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Journal of Shoulder and Elbow Surgery Mar 2024This systematic review and meta-analysis aimed to (1) estimate the prevalence of clavicular tunnel widening (TW) after coracoclavicular stabilization surgery and its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis aimed to (1) estimate the prevalence of clavicular tunnel widening (TW) after coracoclavicular stabilization surgery and its risk factors and (2) assess whether TW is correlated with clavicle fracture or loss of reduction of the acromioclavicular joint (ACJ).
METHODS
In January 2023, 3 electronic databases were searched to collect data on postoperative clavicular TW, its prevalence, magnitude, and correlation with fracture and ACJ loss of reduction. Studies were classified according to the time of surgical intervention, and the clavicular tunnels were categorized by their anatomic location. Mean differences were calculated using a DerSimonian-Laird random-effects model, while binomial outcomes were pooled using the Freeman-Tukey double arcsine transformation. Univariate and multivariate meta-regression analyses were performed to determine the effect of several variables on the proportion of cases with TW.
RESULTS
Fifteen studies (418 shoulders) were included. At the final follow-up, evidence of clavicular TW was found in 70% (95% confidence interval [CI]: 70%-87%; I = 89%) of 221 shoulders. Surgeries in acute cases had a lower prevalence of TW (52%) compared to chronic cases (71%) (P < .001). Significant TW was found in the central tunnel (3.2 mm; 95% CI: 1.8-4.6 mm; P < .001; I = 72%) for acute injuries and in the medial (1.2 mm; 95% CI: 0.7-1.7 mm; P < .001; I = 77%) and lateral (1.5 mm; 95% CI: 0.7-2.3 mm; P < .001; I = 77%) tunnels for chronic cases. Single central-tunnel techniques were positively associated with the prevalence of TW (P = .046), while biotenodesis screw fixation was associated with a lower prevalence (P = .004) in chronic cases. Reconstruction of the ACJ ligament complex with tendon grafts or sutures was associated with a higher prevalence of TW (P < .001). Drill sizes between 2.5 and 5 mm were significantly associated with a lower prevalence of TW, regardless of injury chronicity (P = .012). No correlation was found between TW and the loss of ACJ reduction or clavicle fractures.
CONCLUSIONS
This systematic review and meta-analysis explored TW occurrence following coracoclavicular stabilization surgery. TW was observed in 70% of patients at final follow-up, with a higher prevalence in chronic than in acute cases. Modifiable surgical variables, such as single-tunnel tendon graft constructs for acute or chronic injuries and knotted graft procedures for chronic injuries, were significantly associated with TW. Furthermore, the prevalence of TW increased with concomitant surgical treatment of the ACJ ligament complex, and decreased with drill sizes between 2.5 and 5 mm, regardless of lesion chronicity. These surgical variables should be considered when establishing transosseous tunnels for coracoclavicular stabilization. Clavicle fractures and TW mechanisms require further investigation.
Topics: Humans; Clavicle; Ligaments, Articular; Shoulder; Acromioclavicular Joint; Joint Dislocations; Fractures, Bone
PubMed: 37977250
DOI: 10.1016/j.jse.2023.09.037 -
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 -
Spine Feb 2024A systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
This study systematically reviewed and evaluated the safety and efficacy of spinal endoscopic techniques as a treatment for thoracic ligamentum flavum ossification (TOLF).
SUMMARY OF BACKGROUND DATA
The use of spinal endoscopic techniques for the treatment of TOLF has increased in recent years. The present study is the first comprehensive systematic review and meta-analysis focused on the use of spinal endoscopic techniques for TOLF.
MATERIALS AND METHODS
The Cochrane Central, PubMed, Web of Science, and Embase databases were systematically searched for studies focused on patients undergoing spinal endoscopic techniques to treat symptomatic TOLF.
