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Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Murcia, Spain
Harvard T.H. Chan School of Public Health, Boston, USA
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Purpose
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Different deep-learning models have been employed to aid in the diagnosis of musculoskeletal pathologies. The diagnosis of tendon pathologies could particularly benefit from applying these technologies. The objective of this study is to assess the performance of deep learning models in diagnosing tendon pathologies using various imaging modalities.
Methods
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A meta-analysis was conducted, with searches performed on MEDLINE/PubMed, SCOPUS, Cochrane Library, Lilacs, and SciELO. The QUADAS-2 tool was employed to assess the quality of the studies. Diagnostic measures, such as sensitivity, specificity, diagnostic odds ratio, positive and negative likelihood ratios, area under the curve, and summary receiver operating characteristic, were included using a random-effects model. Heterogeneity and subgroup analyses were also conducted. All statistical analyses and plots were generated using the R software package. The PROSPERO ID is CRD42024506491.
Results
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Eleven deep-learning models from six articles were analyzed. In the random effects models, the sensitivity and specificity of the algorithms for detecting tendon conditions were 0.910 (95% CI: 0.865; 0.940) and 0.954 (0.909; 0.977). The PLR, NLR, lnDOR, and AUC estimates were found to be 37.075 (95%CI: 4.654; 69.496), 0.114 (95%CI: 0.056; 0.171), 5.160 (95% CI: 4.070; 6.250) with a (P < 0.001), and 96%, respectively.
Conclusion
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The deep-learning algorithms demonstrated a high level of accuracy level in detecting tendon anomalies. The overall robust performance suggests their potential application as a valuable complementary tool in diagnosing medical images.
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Purpose
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The aim of this systematic review and meta-analysis is to explore the effect of topical vancomycin powder (VP) in surgical site infection (SSI) prevention and adverse events after joint arthroplasty and to provide a specific theoretical basis for clinical treatment.
Methods
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The review process was conducted according to the PRISMA guidelines. Two independent researchers meticulously screened the literature based on predefined inclusion and exclusion criteria, evaluated the quality of the selected studies, and extracted relevant data. Data analysis was conducted using RevMan 5.4 software.
Results
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This meta-analysis included 24 studies encompassing a total of 34 811 patients. The pooled analysis showed that the topical administration of VP significantly reduced the incidence of SSI. Subgroup analyses by doses, type of joint (hip and knee), and type of surgery (primary and revision) confirmed that vancomycin consistently lowered SSI rates. Moreover, the incidence of SSI caused by gram-negative germs and gram-positive germs decreased following the use of VP, although the reduction was not significant for infections caused by MRSA. However, the use of VP was associated with a significant increase in sterile complications at the incision site and delayed incision healing.
Conclusion
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The topical application of VP is effective in reducing the incidence of infections following joint arthroplasty. Despite an increased risk of complications such as delayed healing of incisions, the pros and cons should be weighed in clinical decision-making. However, it should not be discarded due to side effects.
Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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This review highlights the pivotal role of Kaplan fibers (KFs) in knee stability, particularly in the anterolateral aspect. Studies reveal their complex anatomy with varying attachments to the distal femur, demonstrating a significant impact on knee joint mechanics across different populations.
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Investigations into the biomechanics of KFs show their crucial role in maintaining rotational stability of the knee, especially during rotational movements. Their synergistic function with other knee structures, like the anterolateral ligament, is emphasized, underscoring their importance in knee integrity and function.
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MRI emerges as a key tool in detecting KFs, with varying visibility and prevalence of injuries. The review discusses the development of MRI criteria for accurate diagnosis, highlighting the need for further research to refine these criteria and understand the interplay between KF injuries, anterior cruciate ligament (ACL) ruptures, and associated knee pathologies.
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The review covers various lateral extra-articular tenodesis (LET) techniques used to address residual laxity and instability following ACL reconstruction. Among them, the modified Lemaire technique, which resembles the anatomical and functional characteristics of distal KFs, shows effectiveness in reducing internal rotation and residual laxity.
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The review emphasizes the need for further research to understand the healing dynamics of KF injuries and the efficacy of different LET techniques. It suggests that a comprehensive approach, considering both biomechanical and clinical aspects, is crucial for advancing knee joint health and rehabilitation.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
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Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
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Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
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Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
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Department of Traumatology, Orthopaedics and Disaster Surgery, Moscow, Russia
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Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
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Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele, Milan, Italy
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Purpose
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Growing interest surrounds the role of human gut microbiome in the development of degenerative pathologies such as osteoarthritis (OA), but microbes have recently been detected also in other sites previously considered to be sterile. Evidence emerged suggesting that even native and osteoarthritic knee joints may host several microbial species possibly involved in the osteoarthritic degeneration. This is the first systematic review critically collecting all the available evidence on the existence and composition of knee intra-articular microbiome.
