically review the literature to evaluate the role of SCR in terms of functional outcome scores and failure rates.
PATIENTS AND METHODS
A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 28th January 2019. Clinical studies reporting SCR using any type of graft or surgical technique were included if reporting either functional outcome scores or rate of secondary surgery. The studies were appraised using the Methodological index for non-randomised studies tool.
RESULTS
The search strategy identified nine studies eligible for inclusion; five reported on fascia lata autografts and four studies reported on dermal allografts. All nine studies reported significant improvement in functional scores after SCR. Rates of secondary surgery were only provided in the dermal allograft studies at short-term follow-up (mean 10.9 to 32.4months) and ranged from 0 to 18.6%. Radiological assessment revealed graft failure in 5.5 to 55% of dermal allografts and 4.2 to 36.1% of fascia lata autografts.
CONCLUSION
This review demonstrates that SCR is a useful treatment modality for patients with irreparable rotator cuff tears. SCR was associated with significantly improved functional outcome scores in all studies. All studies reported a preserved or increased mean AHD. The radiological graft failure rate ranged from 4.2 to 55% and the short duration of follow-up in most studies means that this remains an important concern that requires longer-term evaluation.
LEVEL OF EVIDENCE
IV, systematic review.
Topics: Graft Survival; Humans; Joint Capsule; Orthopedic Procedures; Recovery of Function; Reoperation; Rotator Cuff Injuries; Shoulder Injuries; Shoulder Joint; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome
PubMed: 31727588
DOI: 10.1016/j.otsr.2019.07.022 -
Orthopaedics & Traumatology, Surgery &... Sep 2019Arthroscopic capsular release for adhesive capsulitis of the shoulder is a treatment option. The present study aimed to investigate the clinical outcomes following... (Comparative Study)
Comparative Study
INTRODUCTION
Arthroscopic capsular release for adhesive capsulitis of the shoulder is a treatment option. The present study aimed to investigate the clinical outcomes following arthroscopic capsular release among idiopathic, diabetic and secondary adhesive capsulitis.
HYPOTHESIS
Different aetiological groups yield variable outcomes following arthroscopic capsular release.
MATERIALS AND METHODS
A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Database in April 2017. Comparative studies that reported range of motion or functional outcomes following arthroscopic capsular release in patients with adhesive capsulitis were included. A systematic review of the studies was conducted following the PRISMA guidelines.
RESULTS
Six studies met the eligibility criteria. The overall population included 463 patients; 203 idiopathic, 61 diabetic and 199 secondary cases. Of four studies comparing idiopathic and diabetic patients, three reported significantly worse range of movement and function in the diabetic group at various follow up points. No significant difference in function and motion was reported between the idiopathic and secondary groups. Recurrent pain was highest in diabetic patients (26%) compared to idiopathic groups (0%) and the secondary group had a higher rate of revision surgery when compared to the idiopathic group (8.1% vs. 2.4%) DISCUSSION: Arthroscopic capsular release has a high success rate regardless of the underlying aetiology. However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. The rate of revision capsular release is higher among patients with post-surgical adhesive capsulitis when compared to idiopathic cases.
LEVEL OF EVIDENCE
IV, systematic review.
Topics: Arthroscopy; Bursitis; Diabetes Complications; Humans; Joint Capsule Release; Range of Motion, Articular; Reoperation; Shoulder Joint; Shoulder Pain; Treatment Outcome
PubMed: 31202716
DOI: 10.1016/j.otsr.2019.02.014 -
European Review For Medical and... Feb 2019This review assesses the roles of IL-10 in post ACL reconstruction OA, and highlights the potential therapeutic effects of this cytokine.
OBJECTIVE
This review assesses the roles of IL-10 in post ACL reconstruction OA, and highlights the potential therapeutic effects of this cytokine.
MATERIALS AND METHODS
We conducted a systematic review of the literature in order to consolidate evidence of IL10 profiles in synovial fluid (SF) of patients with ACL tears. The review was conducted in accordance with the PRISMA statement. In total, 10 studies were found to be pertinent and were considered in depth. Seven studies reported on trends in IL-10 concentrations after an ACL tear; in addition, three studies described IL-10 concentrations after ACL reconstruction. In all studies, IL-10 levels were assessed using enzyme-linked immunosorbent assay.
RESULTS
IL-10 levels in SF were higher after ACL injury and ACL reconstruction compared to control knees. IL-10 levels were most elevated shortly after injury, but, decreased to more normal levels in chronic lesions. In contrast, the inflammatory cytokine TNF-α remained higher than controls immediately subsequent to, and, even 5 years post-injury.
