-
Orthopedic Research and Reviews 2024Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the... (Review)
Review
PURPOSE
Capitellum and trochlea fractures, also referred to as coronal shear fractures of the distal humerus, are infrequent yet challenging intra-articular fractures of the elbow. There are a variety of surgical approaches and fixation methods with often variable outcomes. This systematic review investigates interventions, outcomes and complications of capitellum and trochlea fractures.
METHODS
A systematic review of studies published in MEDLINE, EMBASE, Web of Science and Cumulative Index to Nursing and Allied Health literature (CINAHL) was conducted to assess the clinical outcomes of capitellum and trochlea fractures managed surgically. Data on patient demographics, surgical approach, implant usage, postoperative outcomes and complications were compiled.
RESULTS
Forty-one studies met the inclusion criteria with a total of 700 patients. Surgical interventions primarily utilized either the lateral (79%) or antero-lateral (15%) approaches with headless compression screws as the most common fixation method (68%). Clinical outcomes were measured using the Mayo Elbow Performance Index (MEPI) with a mean score of 89.9 (±2.6) and the DASH score with a mean of 16.9 (±7.3). Elbow range of motion showed a mean flexion of 126.3° (±19.4), extension of 5.71° (±11.8), pronation of 75.23° (±12.2), and supination of 76.6° (±9.8). The mean flexion-extension arc was 113.7° (±16.9), and the mean pronation-supination arc was 165.31° (±9.41). Complications occurred in 19.8% of cases, with re-interventions required in 8.3% of cases, mainly due to symptomatic implants and elbow stiffness requiring surgical release. Other complications included implant removal (10.4%), overall reported stiff elbows (6%), nerve palsies (2%), non-union (1.5%), and infection (1.2%).
CONCLUSION
The treatment of capitellum and trochlea fractures yields satisfactory outcomes but has a considerable rate of complications and reoperations primarily due to symptomatic implants and elbow stiffness. There is noteworthy variability in the achieved range of motion, suggesting unpredictable outcomes. Deficits in functionality and range of motion are common after surgery, especially with more complex injury patterns.
PubMed: 38947420
DOI: 10.2147/ORR.S472482 -
World Journal of Orthopedics Jun 2024Cheilectomy of the 1 metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding...
BACKGROUND
Cheilectomy of the 1 metatarsophalangeal joint (MTPJ) is one of the most common procedures for the management of hallux rigidus. However, there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy (MIDC) for the management of hallux rigidus.
AIM
To evaluate outcomes following MIDC for the management of hallux rigidus.
METHODS
During November 2023, the PubMed, EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.
RESULTS
Six studies were included. In total, 348 patients (370 feet) underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9 ± 16.5 months. The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows: I (58 patients, 27.1%), II (112 patients, 52.3%), III (44 patients, 20.6%). Three studies performed an additional 1 MTPJ arthroscopy and debridement following MIDC. Retained intra-articular bone debris was observed in 100% of patients in 1 study. The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9 ± 3.2 to a postoperative score of 87.1. The complication rate was 8.4%, the most common of which was persistent joint pain and stiffness. Thirty-two failures (8.7%) were observed. Thirty-three secondary procedures (8.9%) were performed at a weighted mean time of 8.6 ± 3.2 months following the index procedure.
CONCLUSION
This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up. A moderate re-operation rate at short-term follow-up was recorded. The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.
PubMed: 38947256
DOI: 10.5312/wjo.v15.i6.585 -
Orthopedic Reviews 2024Osteoarthritis of the carpometacarpal (CMC) is considered a common musculoskeletal disorder. The treatment of carpometacarpal osteoarthritis could be either by...
BACKGROUND
Osteoarthritis of the carpometacarpal (CMC) is considered a common musculoskeletal disorder. The treatment of carpometacarpal osteoarthritis could be either by conservative or surgical methods. surgical treatment, there are various alternatives, including trapeziectomy and arthroplasty. This study aims to perform a systematic review of the literature to determine the functional outcomes associated with trapeziectomy and arthroplasty in CMC arthritis.
OBJECTIVES
To determine the functional outcomes associated with trapeziectomy and arthroplasty in CMC arthritis patients.