RESULTS
This meta-analysis included 23 studies. We included 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years, with 304 total recorded lesion locations of which 245 were located in the lower thoracic spine. Complications affected 35/323 patients, and the mean operative duration for 305 patients was 108.15±47.34 minutes. For 187 patients, the mean operative bleeding was 25.13±12.54 mL, while for 87 patients the mean duration of hospitalization was 4.59±1.93 days. At last follow-up, functional assessment was performed for 260 patients, of whom 200 were in excellent condition, visual analog scale (VAS) scores were assessed for 160 patients, with a mean improvement of 4.40 (3.95, 4.86) Japanese Orthopedic Association (JOA) scores were recorded for 115 patients, with a mean improvement of 3.49 (2.79,4.18), and modified Japanese Orthopedic Association (mJOA) scores were recorded for 208 patients, with a mean improvement of 3.62 (2.89,4.35).
CONCLUSIONS
These results support several advantages of spinal endoscopic techniques for the treatment of symptomatic TOLF. These include low complication rates, rapid postoperative recovery, and good functional recovery when used for single-segment, non-nodular ossification and no combined dural ossification.
Topics: Male; Female; Humans; Middle Aged; Aged; Osteogenesis; Thoracic Vertebrae; Ossification, Heterotopic; Laminectomy; Decompression, Surgical; Ligamentum Flavum; Retrospective Studies; Treatment Outcome
PubMed: 37937419
DOI: 10.1097/BRS.0000000000004866 -
Acta Orthopaedica Belgica Sep 2023The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of... (Meta-Analysis)
Meta-Analysis
Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis.
The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.
Topics: Humans; Trapezium Bone; Osteoarthritis; Upper Extremity; Thumb; Arthrodesis; Ligaments; Range of Motion, Articular
PubMed: 37935242
DOI: 10.52628/89.3.11618 -
Acta Orthopaedica Belgica Sep 2023Total knee arthroplasty (TKA) is a well-known surgical procedure performed to address end stage osteoarthritis. The main goal is to relieve pain, recover articular...
Total knee arthroplasty (TKA) is a well-known surgical procedure performed to address end stage osteoarthritis. The main goal is to relieve pain, recover articular function and return to normal function as soon as possible. Over the years it is frequently performed in the elderly, but lately there is an increased demand in a younger and more active population. Up to 25% of patients feel dissatisfied about their TKA. The anterior cruciate ligament (ACL) is considered the main anteroposterior stabilizer of the knee; nevertheless the ACL is usually sacrificed during conventional TKA. Research shows this might be an unnecessary sacrifice in certain cases. The considerable dissatisfaction rate in mainly high-demanding patients, together with the literature reports on the importance of the ACL function, were the two main reasons for the development of bicruciate retaining (BCR) total knee arthroplasty. BCR TKA may offer superior knee kinematics and proprioception, through anterior cruciate ligament preservation, but requires a higher level of attention to obtain an accurate and precise component orientation to reach proper ligamentous balancing and restore the native knee biomechanics. Many surgeons abandoned its use due to its challenging technique and inconsistent results. Recent new BCR implant designs are promising. This systematic literature review aims to summarize the current state of BCR TKA and what to expect in the future.
Topics: Humans; Aged; Arthroplasty, Replacement, Knee; Knee Joint; Anterior Cruciate Ligament; Knee Prosthesis; Proprioception; Biomechanical Phenomena; Range of Motion, Articular
PubMed: 37935224
DOI: 10.52628/89.3.11663 -
Journal of Sports Sciences Sep 2023Growing anterior cruciate ligament (ACL) injury incidence is reported in countries across Europe, North America and in Australia for 5-14-year-olds, yet research on... (Review)
Review
Growing anterior cruciate ligament (ACL) injury incidence is reported in countries across Europe, North America and in Australia for 5-14-year-olds, yet research on injury risk reduction predominantly focuses on populations aged > 13 years. For injury risk reduction, it is crucial to understand (i) which modifiable risk factors are associated with ACL injury in children (6-13 years) and (ii) how these risk factors are assessed. Articles were grouped according to sex/gender and/or maturational/age differences and examined modifiable risk factors during different physical screening tasks. The included articles ( = 40) predominantly examined intrinsic risk factors in girls aged 10-13 years. Factors mechanically linked to increased ACL loading at this age included increased peak knee adductor moments, knee valgus angles, hip and knee extension, and ground reaction forces. Assessment focused on laboratory-based assessments (e.g., motion capture, force plates). This review concluded that modifiable risk factors are present in children aged 6-13 years and that injury risk reduction strategies should be implemented as early as possible regardless of sex/gender. Further, screening strategies need updating to be childhood specific and feasible for the wide community. Additional research on extrinsic risk factors, norm values and children aged 6-9 years could allow for more targeted risk reduction strategies.
