The Use of Synthetic Graft for MPFL Reconstruction Surgery: A Systematic Review of the Clinical Outcomes.

(1) Background: Acute patella dislocation (APD) is a prevalent knee injury, with rates between 5.8-77.8 per 100,000. APD often results in repeat lateral patella dislocations due to the instability of the medial patellofemoral ligament (MPFL). Non-operative treatments have a 50% recurrence rate. While autologous grafting for MPFL has been favored, surgeons are now exploring synthetic grafts. We aimed to assess the effectiveness of synthetic grafts in MPFL reconstruction surgeries for repeated patellar dislocations; (2) Methods: Our research was based on a thorough search from the National Institute of Health and Clinical Excellence Healthcare Databases, using the Modified Coleman Methodology Score for quality assessment; (3) Results: Six studies met the inclusion criteria. A total of 284 patients and 230 knees were included. Seventy-five percent of patients were graded to have excellent-good clinical outcomes using the Crosby and Insall Grading System. International Knee Documentation Committee score and Knee injury and Osteoarthritis Outcome Score scores showed 59% and 60% post-operative improvement, respectively; (4) Conclusions: All studies showed improvement in post-operative functional outcomes and report no serious adverse events. The 6 mm, LARS (Orthomedic Ltd., Dollard-des-Ormeaux, QC, Canada) proved to have the most improvement in post-operative outcomes when used as a double bundle graft.

The Role of Frailty Scores to Predict the Outcomes in Non Operative Treatment of Valgus Impacted Neck of Femur Fractures.

OBJECTIVES: The management of valgus-impacted neck of femur fracture is controversial between operative and conservative treatments. This study aimed to investigate the usefulness of the Clinical frailty Score for predicting the prognosis of patients who underwent non-operative treatment for the valgus-impacted neck of femur fracture (NOF). METHODS: A single-centred retrospective review of patients admitted with valgus impacted NOF. Data were collected from patients' records, including demographics, Clinical Frailty Score (CFS), Nottingham Hip Fracture Score (NHFS) and Abbreviated Mental Test Score (AMTS). Patients were followed up to 24 months postoperatively. RESULTS: Fifty-eight patients who were treated non-operatively with a mean follow-up of 2.6 years met our inclusion criteria. Twenty-nine patients failed the non-operative treatment and required replacement surgeries, while 29 had successful outcomes (50%). There were no differences between the two groups' mean age and gender distributions (P 0.527 and 0.139, respectively). The successful group had significantly higher CFS (P 0.013), worse AMTS and higher mortality risk based on the NHFS (P 0.006 and P < 0.001, respectively). CONCLUSION: This study demonstrates that CFS, AMTS and NHFS can be used as predictors when considering non-operative treatment for the valgus-impacted neck of femur fracture. Patients who are frail, demented and high risk based on the NHFS have higher success rates with non-operative treatment.