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Search for other papers by Markus Jaschke in
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Distal biceps tendon (DBT) is a relatively rare injury mainly occurring in middle-aged men while in eccentric biceps muscle contraction.
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Clinical appearance with proximal avulsion of the muscle and specific clinical tests are most of the time sufficient for diagnosing DBT, but if needed ultrasonography and MRI, most often in FABS view, can be used to ensure diagnosis of DBT and partial DBT.
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Surgical anatomical reinsertion has shown to be a successful method of treatment, although conservative treatment can be initiated in older patients.
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Two different approaches are described in literature: single- and double-incision techniques with different fixation methods proving to have similarly good results.
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Major complications of surgical intervention are posterior interosseous nerve palsy and symptomatic heterotropic ossification.
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Overall outcome of surgical intervention has shown high subjective satisfaction with slight weakness in flexion and supination but mostly without loss in range of motion.
Department of Orthopaedics, University Hospital of Ghent, Ghent, Belgium
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Department of Electromechanics, InViLab research group, University of Antwerp, Antwerp, Belgium
Department of Trauma and Orthopedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Purpose
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Emerging reports suggest an important involvement of the ankle/hindfoot alignment in the outcome of knee osteotomy; however, a comprehensive overview is currently not available. Therefore, we systematically reviewed all studies investigating biomechanical and clinical outcomes related to the ankle/hindfoot following knee osteotomies.
Methods
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A systematic literature search was conducted on PubMed, Web of Science, EMBASE and Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on international prospective register of systematic reviews (PROSPERO) (CRD42021277189). Combining knee osteotomy and ankle/hindfoot alignment, all biomechanical and clinical studies were included. Studies investigating knee osteotomy in conjunction with total knee arthroplasty and case reports were excluded. The QUality Appraisal for Cadaveric Studies (QUACS) scale and Methodological Index for Non-Randomized Studies (MINORS) scores were used for quality assessment.
Results
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Out of 3554 hits, 18 studies were confirmed eligible, including 770 subjects. The minority of studies (n = 3) assessed both high tibial- and distal femoral osteotomy. Following knee osteotomy, the mean tibiotalar contact pressure decreased (n = 4) except in the presence of a rigid subtalar joint (n = 1) or a talar tilt deformity (n = 1). Patient symptoms and/or radiographic alignment at the level of the ankle/hindfoot improved after knee osteotomy (n = 13). However, factors interfering with an optimal outcome were a small preoperative lateral distal tibia angle, a small hip–knee–ankle axis (HKA) angle, a large HKA correction (>14.5°) and a preexistent hindfoot deformity (>15.9°).
Conclusions
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Osteotomies to correct knee deformity alter biomechanical and clinical outcomes at the level of the ankle/hindfoot. In general, these changes were beneficial, but several parameters were identified in association with deterioration of ankle/hindfoot symptoms following knee osteotomy.
Search for other papers by Mattia Alessio-Mazzola in
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Purpose
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The results of total knee arthroplasty (TKA) following anterior cruciate ligament (ACL) reconstruction are still under-investigated. The purpose of this research is to investigate the differences between TKA after ACL reconstruction and TKA for primary osteoarthritis through a review and meta-analysis of the literature.
Methods
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Case–control and cohort studies reporting outcomes of TKA following ACL reconstruction were considered eligible for inclusion. The primary endpoint was to systematically review and meta-analyze the reported complications of TKA following ACL reconstruction. The outcomes have been compared with a group of patients who underwent TKA for primary knee osteoarthritis (OA) with any previous ACL surgery. Secondary endpoints were to assess and compare technical difficulties and results including the operative time, the use of revision components, the request for intraoperative release or additional procedures, the revision rate, and the clinical outcomes.
Results
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Seven studies were included involving 1645 participants, 619 of whom underwent TKA in previous ACL reconstruction and 1026 TKA for primary OA with no previous ACL reconstruction. Meta-analysis showed that TKA in previous ACL reconstruction had a significantly higher complication rate (OR = 2.15, P < 0.001), longer operative times (mean differences (MD): 11.19 min; P < 0.001) and increased use of revision components (OR = 2.16; P < 0.001) when compared to the control group without differences of infection, and revision rate.
Conclusions
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TKA in a previous ACL reconstruction has a significantly higher complication rate, longer operative times, and a higher need for revision components and intraoperative soft tissue releases in comparison to TKA for primary OA without previous ACL reconstruction.
