-
Orthopaedic Journal of Sports Medicine Dec 2023There has been recent debate regarding the optimal surgical management strategy for recurrent patellofemoral instability in the presence of an increased tibial... (Review)
Review
Does Tibial Tuberosity Osteotomy Improve Outcomes When Combined With Medial Patellofemoral Ligament Reconstruction in the Presence of Increased Tibial Tuberosity-Trochlear Groove Distance? A Systematic Review and Meta-analysis.
BACKGROUND
There has been recent debate regarding the optimal surgical management strategy for recurrent patellofemoral instability in the presence of an increased tibial tuberosity-trochlear groove (TT-TG) distance. In particular, performing a combined tibial tuberosity osteotomy (TTO) and medial patellofemoral ligament reconstruction (MPFLR) for patients with a TT-TG >20 mm has been questioned, with the hypothesis that an isolated MPFLR (iMPFLR) would be just as effective.
PURPOSE
To pool and compare outcomes after MPFLR+TTO versus iMPFLR in patients with a TT-TG >20 mm.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
PubMed-MEDLINE, Embase, Web of Science, and Cochrane Central were searched, and a systematic review was performed. Included were studies that reported postoperative redislocation rates and/or functional outcome scores for patients with recurrent patellar instability and a TT-TG >20 mm who underwent either MPFLR+TTO or iMPFLR and had minimum 2-year follow-up data. Methodologic quality was assessed using the modified Coleman Methodology Score (mCMS). A proportional meta-analysis comparing redislocation, subjective instability, and total complication rates was performed, and mean postoperative functional outcome scores were pooled using a random-effects model with a restricted maximum likelihood estimator.
RESULTS
In total, 1548 studies were screened, from which 13 were included for analysis. Of the 386 included patients (406 knees), 276 underwent MPFLR+TTO and 110 underwent iMPFLR. The mean mCMS was 61.3 ± 10.5 (range, 48-77). The pooled postoperative redislocation rate was 1.22% (95% CI, 0.22%-7%), with no significant difference between the study groups ( = .9995). The pooled complication rate was 10.17% (95% CI, 6.2%-16.3%) with no difference between groups ( = .9275), although the MPFLR+TTO group had higher heterogeneity in complication rates ( = 79.4%) compared with iMPFLR ( = 0%). There was no group difference in the pooled postoperative Lysholm scores ( = .5177), but patients who underwent iMPFLR had significantly higher postoperative Kujala scores compared with those who underwent MPFLR+TTO ( = .0283).
CONCLUSION
Even in the presence of previously indicative anatomic factors (TT-TG >20 mm), TTO combined with MPFLR does not seem to confer additional benefit compared with iMPFLR. This finding could be advantageous in minimizing the burden of additional surgery with its associated risks. The study findings should, however, be interpreted with caution given the heterogeneity of the studies.
PubMed: 38107841
DOI: 10.1177/23259671231195905 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Aug 2023To evaluate the effects of a Twin-block appliance on the condyles of patients with ClassⅡmalocclusion by conducting a systematic review and a Meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the effects of a Twin-block appliance on the condyles of patients with ClassⅡmalocclusion by conducting a systematic review and a Meta-analysis.
METHODS
Pubmed, Embase, Cochrane Library, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and VIP Database were electronically searched. Randomized controlled trials, controlled clinical trials, and single-arm trials on condylar changes produced by a Twin-block appliance in patients with ClassⅡmalocclusion were included. Two reviewers independently extracted and assessed the risk of bias. Meta-analyses were conducted with Review Manager 5.3.
RESULTS
Eight studies were included; among which, seven were of high quality. After treatment with a twin block appliance, condyles moved anteriorly. The anterior joint spaces decreased (<0.000 01), whereas the posterior spaces increased (<0.000 01). The superior spaces were not changed (=0.11). Moreover, a significant difference was observed in the increase of the condylar space index (<0.000 01). After treatment, the anteroposterior diameters of the condyles and condylar height increased (=0.000 2 and <0.000 01, respectively). By contrast, no significant changes were discovered in the medial external diameters of the condyles (=0.42).
