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Danish Medical Journal Jun 2024In orthopaedics, anterior cruciate ligament (ACL) reconstructions are among the most common surgical interventions. Two methods are preferably used: autografts from the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
In orthopaedics, anterior cruciate ligament (ACL) reconstructions are among the most common surgical interventions. Two methods are preferably used: autografts from the hamstring tendon (HT) or patella tendon (PT). The purpose of this meta-analysis was to compare these two methods when returning to sports.
METHODS
Eleven studies were included based on a literature search conducted in PubMed. The primary outcome was return to preinjury sport level in athletes. Post-operative results such as the Lysholm score, the International Knee Documentation Committee (IKDC) subjective score, the Tegner Activity Score and KT-1000 arthrometry and autograft re-rupture rates were analysed as secondary outcomes.
RESULTS
The analysis showed no significant difference in return to preinjury sports level at a two-year follow-up between patients operated with hamstring or patella autograft. Considering the secondary outcomes, no significant differences were recorded in Lysholm score, IKDC score or re-rupture rate. The Tegner Activity Scale demonstrated a significantly higher activity level in the PT group than in the HT group (OR 0.79, p = 0.003). At the two-year follow-up, the KT-1000 arthrometer analysis also showed a significant difference in laxity, which was higher for the HT autografts (OR -0.31, p = 0.02).
CONCLUSION
This study showed no significant differences between hamstring and patella autografts. Even so, the choice of method when operated for ACL rupture remains crucial for the individual and should be a weighted decision made jointly by the patient and the physician.
Topics: Humans; Return to Sport; Anterior Cruciate Ligament Reconstruction; Hamstring Tendons; Patellar Ligament; Anterior Cruciate Ligament Injuries; Autografts; Transplantation, Autologous; Treatment Outcome
PubMed: 38903025
DOI: 10.61409/A09230599 -
Journal of ISAKOS : Joint Disorders &... Apr 2024Anterolateral augmentation during primary anterior cruciate ligament (ACL) reconstruction (ACLR) may lower rates of ACL graft failure. However, differences in costs... (Review)
Review
IMPORTANCE
Anterolateral augmentation during primary anterior cruciate ligament (ACL) reconstruction (ACLR) may lower rates of ACL graft failure. However, differences in costs between two techniques, lateral extra-articular tenodesis (LET) and anterolateral ligament reconstruction (ALLR), are unclear.
OBJECTIVE
To perform a systematic review and subsequent cost-effectiveness analysis comparing LET versus ALLR in the setting of primary ACLR. The hypothesis was that LET is more cost-effective than ALLR.
EVIDENCE REVIEW
A systematic review was conducted on studies in which patients underwent primary ACLR with a concomitant LET or ALLR with minimum 24 months follow-up published between January 2013 and July 2023. Primary outcomes included ACL graft failure rates and Knee Injury and Osteoarthritis Outcome Survey-Quality of Life (KOOS-QoL) subscale scores, which were used to determine health utilities measured by quality-adjusted life years (QALYs) gained. A decision tree model with one-way and two-way sensitivity analyses compared the cost of primary ACLR with a concomitant LET, independent autograft ALLR, or independent allograft ALLR. Costs were estimated using a combination of QALYs, institution prices, literature references, and a survey sent to 49 internationally recognized high-volume knee surgeons.
FINDINGS
A total of 2505 knees undergoing primary ACLR with concomitant LET (n=1162) or ALLR (n=1343) were identified from 22 studies. There were 77 total ACL graft failures with comparable failure rates between patients receiving LET versus ALLR (2.9% vs. 3.2%, P=0.690). The average QALYs gained was slightly higher for those who received LET (0.77) compared to ALLR (0.75). Survey results revealed a 5 minute longer median self-reported operative time for ALLR (20 min) than LET (15 min). The estimated costs for LET, autograft ALLR, and allograft ALLR were $1,015, $1,295, and $3,068, respectively.
CONCLUSIONS AND RELEVANCE
Anterolateral augmentation during primary ACLR with LET is more cost-effective than independent autograft and allograft ALLR given the lower costs and comparable clinical outcomes. Surgeons may utilize this information when determining the optimal approach to anterolateral augmentation during primary ACLR, although differences in preferred technique and health care systems may influence operative efficiency and material costs.
