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Acta Orthopaedica Belgica Jun 2023The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to...
The management of isolated radial neck and head fractures is controversial. Plate fixation and tripod fixation are two commonly employed techniques but risk damage to soft tissues and implant-related complications. Intramedullary fixation is commonly used in pediatric cases and reduces the potential drawbacks of open fixation. This systematic review aimed to analyze outcomes of intramedullary fixation in adults in terms of function, union, and complication rates. A systematic review of the literature was conducted following the PRISMA guidelines using Medline and EMBASE's online databases. The review was registered on the PROSPERO database. Studies were appraised using the Methodological Index for non-randomized studies (MINORS) tool. Seven studies were deemed eligible for inclusion (n=55). Mean ages of patients ranged from 31.3 to 44.2 years, and mean follow-up ranged from 9 to 86 months. The Mayo Elbow Performance score (MEPs) was reported in five case series (mean scores 81.8 -97.9) and the prevalence of excellent results ranged from 71% and 83%. Although 100% of fractures united, the pooled complication rate was 24% (range 0-50%). The most common complications were elbow stiffness (7%), superficial radial nerve neuropraxia (7%), malunion (5%), and AVN (1.8%). No study reported any patients requiring revision surgery. Intramedullary fixation for radial head and neck fractures appears to provide a reliable alternative treatment option in terms of union, range of motion, and functional outcomes. Further robust trials direct comparing against open fixation techniques are required.
Topics: Humans; Adult; Child; Child, Preschool; Radius Fractures; Treatment Outcome; Radial Head and Neck Fractures; Radius; Elbow Joint; Spinal Fractures; Postoperative Complications; Fracture Fixation, Internal; Range of Motion, Articular; Retrospective Studies
PubMed: 37924555
DOI: 10.52628/89.2.9824 -
Journal of ISAKOS : Joint Disorders &... Apr 2024Cartilage defects are debilitating injuries that can reduce quality of life in patients. However, the poor regenerative properties of cartilage mean that cartilage... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cartilage defects are debilitating injuries that can reduce quality of life in patients. However, the poor regenerative properties of cartilage mean that cartilage repair remains challenging, and many methods have arisen to address that. Autologous matrix-induced chondrogenesis (AMIC®) is a popular technique to manage cartilage defects. Recent advances have allowed AMIC® to be done arthroscopically, instead of a mini-open arthrotomy approach. This systematic review and meta-analysis aims to investigate whether the arthroscopic approach to AMIC® provides better clinical outcomes than does the mini-open approach, in hopes of delineating a gold standard in cartilage repair.
METHODS
With reference to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search of the following databases (PubMed, Embase, Scopus, and Cochrane Library) was performed on 26th October 2022 using a combination of the following search terms: "autologous matrix induced", "chondrogenesis", and "knee". A total of 390 studies were identified, of which, 24 studies were included in our final analysis.
RESULTS
The arthroscopic approach achieves lower Visual Analogue Scale for pain scores. The International Knee documentation Committee) score and Knee Injury and Osteoarthritis Outcome Score were comparable between arthroscopic and open approaches. The open approach achieves a higher Magnetic Resonance Observation of Cartilage Repair Tissue score. Incidence of reported postoperative complications of revision surgery and knee stiffness was higher for the open approach than for the arthroscopic approach, whereas deep vein thrombosis was higher in the arthroscopic approach.
CONCLUSION
The AMIC® repair outcomes indicate that the arthroscopic approach does not hold a distinct advantage over the open approach. The choice of approach should consider surgeon expertise, location of lesion, and patient-specific factors.
LEVEL OF EVIDENCE
Systematic review and meta-analysis; Level III.
Topics: Humans; Cartilage, Articular; Chondrogenesis; Quality of Life; Cartilage Diseases; Knee Joint
PubMed: 37839704
DOI: 10.1016/j.jisako.2023.10.003 -
Materials (Basel, Switzerland) Oct 2023The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure... (Review)
Review
The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.
