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Journal of Human Kinetics Oct 2022The aim of this systematic review and meta-analysis was to determine the therapeutic efficacy of extracorporeal shockwave therapy (ESWT) for athletes with patellar...
The aim of this systematic review and meta-analysis was to determine the therapeutic efficacy of extracorporeal shockwave therapy (ESWT) for athletes with patellar tendinopathy. We searched PubMed, EBSCOHost and Ovid for randomized controlled trials (RCTs) which evaluated the therapeutic efficacy of ESWT in athletes with jumper's knee. The methodological quality of RCTs was rated with the Physiotherapy Evidence Database scale. Data in the meta-analysis were expressed as standardized mean difference (SMDs) and 95% confidence intervals (CIs). Heterogeneity was assessed with I statistics. Of 192 records identified, a total of seven articles met the inclusion criteria. The ESWT and control groups with any other conservative treatment did not differ significantly with respect to the Visual Analogue Scale (VAS) long-term scores obtained at ≥ 6 months of therapy completion (SMD: -0.33; 95% CI: -4.64 to 3.98; p = 0.87; I= 98%). Furthermore, no significant differences were found between the ESWT and control groups regarding the pooled Victorian Institute of Sports Assessment for Patella (VISA-P) scores for long-term outcomes (SMD: 8.21; 95% CI: -39.3 to 55.73; p = 0.73; I= 99%). The ESWT and control groups did not differ significantly on the VAS and VISA-P scores for long-term outcomes. In both cases, heterogeneity was considered to be high. Hence, no clear and generalized conclusions can be drawn regarding ESWT effectiveness in athletes with patellar tendinopathy.
PubMed: 36457482
DOI: 10.2478/hukin-2022-0089 -
Knee Surgery, Sports Traumatology,... Jul 2023This study aimed to explore the efficacy of medial patellofemoral ligament (MPFL) repair versus nonoperative rehabilitation treatment on the rate of patellar... (Meta-Analysis)
Meta-Analysis Review
MPFL repair after acute first-time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta-analysis.
PURPOSE
This study aimed to explore the efficacy of medial patellofemoral ligament (MPFL) repair versus nonoperative rehabilitation treatment on the rate of patellar redislocation and functional outcomes in skeletally mature patients with traumatic, first-time patellar dislocations.
MATERIALS AND METHODS
MEDLINE, PubMed and EMBASE were searched from database inception to May 2022 for studies examining the management options for acute first-time patellar dislocations. This study was conducted in accordance with PRISMA and R-AMSTAR guidelines. Data on redislocation rates, functional outcomes including the Kujala score for anterior knee pain, and complication rates were extracted. A meta-analysis was used to pool the mean postoperative Kujala score and calculate the proportion of patients sustaining redislocations using a random effects model. Quality assessment of included studies was performed for all included studies using the MINORS and Detsky scores.
RESULTS
This review included a total of 25 studies and 1,361 patients. The pooled mean redislocation rate in 15 studies comprising 798 patients in the rehabilitation group was 30% (95% CI 25-36%, I = 65%). Moreover, the pooled mean redislocation rate in 10 studies comprising 170 patients undergoing MPFL repair was 7% (95% CI 3-12%, I = 30%). The pooled mean postoperative Kujala score in 8 studies comprising 396 patients in the rehabilitation group was 82.5 (95% CI 78.3-86.8, I = 91%), compared to a score of 88 (95% CI 87-90, I = 76%) in 3 studies comprising 94 patients in the repair group. Range of motion deficits was reported in 3.8% of 893 patients in the rehabilitation group and 2.0% of 205 patients in the repair group.
CONCLUSION
MPFL repair resulted in a lower rate of redislocation, less knee pain, and noninferiority with respect to a range of motion deficits compared to nonoperative treatment for the management of acute first-time patellar dislocations.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Patellar Dislocation; Patellofemoral Joint; Knee Joint; Knee; Ligaments, Articular; Joint Dislocations; Pain; Joint Instability
PubMed: 36372845
DOI: 10.1007/s00167-022-07222-w -
BMC Musculoskeletal Disorders Oct 2022Patellar resurfacing is optional during total knee replacement (TKR). Some surgeons always resurface the patella, some never resurface, and others selectively resurface.... (Meta-Analysis)
Meta-Analysis
Clinical effectiveness of patellar resurfacing, no resurfacing and selective resurfacing in primary total knee replacement: systematic review and meta-analysis of interventional and observational evidence.