Methods
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A systematic research on the PubMed, Cochrane and Google Scholar databases was performed. Human clinical studies investigating the presence of intra-articular microbiome in native osteoarthritic knee joints with next-generation sequencing techniques were collected.
Results
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A total of eight studies were included reporting data on 255 knees. All the included studies reported evidence supporting the existence of an intra-articular microbiome in native knee joints, with detection rates varying from 5.8% to 100%. Bacteria from the Proteobacteria phylum were found to be among the most identified followed by the Actinobacteria, Firmicutes, Fusobacteria, and Bacteroideta phyla. Proteobacteria phylum were also found to be more common in osteoarthritic knees when compared to healthy joints. Furthermore, several pathways correlating those microbes to knee OA progression have been suggested and summarized in this review.
Conclusions
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Evidence collected in this systematic review suggests that the native knee joint, previously presumed to be a sterile environment, hosts a peculiar intra-articular microbiome with a unique composition. Furthermore, its alteration may have a link with the progression of knee osteoarthritis.
School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
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School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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Purpose
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Low back pain (LBP) has a significant impact on the general population, especially on military personnel. This study aimed to systematically review the relevant literature to determine the prevalence and risk factors of low back pain among military personnel from different military occupational categories.
Methods
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For this systematic review, we searched Embase, PubMed, and Cochrane. We performed study selection, data extraction, and assessed the quality of the evidence using the adapted risk of bias assessment tool by Hoy et al. This review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study is registered on the Center for Open Science, registration DOI: 10.17605/OSF.IO/HRGE8.
Results
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Out of 860 papers, 19 studies met the inclusion criteria. More than 360 000 military people with lumbar pain situation were considered for inclusion in this systematic review. The 1-year prevalence of LBP could be up to 81.7% in the Army, 5.2% in the Marines, and 48.1% in the Air Force. Age (OR = 0.494–2.89), history of LBP (OR = 2.2–8.91), and sedentary position (OR = 0.55–3.63) were the most common physical, sociodemographic, and occupational risk factors, respectively.
Conclusions
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Low back pain was prevalent among military personnel. There was heterogeneity in studies and a significant difference in prevalence and incidence across various occupational categories. Physical, sociodemographic, and occupational risk factors were researched more than psychological risk factors in the military.
CETAPS UR3832, Research Center for Sports and Athletic Activities Transformations, University of Rouen Normandy, Mont-Saint-Aignan, France
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Purpose
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Recurrence of hallux valgus (HV) following corrective surgery is a frequent concern. A recent systematic review estimated recurrence of HV in only 4.9%, which may be an underestimation, as most included studies had short- to mid-term follow-up. The purpose of this systematic review and meta-analysis was to synthesize and critically appraise the literature on the long-term outcomes of shaft osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis, and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years.
Methods
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This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of shaft osteotomies of the M1 for non-inflammatory and non-degenerative HV having a minimum follow-up of 5 years were included. We found five eligible studies comprising six datasets, all assessed Scarf osteotomies with a mean follow-up that ranged from 8 to 14 years.
Results
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The HV recurrence rate was 40%, considering the threshold of >15° hallux valgus angle (HVA), 30% having >20°, and 2% having >25°.
Conclusion
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At a minimum follow-up of 8 years following shaft osteotomies of M1, the HVA was 15.9°, the intermetatarsal angle (IMA) was 7.7°, and the DMAA was 8.3°. Furthermore, the recurrence rates considering the various thresholds of HVA were: 40% having >15°, 20% having >20°, and 2% having >25°.
Level of Evidence
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Meta-analysis, Level IV
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Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H., Germany
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Purpose
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The purpose of the present scoping review is to identify sources of heterogeneity in reporting domains that have the potential to improve surgical decision-making in reverse shoulder arthroplasty associated with glenoid bone grafting.
Methods
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A scoping review was conducted according to the JBI and PRISMA ScR guidelines. Articles covering glenoid bone grafting at the time of reverse shoulder replacement, published between 2012 and 2022 in MEDLINE, Scopus, Epistemonikos, Web of Science, and Cochrane Database of Systematic Reviews, were searched. Reporting of core outcome measures, as well as prosthesis-related variables, rehabilitation protocols, radiographic evaluation methods, and bone graft incorporation assessments, were collected.
