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Cartilage Mar 2024In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the...
Current Lack of Evidence on Treatment Strategies and Clinical Outcomes for Osteochondral Lesions of the Subtalar, Talonavicular, and Calcaneocuboid Joints: A Systematic Review.
OBJECTIVE
In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the midfoot, are rare conditions, but they can also lead to significant morbidity. The objective of this systematic review was to summarize the clinical evidence for the treatment of OCLs of the subtalar, talonavicular, calcaneocuboid, and the other midfoot joints.
DESIGN
A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases was performed in January 2021 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by 2 independent reviewers. Included studies were evaluated with regard to LOE (level of evidence) and QOE (quality of evidence). Variable reporting outcome data, clinical outcomes, and complications were evaluated.
RESULTS
Seventeen studies with 21 patients were included, all of which were case reports (level 5) without any case series reporting greater than 3 patients. There were 5 patients with OCL in the subtalar joint, 15 patients in the talonavicular joint, and 1 patient in the calcaneocuboid joint. Thirteen case reports (4 subtalar joint, 8 talonavicular joint, and 1 calcaneocuboid joint) reported surgical treatment. Surgical procedures mainly included debridement, bone marrow stimulation, fixation, and bone grafting, through open or arthroscopy, all of which resulted in successful outcomes. Four case reports (1 subtalar joint, 3 talonavicular joint) reported successful conservative treatment. Other 13 case reports reported successful surgery after failed conservative treatment. No complications and reoperations were reported.
CONCLUSIONS
The current systematic review revealed that there is no available evidence to ascertain clinical outcomes of both conservative and surgical treatments for cartilage lesions in the talonavicular joint, subtalar joint, and the midfoot joints, owing to the extreme paucity of literature. Both nonoperative and operative treatments can be considered, but no treatment strategies have been established.
Topics: Humans; Tarsal Joints; Subtalar Joint; Ankle Joint; Research Design
PubMed: 38032011
DOI: 10.1177/19476035231216182 -
Foot & Ankle Orthopaedics Oct 2023Lisfranc injuries, if not accurately diagnosed, can result in chronic pain and instability. Previous studies have examined ultrasonographs, radiographs, magnetic...
BACKGROUND
Lisfranc injuries, if not accurately diagnosed, can result in chronic pain and instability. Previous studies have examined ultrasonographs, radiographs, magnetic resonance imaging (MRI), and conventional computed tomography (CT) scan to differentiate Lisfranc instability, but they focused on a healthy/injured scale without differentiating subtle injury. Weightbearing CT (WBCT) has emerged as a diagnostic tool for detecting subtle Lisfranc injuries. This systematic review aimed to compare WBCT with conventional CT in diagnosing Lisfranc injury, and the ability to differentiate injuries of varying severities.
METHODS
The review encompassed PubMed, CINAHL, MEDLINE, SPORTDiscus, and Web of Science databases from inception until July 5, 2023. Inclusion criteria involved studies on CT and/or WBCT for Lisfranc injuries and nonoperative studies. Exclusion criteria composed case reports, commentaries, postoperative imaging studies, pediatric patients, studies with nonobjective radiographic measurements, studies exclusively focused on injury classification, and studies with fewer than 5 patients because of poor statistical power. Data extraction focused on radiographic measurements of the Lisfranc complex, categorized into conventional CT, partial WBCT, and total WBCT.
RESULTS
Out of the initially retrieved 489 articles, 9 met the inclusion criteria. Several studies consistently demonstrate that WBCT provides a higher level of accuracy in measuring the Lisfranc area, offering enhanced sensitivity to detect subtle alterations in joint structure. Moreover, WBCT exhibits superior sensitivity in distinguishing between healthy Lisfranc joints and those with injuries, particularly when identifying dorsal ligament damage. This imaging modality allows for the detection of significant variations in critical measurements like first-second metatarsal (M1-M2) distance, first cuneiform (C1)-M2 distance, and joint volumes, enabling a more comprehensive assessment of Lisfranc joint health especially with subtle instability.
CONCLUSION
This review evaluates the extant literature on WBCT's utility in diagnosing Lisfranc injuries and compares its effectiveness to CT in distinguishing between injuries of varying severity. WBCT, with reliable measurement techniques, appears more adept at detecting subtle Lisfranc instability compared to CT, likely by allowing the assessment of injury under load.