Personalized Arthroplasty Society, Atlanta, Georgia, USA
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
Clinique Orthopédique Duval, Laval, Quebec, Canada
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Personalized Arthroplasty Society, Atlanta, Georgia, USA
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Advanced hemophilic knee arthropathy is a frequent and devastating manifestation of severe hemophilia with significant implications for activities of daily living.
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Hemophilic arthropathy is caused by repeated bleeding, resulting in joint degeneration, pain, deformity and disability.
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In patients with hemophilia and advanced disease, total knee arthroplasty (TKA) has proven to be the most successful intervention, improves physical function and reduces knee pain.
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Hemophilic patients carry additional risks for complications and required specific pre/postoperative considerations. Expert treatment center should be used to improve patient outcome.
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Hemophilic patients present significant surgical challenges such as joint destruction, bone loss, severe ankylosis and oligoarticular involvement. The surgeon performing the arthroplasty must be experienced to manage such problems.
Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
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Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
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Institute of Orthopaedics and Musculoskeletal Science, University College London, United Kingdom
Cleveland Clinic London, United Kingdom
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CT is the principal imaging modality used for the pre-operative 3D planning and assessment of total hip arthroplasty (THA).
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The image quality offered by CT has a radiation penalty to the patient. Higher than necessary radiation exposure is of particular concern when imaging young patients and women of childbearing age, due to the greater risk of radiation-induced cancer in this group.
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A harmonised low-dose CT protocol is needed, evidenced by the huge variability in the 17 protocols reviewed. The majority of the protocols were incomplete, leading to uncertainty among radiographers when performing the scans.
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Only three protocols (20%) were optimised for both ‘field of view’ and image acquisition parameters. 10 protocols (60%) were optimised for ‘field of view’ only. These protocols included imaging of the relevant landmarks in the bony pelvis in addition to the knees – the reference for femoral anteversion.
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CT parameters, including the scanner kilovoltage (kV), milliamperage–time product (mAs) and slice thickness, must be optimised with a ‘field of view’ that includes the relevant bony landmarks. The recommended kV and mAs values were very wide ranging from 100 to 150 and from 100 to 250, respectively.
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The large variability that exists amongst the CT protocols illustrates the need for a more consistent low-dose CT protocol for the planning of THA. This must provide an optimal balance between image quality and radiation dose to the patient.
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Current CT scanners do not allow for measurements of functional pelvic orientation and additional upright imaging modalities are needed to augment them.
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Purpose
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The use of non-biodegradable suture anchors (NBSA) in arthroscopic rotator cuff repair (RCR) has increased significantly. However, several complications such as migration, chondral damage, revision, and imaging difficulties have been reported. Meanwhile, the effectiveness of biodegradable suture anchors (BSA) in overcoming such complications and achieving functional outcomes requires further study. Thus, we aim to compare the clinical outcomes and complications of RCR using BSA and NBSA using direct comparison studies.
Methods
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Two independent reviewers conducted systematic searches in PubMed, Embase, Cochrane Library, and Web of Science from conception to September 2022. Using the RoB 2 and ROBINS-I tools, we assessed the included studies for bias. We applied GRADE to appraise our evidence. Our PROSPERO registration number is CRD42022354347.
Results
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Six studies (two randomized controlled trials, one retrospective cohort, and three case–control studies) involving 423 patients were included (211 patients received BSA and 212 patients received NBSA). BSA was comparable to NBSA in forward flexion, abduction, external rotation, Constant–Murley score, and perianchor cyst formation (P = 0.97, 0.81, 0.56, 0.29, and 0.56, respectively). Retear rates were slightly higher while tendon healing was reduced in BSA compared to NBSA, but the differences were not significant (P = 0.35 and 0.35, respectively).
Conclusion
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BSA and NBSA appear to yield similar shoulder functions and complications in rotator cuff repairs.
Search for other papers by Pududu Archie Rachuene in
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Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa
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Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa
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Structural glenoid defects are common during primary reverse shoulder arthroplasty (RSA) and are often associated with poor outcomes.
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The lack of pre-operative imaging protocols for determining the depth and degree of glenoid wear hinders our ability to accurately plan and correct these defects.
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Although bone grafting has been reported to be effective in reducing glenoid wear during RSA, there is limited information on when to utilise it and how to prepare the graft.
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We conducted this review to assess the evidence for the management of glenoid defects, with an emphasis on bone grafts to treat structural glenoid bone loss in primary RSA patients.
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Trauma and Orthopedics Department, Centre of Posgraduate Medical Education, Otwock, Poland
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Purpose
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The goal of this study was to review available literature on periprosthetic shoulder fractures to evaluate epidemiology, risk factors and support clinical decision-making regarding diagnostics, preoperative planning, and treatment options.