CONCLUSIONS
A Twin-block appliance can promote the growth of a condyle in the posterior and upper direction and move it forward in favor of the correction of Class Ⅱ malocclusion.
Topics: Humans; Malocclusion, Angle Class II; Temporomandibular Joint; Bone and Bones; China; Orthodontic Appliances, Functional; Cephalometry
PubMed: 37474479
DOI: 10.7518/hxkq.2023.2023052 -
Children (Basel, Switzerland) May 2021This study aimed to review the data available in the current literature concerning the complications and recurrence of instability following medial patellofemoral...
BACKGROUND
This study aimed to review the data available in the current literature concerning the complications and recurrence of instability following medial patellofemoral ligament (MPFL) reconstruction for patellar instability in young and adolescent patients (those <20 years old).
METHODS
A systematic review was performed based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two independent reviewers searched the PubMed, Scopus, EMBASE, and Cochrane databases. The terms "medial patellofemoral ligament" or "MPFL" and "reconstruction" and "young" or "adolescents" or "children" were used. The inclusion criteria for the literature review comprised studies that reported the complications and recurrences of instability in patients who had undergone MPFL reconstruction for patellar instability.
RESULTS
In all, 332 patients were included in the review, of which 195 were females (63.5%) and 112 were males (36.5%), and they totaled 352 treated knees. The mean age at the time of the surgery was 14.28 years, and the mean follow-up duration was 30.17 months. A total of 16 (4.5%) complications were reported: one (0.3%) patella fracture, one (0.3%) screw removal due to intolerance, one (0.3%) infection, five (1.4%) wound complications, six (1.7%) subluxations and two (0.6%) instances of post-operative stiffness. A total of 18 (5.1%) recurrences of patellar instability were recorded.
CONCLUSIONS
MPFL reconstruction in young patients can be considered an effective and safe treatment leading to clinical improvement in terms of recurrence of dislocation. No major complications related to the technique were reported, but a high level of research evidence is required to better evaluate the clinical results in a long-term follow-up.
PubMed: 34064244
DOI: 10.3390/children8060434 -
Knee Surgery & Related Research Jun 2023This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute... (Review)
Review
PURPOSE
This study sought to clarify treatment evidence to treat patellar dislocation by evaluating which treatment could yield better improvement of clinical outcomes for acute patellar dislocation in children and adolescents 18 years of age or younger.
MATERIALS AND METHODS
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials electronic databases were searched for relevant articles comparing clinical outcomes of conservative and surgical treatments for acute patellar dislocation in children and adolescents published from March 2008 to August 2022. Data searching, extraction, analysis, and quality assessment were performed on the basis of the Cochrane Collaboration guidelines. The quality assessment of each study was investigated using the Physiotherapy Evidence Database (PEDro) critical appraisal scoring system and Newcastle-Ottawa Quality Assessment Scale scores. To calculate the overall combined effect size for each outcome, Review Manager Version 5.3 (The Cochrane Collaboration, Software Update, Oxford) was employed.
RESULTS
Three randomized controlled trials (RCTs) and one prospective study were investigated. In terms of pain [mean difference (MD) 6.59, 95% confidence interval (CI) 1.73-11.45, I 0%], there were significantly better outcomes in conservative group. Nevertheless, there were no significant differences in any evaluated outcomes such as redislocation [risk ratio (RR) 1.36, 95% CI 0.72-2.54, I 65%], Kujala score (MD 3.92, 95% CI -0.17 to 8.01, I 0%), Tegner score (MD 1.04, 95% CI -0.04 to 2.11, I 71%), or subjective results (RR 0.99, 95% CI 0.74-1.34, I 33%) between conservative and surgical treatment groups.