PubMed: 37834699
DOI: 10.3390/ma16196562 -
Arthroscopy : the Journal of... Apr 2024To systematically review (1) biomechanical properties of augmented elbow ulnar collateral ligament (UCL) repair compared with reconstruction and (2) clinical efficacy... (Review)
Review
Elbow Ulnar Collateral Ligament Repair With Suture Augmentation Is Biomechanically Equivalent to Reconstruction and Clinically Demonstrates Excellent Outcomes: A Systematic Review.
PURPOSE
To systematically review (1) biomechanical properties of augmented elbow ulnar collateral ligament (UCL) repair compared with reconstruction and (2) clinical efficacy and complication rates of UCL repair with and without augmentation.
METHODS
A systematic review was completed August 15, 2023, identifying articles that (1) biomechanically compared suture augmented UCL repair and reconstruction and (2) clinically evaluated medial elbow UCL repairs. Search terms included: "UCL repair" OR "internal brace" OR "suture augmentation" AND "UCL reconstruction." For inclusion, biomechanical studies compared augmented repair with reconstruction; clinical studies required clinical outcomes with minimum 6-month follow-up. Biomechanical data included torsional stiffness, gap formation, peak torque, and failure torque. Clinical data included return to previous level of play, time to return, functional outcomes, and complications.
RESULTS
In total, 8 biomechanical and 9 clinical studies were included (5 with and 4 without augmentation). In most biomechanical studies, augmented repairs demonstrated less gap formation, with equivalent torsional stiffness, failure load, and peak torque compared with reconstruction. Clinical outcomes in 104 patients without augmentation demonstrated return to previous level of 50% to 94% for nonprofessional athletes and 29% for professional baseball pitchers. Suture augmented repairs in 554 patients demonstrated return to previous level from 92% to 96%, at 3.8 to 7.4 months, with Kerlan Jobe Orthopaedic Clinic scores of 86 to 95. The overall complication rate for augmented UCL repair was 8.7%; most commonly ulnar neuropraxia (6%).
CONCLUSIONS
Biomechanically, UCL repair with augmentation provided less gapping with equivalent torsional stiffness and failure compared with reconstruction. Clinically, augmented UCL repair demonstrated excellent return to previous level of play and Kerlan Jobe Orthopaedic Clinic scores with modest complications and time to return. Augmented UCL repair is biomechanically equivalent to reconstruction and may be a viable alternative to reconstruction in indicated athletes.
CLINICAL RELEVANCE
UCL repair with suture augmentation is biomechanically equivalent to reconstruction and clinically demonstrates excellent outcomes.
Topics: Humans; Elbow; Collateral Ligament, Ulnar; Ulna; Ulnar Collateral Ligament Reconstruction; Elbow Joint; Baseball; Sutures; Collateral Ligaments
PubMed: 37832744
DOI: 10.1016/j.arthro.2023.09.030 -
Musculoskeletal Science & Practice Nov 2023Guidelines recommend exercise for the management of knee osteoarthritis (OA), however, recently it has been suggested that including additional lifestyle modifications... (Meta-Analysis)
Meta-Analysis Review
The addition of structured lifestyle modifications to a traditional exercise program for the management of patients with knee osteoarthritis: A systematic review and meta-analysis of randomised trials.
BACKGROUND
Guidelines recommend exercise for the management of knee osteoarthritis (OA), however, recently it has been suggested that including additional lifestyle modifications with a traditional exercise program may elicit greater benefits than exercise alone.
OBJECTIVES
To investigate the influence of the addition of lifestyle modifications to a traditional exercise program, with respect to functional outcomes and quality of life among individuals with knee OA.
DESIGN
Systematic review and meta-analysis.
METHODS
Four databases were searched to identify randomised controlled trials comparing an exercise program, which included the addition of lifestyle modifications, to an exercise program alone in individuals with knee OA. Methodological quality of included studies was assessed via the PEDro scale. Results synthesis through meta-analysis using a random effects model was conducted to determine the pooled effect on eligible outcomes and a GRADE approach was utilised to rate the certainty of evidence.