PubMed: 38027457
DOI: 10.1177/24730114231209767 -
Journal of Orthopaedic Surgery (Hong... 2023To determine whether a double anchor is more effective than a single anchor in the surgical repair of the anterior talofibular ligament (ATFL) in patients with ankle... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine whether a double anchor is more effective than a single anchor in the surgical repair of the anterior talofibular ligament (ATFL) in patients with ankle instability.
METHODS
This study searched PubMed, Embase and the Cochrane Library to identify potential studies that compared the clinical outcomes of double anchors and single anchors for ATFL repair from inception to July 31st, 2023. The study aligned with the 2020 Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and checklist. The Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tool was used to evaluate methodologic quality and risk of bias. The meta-analysis was performed with random effects. Outcomes, including American Orthopaedic Foot & Ankle Society Score (AOFAS), Karlsson Ankle Functional Score (KAFS), Tegner activity score, return to sport rate, complications and revision surgery events, were recorded.
RESULTS
A total of 845 articles were identified after an initial search of the three databases. Four retrospective studies involving 231 individuals were included for further analysis. There was no significant difference between the single-anchor group and the two-anchor group in terms of the AOFAS (risk ratio, -0.44, [-2.22; 1.34]) or KAFS (mean difference, -2.81, [-6.87; 1.25]). However, in terms of the Tegner activity score and the return to sport rate, the single-anchor group had significantly lower scores and longer times than the double-anchor group. No complications or revision surgery events were reported.
CONCLUSIONS
In patients with chronic ankle instability, both single anchors and double anchors can provide good functional outcomes. For patients who participate in physically demanding sports, double anchors may be a superior option.
LEVEL OF EVIDENCE
Level Ⅲ, meta-analysis of Level Ⅲ.
Topics: Humans; Retrospective Studies; Arthroscopy; Lateral Ligament, Ankle; Ankle Joint; Cohort Studies; Joint Instability
PubMed: 37992222
DOI: 10.1177/10225536231217914 -
Journal of ISAKOS : Joint Disorders &... Apr 2024Men have a higher risk of Achilles tendon (AT) injury, and the impact of morphological and mechanical sex differences may play a role. (Review)
Review
IMPORTANCE
Men have a higher risk of Achilles tendon (AT) injury, and the impact of morphological and mechanical sex differences may play a role.
AIM
The aim of this study is to systematically review the literature to determine whether there are sex-specific differences in AT morphological and mechanical properties and analyze how these differences may impact AT injury in both men and women.
EVIDENCE REVIEW
A systematic literature search of articles published between 2001 and 2021, in the MEDLINE, EMBASE, and Cochrane databases was performed during May 2022 according to PRISMA. The primary outcome measures included sex-related differences in the mechanical and morphological properties of the Achilles tendon. Secondary outcomes included impact of sex on Achilles tendon properties and adaptation.
FINDINGS
Nineteen studies with a total of 1,143 participants (613 men and 530 women) were included in this systematic review. Men had increased measurements when compared with women in the following: AT length, thickness, cross-sectional area (CSA), stiffness, peak force, loading rate, and voluntary muscle contraction. Women had an increase in CSA deformation, strain, and compliance.
CONCLUSIONS AND RELEVANCE
Our study demonstrates that men have an increased AT length, thickness, and CSA, indicating that men may be subjected biomechanically to higher loads in their day-to-day activities. In addition, men have lower deformation and compliance properties, along with increased AT stiffness, reducing their capacity to adapt during loading, potentially increasing their risk of injury.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Male; Female; Achilles Tendon; Sex Characteristics; Tendon Injuries
PubMed: 37967617
DOI: 10.1016/j.jisako.2023.11.001 -
Journal of Orthopaedic Surgery and... Nov 2023Approximately 20% of acute ankle sprains progress to chronic lateral ankle instability (CLAI) requiring surgical intervention. There has been growing interest among... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Approximately 20% of acute ankle sprains progress to chronic lateral ankle instability (CLAI) requiring surgical intervention. There has been growing interest among surgeons regarding whether arthroscopic techniques can replace open Brostrom-Gould surgery in treating CLAI. The purpose of this study was to pool the results of multiple studies comparing the treatment effects of these two fixation approaches.
METHODS
Our study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on CLAI that were repaired using the arthroscopic or open Broström-Gould technique. Through a comprehensive meta-analysis, we evaluated several outcomes, including post-operative function, radiological measurements, complications, and time efficiency.