CONCLUSIONS
Despite better pain outcomes with conservative group, the present study revealed no significant differences in clinical outcomes between conservative treatment and surgical treatment in children and adolescents with acute patellar dislocation. Since there are no significant differences in clinical outcomes between the two groups, routine surgical treatment is not advocated for treating acute patellar dislocation in children and adolescents.
PubMed: 37349852
DOI: 10.1186/s43019-023-00189-z -
The American Journal of Sports Medicine Nov 2016A patellar dislocation is a common knee injury in the young, athletic patient population. Recent trends indicate that the use of long-term nonoperative treatment is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A patellar dislocation is a common knee injury in the young, athletic patient population. Recent trends indicate that the use of long-term nonoperative treatment is decreasing, and surgical intervention is more commonly recommended for those patients who fail initial nonoperative management with recurrent patellar dislocations. Medial patellofemoral ligament (MPFL) reconstruction has become increasingly utilized in this regard.
PURPOSE
To evaluate outcomes, particularly return to sports and its relationship to postoperative instability, of isolated MPFL reconstruction for the treatment of recurrent patellar dislocations.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A review of the current literature was performed using the terms "medial patellofemoral ligament reconstruction" and "MPFL reconstruction" in the electronic search engines PubMed and EBSCOhost (CINAHL, MEDLINE, SPORTDiscus) on July 29, 2015, yielding 1113 abstracts for review. At the conclusion of the search, 14 articles met the inclusion criteria and were included in this review of the literature. Means were calculated for population size, age, follow-up time, and postoperative Tegner scores. Pooled estimates were calculated for postoperative Kujala scores, return to play, total risk of postoperative instability, risk of positive apprehension sign, and risk of reoperation.
RESULTS
The mean patient age associated with MPFL reconstruction was 24.4 years, with a mean postoperative Tegner score of 5.7. The pooled estimated mean postoperative Kujala score was 85.8 (95% CI, 81.6-90.0), with 84.1% (95% CI, 71.1%-97.1%) of patients returning to sports after surgery. The pooled total risk of recurrent instability after surgery was 1.2% (95% CI, 0.3%-2.1%), with a positive apprehension sign risk of 3.6% (95% CI, 0%-7.2%) and a reoperation risk of 3.1% (95% CI, 1.1%-5.0%).
CONCLUSION
A high percentage of young patients return to sports after isolated MPFL reconstruction for chronic patellar instability, with short-term results demonstrating a low incidence of recurrent instability, postoperative apprehension, and reoperations.
Topics: Humans; Incidence; Joint Instability; Patellar Dislocation; Patellar Ligament; Postoperative Period; Recurrence; Return to Sport; Treatment Outcome
PubMed: 26872895
DOI: 10.1177/0363546515624673 -
Diagnostics (Basel, Switzerland) Nov 2022We sought to systematically review and meta-analy the role of cerebral blood flow (CBF) in the medial temporal lobe (MTL) using arterial spin labeling magnetic resonance... (Review)
Review
We sought to systematically review and meta-analy the role of cerebral blood flow (CBF) in the medial temporal lobe (MTL) using arterial spin labeling magnetic resonance imaging (ASL-MRI) and compare this in patients with Alzheimer's disease (AD), individuals with mild cognitive impairment (MCI), and cognitively normal adults (CN). The prevalence of AD is increasing and leading to high healthcare costs. A potential biomarker that can identify people at risk of developing AD, whilst cognition is normal or only mildly affected, will enable risk-stratification and potential therapeutic interventions in the future. All studies investigated the role of CBF in the MTL and compared this among AD, MCI, and CN participants. A total of 26 studies were included in the systematic review and 11 in the meta-analysis. Three separate meta-analyses were conducted. Four studies compared CBF in the hippocampus of AD compared with the CN group and showed that AD participants had 2.8 mL/min/100 g lower perfusion compared with the CN group. Eight studies compared perfusion in the hippocampus of MCI vs. CN group, which showed no difference. Three studies compared perfusion in the MTL of MCI vs. CN participants and showed no statistically significant differences. CBF measured via ASL-MRI showed impairment in AD compared with the CN group in subregions of the MTL. CBF difference was significant in hippocampus between the AD and CN groups. However, MCI and CN group showed no significant difference in subregions of MTL.
