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Oral and Maxillofacial Surgery Apr 2024Our study aims to estimate the prevalence of lingual nerve injury following bilateral sagittal split osteotomy (BSSO). (Review)
Review
PURPOSE
Our study aims to estimate the prevalence of lingual nerve injury following bilateral sagittal split osteotomy (BSSO).
METHODS
Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed.
RESULTS
In total, eleven eligible studies comprising a total of 1,882 participants were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of lingual sensory impairment was estimated to be as high as 0.1% (95% CI 0.0%-0.6%) with moderate heterogeneity observed between studies.
CONCLUSION
It is important for healthcare professionals to be aware of this issue, despite the relatively low rate of lingual nerve deficit after BSSO. Additional research will provide a more comprehensive understanding of the underlying factors contributing to lingual nerve injury, leading to improved preventive measures and treatment strategies. Furthermore, insights gained from future studies will enable healthcare professionals to inform patients about the potential complications and manage their expectations before undergoing BSSO.
PubMed: 38622272
DOI: 10.1007/s10006-024-01247-w -
Foot & Ankle Orthopaedics Apr 2024Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited...
BACKGROUND
Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines.
METHODS
A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms , , , , , and . Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies.
RESULTS
A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO.
CONCLUSION
Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.
PubMed: 38617581
DOI: 10.1177/24730114241241320 -
Journal of Orthopaedics Aug 2024Varus deformity is common in medial compartment knee osteoarthritis (OA). This coronal plane malalignment is compensated for by static and dynamic adjustments in the... (Review)
Review
BACKGROUND
Varus deformity is common in medial compartment knee osteoarthritis (OA). This coronal plane malalignment is compensated for by static and dynamic adjustments in the position of the adjacent joints, principally in the hindfoot & ankle. Varus knee OA can be treated in selected patients with high tibial osteotomy (HTO) and stabilised with a fixed angle plate or circular frame, which may reverse these compensatory adjustments. The aim of this systematic review is to determine the evidence available for static and dynamic compensations with the main objectives being to improve deformity planning and optimise patient outcomes.
METHOD
A systematic review with meta-analysis was designed using the PRISMA template to meet the research aims & objectives.
RESULTS
A total of 1006 patients (1020 knees) with acombined mean age of 54.5 years, female:male ratio of 0.9:1 were extracted from 19 included studies. The methodologies of the majority of studies were at high risk of bias according to the Newcastle-Ottawa Scale demonstrating significant heterogeneity. The combined mean change in the HKA axis was 7.7°; MPTA 7.4°; TT, 0.21°; TI 4.56° & AJLO 4° . Preoperative hindfoot valgus compensation reverts towards neutral post-HTO. There is limited evidence available for a direct relationship between static alignment and dynamic gait parameters.
CONCLUSIONS
An inverse relationship between ankle and hindfoot alignment in varus deformity of the knee forms the basis of this compensation theory. In cases with a stiff hindfoot which may not revert postoperatively, the reconstructive orthopaedic surgeon may consider angulation with translation HTO, in order to optimise joint alignment and minimise transference of symptoms to the foot and ankle.
PubMed: 38586600
DOI: 10.1016/j.jor.2024.02.022 -
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 -
Archives of Orthopaedic and Trauma... May 2024Progressive collapsing foot deformity (PCFD), formally known as "adult-acquired flatfoot deformity" (AAFFD), is a complex foot deformity consisting of multiple...
INTRODUCTION
Progressive collapsing foot deformity (PCFD), formally known as "adult-acquired flatfoot deformity" (AAFFD), is a complex foot deformity consisting of multiple components. If surgery is required, joint-preserving procedures, such as a medial displacement calcaneal osteotomy (MDCO), are frequently performed. The aim of this systematic review is to provide a summary of the evidence on the impact of MDCO on foot biomechanics.
MATERIALS AND METHODS
A systematic literature search across two major sources (PubMed and Scopus) without time limitation was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria. Only original research studies reporting on biomechanical changes following a MDCO were included. Exclusion criteria consisted of review articles, case studies, and studies not written in English. 27 studies were included and the methodologic quality graded according to the QUACS scale and the modified Coleman score.
RESULTS
The 27 included studies consisted of 18 cadaveric, 7 studies based on biomechanical models, and 2 clinical studies. The impact of MDCO on the following five major parameters were assessed: plantar fascia (n = 6), medial longitudinal arch (n = 9), hind- and midfoot joint pressures (n = 10), Achilles tendon (n = 5), and gait pattern parameters (n = 3). The quality of the studies was moderate to good with a pooled mean QUACS score of 65% (range 46-92%) for in-vitro and a pooled mean Coleman score of 58 (range 56-65) points for clinical studies.
CONCLUSION
A thorough knowledge of how MDCO impacts foot function is key in properly understanding the postoperative effects of this commonly performed procedure. According to the evidence, MDCO impacts the function of the plantar fascia and Achilles tendon, the integrity of the medial longitudinal arch, hind- and midfoot joint pressures, and consequently specific gait pattern parameters.
Topics: Humans; Biomechanical Phenomena; Calcaneus; Flatfoot; Foot; Foot Deformities, Acquired; Gait; Osteotomy
PubMed: 38554203
DOI: 10.1007/s00402-024-05267-9 -
Knee Surgery & Related Research Mar 2024This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO). (Review)
Review
PURPOSE
This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO).
MATERIALS AND METHODS
The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and Google Scholar, covering articles published until August 31, 2023.