Topics: Female; Humans; Child; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Knee Joint; Knee; Risk Factors; Biomechanical Phenomena
PubMed: 37930935
DOI: 10.1080/02640414.2023.2268900 -
Knee Surgery, Sports Traumatology,... Dec 2023Stress radiographs are an easily accessible, cost-effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective,... (Review)
Review
PURPOSE
Stress radiographs are an easily accessible, cost-effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective, quantifiable, and functional assessment of the injured ligament and can be a useful adjunct when planning surgical management and to objectively assess postoperative outcomes. This study aimed to review the literature reporting on stress radiographic techniques in evaluating knee ligament injury and instability and propose thresholds for interpreting stress radiography techniques.
METHODS
The following three databases, OVID MEDLINE, the EMBASE library, and the Cochrane Controlled Trials Register, were systematically searched on January 23, 2023, for studies published from January 1970 to January 2023. The search extended to the reference lists of all relevant studies and orthopedic journals. Included studies were those that described a stress technique for the diagnosis of knee ligament injury; studies that reported a description or comparison of the accuracy and/or reliability of one or several stress radiography techniques, or studies that reported a comparison with alternative diagnostic modalities.
RESULTS
Sixteen stress radiography techniques were reported for assessing the ACL with stress applied in the anterior plane, 10 techniques for assessing the PCL with stress applied in the posterior plane, 3 techniques for valgus stress, and 4 techniques for varus stress. The Telos device was the most commonly used stress device in the ACL and PCL studies. There was no consensus on the accuracy and reliability of stress radiography techniques for the diagnosis of any knee ligament injury. Stress radiography techniques were compared with alternative diagnostic techniques including instrumented arthrometry, MRI, and physical examination in 18 studies, with variability in the advantages and disadvantages of stress radiography techniques and alternatives. Analysis of results pooled from different studies demonstrated average delta gapping in knees with a completely injured ligament compared to the normal contralateral knee as per the following: for the ACL 4.9 ± 1.4 mm; PCL 8.1 ± 2.5 mm; MCL 2.3 ± 0.05 mm; and the FCL 3.4 ± 0.2 mm.
CONCLUSION
Despite heterogeneity in the available literature with regard to stress examination techniques and device utilization, the data support that stress radiography techniques were accurate and reliable when compared to numerous alternatives in the diagnosis of acute and chronic knee ligament injuries. The present study also provides average increased ipsilateral compartment gapping/translation for specific knee ligament injuries based on the best available data. These values provide a reference standard for the interpretation of stress radiography techniques, help to guide surgical decision-making, and provide benchmark values for future investigations.
LEVEL OF EVIDENCE
III.
Topics: Humans; Reproducibility of Results; Knee Joint; Radiography; Knee Injuries; Posterior Cruciate Ligament; Ligaments; Soft Tissue Injuries; Anterior Cruciate Ligament Injuries; Joint Instability
PubMed: 37923947
DOI: 10.1007/s00167-023-07617-3 -
Journal of Orthopaedic Surgery and... Nov 2023The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations.
PURPOSE
The purpose of the study was to summarize the available evidence and identify risk factors for osteochondral injuries (OCIs) after patellar dislocations.
METHODS
A systematic literature review was conducted in PubMed, Embase, Web of Science, Cochrane Library, and China national knowledge infrastructure from inception to December 22, 2022, according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Studies regarding risk factors for OCIs after patellar dislocations were included. Literature search, data extraction, and quality assessment were performed independently by two authors.
RESULTS
A total of 16 studies with 1945 patients were included. The risk factors for OCIs after patellar dislocation were categorized into four main categories, including demographic characteristics, patellar depth and position, femoral trochlear morphology, and other risk factors in this study. Five and three studies supported the idea that male sex and skeletal maturation may be risk factors, respectively. Normal femoral trochlea (two studies) and complete medial patellofemoral ligament (MPFL) injuries (two studies) may be associated with the development of OCIs. Three studies show that ligamentous laxity or joint hypermobility may prevent OCIs. Patellar depth and position (eight studies) may not be associated with the development of OCIs.