PubMed: 36552974
DOI: 10.3390/diagnostics12122967 -
Journal of Orthopaedic Surgery and... Aug 2022We aimed to compare the postoperative clinical efficacy and safety of medial pivot (MP) prosthesis and posterior-stabilized (PS) prosthesis in the treatment of knee... (Meta-Analysis)
Meta-Analysis
PURPOSE
We aimed to compare the postoperative clinical efficacy and safety of medial pivot (MP) prosthesis and posterior-stabilized (PS) prosthesis in the treatment of knee osteoarthritis (KOA).
METHODS
All studies involving MP and PS prosthesis in PubMed, EMBASE, Cochrane Library, and Web of Science were searched since the establishment of the database. The included outcomes were knee range of motion (ROM), functional score, radiographic results, complication rate, and revision rate. Studies were independently evaluated by the Newcastle-Ottawa Scale for case-control studies and the assessment tool of the Cochrane Collaboration for randomized controlled trials. I was used to test the heterogeneity, and fixed- or random-effects models were selected for meta-analysis according to the heterogeneity results.
RESULTS
A total of 19 studies, consisting of 3592 patients and 3783 knees (MP: 1811 knees, PS: 1972 knees), were included in the meta-analysis. The WOMAC (MD = - 1.11, 95% CI - 1.98 to - 0.23; P = 0.01) and HSS (MD = - 4.32, 95% CI - 8.30 to - 0.34; P = 0.03) in the MP group were significantly lower compared with the PS group, and the complication rate (OR 0.53, 95% CI 0.33-0.87; P = 0.01) was also lower compared with the PS group. There was no significant difference in ROM, radiographic results, and revision rate between the two groups (P > 0.5).
CONCLUSIONS
The existing literature provided evidence to support better clinical effect and lower complication rate of MP prosthesis compared to PS prosthesis. These results provide a reference for clinicians when choosing a suitable prosthesis.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Prosthesis Design; Range of Motion, Articular
PubMed: 35986362
DOI: 10.1186/s13018-022-03285-0 -
Indian Journal of Orthopaedics Feb 2023The purpose of this systematic review aimed to investigate the clinical outcome of medial patellofemoral ligament (MPFL) reconstruction, MPFL repair and medial reefing...
PURPOSE
The purpose of this systematic review aimed to investigate the clinical outcome of medial patellofemoral ligament (MPFL) reconstruction, MPFL repair and medial reefing for patients with first-time patellar dislocation.
METHODS
Databases of PubMed, EMBASE, Cochrane Library and Web of Science were searched up to May 8, 2022. Only articles treating first-time patellar dislocation with MPFL reconstruction, MPFL repair and medial reefing were included in the analysis. Eligible identification, data extraction, quality assessment and statistical analysis were performed by two independent reviewers. The primary outcome measures were the incidences of postoperatively redislocation and reoperation. The second outcomes were the Kujala functional score and complications (including infection, osteoarthritis, and loss of range of motion).
RESULTS
Twenty-two studies involving 668 patients met the inclusion criteria. Of which, four studies involving 126 patients were in MPFL reconstruction group, ten studies involving 220 patients in MPFL repair group and 9 studies involving 322 patients in medial reefing group. Our results showed that the MPFL reconstruction (1.8%, 95% CI - 0.5 to 4.0%) had a significantly lower rate of postoperative redislocation and reoperation rate than the MPFL repair (15.4%, 95% CI 5.2-25.7%) and medial reefing (18.0%, 95% CI 9.3-26.7%). Besides, no significant differences were found in the Kujala score and complication rate among the three treatments.