LEVEL OF EVIDENCE
Systematic review; Level of evidence, IV.
PubMed: 38604570
DOI: 10.1016/j.jisako.2024.04.004 -
Journal of Orthopaedic Surgery and... Apr 2024Medial patellar ligament reconstruction (MPFL-R) in combination with derotational distal femoral osteotomy (DDFO) for treating recurrent patellar dislocation (RPD) in...
Medial patellar ligament reconstruction in combination with derotational distal femoral osteotomy for treating recurrent patellar dislocation in the presence of increased femoral anteversion: a systematic review.
BACKGROUND
Medial patellar ligament reconstruction (MPFL-R) in combination with derotational distal femoral osteotomy (DDFO) for treating recurrent patellar dislocation (RPD) in the presence of increased femoral anteversion is one of the most commonly used surgical techniques in the current clinical practice. However, there are limited studies on the clinical outcomes of MPFL-R in combination with DDFO to treat RPD in the presence of increased femoral anteversion.
PURPOSE
To study the role of MPFL-R in combination with DDFO in the treatment of RPD in the presence of increased femoral anteversion.
METHODS
A systematic review was performed according to the PRISMA guidelines by searching the Medline, Embase, Web of Science, and Cochrane Library databases through June 1, 2023. Studies of patients who received MPFL-R in combination with DDFO after presenting with RPD and increased femoral anteversion were included. Methodological quality was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. Each study's basic characteristics, including characteristic information, radiological parameters, surgical techniques, patient-reported outcomes, and complications, were recorded and analyzed.
RESULTS
A total of 6 studies with 231 patients (236 knees) were included. Sample sizes ranged from 12 to 162 patients, and the majority of the patients were female (range, 67-100%). The mean age and follow-up ranges were 18 to 24 years and 16 to 49 months, respectively. The mean femoral anteversion decreased significantly from 34° preoperatively to 12° postoperatively. In studies reporting preoperative and postoperative outcomes, significant improvements were found in the Lysholm score, Kujala score, International Knee Documentation Committee score, and visual analog scale for pain. Postoperative complications were reported in all studies, with an overall reported complication rate of 4.7%, but no redislocations occurred during the follow-up period.
CONCLUSION
For RPD with increased femoral anteversion, MPFL-R in combination with DDFO leads to a good clinical outcome and a low redislocation rate. However, there was no consensus among researchers on the indications for MPFL-R combined with DDFO in the treatment of RPD.
Topics: Humans; Male; Female; Patellar Dislocation; Patellofemoral Joint; Patellar Ligament; Knee Joint; Joint Dislocations; Osteotomy; Ligaments, Articular; Joint Instability
PubMed: 38582853
DOI: 10.1186/s13018-024-04709-9 -
JBJS Reviews Apr 2024The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee. ACL reconstruction (ACLR) proves the standard for treating this injury. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee. ACL reconstruction (ACLR) proves the standard for treating this injury. However, graft choice and method of fixation remain a heavily debated topic. This study investigates the following: bone-patellar tendon-bone (BPTB) vs. hamstring tendon (HT) autograft, single-bundle vs. double-bundle hamstring graft, and metal vs. bioabsorbable screws in ACLR.
METHODS
A systematic review was performed on PubMed and Google Scholar according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were collected on patient demographics, complications, and functionality scores including International Knee Documentation Committee (IKDC) and Lysholm scores. A systematic review and meta-analysis were conducted with Review Manager. Outcome measurements were determined using forest plots with significant differences considered p < 0.05.
RESULTS
Twenty-five studies were included, accounting for 2,170 patients. No statistically significant difference was appreciated when comparing BPTB to hamstring autografts. Patients who received a double bundle HT autograft exhibited significantly superior outcomes in terms of revision (p = 0.05), failure (p = 0.002), normal pivot shift tests (p = 0.04), and normal IKDC (p = 0.008). When comparing screw types, bioabsorbable screws had a greater Lysholm score (p = 0.01) and lower failure rates for copolymer screws (p = 0.03).