RESULT
A total of 686 patients from 11 studies were included in the analysis. Among them, 351 patients underwent open repair, and 335 underwent arthroscopic Brostrom-Gould surgery. The present study revealed that arthroscopic and open Brostrom-Gould techniques demonstrated no significant differences in talar tilt, talar anterior translation, complication rate, and time to return to previous level of activity. Furthermore, no significant differences were observed in AOFAS, K-P, VAS, and Tegner scores at the 2-year follow-up. However, significant differences were noted between the two surgical approaches in terms of early weight-bearing (WMD = - 1.33 weeks, 95% CI = [- 1.91, - 0.76], P = 0.17, I = 40%), as well as AOFAS scores (WMD = 1.00, 95% CI = [0.05, 1.95], P = 0.73, I = 0%), K-P scores (WMD = 1.57, 95% CI = [0.49, 2.64], P = 0.15, I = 47%), and VAS scores (WMD = - 0.15, 95% CI = [- 0.60, 0.29], P < 0.08, I = 61%) within the first postoperative year.
CONCLUSIONS
Our findings support that arthroscopic repair yields comparable outcomes to open surgery. Consequently, we advocate for adopting arthroscopic repair as a preferred alternative to the conventional open Broström-Gould procedure for treating chronic lateral ankle instability.
Topics: Humans; Lateral Ligament, Ankle; Ankle Joint; Ankle; Arthroscopy; Radiography; Joint Instability; Retrospective Studies
PubMed: 37964306
DOI: 10.1186/s13018-023-04292-5 -
Sensors (Basel, Switzerland) Oct 2023This systematic review aimed to provide a comprehensive overview of the effects of functional electrical stimulation (FES) on gait characteristics in healthy individuals. (Review)
Review
BACKGROUND
This systematic review aimed to provide a comprehensive overview of the effects of functional electrical stimulation (FES) on gait characteristics in healthy individuals.
METHODS
Six electronic databases (PubMed, Embase, Epistemonikos, PEDro, COCHRANE Library, and Scopus) were searched for studies evaluating the effects of FES on spatiotemporal, kinematic, and kinetic gait parameters in healthy individuals. Two examiners evaluated the eligibility and quality of the included studies using the PEDro scale.
RESULTS
A total of 15 studies met the inclusion criteria. The findings from the literature reveal that FES can be used to modify lower-limb joint kinematics, i.e., to increase or reduce the range of motion of the hip, knee, and ankle joints. In addition, FES can be used to alter kinetics parameters, including ground reaction forces, center of pressure trajectory, or knee joint reaction force. As a consequence of these kinetics and kinematics changes, FES can lead to changes in spatiotemporal gait parameters, such as gait speed, step cadence, and stance duration.
CONCLUSIONS
The findings of this review improve our understanding of the effects of FES on gait biomechanics in healthy individuals and highlight the potential of this technology as a training or assistive solution for improving gait performance in this population.
Topics: Humans; Walking; Gait; Knee Joint; Knee; Lower Extremity; Biomechanical Phenomena
PubMed: 37960383
DOI: 10.3390/s23218684 -
Musculoskeletal Surgery Mar 2024The purpose of this systematic review was to analyze the current use of adipose-derived mesenchymal stem cells (ADMSCs) and present the available evidence on their... (Review)
Review
The purpose of this systematic review was to analyze the current use of adipose-derived mesenchymal stem cells (ADMSCs) and present the available evidence on their therapeutic potential in the treatment of ankle orthopedic issues, evaluating the applications and results. A literature search of PubMed, Google Scholar, EMBASE and Cochrane Library database was performed. The review was conducted following PRISMA guidelines. Risk of bias assessment was conducted through the Methodological Index for Non-Randomized Studies (MINORS) criteria. Initial search results yielded 4348 articles. A total of 8 articles were included in the review process. No clinical evidence has demonstrated the effectiveness of one isolation method over the other, but nonenzymatic mechanical method has more advantages. In all studies included significant clinical outcomes improvement were recorded in patients affected by osteochondral lesion and osteoarthritis of ankle. All studies performed a concomitant procedure. No serious complications were reported. ADMSC injection, especially through the nonenzymatic mechanical methods, looks to be simple and promising treatment for osteochondral lesions and osteoarthritis of the ankle, with no severe complications. The current scarcity of studies and their low-quality level preclude definitive conclusions presently. LEVEL OF EVIDENCE: III.