CONCLUSION
The available evidence demonstrated that MPFL reconstruction could achieve significantly lower redislocation rate and reoperation rate than MPFL repair and medial reefing after first-time patella dislocation. Furthermore, there was not enough evidence to reveal that MPFL reconstruction provided better functional outcome compared with MPFL repair and medial reefing. MPFL reconstruction is a preferred surgical treatment for patients with first-time patellar dislocation.
LEVEL OF EVIDENCE
Level IV, systematic review of Level I-IV.
PubMed: 36777132
DOI: 10.1007/s43465-022-00770-w -
Arthritis Care & Research Jul 2016Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Lateral wedge insoles are intended to reduce biomechanical risk factors of medial knee osteoarthritis (OA) progression, such as increased knee joint load; however, there has been no definitive consensus on this topic. The aim of this systematic review and meta-analysis was to establish the within-subject effects of lateral wedge insoles on knee joint load in people with medial knee OA during walking.
METHODS
Six databases were searched from inception until February 13, 2015. Included studies reported on the immediate biomechanical effects of lateral wedge insoles during walking in people with medial knee OA. Primary outcomes of interest relating to the biomechanical risk of disease progression were the first and second peak external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI). Eligible studies were pooled using random-effects meta-analysis.
RESULTS
Eighteen studies were included with a total of 534 participants. Lateral wedge insoles resulted in a small but statistically significant reduction in the first peak EKAM (standardized mean difference [SMD] -0.19; 95% confidence interval [95% CI] -0.23, -0.15) and second peak EKAM (SMD -0.25; 95% CI -0.32, -0.19) with a low level of heterogeneity (I(2) = 5% and 30%, respectively). There was a favorable but small reduction in the KAAI with lateral wedge insoles (SMD -0.14; 95% CI -0.21, -0.07, I(2) = 31%). Risk of methodologic bias scores (quality index) ranged from 8 to 13 out of 16.
CONCLUSION
Lateral wedge insoles cause small reductions in the EKAM and KAAI during walking in people with medial knee OA. Current evidence demonstrates that lateral wedge insoles appear ineffective at attenuating structural changes in people with medial knee OA as a whole and may be better suited to targeted use in biomechanical phenotypes associated with larger reductions in knee load.
Topics: Aged; Biomechanical Phenomena; Disease Progression; Female; Foot Orthoses; Humans; Male; Middle Aged; Osteoarthritis, Knee
PubMed: 26605535
DOI: 10.1002/acr.22797 -
Life (Basel, Switzerland) Dec 2021Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A... (Review)
Review
INTRODUCTION
Chondral and soft tissue injuries can be associated with first time patellar dislocation, but it is unclear how common they are, and which tissues are affected. A systematic review of the literature was performed to investigate the frequency, location, and extent of chondral and medial patellofemoral ligament (MPFL) injuries in patients following first time patellar dislocation.
METHODS
This systematic review was conducted according to the PRISMA guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2021. All the published clinical studies reporting the frequency, location, and extent of soft tissue lesions following first time patellar dislocation were accessed. Studies reporting data on habitual, congenital, or recurrent patellofemoral instability were excluded.
RESULTS
Data from 42 articles (2254 patients, mean age 21.6 ± 7.3 years) were retrieved. Ninety-eight percent of patients who experienced first time patellar dislocation demonstrated MPFL rupture at MRI. Forty-eight percent of MPFL ruptures were located at the patellar side, 34% at the femoral insertion site, and 18% in the midportion. Eighty-five percent of patients showed signs of patellar chondral damage at MRI, and trochlear chondral injuries were evidenced in 47% of patients. Intra-articular loose bodies were observed in 11.5% of patients. At arthroscopy, the medial facet and the crest of the patella more commonly exhibited chondral lesions than the lateral facet and femoral trochlea.
CONCLUSIONS
Most patients suffer chondral damage and MPFL tears following after a first time patellar dislocation.
PubMed: 34947891
DOI: 10.3390/life11121360