CONCLUSION
Overall, the data collected suggested that BPTB and HT autografts display similar postoperative results. However, if an HT autograft is used, the data suggest a double-bundle graft improves both functionality and decreases the possible complications. Finally, bioabsorbable screws prove superior to metal screws when looking at both functionality and failure rates. Further research into the superior graft type is still needed.
LEVEL OF EVIDENCE
Level II. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Tendons; Anterior Cruciate Ligament Reconstruction; Knee Joint; Anterior Cruciate Ligament; Patellar Ligament
PubMed: 38574182
DOI: 10.2106/JBJS.RVW.23.00222 -
Advances in Rheumatology (London,... Mar 2024Osteoarthritis (OA) affects the entire joint, causing structural changes in articular cartilage, subchondral bone, ligaments, capsule, synovial membrane, and... (Meta-Analysis)
Meta-Analysis
Effects of intra-articular injection of platelet-rich plasma on the inflammatory process and histopathological characteristics of cartilage and synovium in animals with osteoarthritis: a systematic review with meta-analysis.
BACKGROUND
Osteoarthritis (OA) affects the entire joint, causing structural changes in articular cartilage, subchondral bone, ligaments, capsule, synovial membrane, and periarticular muscles that afflicts millions of people globally, leading to persistent pain and diminished quality of life. The intra-articular use of platelet-rich plasma (PRP) is gaining recognition as a secure therapeutic approach due to its potential regenerative capabilities. However, there is controversial clinical data regarding efficacy of PRP for OA treatment. In this context, gathering scientific evidence on the effects of PRP in treating OA in animal models could provide valuable insights into understanding its impact on aspects like cartilage health, synovial tissue integrity, and the inflammatory process in affected joints. Thus, the objective of this study was to assess the effects of PRP injections on inflammation and histopathological aspects of cartilage and synovium in animal models of OA through a comprehensive systematic review with meta-analysis.
METHODS
A electronic search was conducted on Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases for relevant articles published until June 2022. A random-effects meta-analysis was employed to synthesize evidence on the histological characteristics of cartilage and synovium, as well as the inflammatory process. The GRADE approach was utilized to categorize the quality of evidence, and methodological quality was assessed using SYRCLE's RoB tool.
RESULTS
Twenty-one studies were included in the review, with twelve of them incorporated into the meta-analysis. PRP treatment demonstrated superior outcomes compared to the control group in terms of cartilage histology (very low quality; p = 0.0002), synovium histology (very low quality; p < 0.0001), and reductions in proinflammatory markers, including IL-1 (low quality; p = 0.002), IL-6 (very low quality; p < 0.00001), and TNF-α (very low; p < 0.00001). However, PRP treatment did not yield a significant impact on PDGF-A levels (very low quality; p = 0.81).
CONCLUSION
PRP appears capable of reducing proinflammatory markers (IL-1, IL-6, TNF-α) and mitigating cartilage and synovium damage in animals with OA. However, the levels of evidence of these findings are low to very low. Therefore, more rigorous studies with larger samples are needed to improve the quality of evidence.
PROSPERO REGISTRATION
CRD42022250314.
Topics: Animals; Humans; Tumor Necrosis Factor-alpha; Interleukin-6; Quality of Life; Osteoarthritis; Synovial Membrane; Injections, Intra-Articular; Cartilage, Articular; Platelet-Rich Plasma; Interleukin-1
PubMed: 38553767
DOI: 10.1186/s42358-024-00364-0 -
Foot & Ankle Specialist Mar 2024Plafond-plasty is a joint-preserving procedure to treat varus ankle osteoarthritis (OA) with asymmetrical joint involvement. The aim of this systematic review and... (Review)
Review
BACKGROUNDS
Plafond-plasty is a joint-preserving procedure to treat varus ankle osteoarthritis (OA) with asymmetrical joint involvement. The aim of this systematic review and meta-analysis was to evaluate indications, different surgical techniques, associated procedures, and results of plafond-plasty in varus ankle OA and to analyze the level of evidence (LOE) and quality of evidence (QOE) of the included studies.