BACKGROUND
Patellar resurfacing is optional during total knee replacement (TKR). Some surgeons always resurface the patella, some never resurface, and others selectively resurface. Which resurfacing strategy provides optimal outcomes is unclear. We assessed the effectiveness of patellar resurfacing, no resurfacing, and selective resurfacing in primary TKR.
METHODS
A systematic review and meta-analysis was performed. MEDLINE, Embase, Web of Science, The Cochrane Library, and bibliographies were searched to November 2021 for randomised-control trials (RCTs) comparing outcomes for two or more resurfacing strategies (resurfacing, no resurfacing, or selective resurfacing) in primary TKR. Observational studies were included if limited or no RCTs existed for resurfacing comparisons. Outcomes assessed were patient reported outcome measures (PROMs), complications, and further surgery. Study-specific relative risks [RR] were aggregated using random-effects models. Quality of the evidence was assessed using GRADE.
RESULTS
We identified 33 RCTs involving 5,540 TKRs (2,727 = resurfacing, 2,772 = no resurfacing, 41 = selective resurfacing). One trial reported on selective resurfacing. Patellar resurfacing reduced anterior knee pain compared with no resurfacing (RR = 0.65 (95% CI = 0.44-0.96)); there were no significant differences in PROMs. Resurfacing reduced the risk of revision surgery (RR = 0.63, CI = 0.42-0.94) and other complications (RR = 0.54, CI = 0.39-0.74) compared with no resurfacing. Quality of evidence ranged from high to very low. Limited observational evidence (5 studies, TKRs = 215,419) suggested selective resurfacing increased the revision risk (RR = 1.14, CI = 1.05-1.22) compared with resurfacing. Compared with no resurfacing, selective resurfacing had a higher risk of pain (RR = 1.25, CI = 1.04-1.50) and lower risk of revision (RR = 0.92, CI = 0.85-0.99).
CONCLUSIONS
Level 1 evidence supports TKR with patellar resurfacing over no resurfacing. Resurfacing has a reduced risk of anterior knee pain, revision surgery, and complications, despite PROMs being comparable. High-quality RCTs involving selective resurfacing, the most common strategy in the UK and other countries, are needed given the limited observational data suggests selective resurfacing may not be effective over other strategies.
Topics: Humans; Patella; Arthroplasty, Replacement, Knee; Knee Joint; Treatment Outcome; Pain
PubMed: 36273138
DOI: 10.1186/s12891-022-05877-7 -
Knee Surgery, Sports Traumatology,... Jun 2023The purpose of this study was to analyze the diagnostic accuracy of magnetic resonance imaging (MRI) to detect and grade the severity of patellofemoral (PF) cartilage... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this study was to analyze the diagnostic accuracy of magnetic resonance imaging (MRI) to detect and grade the severity of patellofemoral (PF) cartilage injuries.
METHODS
A systematic review was conducted on PubMed, EMBASE and Cochrane Library databases (up to July 1st 2022) to search for studies that reported the diagnostic accuracy of MRI to detect and grade PF cartilage injuries as compared to diagnostic arthroscopy. Risk of bias was judged using the QUADAS-2 tool. Quantitative syntheses were performed to calculate the diagnostic accuracy metric-sensitivity, specificity, positive likelihood (LR+) and negative likelihood (LR-) ratios, diagnostic odds ratio (DOR)-and presented as median with 25% and 75% percentiles. The summary receiver operating characteristic (SROC) curves were also calculated. Diagnostic accuracy metrics were calculated for all PF cartilage injuries and then sub-grouped by patellar and trochlear lesions. Diagnostic accuracy was also calculated according to the grading of cartilage injuries.
RESULTS
Forty-five studies were included for qualitative analyses and forty studies were included for quantitative synthesis. A total of 3534 participants with a weighted mean age of 38.1 years were included. Diagnostic accuracy was generally high: sensitivity (0.8, 0.6-1.0), specificity (0.9, 0.8-1.0), LR+ (6.4, 3.1-15.3), LR- (0.3, 0.2-0.4) and DOR (21.3, 9.9-121.1). The area under the curve (AUC) of the SROC was 0.9. The diagnostic accuracy was slightly higher for patellar (sensitivity 0.8, specificity 0.8, LR+ 5.3, LR- 0.2, DOR 28.8) than for trochlear lesions (sensitivity 0.7, specificity 0.9, LR+ 5.5, LR- 0.4, DOR 14.3). The sensitivity was generally higher when grading advanced (vs. early or intermediate) cartilage injuries of the patella.