METHODS
A systematic review was conducted according to PRISMA guidelines and performed on August 2022 by one independent reviewer (author) using PubMed database, EBSCO Host, EMBASE, and ScienceDirect. The literature search will be based on (PICO) criteria, as mentioned in the following: Patients with any carpometacarpal arthritis; with the intervention of using carpometacarpal arthroplasty as their method of surgery; control with trapeziectomy and primary outcome of functional outcome. Clinical outcomes using patient-reported outcome measures and complications were included. The quality of the included studies was evaluated with Cochrane risk-of-bias assessment tools. Quantitative analysis was performed by Review Manager 5.4.
RESULTS
Three studies met the inclusion criteria for the systematic review. Both treatments resulted in significant improvements in functional scores. When matching patients according to preoperative function, patients receiving arthroplasty had better postoperative function (Quick DASH: trapeziectomy = 25.1, ARPE = 16.8).
CONCLUSION
This study showed that variable results of clinical outcomes improved after trapezeictomy and arthroplasty in patients with CMC arthritis. Evidence showed that arthroplasty allows for a better improvement in functional outcome.
PubMed: 38947179
DOI: 10.52965/001c.117651 -
Orthopedic Reviews 2024Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more...
Femorotibial angle on short knee radiographs fails to accurately predict the lower limb mechanical alignment. A systematic review and meta-analysis on different femorotibial angle definitions and short knee radiograph types.
INTRODUCTION
Hip-knee-ankle angle (HKA) on Full Limb Radiographs (FLRs) is the gold standard for coronal knee alignment assessment. Despite the widespread utilization of the more convenient femorotibial angle (FTA) on either antero-posterior (AP) or postero-anterior (PA) short knee radiographs (SKRs), its definition and correlation with HKA remains controversial. This review is the first to systematically investigate FTA-HKA correlation and the effect of different FTA methods and SKRs.
METHODS
Systematic literature search (Pubmed, Scopus, Cochrane Library) followed PRISMA guidelines, to evaluate studies examining the FTA-HKA correlation. Meta-analyses compared the 3 most common FTA methods, knee center determination method and SKR types.
RESULTS
17 studies (2597 patients, 3234 knees) were included. The strongest correlation with HKA (r = 0.78) was found for FTA Method 1 (angle formed by lines drawn from the midpoint of tibial spines to points 10 cm above and below the joint line). No significant differences were observed when grouping the FTA methods by knee center assessment (Group I, r = 0.78; Group II, r = 0.77). AP SKRs showed a trend towards stronger FTA-HKA correlation compared to PA SKRs, in both Method 1 (r = 0.79 vs 0.75) and Method 3 (r = 0.80 vs 0.66).
CONCLUSION
Irrespective of its definition or type of SKR used, FTA lacks reliable accuracy in predicting the HKA in most knees. FLRs should be used whenever precise estimation of the patient's alignment is necessary. Caution is warranted in interpreting studies investigating knee alignment or knee arthroplasty outcomes based on FTA.
PubMed: 38947178
DOI: 10.52965/001c.120053 -
The Bone & Joint Journal Jul 2024Proximal humeral fractures are the third most common fracture among the elderly. Complications associated with fixation include screw perforation, varus collapse, and... (Meta-Analysis)
Meta-Analysis Comparative Study
AIMS
Proximal humeral fractures are the third most common fracture among the elderly. Complications associated with fixation include screw perforation, varus collapse, and avascular necrosis of the humeral head. To address these challenges, various augmentation techniques to increase medial column support have been developed. There are currently no recent studies that definitively establish the superiority of augmented fixation over non-augmented implants in the surgical treatment of proximal humeral fractures. The aim of this systematic review and meta-analysis was to compare the outcomes of patients who underwent locking-plate fixation with cement augmentation or bone-graft augmentation versus those who underwent locking-plate fixation without augmentation for proximal humeral fractures.
METHODS
The search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles involving patients with complex proximal humeral fractures treated using open reduction with locking-plate fixation, with or without augmentation, were considered. A meta-analysis of comparative studies comparing locking-plate fixation with cement augmentation or with bone-graft augmentation versus locking-plate fixation without augmentation was performed.
RESULTS
A total of 19 studies were included in the qualitative synthesis, and six comparative studies were included in the meta-analysis. Overall, 120 patients received locking-plate fixation with bone-graft augmentation, 179 patients received locking-plate fixation with cement augmentation, and 336 patients received locking-plate fixation without augmentation. No statistically relevant differences between the augmented and non-augmented cohorts were found in terms of the Disabilities of the Arm, Shoulder and Hand questionnaire score and Constant-Murley Score. The cement-augmented group had a significantly lower rate of complications compared to the non-augmented group.