METHODS
A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane.
RESULTS
Five studies evaluating 99 ankles were included. A non-rigid varus ankle deformity and an ankle OA Takakura stage 3b or less were the most recommended pre-operative indications. Meta-analysis showed a significant post-operative improvement in clinical and radiological parameters. Many associated surgical procedures have been reported, the most frequent being medial additional supramalleolar osteotomy and lateral ankle ligament reconstruction. The level of evidence and methodological quality assessment of the included studies showed an overall low quality.
CONCLUSION
Plafond-plasty seems to be a promising surgical option when managing varus ankle OA with asymmetrical joint involvement, extending the indications for joint sparing surgery. Additional associated procedures should be carefully evaluated case-by-case.
LEVELS OF EVIDENCE
.
PubMed: 38504416
DOI: 10.1177/19386400241236321 -
European Journal of Orthopaedic Surgery... May 2024As a therapeutic intervention for several musculoskeletal illnesses, the benefits and effectiveness of Kinesio taping (KT) are currently unclear. This systematic review... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
As a therapeutic intervention for several musculoskeletal illnesses, the benefits and effectiveness of Kinesio taping (KT) are currently unclear. This systematic review and meta-analysis's (MA) goal is to evaluate the effectiveness of KT for anterior cruciate ligament (ACL) reconstruction and its impact on clinical outcomes.
METHODS
A comprehensive search of online databases was done to discover relevant studies. Inclusion criteria included controlled or randomized clinical trials that were published in English. Changes in pain, flexion strength, and extension strength were among the outcomes of interest. RevMan 5.4 was used to extract and analyze data.
RESULTS
After satisfying the inclusion requirements, five studies were included in the MA. Pooled analysis showed that, in comparison with the intervention group, the control group had a statistically significant improvement in flexion strength (Standardized mean difference (SMD) = 0.44, 95% Confidence interval (CI) [0.01, 0.87], p = 0.04). Extension strength and pain, however, did not significantly differ between the intervention and control groups (SMD = 30, 95% CI [- 0.12, 0.72], p = 0.16), (SMD = 0.26, 95% CI [- 0.14, 0.66], p = 0.20), respectively.
CONCLUSIONS
This analysis suggests limited to no benefits of KA post-ACL reconstruction. While the control group surprisingly showed better improvement in flexion strength, no significant differences were found in extension strength and pain. Further rigorous trials are needed to confirm its utility in rehabilitation.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Athletic Tape; Anterior Cruciate Ligament Injuries; Range of Motion, Articular; Treatment Outcome; Muscle Strength
PubMed: 38502344
DOI: 10.1007/s00590-024-03878-x -
JBJS Reviews Mar 2024Kinesio taping (KT) has been shown to be clinically effective in a wide range of musculoskeletal disorders. Despite evidence supporting KT, there still needs to be more... (Meta-Analysis)
Meta-Analysis
Effect of Postoperative Kinesio Taping on Knee Edema, Pain, and Range of Motion After Total Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials.
BACKGROUND
Kinesio taping (KT) has been shown to be clinically effective in a wide range of musculoskeletal disorders. Despite evidence supporting KT, there still needs to be more certainty regarding its clinical worthiness in managing postoperative conditions. This study aims to assess the effect of postoperative KT on knee edema, pain, and range of motion (ROM) when added to routine physiotherapy after knee surgery.
METHODS
In this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Web of Science, and CENTRAL databases were searched from their inception to July 2023. Randomized controlled trials (RCTs) comparing routine physiotherapy with and without KT were included. Random-effect models were used to calculate the standardized mean difference (SMD), confidence interval, and heterogeneity (I2).
RESULTS
Sixteen RCTs on 842 operated knees were included. KT reduced knee edema in first week (SMD, -0.59, p < 0.001), 14th postoperative day (POD) (SMD, -0.78, p < 0.001), and 28 to 42 days postop (SMD, -0.66, p < 0.001). The KT demonstrated significant pain improvement in second week (SMD, -0.87, p < 0.001) and the fourth week (SMD, -0.53, p < 0.001). The KT groups demonstrated ROM improvement within second week (SMD, 0.69, p = 0.010) and in the 28th POD (SMD, 0.89, p = 0.009). Subgroup analysis demonstrated minimal heterogeneity in anterior cruciate ligament reconstruction (ACLR) cases. However, it did not show significant superiority regarding ankle, calf, or thigh edema and Lysholm scale.