Topics: Humans; Ankle; Ankle Joint; Osteoarthritis; Stem Cells; Treatment Outcome; Talus
PubMed: 37943411
DOI: 10.1007/s12306-023-00798-7 -
Journal of the American Podiatric... 2023Lateral wedges are a common intervention used to alter biomechanical function of the lower limb. Although there is evidence investigating the use and impact of lateral... (Review)
Review
Lateral wedges are a common intervention used to alter biomechanical function of the lower limb. Although there is evidence investigating the use and impact of lateral wedges in individuals with medial knee osteoarthritis, knowledge of how these wedges affect foot function in healthy adults is limited. Therefore, this study intends to investigate how lateral wedging affects foot function in healthy adults and, furthermore, how wedge design influences the outcome. The framework outlined by Arksey and O'Malley was used for this scoping review. To ensure methodologic quality and transparent reporting, the study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews preferred reporting guidelines. A systematic search was conducted using MEDLINE by means of EBSCO; SPORT Discuss; CINAHL; AMED by means of OVID; and Scopus. The initial search yielded 252 articles in total; 21 studies were included in the final analysis. Significant incongruence exists in descriptions of wedge length among the 21 included studies. Thirteen studies (61%) reported using full-length wedges, five studies did not report wedge length, and only one study analyzed more than one wedge length. Ethylene vinyl acetate was the most common material, and reporting of hardness was inconsistent. A broad range of inclination angles were used, with limited explanation for why these values were selected. All but one study that analyzed ankle/subtalar joint frontal plane moments reported an increase in the external eversion moment. The review identified significant variation in the design of wedges used within this body of work and a lack of investigation into the influence of wedge design. Wedge design appears to be a secondary consideration, with very few studies examining multiple material types or wedge placements. All but one of the included studies reported a significant change in ankle/subtalar joint moments with lateral wedging. Unfortunately, further generalization was not possible because of the inconsistency and variation.
Topics: Adult; Humans; Foot Orthoses; Osteoarthritis, Knee; Foot; Ankle Joint; Sports; Knee Joint; Biomechanical Phenomena
PubMed: 37934589
DOI: 10.7547/21-180 -
The Cochrane Database of Systematic... Nov 2023Fractures of the calcaneus (heel bone) comprise up to 2% of all fractures. These fractures are mostly caused by a fall from a height, and are common in younger adults.... (Review)
Review
BACKGROUND
Fractures of the calcaneus (heel bone) comprise up to 2% of all fractures. These fractures are mostly caused by a fall from a height, and are common in younger adults. Treatment can be surgical or non-surgical; however, there is clinical uncertainty over optimal management. This is an update of a Cochrane Review first published in 2013.
OBJECTIVES
To assess the effects (benefits and harms) of surgical versus conservative treatment of displaced intra-articular calcaneal fractures.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE, Embase, and clinical trials registers in November 2022.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs comparing surgical versus non-surgical management of displaced intra-articular calcaneal fractures in skeletally mature adults (older than 14 years of age). For surgical treatment, we included closed manipulation with percutaneous wire fixation, open reduction with internal fixation (ORIF) with or without bone graft, or primary arthrodesis. For non-surgical treatment, we included ice, elevation and rest, or plaster cast or splint immobilisation.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodological procedures. We collected data for the following outcomes: function in the short term (within three months of injury) or long term (more than three months after injury), chronic pain, health-related quality of life (HRQoL) and ability to return to normal activities, as well as complications which may or may not have led to an unplanned return to theatre.