CONCLUSION
While locking-plate fixation with cement augmentation appears to produce a lower complication rate compared to locking-plate fixation alone, functional outcomes seem comparable between augmented and non-augmented techniques.
Topics: Humans; Bone Plates; Shoulder Fractures; Fracture Fixation, Internal; Bone Cements; Bone Transplantation; Treatment Outcome
PubMed: 38945543
DOI: 10.1302/0301-620X.106B7.BJJ-2023-1113.R1 -
Journal of ISAKOS : Joint Disorders &... Jun 2024Patients with excessive posterior tibial slope (PTS) may have higher risks of anterior cruciate ligament (ACL) reconstruction (ACL-R) failure, and clinical outcomes... (Review)
Review
IMPORTANCE
Patients with excessive posterior tibial slope (PTS) may have higher risks of anterior cruciate ligament (ACL) reconstruction (ACL-R) failure, and clinical outcomes after revision ACL-R procedures are typically poor.
OBJECTIVE
To perform a systematic review of the literature summarizing the clinical and radiological outcomes of the surgical treatment of ACL insufficiency in the setting of excessive PTS using a tibial deflexion osteotomy combined with ACL-R.
EVIDENCE REVIEW
A systematic review of the literature was performed using PubMed, Cochrane Library, and OVID Medline databases from 1990 to present. Inclusion criteria were: studies of outcomes of isolated tibial deflexion osteotomies performed with primary or revision ACL-R in the English language. Data extracted included study demographic information, type of tibial deflexion osteotomy and concomitant procedures, radiological outcomes, patient reported outcome scores, and postoperative complications FINDINGS: Six studies, with 133 knees were identified. All included studies were retrospective case series, with a weighted mean follow-up of 3.39 years. In 106 of 133 (79.7%) knees, tibial deflexion osteotomy was performed concomitantly with an ACL-R, whereas in 27 of 133 (20.3%) knees the procedures were staged. 22, 45, and 66 of 133 knees (16.5%, 33.8%, and 49.6%) underwent primary, 1 revision, and 2 or greater revision ACL-R, respectively. 3 of 133 (2.25%) knees demonstrated recurrent ACL graft failure at final follow-up. On average, PTS decreased from 15.2 degrees preoperatively to 7.1 degrees postoperatively. Mean International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores increased from 42.5, 46.4, and 4.2 preoperatively to 71.8, 89.0, and 6.7 postoperatively.
CONCLUSIONS
The results of this review suggest that combined ACL-R and tibial deflexion osteotomy may be effective in decreasing PTS and improving knee function and stability.
STUDY DESIGN
Systematic Review; Level of evidence 4.
PubMed: 38945397
DOI: 10.1016/j.jisako.2024.06.010 -
The Journal of Foot and Ankle Surgery :... Jun 2024Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques... (Review)
Review
Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR=0.60, CI 0.36-1.02, p=0.06) however, EF was associated with greater odds of deep hardware infections (OR=3.67, 1.97-6.83, p <0.05) and amputations (OR=3.17, CI 1.06-9.54, p =0.04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD=31.23, CI-25.11-37.34, p <0.05) and intraoperative blood loss (MD=46.31, CI-24.93-67.69, p <0.05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes. However, IF patients are more likely to achieve primary union and less likely to have deep infections, being mindful that EF techniques were usually indicated for more complex cases. LEVEL OF EVIDENCE: IV.
PubMed: 38944233
DOI: 10.1053/j.jfas.2024.05.010 -
Journal of Shoulder and Elbow Surgery Jun 2024Rotator cuff tears (RCTs) are a prevalent cause of shoulder pain and dysfunction. For those who fail initial conservative treatment, operative intervention can be... (Review)
Review
INTRODUCTION
Rotator cuff tears (RCTs) are a prevalent cause of shoulder pain and dysfunction. For those who fail initial conservative treatment, operative intervention can be pursued. A significant and common complication after rotator cuff repair (RCR) is retearing or non-healing. Numerous augmentations to traditional suture RCR have been studied. Of these, the Smith+Nephew Regeneten bioinductive collagen patch has had promising initial results; however, analytic data for its use is lacking, and there is no meta-analysis comparing the available data to historical RCR outcomes.