Methods
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Two authors cross-checked the PubMed and Web of Science medical databases. The inclusion criteria were as follows: original human studies published in English, with the timeframe not limited, and the following keywords were used: ‘periprosthetic shoulder fracture,’ ‘total shoulder arthroplasty periprosthetic fractures,’ ‘total shoulder arthroplasty fracture,’ and ‘total shoulder replacement periprosthetic fracture.’ Seventy articles were included in the review. All articles were retrieved using the aforementioned criteria.
Results
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The fracture rate associated with total shoulder arthroplasty varied between 0 and 47.6%. Risk factors for periprosthetic fractures were female gender, body mass index < 25 kg/m2, smoking, rheumatoid arthritis, and Parkinson’s disease. The most commonly used classification is the Wright and Coefield classification. Periprosthetic fractures can be treated both, conservatively and operatively.
Conclusion
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Periprosthetic fracture frequency after shoulder arthroplasty ranges from 0 to 47.6%. The most common location of the fracture is the humerus and most commonly occurs intraoperatively. The most important factor influencing treatment is stem stability. Fractures with stem instability require revision arthroplasty with stem replacement. Fractures with a stable stem depending on the location, displacement and bone stock quality can be treated both conservatively and operatively. For internal fixation plates with cables and screws are most commonly used.
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Department of Surgery, EOC, Service of Orthopaedics and Traumatology, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Purpose
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The study of the placebo effect is key to elucidate the ‘real effect’ of conservative interventions for plantar fasciitis. The aim of this meta-analysis was to quantify the impact of placebo in the different conservative treatments of plantar fasciitis.
Methods
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A systematic literature review was performed on double-blind placebo-controlled trials (RCTs) according to PRISMA guidelines on PubMed, Embase, and Web of Science. The meta-analysis primary outcome was the 0–10 pain variation after placebo treatments analyzed at 1 week, 1, 3, 6, and 12 months. The risk of bias was assessed using the RoB 2.0 tool, while the overall quality of evidence was graded according to the GRADE guidelines.
Results
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The placebo effect for conservative treatments was studied in 42 double-blind RCTs on 1724 patients. The meta-analysis of VAS pain showed a statistically significant improvement after placebo administration of 2.13/10 points (P < 0.001), being highest at 12 months with 2.79/10 points (P < 0.001). The improvement of the placebo groups was higher in the extracorporeal shock wave therapy studies compared to the injection studies (2.59 vs 1.78; P = 0.05). Eight studies had a low risk of bias, 23 studies had ‘some concerns,’ and 4 studies had a high risk of bias. The GRADE evaluation showed an overall high quality of evidence.
Conclusion
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This systematic review and meta-analysis demonstrated that the placebo effect represents an important component of all conservative approaches to treat plantar fasciitis. This effect is statistically and clinically significant, increases over time, and depends on the type of conservative treatment applied to address plantar fasciitis.
Search for other papers by Francisca Gámiz-Bermúdez in
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Purpose
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The objective of this systematic review was to assess a possible relationship between stomatognathic alterations and idiopathic scoliosis (IS).
Design
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This study is a systematic review with meta-analysis of observational studies.
Methods
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The protocol of this systematic review with meta-analysis was registered in PROSPERO (CRD42022370593). A bibliographic search was carried out in the Pubmed (MEDLINE), Scopus, Web of Science and CINAHL databases using the MeSH terms ‘Scoliosis’ and ‘Stomatognathic Disease’. The odds ratio (OR) of prevalence and standardized mean difference (SMD) were used to synthesize the results.
Results
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Of 1592 studies located, 14 studies were selected with 3018 subjects (age: 13.9 years). IS was related to Angle’s class II (OR = 2.052, 95% CI = 1.236–3.406) and crossbite (OR = 2.234, 95% CI = 1.639–3.045). Patients with malocclusion showed a higher prevalence of IS than controls (OR = 4.633, 95% CI = 1.467–14.628), and subjects with IS showed high overjet (SMD = 0.405, 95% CI = 0.149–0.661) and greater dysfunction due to temporomandibular disorders (SMD = 1.153, 95% CI = 0.780–1.527).
Conclusion
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Compared with healthy controls, subjects with IS have twice the risk of suffering from occlusion disorders, present greater temporomandibular dysfunction and have a greater overjet in the incisors. Moreover, subjects with malocclusion have an IS prevalence up to four times higher. The systematic orofacial examination of patients with IS should be recommended.