CONCLUSION
This study suggests that adding KT to routine postoperative physiotherapy reduces pain and knee edema after total knee arthroplasty or ACLR. Low to very low certainty of evidence for all outcomes and the limited number of studies emphasize the need for more high-quality primary studies to explore the optimal method of KT application and its effectiveness in specific knee surgeries.
LEVEL OF EVIDENCE
Level I. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Arthroplasty, Replacement, Knee; Randomized Controlled Trials as Topic; Pain; Musculoskeletal Diseases; Range of Motion, Articular; Anterior Cruciate Ligament Reconstruction; Edema
PubMed: 38489396
DOI: 10.2106/JBJS.RVW.23.00221 -
The Journal of Hand Surgery, European... May 2024There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates... (Meta-Analysis)
Meta-Analysis
There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates which primary repair technique and postoperative immobilization protocol result in the best clinical outcomes. A literature search was conducted in Embase, Medline ALL Ovid, Web of Science Core Selection and Cochrane Central Register of Controlled Trials. Pain, stability, tip pinch strength, key pinch strength, grip strength, return to work and metacarpophalangeal joint range of motion were collected as postoperative outcomes. In total, 29 studies were included. All surgical techniques resulted in satisfactory clinical outcomes, with no significant differences between bone anchor reinsertion, suture fixation, K-wire fixation and a combination of techniques. K-wire immobilization resulted in worse postoperative pain, but similar stability compared to immobilization without a K-wire. Clinical outcomes after thumb UCL repair are excellent, with no differences in clinical outcomes noted among surgical techniques.
Topics: Humans; Collateral Ligament, Ulnar; Thumb; Bone Wires; Rupture; Hand Strength; Range of Motion, Articular; Suture Anchors; Treatment Outcome; Ulnar Collateral Ligament Reconstruction
PubMed: 38488512
DOI: 10.1177/17531934241235556 -
Knee Surgery, Sports Traumatology,... May 2024Surgeons generally consider the donor age as a factor that negatively influences the quality of allograft used in anterior cruciate ligament (ACL) reconstruction,...
PURPOSE
Surgeons generally consider the donor age as a factor that negatively influences the quality of allograft used in anterior cruciate ligament (ACL) reconstruction, however, the available evidence does not clearly support this statement. The purpose of the study was to investigate if donor age influences the biomechanical properties of allografts used in ACL reconstruction.
METHODS
A comprehensive literature search was conducted for all relevant articles using MEDLINE (PubMed), Scopus, and Cochrane Collaboration Library, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Studies including the analysis of the correlation between biomechanical properties of the allografts and donor age were selected. The role of donor age was labelled as 'none' if absent, 'higher' or 'lower' if the properties were higher or lower in older specimens with respect to younger. The correlation was defined as 'weak' or 'strong' according to each study definition.
RESULTS
No conflicting role of donor age was reported for modulus of elasticity, load to failure, strain, stiffness and displacement. The only parameters where the significant results were consistent were the tensile strength and the stress (low or moderate correlations). When considering the tested samples with a donor's age <65 years, a significant role of age was reported in only four out of 13 groups of graft tested (patellar tendon, fascia lata, anterior tibialis tendon and posterior tibialis tendon).
CONCLUSION
The current literature did not allow to state that the donor age negatively influences the biomechanical properties of allografts, making it impossible to identify a clear age cut-off value to exclude them from ACL reconstruction procedures.
LEVEL OF EVIDENCE
Level IV, systematic review.
Topics: Humans; Anterior Cruciate Ligament Reconstruction; Biomechanical Phenomena; Allografts; Age Factors; Tissue Donors; Tensile Strength; Middle Aged; Anterior Cruciate Ligament
PubMed: 38488223
DOI: 10.1002/ksa.12113