RESULTS
Meta-analysis of seven studies showed the inclusion of lifestyle modifications to an exercise program can further decrease pain intensity (SMD -0.68 [95% CI -1.26 to -0.10]), improve joint stiffness (MD -0.69 [95% CI -1.21, -0.17]) and increase physical function (MD -1.26 s ([95% CI -1.34, -1.17]) at six-months. Individual results showed improvements in quality of life with the addition of lifestyle modifications, however, this was not demonstrated through meta-analysis.
CONCLUSION
This systematic review supports the inclusion of additional lifestyle modifications to a traditional exercise program, for pain intensity, joint stiffness and physical function for individuals with knee OA.
TRIAL REGISTRATION
PROSPERO registration number: CRD42021279594.
Topics: Humans; Osteoarthritis, Knee; Exercise Therapy; Quality of Life; Arthralgia; Life Style; Randomized Controlled Trials as Topic
PubMed: 37793243
DOI: 10.1016/j.msksp.2023.102858 -
BMC Musculoskeletal Disorders Sep 2023Arthroscopic Bankart repair is the most common procedure in patients with anterior shoulder instability. Various repair techniques using suture anchors have been used to... (Meta-Analysis)
Meta-Analysis
No difference in biomechanical properties of simple, horizontal mattress, and double row repair in Bankart repair: a systematic review and meta-analysis of biomechanical studies.
BACKGROUND
Arthroscopic Bankart repair is the most common procedure in patients with anterior shoulder instability. Various repair techniques using suture anchors have been used to improve the strength of fixation and surgical outcomes in arthroscopic Bankart surgery. However, evidence regarding which method is superior is lacking. This systematic review and meta-analysis study was designed to compare the biomechanical results of simple versus horizontal mattress versus double-row mattress for Bankart repair.
METHODS
A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed to identify comparative biomechanical studies comparing the simple, horizontal mattress, and double-row techniques commonly used in Bankart repair for anterior shoulder instability. Biomechanical results included the ultimate load to failure, stiffness, cyclic displacement, and mode of failure after the ultimate load. The methodological quality was assessed based on the Quality Appraisal for Cadaveric Studies (QUACS) scale for biomechanical studies.
RESULTS
Six biomechanical studies comprising 125 human cadavers were included in this systematic review. In biomechanical studies comparing simple and horizontal mattress repair and biomechanical studies comparing simple and double-row repair, there were no significant differences in the ultimate load to failure, stiffness, or cyclic displacement between the repair methods. The median QUACS scale was 11.5 with a range from 10 to 12, indicating a low risk of bias.
CONCLUSION
There was no biomechanically significant difference between the simple, horizontal mattress, and double-row methods in Bankart repair. Clinical evidence such as prospective randomized controlled trials should be conducted to evaluate clinical outcomes according to the various repair methods.
LEVEL OF EVIDENCE
Systematic review, Therapeutic level IV.
Topics: Humans; Joint Instability; Prospective Studies; Shoulder Joint; Amputation, Surgical; Arthroplasty
PubMed: 37759194
DOI: 10.1186/s12891-023-06864-2 -
European Journal of Physical and... Dec 2023Adhesive capsulitis, a condition marked by pain and stiffness of the shoulder, can have a frustrating clinical course for patients and health care professionals. Despite...
INTRODUCTION
Adhesive capsulitis, a condition marked by pain and stiffness of the shoulder, can have a frustrating clinical course for patients and health care professionals. Despite huge research interest, a universally accepted and used definition of clinical criteria for the diagnosis of adhesive capsulitis is currently still lacking. This systematic review aimed to identify diagnostic values for clinical examinations tests used in the diagnosis of adhesive capsulitis.
EVIDENCE ACQUISITION
A total of 5 electronic databases (PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials [CENTRAL] and PEDro) were searched for relevant studies from 2002 until October 2022 using the terms: "adhesive capsulitis AND diagnosis" and "frozen shoulder AND diagnosis." The Downs and Black Checklist (modified) was used to assess the risk of bias. The study protocol was prospectively registered at the International prospective register of systematic reviews (PROSPERO, CRD42022365993).
