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Arthroscopy : the Journal of... Feb 2024To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate outcomes of arthroscopic single-bundle (SB) versus anatomic double-bundle (ADB) anterior cruciate ligament reconstruction (ACLR) in adults through a synthesis of randomized controlled trials (RCTs). We hypothesized that SB and ADB methods would lead to similar outcomes after reconstruction of ACL rupture.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist guided our reporting. To identify RCTs that compared SB and ADB reconstructions, a thorough literature search was conducted of PubMed, Embase, Cochrane library, and Web of Science. The methodologic quality of each included study was independently assessed by 2 authors using the Cochrane Collaboration's risk of bias tool. The Anatomic ACL Reconstruction Scoring Checklist (AARSC) was used to screen the eligibility of each study's operative approaches. Twelve clinical outcomes were investigated through pooled analyses conducted using Review Manager 5.3.
RESULTS
This meta-analysis synthesized 13 RCTs comparing postoperative outcomes between ADB and SB reconstructions of ACLs. After a minimum follow-up of 12 months, ADB and SB technique resulted in similar subjective clinical outcomes, including the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score sports subscale. Similarly, no statistically significant outcomes were found for objective outcomes such as International Knee Documentation Committee objective grade, pivot-shift test, Lachman test, side-to-side difference, extension deficit, flexion deficit, and osteoarthritis change. However, patients who underwent SB reconstruction had significantly greater complication rates than those that underwent ADB reconstruction.
CONCLUSIONS
When an ACLR approach meets a minimal total AARSC score of 8, ADB and SB techniques may result in similar subjective and objective outcomes, but the ADB technique may lead to lower complication rates following surgery. We recommend that surgeons favor ADB ACLR, as guided by the AARSC.
LEVEL OF EVIDENCE
Level I, systematic review and meta-analysis of Level I randomized controlled trials.
Topics: Adult; Humans; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Knee Joint; Knee Injuries; Osteoarthritis; Treatment Outcome
PubMed: 37230187
DOI: 10.1016/j.arthro.2023.05.017 -
JSES Reviews, Reports, and Techniques Nov 2023Reports of glenohumeral translation in shoulders with traumatic anterior instability have been presented. The aim of this systematic review was to investigate... (Review)
Review
BACKGROUND
Reports of glenohumeral translation in shoulders with traumatic anterior instability have been presented. The aim of this systematic review was to investigate anterior-posterior translation in shoulders with traumatic anterior instability.
METHODS
This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies including patients aged ≥15 years with previous traumatic anterior shoulder dislocation or subluxation were included. The outcome was anterior-posterior glenohumeral translation. A search of PubMed, Embase, and Cochrane library was performed on July 17, 2022. Two reviewers individually screened titles and abstracts, reviewed full text, extracted data, and performed quality assessment.
RESULTS
Twenty studies (582 unstable shoulders in total) of varying quality were included. There was a lack of standardization and unity across studies. Radiography, ultrasound, computed tomography, magnetic resonance imaging, motion tracking, instrumentation, and manual testing were used to assess the glenohumeral translation. The glenohumeral translation in unstable shoulders ranged from 0.0 ± 0.8 mm to 11.6 ± 3.7 mm, as measured during various motion tasks, arm positions, and application of external force. The glenohumeral translation was larger or more anteriorly directed in unstable shoulders than in stable when contralateral healthy shoulders or a healthy control group were included in the studies. Several studies found that the humeral head was more anteriorly located on the glenoid in the unstable shoulders.
CONCLUSION
This systematic review provides an overview of the current literature on glenohumeral translation in traumatic anterior shoulder instability. It was not able to identify a threshold for abnormal translation in unstable shoulders, due to the heterogeneity of data. The review supports that not only the range of translation but also the direction hereof as well as the location of the humeral head on the glenoid seem to be part of the pathophysiology. Technical development and increased attention to research methodology in recent years may provide more knowledge and clarity on this topic in the future.
PubMed: 37928995
DOI: 10.1016/j.xrrt.2023.07.002 -
Journal of Orthopaedic Surgery and... Aug 2021The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of anterior cruciate ligament reconstruction (ACLR) is to restore the function of the knee joint, protect the cartilage, and reduce the occurrence of osteoarthritis. However, due to the structural limitations of the human body, it is not possible to perform ACLR with conventional sutures. To restore normal functioning of the anterior cruciate ligament (ACL), a new ligament must be reconstructed in the position of the previous ACL.