CONCLUSION
The MRI is able to diagnose PF cartilage injuries with reasonably high diagnostic accuracy (as compared to arthroscopy). Clinicians can rely on MRI to reliably diagnose PF cartilage injuries (with some limitations) which will play an important role in deciding for surgical or non-operative treatment.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Adult; Sensitivity and Specificity; Magnetic Resonance Imaging; ROC Curve; Odds Ratio; Cartilage
PubMed: 36266368
DOI: 10.1007/s00167-022-07203-z -
The Knee Dec 2022Chondral defects can be a particularly challenging clinical presentation. Because damaged cartilage does not heal itself, an evolution of multiple new surgical... (Review)
Review
INTRODUCTION
Chondral defects can be a particularly challenging clinical presentation. Because damaged cartilage does not heal itself, an evolution of multiple new surgical treatments designed specifically for cartilage repair and restoration have been introduced. Internal fixation has demonstrated good benefits in case reports and small qualitative studies. Our systematic review aimed to evaluate the effectiveness of internal fixation in the management of acute chondral fractures.
METHODS
A comprehensive search strategy was carried out using the NICE Healthcare Databases Advanced Search. The systematic review was prospectively registered with PROSPERO (CRD42022302976) and was performed in accordance with the PRISMA guidelines.
RESULTS
Eleven studies consisting of fifty patients were included in this systematic review. Seventy-eight percent of patients showed good results and twenty-two percent of the cases had excellent results. Ninety-two percent of patients returned to preoperative level of sport activities at the end of the follow-up period. All of them returned to the original activity level without pain, stiffness, or restriction of movement after 1 year latest. The majority of patients had no complications at all, good recovery time and satisfactory outcomes for pain and activity level. The only complications presented were patella instability and quadriceps weakness.
CONCLUSION
Internal fixation for acute chondral fractures is an effective method to treat acute chondral fractures in both adolescents and young adults that want to get back to an active lifestyle. However, more data examining the long-term functional status, quality of life (QoL), recovery post-injury and pain free sports activity involvement are needed.
Topics: Young Adult; Adolescent; Humans; Quality of Life; Fracture Fixation, Internal; Cartilage Diseases; Fractures, Cartilage; Joint Instability; Treatment Outcome
PubMed: 36257177
DOI: 10.1016/j.knee.2022.08.001 -
International Orthopaedics Dec 2022The use of metallic implants for the treatment of patella fractures often involves complications related to the hardware. As a result, there has been a considerable... (Meta-Analysis)
Meta-Analysis Review
Fixation of patella fractures with metallic implants is associated with a significantly higher risk of complications and re-operations than non-metallic implants: a systematic review and meta-analysis.
PURPOSE
The use of metallic implants for the treatment of patella fractures often involves complications related to the hardware. As a result, there has been a considerable focus on the use of non-metallic implants. The aim of this study was to determine the differences in clinical outcomes, including the rates of complications and re-operations following the surgical management of patellar fractures with metallic versus non-metallic implants.
METHODS
The systematic review was conducted in accordance with PRISMA guidelines. Two investigators independently applied the search strategy to PubMed, SCOPUS, Google Scholar, and Cochrane databases, limited to publications between 1st January 2000 to 30st September 2021. The search strategy identified studies in which there was a comparison between the clinical outcome of the metallic and non-metallic fixation. Meta-analysis was conducted according to the Cochrane Collaboration and Quality of Reporting of Meta-Analysis (QUORUM) guidelines.
RESULTS
A total of 19 studies were selected for the systematic review and seven studies for the meta-analysis. Two hundred ninety-sixt patients formed the pooled study population for the meta-analysis. The outcomes evaluated in the meta-analysis were range of motion (ROM), complications, and re-operation rates. There was no significant difference between groups regarding ROM, but the risk ratio (RR) of re-operation (RR 0.19, 95% CI [0.09-0.41]) and complications (RR 0.30, 95% CI [0.17-0.55]) was significantly in favor of fixation with non-metallic implants.