METHODS
A PRISMA-guided literature search was conducted using Ovid MEDLINE, PubMED, Cochrane, and ClinicalTrials.gov. 13 studies met inclusion and exclusion criteria. Only clinical trials on full and partial-thickness tears were included. American Shoulder and Elbow Surgeon score (ASES), Constant-Murley score (CMS), the visual analog scale for pain (VAS), the minimal clinically important difference (MCID), tendon thickness, and complication rates were primary outcomes of interest. A meta-analysis was performed to determine the overall complication and retear rate from the included studies.
RESULTS
ASES, CMS, and VAS improved significantly in all studies that reported them, and most patients achieved MCID. Patient-reported outcome measure (PROM) improvements were similar to historical improvements in standard RCR, and a similar proportion of patients achieved MCID after standard repair. Tendon thickness improved significantly and to a similar degree as standard RCR. Overall retear rate after full thickness RCR augmented with the bioinductive patch was 8.3%. For partial thickness RCR, total retear rate of 1.1% across all patients. The overall complication rate with the bioinductive patch was 15.5% across all full-thickness RCR studies and 16.2% in partial thickness RCR. We found overall retear rate to be lower after augmentation with the bioinductive patch compared to traditional repair; however, the overall complication rate was similar for full-thickness tears and higher for partial-thickness tears. Lastly, adverse reactions to the bioinductive patch were noted at 0.2%.
CONCLUSIONS
The bioinductive collagen patch appears to be a safe augmentation for rotator cuff repair. Patients are likely to experience significant subjective improvement in PROMs and significant increases in tendon thickness. Retear rate has been a concern after RCR for decades, and the bioinductive patch may help mitigate this risk. There is a lack of case-control studies comparing the bioinductive patch to traditional suture RCR. Such data is needed to better determine the role of the bioinductive patch in the treatment of full and partial-thickness rotator cuff repairs.
PubMed: 38942225
DOI: 10.1016/j.jse.2024.05.002 -
Arthroscopy : the Journal of... Jun 2024The objective of the current study was to analyze if the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional... (Review)
Review
PURPOSE
The objective of the current study was to analyze if the arthroscopic Bankart repair using a knotless suture anchor has a better functional outcome than the conventional knot-tying Bankart repair.
METHODS
Comprehensive literature search was done in Pubmed, Scopus, Embase, and Cochrane databases in May 2023. Studies comparing the clinical outcome of Bankart repair using knotless and knot-tying techniques were included in the study. In vitro, animal, and level 4 and 5 studies were excluded. The risk of bias of randomized controlled trials (RCT) was calculated according to the RoB 2 tool, and for non-randomized studies, MINORS criteria were used. Statistical analysis was done using RevMan software.
RESULTS
A total of nine studies, including two RCT and seven non-randomized comparative studies involving 720 patients, were included in the systematic review. The ROWE score ranged 81.7 to 94.3 in the knot-tying and 86 to 96.3 in the knotless group. VAS scores at final follow-up ranged between 0.1 to 1.7 in the knot-tying and 0.7 to 2.5 in the knotless group. The rate of redislocation, subluxation, and revision surgery in the knot-tying group ranged from 0 to 14.7%, 16.7 to 29.7%, and 1.6 to 17.6%, respectively, while that in the knotless group ranged from 2.4 to 23.8%, 7.4 to 22.2%, and 2.4 to 19%, respectively. The mean external rotation was 54 to 65 degrees in the knot-tying and 61 to 99 in the knotless group. The mean forward-flexion was 164 to 172 in the knot-tying and 165 to 174 in the knotless group. Our subjective synthesis doesn't reveal any difference in the outcome between the two groups.
CONCLUSION
The available literature does not demonstrate a clear difference in functional outcomes, residual pain, and rate of complications like redislocation, subluxation and revision surgery between Bankart repair performed with knotted and knotless anchors.
PubMed: 38942097
DOI: 10.1016/j.arthro.2024.05.036 -
BMC Musculoskeletal Disorders Jun 2024The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has... (Comparative Study)
Comparative Study
Salvage Latarjet may provide worse outcomes in terms of recurrent instability and returning to sports compared to primary Latarjet: a systematic review of comparative studies.
BACKGROUND
The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown.
METHODS
Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK).
RESULTS
Twelve studies were included in the systematic review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion.
CONCLUSION
Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion.
PROSPERO ID
CRD42023492027.
Topics: Humans; Joint Instability; Return to Sport; Salvage Therapy; Recurrence; Shoulder Joint; Treatment Outcome; Range of Motion, Articular; Shoulder Dislocation; Reoperation; Orthopedic Procedures
PubMed: 38937741
DOI: 10.1186/s12891-024-07593-w