CONCLUSIONS
IL-10 is a modulatory cytokine with an active role in antagonizing TNF-α in the knee joint environment. Consideration of the role of IL-10 in the knee has now shifted from simply a key biomarker to having active therapeutic potential in the prevention of OA after ACL injury.
Topics: Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Humans; Interleukin-10; Synovial Fluid; Time Factors; Tumor Necrosis Factor-alpha
PubMed: 30779058
DOI: 10.26355/eurrev_201902_16979 -
Osteoarthritis and Cartilage Apr 2019To perform a systematic review of the small molecule metabolism studies of osteoarthritis utilising nuclear magnetic resonance (NMR) or mass spectroscopy (MS) analysis...
OBJECTIVE
To perform a systematic review of the small molecule metabolism studies of osteoarthritis utilising nuclear magnetic resonance (NMR) or mass spectroscopy (MS) analysis (viz., metabolomics or metabonomics), thereby providing coherent conclusions and reference material for future study.
METHOD
We applied PRISMA guidelines (PROSPERO 95068) with the following MESH terms: 1. "osteoarthritis" AND ("metabolic" OR "metabonomic" OR "metabolomic" OR "metabolism") 2. ("synovial fluid" OR "cartilage" OR "synovium" OR "serum" OR "plasma" OR "urine") AND ("NMR" or "Mass Spectroscopy"). Databases searched were "Medline" and "Embase". Studies were searched in English and excluded review articles not containing original research. Study outcomes were significant or notable metabolites, species (human or animal) and the Newcastle-Ottawa Score.
RESULTS
In the 27 studies meeting the inclusion criteria, there was a shift towards anaerobic and fatty acid metabolism in OA disease, although whether this represents the inflammatory state remains unclear. Lipid structure and composition was altered within disease subclasses including phosphatidyl choline (PC) and the sphingomyelins. Macromolecular proteoglycan destruction was described, but the correlation to disease factors was not demonstrated. Collated results suggested arachidonate signalling pathways and androgen sex hormones as future metabolic pathways for investigation.
CONCLUSION
Our meta-analysis demonstrates significant small molecule differences between sample types, between species (such as human and bovine), with potential OA biomarkers and targets for local or systemic therapies. Studies were limited by numbers and a lack of disease correlation. Future studies should use NMR and MS analysis to further investigate large population subgroups including inflammatory arthropathy, OA subclasses, age and joint differences.
Topics: Animals; Biomarkers; Cartilage; Humans; Magnetic Resonance Spectroscopy; Mass Spectrometry; Metabolomics; Osteoarthritis; Synovial Membrane
PubMed: 30287397
DOI: 10.1016/j.joca.2018.08.024 -
The Iowa Orthopaedic Journal 2018Arthroscopic management of the hip capsule has become a topic of debate in recent literature. Few comparative studies exist to help establish clear treatment...
INTRODUCTION
Arthroscopic management of the hip capsule has become a topic of debate in recent literature. Few comparative studies exist to help establish clear treatment recommendations.
METHODS
Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was conducted using PubMed, CINAHL, EMBASE, sportDiscus (EBSCO) and Cochrane Central Register of Controlled Trials databases by two independent investigators. Comparative studies evaluating outcomes after two or more distinct treatment approaches to capsule management were included.
RESULTS
The review yielded 7 articles that met inclusion criteria. Outcomes included in the review include patient reported outcome measures (mHHS, HOS, NASH) in 5 articles, return to sport in 1 article, and formation of postoperative heterotopic ossification (HO) in 1 article. In two articles evaluating the outcomes of revision hip arthroscopy, plication was associated with > 10 point improvements in HOS-ADL and mHHS scores when compared to no plication. The literature is inconclusive regarding routine hip capsule closure in primary arthroscopy, with one study supporting the practice, and one study showing no difference; capsular closure may help accelerate return to sports and improve outcomes while decreasing revisions in cases of borderline dysplasia. Closure does not influence HO rates after surgery.
CONCLUSION
There is insufficient evidence in the present literature to suggest routine closure of inter-portal capsulotomies after primary hip arthroscopy impacts patient outcomes. Capsular closure or plication should be given strong consideration in revision cases. Complete closure or plication may influence outcomes in patients with borderline dysplasia, for athletes wishing to return to sport, and in cases of extensile capsulotomies, although the data are inconclusive. Prospective, high level studies are indicated to create evidence-based treatment recommendations for capsular management in hip arthroscopy.