CONCLUSION
The use of non-metallic implants for fixation of patella fractures was associated with significantly lower risk of complications and re-operations than fixation with metallic implants, without any difference between groups with respect to the final range of motion or functional outcome measures.
Topics: Humans; Patella; Fractures, Bone; Fracture Fixation, Internal; Reoperation; Knee Injuries; Treatment Outcome
PubMed: 36208340
DOI: 10.1007/s00264-022-05565-0 -
Musculoskeletal Surgery Jun 2023Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to... (Review)
Review
PURPOSE
Patella maltracking is among the most frequent causes of poor outcomes and early failure after total knee arthroplasty (TKA), with an incidence that ranges from 1 to 20%. Even if there is agreement between authors regarding the preoperative and intraoperative management of patella maltracking in TKA, less clear are postoperative conducts. The purpose of this systematic review is to summarize and compare surgical techniques used to treat patella maltracking after TKA.
METHODS
A systematic review of the literature was performed with a primary search on Medline through PubMed. The PRISMA 2009 flowchart and checklist were used to edit the review. Screened studies had to provide clinical, functional and radiological results and complications of the proposed treatment to be included in the review.
RESULTS
A total of 21 articles were finally included. Three main types of surgical procedures and other minor techniques have been identified to manage patella maltracking after TKA. The choice of the proper technique to use in the specific case depends on several factors, first of all the malpositioning of the prosthetic components.
CONCLUSION
Patella maltracking after TKA represents a frequent and challenging problem for orthopedic surgeons. Treatments described in the literature are often able to correct an abnormal patellar tracking; nevertheless, authors report variable percentages of residual knee pain and dissatisfaction in re-treated patients. Therefore, it would be desirable to prevent the maltracking condition at the time of primary arthroplasty, using proper surgical precautions.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Knee Joint; Radiography
PubMed: 36197592
DOI: 10.1007/s12306-022-00764-9 -
Sports Health May 2023Patellar tendinopathy (PT), or jumper's knee, is a chronic painful overuse patellar tendon injury. For PT, prevention is more important than treatment. However, there is... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Patellar tendinopathy (PT), or jumper's knee, is a chronic painful overuse patellar tendon injury. For PT, prevention is more important than treatment. However, there is still a lack of strong evidence to confirm the effectiveness of prevention.
OBJECTIVE
This study will analyze by meta-analysis the effect of a prophylactic program on high PT risk people (but without PT) in reducing PT occurrence.
DATA SOURCES
PubMed, Embase, the Cochrane Library, Scopus, and Ebscohost, from inception to January 11, 2022.
STUDY SELECTION
A study comparing the effects of prophylactic programs and controls on the risk of PT was included in the analysis. After a database search with search terms ((patellar tendinopathy) OR (jumper's knee) OR (patellar tendinitis) OR (patellar tendinosis) OR (patellar tendonitis)) AND ((Prevent*) OR (prophyla*)), a total of 1444 items were obtained. Of these, 11 studies with 6091 participants were eligible for inclusion in this meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
LEVEL OF EVIDENCE
Level 2.
DATA EXTRACTION
The first author's name, publication year, study design, country, population, mean age, sex, prophylactic program, control, study duration, and the frequency or incidence of PT in each group were extracted.
RESULTS
A total of 11 articles were included in the analysis. Overall, no significant difference was considered in the risk of PT between the prophylactic program and control groups based on the random-effect model (odds ratio [OR], 0.85; 95% CI, 0.67, 1.08; = 0.18). In the recruit subgroup, there was even a tendency to elevate the risk of PT occurrence after prophylaxis was executed (OR, 1.89; 95% CI, 0.68, 5.28; = 0.22). In athletes, the prophylactic program tended to decrease the risk of PT compared with the control (OR, 0.81; 95% CI, 0.63, 1.04; = 0.10); however, the difference was not statistically significant. Trial sequential analysis results suggested that prophylaxis may still be effective for athletes, but this needs to be confirmed with a larger sample size.
CONCLUSION
The risk of PT cannot be reduced with the current prophylactic program. However, for athletes, the negative results may be due to insufficient sample size.