Results
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For the final analysis, a total of 14 articles were considered. There were 649 operated shoulders with a mean patient age of 72 years, ranging from 48 to 85 years. Analysis of preoperative ranges of motion and patient-reported outcome measures revealed increased heterogeneity in patient selection between studies. Reporting of implant-related parameters was the most inconsistent. Rehabilitation protocols were scarcely reported. Assessment of graft incorporation and radiographic evaluation of choice revealed that there is no consistent method or measurement and the clinical relevance of radiolucent lines at the graft-glenoid bone interface is unclear.
Conclusion
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Addressing implant-related reporting gaps has the highest potential to improve surgical decision-making and provide orthopedic surgeons with a more comprehensive understanding of published results on glenoid bone grafting at the time of primary reverse shoulder arthroplasty.
Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Trauma Orthopaedic Research Copenhagen Hvidovre (TORCH), Department of Orthopaedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
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Advanced therapies are expected to play a crucial role in supporting repair after injury, halting the degeneration of musculoskeletal tissue to enable and promote physical activity.
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Despite advancements, the progress in developing advanced therapies in orthopaedics lags behind specialties like oncology, since innovative regenerative treatment strategies fall short of their expectations in musculoskeletal clinical trials.
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Researchers should focus on understanding the mechanism of action behind the investigated target before conducting clinical trials.
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Strategic research networks are needed that not only enhance scientific exchange among like-minded researchers but need to include early on commercial views, companies and venture perspectives, regulatory insights and reimbursement perspectives. Only in such collaborations essential roadblocks towards clinical trials and go-to-patients be overcome.
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Department of Mechanical Engineering, University College London, UK
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Department of Mechanical Engineering, University College London, UK
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Royal National Orthopaedic Hospital, Stanmore, UK.
Cleveland Clinic London, London, UK
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Three-dimensional printing is a rapidly growing manufacturing method for orthopaedic implants and it is currently thriving in several other engineering industries. It enables the variation of implant design and the construction of complex structures which can be exploited in orthopaedics and other medical sectors.
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In this review, we develop the vocabulary to characterise 3D printing in orthopaedics from terms defined by industries employing 3D printing, and by fully examining a 3D-printed off-the-shelf acetabular cup (Fig. 1). This is a commonly used 3D-printed implant in orthopaedics, and it exhibits a range of prominent features brought about by 3D printing.
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The key features and defects of the porous and dense regions of the implant are clarified and discussed in depth to determine reliable definitions and a common understanding of characteristics of 3D printing between engineers and medical experts in orthopaedics.
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Despite the extensive list of terminology derived here, it is clear significant gaps exist in the knowledge of this field. Therefore, it is necessary for continued investigations of unused implants, but perhaps more significantly, examining those in vivo and retrieved to understand their long-term impact on patients and the effects of certain features (e.g. surface-adhered particles).
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Analyses of this kind will establish an understanding of 3D printing in orthopaedics and additionally it will help to update the regulatory approach to this new technology.
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Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland
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Purpose
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Intra-articular corticosteroid (CS) injections for knee osteoarthritis (OA) management are endorsed by several scientific societies, while the use of hyaluronic acid (HA) and platelet-rich plasma (PRP) is more controversial. Aim of the study was to quantify and compare the clinical effectiveness of CS injections with respect to HA and PRP in patients with knee OA.
Methods
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The search was conducted on PubMed, Cochrane, and Web of Science following the PRISMA guidelines. Randomized controlled trials (RCTs) on the comparison of CS injections and HA or PRP injections for the treatment of knee OA were included. The minimal clinically important difference (MCID) was used to interpret the clinical relevance of the improvements at different follow-ups up to 12 months. The study quality was assessed using the Cochrane RoB-2 tool and the GRADE guidelines.
Results
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Thirty-five RCTs were included (3348 patients). The meta-analysis comparing CS and HA revealed no difference in terms of WOMAC improvement, while HA showed superior VAS pain improvement at long-term follow-up (P = 0.011), without reaching the MCID. PRP offered a superior WOMAC improvement compared to CS at short- (P = 0.002), mid- (P < 0.001, exceeding the MCID), and long-term (P < 0.001, exceeding the MCID) follow-ups. PRP offered a superior VAS improvement at mid- (P < 0.001, exceeding the MCID) and long-term (P = 0.023) follow-ups.
Conclusion
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CS injections for knee OA offer similar results to HA and PRP only at short term, while there is an overall superiority of PRP at longer follow-ups. This difference is not only statistically significant but also clinically relevant in favour of PRP.