MAIN RESULTS
We included 10 RCTs and two quasi-RCTs with 1097 participants. Sample sizes in studies ranged from 29 to 424 participants. Most participants were male (86%), and the mean age in studies ranged from 28 to 52 years. In the surgical groups, participants were mostly managed with ORIF with plates, screws, or wires; one study used only minimally invasive techniques. Participants in the non-surgical groups were managed with a plaster cast, removable splint or a bandage, or with rest, elevation, and sometimes ice. Risk of performance bias was unavoidably high in all studies as it was not possible to blind participants and personnel to treatment; in addition, some studies were at high or unclear risk of other types of bias (including high risk of selection bias for quasi-RCTs, high risk of attrition bias, and unclear risk of selective reporting bias). We downgraded the certainty of all the evidence for serious risk of bias. We also downgraded the certainty of the evidence for imprecision for all outcomes (except for complications requiring return to theatre for subtalar arthrodesis) because the evidence was derived from few participants. We downgraded the evidence for subtalar arthrodesis for inconsistency because the pooled data included high levels of statistical heterogeneity. We found that surgical management may improve function at six to 24 months after injury when measured using the American Orthopaedic Foot and Ankle Society (AOFAS) score (mean difference (MD) 6.58, 95% confidence interval (CI) 1.04 to 12.12; 5 studies, 319 participants; low-certainty evidence). We are not aware of a published minimal clinically important difference (MCID) for the AOFAS score for this type of fracture. Previously published MCIDs for other foot conditions range from 2.0 to 7.9. No studies reported short-term function within three months of injury. Surgical management may reduce the number of people with chronic pain up to 24 months after injury (risk ratio (RR) 0.56, 95% CI 0.37 to 0.84; 4 studies, 175 participants; low-certainty evidence); this equates to 295 per 1000 fewer people with pain after surgical management (95% CI 107 to 422 per 1000). Surgical management may also lead to improved physical HRQoL (MD 6.49, 95% CI 2.49 to 10.48; 2 studies, 192 participants; low-certainty evidence). This outcome was measured using the physical component score of the 36-Item Short Form Health Survey. We used a change in effect of 5% to indicate a clinically important difference for this scoring system and thus judged that the difference in HRQoL between people treated surgically or non-surgically includes both clinically relevant and not relevant changes for those treated surgically. There may be little or no difference in the number of people who returned to work within 24 months (RR 1.26, 95% CI 0.94 to 1.68; 5 studies, 250 participants; low-certainty evidence) or who require secondary surgery for subtalar arthrodesis (RR 0.38, 95% CI 0.09 to 1.53; 3 studies, 657 participants; low-certainty evidence). For other complications requiring return to theatre in people treated surgically, we found low-certainty evidence for amputation (2.4%; 1 study, 42 participants), implant removal (3.4%; 3 studies, 321 participants), deep infection (5.3%; 1 study, 206 participants), and wound debridement (2.7%; 1 study, 73 participants). We found low-certainty evidence that 14% of participants who were treated surgically (7 studies, 847 participants) had superficial site infection.
AUTHORS' CONCLUSIONS
Our confidence in the evidence is limited. Although pooled evidence indicated that surgical treatment may lead to improved functional outcome but with an increased risk of unplanned second operations, we judged the evidence to be of low certainty as it was often derived from few participants in studies that were not sufficiently robust in design. We found no evidence of a difference between treatment options in the number of people who needed late reconstruction surgery for subtalar arthritis, although the estimate included the possibility of important harms and benefits. Large, well-conducted studies that attempt to minimise detection bias and that measure functional outcomes using calcaneal-specific measurement tools would increase the confidence in these findings. Given that minimally invasive surgical procedures are already becoming more prevalent in practice, research is urgently needed to determine whether these newer surgical techniques offer better outcomes with regard to function, pain, quality of life, and postoperative complications for intra-articular displaced calcaneal fractures.
Topics: Male; Adult; Humans; Middle Aged; Female; Fracture Fixation; Chronic Pain; Ice; Fractures, Bone; Bandages
PubMed: 37933733
DOI: 10.1002/14651858.CD008628.pub3 -
Zhonghua Wai Ke Za Zhi [Chinese Journal... Dec 2023The limited coverage of soft tissue and complex biomechanical factors make resection and reconstruction of distal tibial tumors extremely challenging. Megaprosthesis can...
The limited coverage of soft tissue and complex biomechanical factors make resection and reconstruction of distal tibial tumors extremely challenging. Megaprosthesis can provide good mechanical strength for tumor en bloc resection, but there are many postoperative complications, and the problems of insufficient soft tissue coverage and postoperative ankle instability must be solved. The development of three-dimensional digital technology may provide a new treatment strategy for distal tibial reconstruction. Compared to ankle joint preservation endoprostheses, the rapid osseointegration effect of three dimensional-printed megaprosthesis with ankle arthrodesis provides better ankle joint stability and postoperative function. In addition, the three dimensional-printed megaprosthesis may improve complications such as insufficient soft tissue coverage and talus collapse by reducing the circumference of the prosthesis and matching it with the talus through personalized design. Of course, there are few research reports on distal tibial prostheses, and the safety of three dimensional-printed megaprosthesis with ankle arthrodesis needs to be confirmed through extensive long-term follow-up studies. The selection of proximal and distal fixation methods for prostheses needs to be explored in future research.
Topics: Humans; Tibia; Treatment Outcome; Bone Neoplasms; Ankle Joint; Postoperative Complications; Retrospective Studies
PubMed: 37932151
DOI: 10.3760/cma.j.cn112139-20230510-00200