Topics: Arthroscopy; Femoracetabular Impingement; Hip Joint; Humans; Joint Capsule; Joint Instability; Treatment Outcome
PubMed: 30104930
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Nov 2018Several tests are used before reimplantation to detect persistent infection in patients with periprosthetic joint infection (PJI) undergoing two-stage revision. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several tests are used before reimplantation to detect persistent infection in patients with periprosthetic joint infection (PJI) undergoing two-stage revision. However, there is no consensus as to the optimal tests for excluding persistent infection or predicting successful reimplantation by stage. We aimed to determine the accuracy of different tests used to detect persistent infection after the first stage, and/or predicting failure following reimplantation in patients with PJI.
METHODS
We conducted a systematic review and meta-analysis of PubMed, Embase and the Cochrane Library databases. Two reviewers independently conducted quality assessments and data extractions to estimate pooled sensitivity and specificity, diagnostic odds ratio and area under the receiver operating characteristic curves (AUSROC) for each test.
RESULTS
We included 24 studies published between May 1999 and September 2017. Synovial fluid polymorphonuclear neutrophils (PMN)% had the highest sensitivity of 0.70, followed by serum erythrocyte sedimentation rate (0.57) and spacer sonication fluid culture (0.53). Synovial fluid culture had the highest specificity of 0.97, followed by frozen section (0.93) and the Musculoskeletal Infection Society criteria (0.92). Spacer sonication fluid culture was the most accurate test with an AUSROC of 0.8089, followed by synovial fluid culture (0.7749) and frozen section (0.7819).
DISCUSSION
Spacer sonication fluid culture had a relatively high diagnostic accuracy. We emphasize that no test can be used alone to exclude persistent infection beyond the first stage and/or predict failed reimplantation beyond the second stage.
LEVEL OF EVIDENCE
II, systematic review and meta-analysis of level 2 to level 4 studies with inconsistent results.
Topics: Arthroplasty, Replacement; Blood Sedimentation; Diagnostic Tests, Routine; Frozen Sections; Humans; Joint Prosthesis; Leukocyte Count; Neutrophils; Prosthesis-Related Infections; ROC Curve; Reoperation; Synovial Fluid
PubMed: 30030145
DOI: 10.1016/j.otsr.2018.03.017 -
Hand (New York, N.Y.) Jan 2020Although many techniques have been described, there is no clear optimal surgical treatment for chronic scapholunate interosseous ligament (SLIL) disruption. We... (Meta-Analysis)
Meta-Analysis
Although many techniques have been described, there is no clear optimal surgical treatment for chronic scapholunate interosseous ligament (SLIL) disruption. We identified 255 articles reporting outcomes of SLIL reconstruction. Of these, 40 studies (978 wrists) met eligibility requirements and reported sufficient data on radiographic outcomes to be included in the study. The mean and standard deviation of preoperative and follow-up assessments including scapholunate gap (SLG) and scapholunate angle (SLA) were used to calculate pooled standardized mean differences (SMD) with 95% confidence intervals (CIs). For other radiographic or clinical outcomes, there were not enough reported data to calculate a pooled effect size, and pooled nonstandardized comparisons were made. The SMD between preoperative and postoperative SLA in tenodesis reconstruction was 0.7 (CI, 0.29 to 1.11, = .001) and 0.04 (CI, -0.27 to 0.38, = .8) for capsulodesis reconstruction. For SLG, tenodesis demonstrated an SMD of 1.1 (CI, 0.6 to 1.55, < .001) compared with 0.1 (CI, -0.36 to 0.59, = .6) for capsulodesis reconstruction. Tenodesis had a significant improvement compared with capsulodesis in SLA ( = .01) and SLG ( = .005). Tenodesis also showed improvement in grip strength and Disabilities of the Arm, Shoulder and Hand scores. Comparing preoperative and postoperative radiographic measurements, tenodesis reconstruction demonstrated significantly improved SLG and SLA relative to capsulodesis. Interpreted in the context of the limitations, existing data demonstrates some benefit of tenodesis reconstruction.
Topics: Adult; Chronic Disease; Female; Humans; Joint Capsule; Ligaments, Articular; Lunate Bone; Male; Middle Aged; Radiography; Plastic Surgery Procedures; Scaphoid Bone; Tenodesis; Treatment Outcome; Wrist Injuries; Wrist Joint
PubMed: 30027766
DOI: 10.1177/1558944718787289