EVIDENCE SYNTHESIS
The initial database search identified 1799 studies, of which 9 (0.50%) were eventually included in the systematic review. Non-intrusive shoulder range of motion measurements in patients with adhesive capsulitis using the Kinect for Windows (Microsoft, Redmond, WA, USA) showed high correlation with clinical range of motion measurement. Two specific clinical tests, the affected-unaffected shoulder approach of the Coracoid Pain Test and the Distension Test in Passive External Rotation, were identified and presented excellent sensibility and specificity in the diagnosis of adhesive capsulitis, in their original study. Comparison between clinical tests was not possible due to the heterogeneity in clinical tools.
CONCLUSIONS
This systematic review identified several physical examination tests developed for the diagnosis of adhesive capsulitis but could not compare them nor advance a set of clinical diagnostic tests that are scientifically validated. Further research is warranted to obtain validation of clinical diagnosis tools for adhesive capsulitis.
Topics: Humans; Bursitis; Pain; Range of Motion, Articular; Shoulder Joint
PubMed: 37737049
DOI: 10.23736/S1973-9087.23.07940-6 -
Journal of Sports Science & Medicine Sep 2023Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in... (Meta-Analysis)
Meta-Analysis Review
Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in the range of motion after static stretching. However, to date, the effects of acute and long-term static stretching on MTS are not well understood. The purpose of this meta-analysis was to investigate the effects of acute and long-term static stretching training on MTS, in young healthy participants. PubMed, Web of Science, and EBSCO published before January 6, 2023, were searched and finally, 17 papers were included in the meta-analysis. Main meta-analysis was performed with a random-effect model and subgroup analyses, which included comparisons of sex (male vs. mixed sex and female) and muscle (hamstrings vs. plantar flexors) were also performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on MTS. For acute static stretching, the result of the meta-analysis showed a moderate decrease in MTS (effect size = -0.772, Z = -2.374, 95% confidence interval = -1.409 - -0.325, p = 0.018, I = 79.098). For long-term static stretching, there is no significant change in MTS (effect size = -0.608, Z = -1.761, 95% CI = -1.284 - 0.069, p = 0.078, I = 83.061). Subgroup analyses revealed no significant differences between sex (long-term, p = 0.209) or muscle (acute, p =0.295; long-term, p = 0.427). Moreover, there was a significant relationship between total stretching duration and MTS in acute static stretching (p = 0.011, R2 = 0.28), but not in long-term stretching (p = 0.085, R < 0.01). Whilst MTS decreased after acute static stretching, only a tendency of a decrease was seen after long-term stretching.
Topics: Female; Male; Humans; Muscle Stretching Exercises; Tendons; Muscles; Hamstring Muscles
PubMed: 37711702
DOI: 10.52082/jssm.2023.465 -
PloS One 2023Rheumatoid arthritis (RA) is an inflammatory, systemic and chronic disease that mainly affects the joints. It is characterized mainly by pain, edema and joint stiffness,... (Meta-Analysis)
Meta-Analysis
Rheumatoid arthritis (RA) is an inflammatory, systemic and chronic disease that mainly affects the joints. It is characterized mainly by pain, edema and joint stiffness, which can lead to significant loss of functional capacity and quality of life. Several physical therapy resources are used in the treatment of AR, such as low-level laser therapy (LLLT) and its analgesic and anti-inflammatory effects. However, the efficacy of LLLT in AR is still controversial. The objective of this study is to evaluate the efficacy of low-level laser therapy in adults with RA. Methods and findings: We searched MEDLINE, EMBASE, CENTRAL, PEDro, LILACS, IBECS, CUMED, SCIELO and ClinicalTrials.gov. Two researchers independently selected studies, extracted data, evaluated the risk of bias and assessed the certainty of evidence using GRADE approach. Disagreements were resolved by a third author. Meta-analyses were performed. Currently available evidence was from 18 RCTs, with a total of 793 participants. We found low-quality evidence suggesting there may be no difference between using infrared laser and sham in terms of pain, morning stiffness, grip strength, functional capacity, inflammation, ROM, disease activity and adverse events. The evidence is very uncertain about the effects of red laser compared to sham in pain, morning stiffness. The evidence is also very uncertain about the effects of laser acupuncture compared to placebo in functional capacity, quality of life, range of motion and inflammation. Conclusions: Thus, infrared laser may not be superior to sham in RA patients. There is insufficient information to support or refute the effectiveness of red laser, laser acupuncture and reflexology for treating patients with RA.