Topics: Humans; Patellar Ligament; Tendinopathy; Cumulative Trauma Disorders; Athletes; Patella
PubMed: 36146934
DOI: 10.1177/19417381221121808 -
Physical Therapy Dec 2022The nociceptive pain processing of soft-tissue overuse conditions is under debate because no consensus currently exists. The purpose of this meta-analysis was to compare... (Meta-Analysis)
Meta-Analysis
A Closer Look at Localized and Distant Pressure Pain Hypersensitivity in People With Lower Extremity Overuse Soft-Tissue Painful Conditions: A Systematic Review and Meta-Analysis.
OBJECTIVE
The nociceptive pain processing of soft-tissue overuse conditions is under debate because no consensus currently exists. The purpose of this meta-analysis was to compare pressure pain thresholds (PPTs) in symptomatic and distant pain-free areas in 2 groups: participants with symptomatic lower extremity overuse soft-tissue conditions and controls who were pain free.
METHODS
Five databases were searched from inception to December 1, 2021, for case-control studies comparing PPTs between individuals presenting with symptomatic lower extremity tendinopathy/overuse injury and controls who were pain free. Data extraction included population, diagnosis, sample size, outcome, type of algometer, and results. The methodological quality (Newcastle-Ottawa Quality Assessment Scale) and evidence level (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Meta-analyses of symptomatic, segmental related, and distant pain-free areas were compared.
RESULTS
After screening 730 titles and abstracts, a total of 19 studies evaluating lower extremity overuse conditions (Achilles or patellar tendinopathy, greater trochanteric pain syndrome, plantar fasciitis, and iliotibial band syndrome) were included. The methodological quality ranged from fair (32%) to good (68%). Participants with lower extremity overuse injury had lower PPTs in both the painful and nonpainful areas, mirrored test-site, compared with controls (affected side: mean difference [MD] = -262.92 kPa, 95% CI = 323.78 to -202.05 kPa; nonaffected side: MD = -216.47 kPa, 95% CI = -304.99 to -127.95 kPa). Furthermore, people with plantar fasciitis showed reduced PPTs in the affected and nonaffected sides at segmental-related (MD = -176.39 kPa, 95% CI = -306.11 to -46.68 kPa) and distant pain-free (MD = -97.27 kPa, 95% CI = 133.21 to -61.33 kPa) areas compared with controls.
CONCLUSION
Low- to moderate-quality evidence suggests a reduction of PPTs at the symptomatic area and a contralateral/mirror side in lower extremity tendinopathies and overuse conditions compared with pain-free controls, particularly in plantar fasciitis and greater trochanteric pain syndrome. Participants with plantar fasciitis showed a reduction of PPTs on the affected and non-affected sides at a segmental-related area (very low-quality evidence) and at a remote asymptomatic area (moderate-quality evidence).
IMPACT
Some overuse peripheral pain conditions may be more associated with pressure pain sensitivity than others. Accordingly, examination and identification of conditions more peripherally, centrally, or mixed mediated could potentially lead to more specific and different treatment strategies.
Topics: Hyperalgesia; Humans; Tendinopathy; Cumulative Trauma Disorders; Pain Measurement; Pressure; Lower Extremity; Pain Threshold
PubMed: 36124704
DOI: 10.1093/ptj/pzac119 -
Journal of Back and Musculoskeletal... 2023Patellofemoral pain syndrome (PPS) is defined as a condition in the patellofemoral joint that can present with pain, functional deficit, crepitus, and instability. Its...
BACKGROUND
Patellofemoral pain syndrome (PPS) is defined as a condition in the patellofemoral joint that can present with pain, functional deficit, crepitus, and instability. Its etiology appears to lie in excessive loading of the patellofemoral joint due to mispositioning of the patella. The application of taping has recently increased, to manage PPS. However, the level of scientific evidence in this sense is unknown.
OBJECTIVE
To determine the effect of different types of taping in subjects with PPS.
METHODS
A bibliographic search was carried out in January and February 2021 in Scopus, Web of Science, PubMed, Medline, SPORTDiscus, PEDro and CINAHL.
RESULTS
A total of 13 studies were included for qualitative analysis. The mean score on the PEDro scale was 5.30 points. Most of the articles reflect a decrease in pain after the taping intervention, while variables such as functionality, muscle activity and biomechanical modification do not show positive effects.
CONCLUSION
Taping appears to have positive effects on pain in subjects with PPS. However, the evidence is contradictory with the rest of the variables studied.
Topics: Humans; Patellofemoral Pain Syndrome; Patella; Pain; Pain Measurement
PubMed: 35964172
DOI: 10.3233/BMR-220099