OBJECTIVE
To compare autografts and synthetic grafts in terms of postoperative knee stability and function SEARCH METHODS: The protocol for this study was registered with PROSPERO (CRD42021243451). Two reviewers independently searched the PubMed, Embase, and the Cochrane Library databases from database inception though February 10, 2021. The following search method was used: ((Autograft) OR (Autologous) OR (Autotransplant)) OR Artificial Ligament AND (Anterior Cruciate Ligament Injury [MeSH Terms]) AND (Randomized controlled trial [MeSH Terms]). Methodological quality was assessed by the Cochrane risk of bias tool.
SELECTION CRITERIA
We only included randomized controlled trials (level I) that compared autograft and synthetic graft interventions in participants with ACL injury. We included trials that evaluated ACLR using at least one outcome (Lachman test, pivot shift test, IKDC grades, or complications).
RESULTS
A total of 748 studies were identified in the initial literature search, and seven studies that examined only bone-patellar tendon-bone (BPTB) grafts compared with artificial grafts met the predetermined inclusion criteria. The results showed that BPTB grafts were associated with significantly better pivot shift test and Lachman test results and better IKDC grades and lower complication rates than synthetic grafts.
CONCLUSIONS
This review indicates that for adults, BPTB grafts perform more favorably than synthetic grafts in ACLR in terms of knee stability, function, and complication. More research is needed to compare autologous tendons and allogeneic tendons with artificial ligaments, especially in elderly individuals.
LEVEL OF EVIDENCE
Level I, systematic review and meta-analysis.
Topics: Adult; Aged; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Humans; Knee Joint; Patellar Ligament; Tendons; Transplantation, Autologous
PubMed: 34348750
DOI: 10.1186/s13018-021-02624-x -
Experimental and Clinical... Aug 2020In recent years, there have been rapid advances in the field of keratoconus. Penetrating keratoplasty and deep anterior lamellar keratoplasty are the standard surgical... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
In recent years, there have been rapid advances in the field of keratoconus. Penetrating keratoplasty and deep anterior lamellar keratoplasty are the standard surgical procedures. Nevertheless, controversy remains regarding the outcomes of both procedures in the treatment of keratoconus. Therefore, we conducted a meta-analysis comparing postoperative outcome measures of penetrating keratoplasty versus deep anterior lamellar keratoplasty for keratoconus.
MATERIALS AND METHODS
We searched PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews for eligible studies comparing best-corrected visual acuity, spherical equivalent, refractive cylinder, topography cylinder, and graft rejection episodes and complications of penetrating keratoplasty and deep anterior lamellar keratoplasty. Seven risk domains from software Review Manager 5.3 (The Cochrane Collaboration, Oxford, UK) were applied as quality assessments for the eligible studies. A random-effects model was used for data synthesis.
RESULTS
Thirteen eligible studies were included in our meta-analysis, which encompassed 530 eyes that underwent penetrating keratoplasty and 568 eyes that underwent deep anterior lamellar keratoplasty. With regard to best-corrected visual acuity, refractive cylinder, and topography cylinder, we found no significant differences in results between the 2 procedures (P = .49 and .47, respectively). However, spherical equivalent results were significantly greater in the deep anterior lamellar keratoplasty group than in the penetrating keratoplasty group (P < .001). The risk of graft rejection episodes was more prominent in the penetrating keratoplasty than in the deep anterior lamellar keratoplasty group (odds ratio = 2.69; P = .001). The odds ratio for complications was 1.79 (P = .03). Three studies showed moderate risk of bias, and the other 10 showed high risk of bias.
CONCLUSIONS
Deep anterior lamellar keratoplasty is preferred over penetrating keratoplasty for the treatment of keratoconus because of its low risk of rejection and complications.
Topics: Adolescent; Adult; Aged; Corneal Transplantation; Female; Graft Rejection; Humans; Keratoconus; Keratoplasty, Penetrating; Male; Middle Aged; Recovery of Function; Refractive Errors; Risk Assessment; Risk Factors; Treatment Outcome; Visual Acuity; Young Adult
PubMed: 31724924
DOI: 10.6002/ect.2019.0123 -
Translational Andrology and Urology Jun 2021Urethral surgery outcomes are often evaluated by assessing urinary flow and urethral patency. However, sexual consequences may appear after urethroplasty, impairing... (Review)
Review
BACKGROUND
Urethral surgery outcomes are often evaluated by assessing urinary flow and urethral patency. However, sexual consequences may appear after urethroplasty, impairing quality of life and patient's perception of success.The aim of this study is to assess the relationship between anterior urethral reconstruction and postoperative sexual dysfunction, including the proposed factors predicting sexual outcomes.
METHODS
We searched in PubMed database using the terms: "anterior urethroplasty", bulbar urethroplasty" or "penile urethroplasty", and "sexual dysfunction", "erectile function" or "ejaculation". Articles were independently evaluated for inclusion based on predetermined criteria. Systematic data extraction was followed by a comprehensive summary of evidence.