Topics: Humans; Adult; Low-Level Light Therapy; Quality of Life; Arthritis, Rheumatoid; Inflammation; Pain; Randomized Controlled Trials as Topic
PubMed: 37683021
DOI: 10.1371/journal.pone.0291345 -
PloS One 2023Atherosclerosis and osteoarthritis are closely related. However, no high-quality studies have investigated the potential of micro-fragmented adipose tissue to treat... (Meta-Analysis)
Meta-Analysis
Autologous micro-fragmented adipose tissue in the treatment of atherosclerosis patients with knee osteoarthritis in geriatric population: A systematic review and meta-analysis.
BACKGROUND
Atherosclerosis and osteoarthritis are closely related. However, no high-quality studies have investigated the potential of micro-fragmented adipose tissue to treat patients with atherosclerosis accompanied by osteoarthritis.
METHODS
PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, WANFANG DATA, and CQVIP were searched for potentially eligible studies published before October 13, 2022. Due to the statistical limitations of the existing relevant literature, it is not possible to make direct statistics on the patients with osteoarthritis accompanied by atherosclerosis treated by micro-fragmented adipose tissue. The primary outcome consisted of two parts: 1) Correlation between atherosclerosis and osteoarthritis; 2) Scores of the Knee injury and Osteoarthritis Outcome Score (KOOS). And secondary outcomes were pain assessed by visual analog scale (VAS) or numeric rating scale (NRS), quality of life (QoL) (assessed using tools apart from the KOOS), and adverse events (AEs). Random meta-analysis was conducted using STATA 14.0.
RESULTS
Nineteen studies were included. The metaanalysis evidenced a positive association between atherosclerosis and osteoarthritis (OR 1.17, CI 1.01-1.36). The mean absolute difference in KOOS subscale scores between pre- and post-treatment (mean with 95% confidence interval [CI]) was 19.65 (13.66, 25.63), 14.20 (4.64, 23.76), 19.95 (13.02, 26.89), 25.23 (14.80, 35.66), and 26.01 (13.68, 38.35) for pain, symptoms, activities of daily living (ADL), sports/recreation, and quality-of-life (QOL), respectively. The mean differences in VAS, resting VAS, activity VAS, and NRS between pre- and post-treatment was -8.24 (-10.66, -5.82), -3.61 (-4.49, -2.72), -4.17 (-4.89, -3.44), and -2.17 (-4.06, and -0.28), respectively. The mean difference in score of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EQ-5D, and University of California in Los Angeles (UCLA) between pre- and post-treatment was -24.81 (-40.80, -8.82), 0.07 (0.02, 0.12), and 0.30 (-0.42, 1.02), respectively. The mean difference in Tegner score and the International Knee Documentation Committee (IKDC) score between pre- and post-treatment was 0.67 (-0.62, 1.97) and 13.70 (6.35, 21.04), respectively. The use of micro-fragmented adipose tissue was associated with risk of bruising, bleeding, hematoma, drainage, infection, soreness, swelling, pain, and stiffness in harvest and injection sites.
CONCLUSION
Atherosclerosis and osteoarthritis share common risk factors and comorbidity. And the use of micro-fragmented adipose tissue may benefit for improving symptoms of knee osteoarthritis accompanied by atherosclerosis although may lead to some mild adverse events. Randomized controlled trials with long-term follow-up are necessary for further evaluation because many limitations of this meta-analysis cannot be ignored.
Topics: Aged; Humans; Osteoarthritis, Knee; Quality of Life; Activities of Daily Living; Adipose Tissue; Atherosclerosis
PubMed: 37651377
DOI: 10.1371/journal.pone.0289610