RESULTS
Sixteen studies (1277 patients) revealed that HTO, with or without concurrent cartilage procedures, leads to cartilage regeneration based on the International Cartilage Repair Society (ICRS) grade during second-look arthroscopy. No concurrent procedure showed improvement in ICRS grade (mean difference: - 0.80 to - 0.49). Microfracture (mean difference: - 0.75 to - 0.22), bone marrow aspirate concentrate (BMAC) (mean difference: - 1.37 to - 0.67), and human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) (mean difference: - 2.46 to - 1.81) procedures also demonstrated positive outcomes. Clinical outcome assessments for each cartilage procedure were also improved during postoperative follow-up, and no specific complications were reported.
CONCLUSIONS
HTO with or without concurrent cartilage procedures promotes cartilage regeneration observed during second-look arthroscopy, with improved clinical outcomes. Future randomized controlled trials on the same topic, along with subsequent meta-analyses, are necessary for conclusive findings.
PubMed: 38549124
DOI: 10.1186/s43019-024-00221-w -
Acta Chirurgiae Plasticae 2023The purpose of this study was to collect and present all the available evidence regarding avascular maxillary necrosis following maxillary osteotomy for orthognathic...
PURPOSE
The purpose of this study was to collect and present all the available evidence regarding avascular maxillary necrosis following maxillary osteotomy for orthognathic surgery.
METHODS
We performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library dataset in accordance with the PRISMA guideline. We included studies that report on avascular maxillary necrosis after any maxillary osteotomy used in the frame of orthognathic surgery.
RESULTS
Sixteen studies reporting a total of 65 patients with postoperative avascular maxillary necrosis were included. Those reported avascular necrosis in 32 female patients and 19 male patients. Multisegmented Le Fort I osteotomy was the most common type of related operation amongst the patients followed by single segment Le Fort I osteotomy.
CONCLUSIONS
Although avascular maxillary necrosis is a very rare complication after maxillary orthognathic surgery it can be complicated with partial / complete loss of the maxilla. A personalized selection of the surgical technique should be made for any patient. Caution is warranted in cleft patients and in patients undergoing multisegmented Le Fort I osteotomies, so that the vitality of the maxilla and especially its anterior part is preserved. In the case when avascular necrosis arises, management should be immediate and precise. As for the reconstruction, it needs to be tailored according to the maxillary defect.
Topics: Humans; Male; Female; Maxilla; Orthognathic Surgery; Osteotomy, Le Fort; Craniotomy; Osteonecrosis
PubMed: 38538299
DOI: 10.48095/ccachp2023117 -
Global Spine Journal Mar 2024Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVES
Intraoperative neuromonitoring (IOMN) has become a standard practice in the detection and prevention of nerve damage and postoperative deficit. While multicenter studies have addressed this inquiry, there have been no systematic reviews to date. This systematic review identifies the leading causes of IONM alerts during adult spinal deformity (ASD) surgeries.
METHODS
Following PRISMA guidelines, a literature search was performed in PubMed and Embase. IONM alert causes were grouped by equivalent terms used across different studies and binned into larger categories, including surgical maneuver, Changes in blood pressure/temperature, Oxygenation, Anesthesia, Patient position, and Unknown.
RESULTS
Inclusion criteria were studies on adult patients receiving ASD correction surgery using IONM with documented alert causes. 1544 references were included in abstract review, 128 in full text review, and 16 studies qualified for data extraction. From those studies, there was a total of 3945 adult patients with 299 IONM alerts. Surgical maneuver led the alert causes (258 alerts/86.3%), with signal loss most commonly occurring at correction or osteotomy (101/33.8% and 95/31.8% respectively). Pedicle screw placement caused 35 alerts (11.7%). Changes in temperature and blood pressure were the third largest category (34/11.4%).
CONCLUSIONS
The most frequent causes of IONM alerts in ASD surgery were surgical maneuvers such as correction, osteotomy, and pedicle screw placement. This information provides spine surgeons with a quantitative perspective on the causes of IONM changes and show that most occur at predictable times during ASD surgery.
PubMed: 38532704
DOI: 10.1177/21925682241242693 -
The British Journal of Oral &... May 2024Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ)... (Review)
Review
Failures in orthognathic surgery are associated with different factors, including those related to untreated or undiagnosed preoperative temporomandibular joint (TMJ) disorders. This systematic review aimed to assess potential alterations in the condylar head following orthognathic surgery. A systematic search for randomised controlled trials and retrospective studies was performed. For inclusion in the review, studies had to meet the following eligibility criteria according to the PICO framework: Patients: patients with orthognathic deformity and temporomandibular dysfunction (or temporomandibular osteoarthritis); Intervention: patients submitted to orthognathic surgery concomitantly with TMJ disjunction; Control: patients undergoing only orthognathic surgery with or without presurgical data; and Outcome: changes in temporomandibular joint position and volume. Nine studies met all the inclusion criteria and were selected for qualitative analysis. The results of this review show that simultaneous articular disc repositioning and orthognathic surgery provide better results in patients with preoperatively diagnosed condylar osteoarthritic changes. In conclusion, condylar remodelling (resorption/deposition) and its extent are determined by the direction of condylar displacement during surgery. Other factors such as age are also associated with the development of condylar resorption.
Topics: Humans; Mandibular Condyle; Orthognathic Surgical Procedures; Temporomandibular Joint Disorders; Temporomandibular Joint Disc; Osteoarthritis
PubMed: 38521741
DOI: 10.1016/j.bjoms.2024.01.004 -
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