RESULTS
Thirty-eight studies were included for final analysis. No randomised trial on the topic was found. Urethral surgery might affect different aspects of sexual function: erectile function, ejaculatory function, penile shape and length, and genital sensitivity, leading to severe sexual dysfunction. Patient perception of sexual impairment was related to post-operative satisfaction.
CONCLUSIONS
Sexual dysfunction after anterior urethral reconstruction is an important issue that must be appropriately discussed during preoperative patient counselling. Reported outcomes after anterior urethroplasty should include sexual consequences and relevance, evaluated using validated tools.
PubMed: 34295743
DOI: 10.21037/tau-20-1307 -
Global Spine Journal Sep 2022Systematic review and meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
Patients with lateral cervical disc and foraminal pathology can be treated with anterior and posterior approaches including anterior cervical discectomy and fusion(ACDF), cervical total disc arthroplasty(TDA), and minimally invasive posterior cervical foraminotomy(MIS-PCF). Although MIS-PCF may have some advantages over the anterior approaches, few comparative studies and meta-analyses have been done to assess superiority.
METHODS
This study includes a systematic review of the literature and meta-analysis of studies directly comparing minimally invasive posterior cervical foraminotomy to either anterior cervical discectomy and fusion or cervical total disc arthroplasty.
RESULTS
In comparing patients undergoing ACDF and MIS-PCF, operative time ranged from 68 to 97.8 minutes in the ACDF group compared to 28 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 33.84 to 112.8 hours in the ACDF group compared to 13.68 to 83.6 hours in the MIS-PCF group. The total complication rates were 3.72% in the ACDF group and 3.73% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the complication rate between the two procedures(OR .91; 95% CI 0.13, 6.43; P = .92, I = 59%). The total reoperation rate was 3.5% in the ACDF group and 5.4% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the reoperation rate between the two procedures(OR .66; 95% CI 0.33, 1.33; P = .25, I = 0). In comparing patients undergoing TDA and MIS-PCF, operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group. The complication rate ranged from 23.5 to 28.6% in the TDA group and 0 to 14.3% in the MIS-PCF group. The overall reoperation rates were 2.6% in the TDA group and 10.2% in the MIS-PCF group.
CONCLUSIONS
There is no clear superiority between MIS-PCF and ACDF/TDA in terms of operative time, postoperative length of stay, or rate of complications/reoperations. Further studies with increased follow-up intervals >48 months, and higher sample sizes are necessary to determine the true superiority of MIS-PCF and anterior neck approaches in treatment of lateral disc and foraminal pathology.
PubMed: 34879736
DOI: 10.1177/21925682211055094 -
Turkish Neurosurgery 2024To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF).
AIM
To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF).
MATERIAL AND METHODS
Major databases, registries, and other relevant material were screened for prospective trials directly comparing AECD and ACDF. No restrictions were imposed. Meta-analysis was not conducted due to high heterogeneity.
RESULTS
After screening a total of 1339 articles, 2 studies enrolling 225 patients were included. One of these is a randomizedcontrolled- trial, including 120 patients, with a 14% lost to follow-up, showing no statistically significant differences in clinical outcomes according to the visual analogue scale (VAS) of the neck/arm and the North American Spine Society criteria regarding pain/neurological status. Radiological follow-up showed no adjacent-segment disease, with both groups presenting a statistically non-significant progression of a pre-existing adjacent-disc degeneration, and no difference in kyphosis. Recurrence was registered in 7.4% and 6.1% of patients who underwent AECD and ACDF, respectively. No statistically apparent differences in complications were observed. The second is a cohort study, including 135 patients with a 14.8% lost to follow-up. No statistically significant difference was found in clinical outcomes assessed using the VAS of the neck/arm and the neck disability index. No radiological data were provided. Recurrence was reported in 4% and 2% of patients in the AECD and ACDF group, respectively. No remarkable differences in complications were reported. Both studies reported that the surgical time was statistically shorter in AECD.
CONCLUSION
A definitive conclusion cannot be drawn. Single-level AECD seems to have results equivalent to ACDF, presenting even some benefits. Technical limitations combined with required surgical skills and experience should be considered. We recommend cautious employment in anticipation of future updates.