CONCLUSIONS
Based on the available evidence, an increased risk of OCIs following patellar dislocation may be associated with male sex and skeletal maturation. Furthermore, normal femoral trochlea and complete MPFL injuries may increase the risk of OCIs, while factors such as ligamentous laxity or joint hypermobility may reduce the risk.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II and IV studies.
Topics: Humans; Male; Patellar Dislocation; Joint Instability; Patella; Knee Joint; Femur; Ligaments, Articular; Intra-Articular Fractures; Patellofemoral Joint; Risk Factors
PubMed: 37915023
DOI: 10.1186/s13018-023-04265-8 -
The Journal of Hand Surgery... Oct 2023There is no consensus for the appropriate surgical management of symptomatic chronic ulnar collateral ligament (UCL) injuries of the thumb. The aim of this study is to...
There is no consensus for the appropriate surgical management of symptomatic chronic ulnar collateral ligament (UCL) injuries of the thumb. The aim of this study is to systematically review the treatment of chronic thumb metacarpophalangeal (MCP) joint UCL injuries to determine the optimal approach to treatment. A systematic review of PubMed, Medline, Embase and ePub Ahead of Print was performed in accordance with Preferred Reporting of Items in Systematic Review and Meta-Analysis (PRISMA) guidelines. Data from 11 studies using various surgical techniques in 245 thumbs were heterogenous and meta-analysis of results not possible. These data were qualitatively assessed. Direct repair, reconstruction with free tendon grafts and arthrodesis all demonstrated favourable outcomes with patient-reported outcome measures (PROMs). Direct repair can be safely performed more than 2 months following injury. Arthrodesis may be considered in heavy manual labourers or those with osteoarthrosis. Tendon grafting is safe, yet the optimal type and configuration are yet to be determined for reconstructive methods. Level III (Therapeutic).
Topics: Humans; Collateral Ligament, Ulnar; Collateral Ligaments; Hand Injuries; Tendons; Thumb
PubMed: 37905362
DOI: 10.1142/S2424835523500637 -
Journal of Clinical Medicine Oct 2023Osteoarthritis (OA) is one of the most common chronic diseases in the world. It is frequently accompanied by high levels of persistent pain, as well as substantial... (Review)
Review
PURPOSE
Osteoarthritis (OA) is one of the most common chronic diseases in the world. It is frequently accompanied by high levels of persistent pain, as well as substantial impairments in function and functional capacity. This review aims to systematically analyze the changes in proprioception and related mechanoreceptors in OA patients.
METHODS
Studies from September 2013 to September 2023 were identified by conducting searches on the PubMed, Web of Science, and Scopus electronic databases following the PRISMA statement. One reviewer independently assessed and screened the literature, extracted the data, and graded the studies. The body of evidence underwent an evaluation and grading process using the ROBINS-I tool, which was specifically designed to assess the risk of bias in non-randomized studies of interventions. Results were summarized using descriptive methods.
RESULTS
A search through 37 studies yielded 14 clinical studies that were ultimately included. The primary focus of the studies was on the knee joint, particularly the posterior cruciate ligament (PCL). The studies found that PCL in OA patients had impaired proprioceptive accuracy, possibly due to changes in mechanoreceptors (Ruffini, Pacini, and Golgi Mazzoni corpuscles). This suggests that dysfunctional articular mechanoreceptors, especially in severe cases of OA, may contribute to reduced proprioception. Dynamic stabilometry also identified significant proprioceptive deficits in patients with knee articular cartilage lesions, underscoring the impact of such lesions on knee proprioception.
CONCLUSIONS
Literature data have shown that proprioceptive accuracy may play an important role in OA, particularly in the knee PCL and cartilage. However, the role of proprioception and related mechanoreceptors needs to be further clarified. Future studies focusing on the relationship between proprioception, OA disease, and symptoms, considering age and gender differences, and exploring OA joints other than the knee should be conducted to improve clinical and surgical outcomes in cases where proprioception and mechanoreceptors are impaired in OA patients.
PubMed: 37892761
DOI: 10.3390/jcm12206623