Topics: Humans; Diskectomy; Spinal Fusion; Cervical Vertebrae; Endoscopy; Treatment Outcome; Intervertebral Disc Degeneration
PubMed: 38650569
DOI: 10.5137/1019-5149.JTN.44424-23.2 -
Clinical Cardiology Apr 2023The efficacy of anteriolateral versus anterior-posterior electrode positions in the success of atrial fibrillation's (AF) electrical cardioversion is unclear. Our aim is... (Meta-Analysis)
Meta-Analysis Review
The efficacy of anteriolateral versus anterior-posterior electrode positions in the success of atrial fibrillation's (AF) electrical cardioversion is unclear. Our aim is to perform a meta-analysis to compare the success rate of both electrode positions. PUBMED, WOS, OVID, and SCOPUS were searched. Inclusion criteria were clinical trials that compared anterior-lateral with anterior-posterior electrodes in external cardioversion of AF. After the full-text screening, 11 trials were included in the analysis. The total number of patients included in the study is 1845. The pooled analysis showed a statistically significant association between anterior-lateral electrode and increased cardioversion rate of AF (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.02-1.92, p = .04). Subgroup analysis revealed a statistically significant association between the anterior-lateral electrode and increased cardioversion rate of AF in subgroups of less than five shocks, patients with 60 years old or more and patients with left atrial (LA) diameter >45 mm (OR = 1.72, 95% CI = 1.17-2.54, p = .006), (OR = 1.73, 95% CI = 1.18-2.54, p = .005), and (OR = 1.86, 95% CI = 1.04-3.34, p = .04), respectively. Anteriolateral electrode is more effective than anterior-posterior electrode in external cardioversion of AF, particularly in patients who have received less than 5 shocks, are 60 years old or older and have a LA diameter greater than 45 mm.
Topics: Humans; Middle Aged; Atrial Fibrillation; Electric Countershock; Heart Atria; Electrodes; Atrial Appendage; Treatment Outcome
PubMed: 36756856
DOI: 10.1002/clc.23987 -
Arthroscopy, Sports Medicine, and... Aug 2022To summarize the quantitative and qualitative anatomy of the acromioclavicular (AC) and coracoclavicular (CC) ligaments of the AC joint. (Review)
Review
PURPOSE
To summarize the quantitative and qualitative anatomy of the acromioclavicular (AC) and coracoclavicular (CC) ligaments of the AC joint.
METHODS
A systematic review of the literature evaluating the quantitative and qualitative anatomy of the CC and AC ligaments of the AC joint was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS
The conoid ligament (CL) arises from the posterior coracoid precipice and courses with a tapered inferior apex to insert on the conoid tubercle of the posteroinferior clavicle. The trapezoid ligament originates from the anterior-superior coracoid with medially extending fibers anterior to the conoid's C-shaped footprint and runs with the CL to insert along the trapezoid line on the inferior aspect of the anterior clavicle, anterolateral to the conoid tubercle. The AC capsule's superoposterior bundle and the CL are robust stabilizing ligaments characterized by prominent attachment sites to the posteroinferior clavicle.
CONCLUSIONS
Clear and consistent quantitative and qualitative descriptions of the CC ligaments (CL and trapezoid ligament) have been well defined; however, quantitative data on the capsuloligamentous anatomy of AC ligaments (superoposterior and anteroinferior) ligaments) remain limited.
CLINICAL RELEVANCE
There are high complication and failure rates after AC joint stabilization. To improve patient outcomes, the anatomy of the CC and AC joints needs to be better understood.
PubMed: 36033198
DOI: 10.1016/j.asmr.2022.04.026 -
Osteoarthritis and Cartilage Open Sep 2023Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical... (Review)
Review
Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments.
INTRODUCTION
Context: The development of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is now widely recognized. The impact of surgical or non-surgical management on the development of post-traumatic osteoarthritis is still debated in the medical community.Here, we present a meta-analysis comparing the impact of surgical or non-surgical management of ACL injuries on the development of knee OA.
METHOD
A systematic literature review was conducted using data from the PubMed, EMBASE, Medline, and Cochrane libraries from February to May 2019. Only randomized clinical trials published between 2005 and 2019 with a non-surgical group and a surgical group were included to explore the onset or progression of knee OA after ACL injury. Trials had to have at least one radiographic endpoint (Kellgren-Lawrence scoring system). Heterogeneity was assessed using the Cochrane's Q and I statistical methods.
RESULTS
Only three randomized controlled trials met the inclusion criteria and were selected for meta-analysis. Of the 343 injured knees included in the studies, 180 underwent ACL reconstruction and 163 underwent non-surgical treatment. The relative risk of knee osteoarthritis was higher after surgery than after non-surgical treatment (RR 1.72, CI 95% [1.18-2.53], I = 0%).
CONCLUSION
The results of this meta-analysis suggest a predisposition to knee osteoarthritis after ACL reconstruction surgery compared with non-surgical management. Due to the small number of good quality studies available, further well-conducted randomised studies are needed to confirm these findings.
PubMed: 37252633
DOI: 10.1016/j.ocarto.2023.100366