Anterior cruciate ligament reconstruction-rehabilitation research methodological quality: a systematic review with world region comparisons.

PURPOSE: A systematic review and world region comparison of combined ACL reconstruction-rehabilitation studies was performed. METHODS: Studies that combined ACL surgical-rehabilitative management published between January 1990 and June 2014 were evaluated. The combined terms "rehabilitation" and "anterior cruciate ligament reconstruction" or "ACL reconstruction" were used to search the CINAHL Plus, Cochrane Library, MEDLINE, PEDro, and PubMed databases. A total of 5920 studies were initially identified. Inclusion criteria reduced this total to 299 studies that underwent abstract review. Following this, 155 studies underwent full text review and 109 met all inclusion criteria for Modified Coleman Methodology Score (MCMS) evaluation. RESULTS: Overall, MCMS were 74.0 ± 17 (mean ± standard deviation). Europe had slightly greater MCMS than North America (P = 0.041). Specific MCMS components that displayed significant world region differences included use of an independent investigator (Europe > North America and Asia; P = 0.047), including a patient-completed written assessment (Europe > North America and Asia; P = 0.009), allowing the patient to complete the assessment without medical, surgical, or rehabilitation personnel intervention (Europe > North America and Asia; P = 0.009), and use of well-described subject selection or inclusion criteria (Europe > North America and Asia; P = 0.004). Tegner Activity Scale (P = 0.042) and VAS-Pain Scale (P = 0.007) use was greater in Europe compared with other world regions. Primary rehabilitation theme frequency was comparable between world regions (n.s.). CONCLUSION: Regional research methodological quality differences were observed. Europe displayed a slightly greater MCMS for combined ACL reconstruction-rehabilitation studies. With this information, research groups can design better team-based approaches to ensure that study findings provide sufficient significance to foster meaningful patient care improvements. LEVEL OF EVIDENCE: Systematic review, Level III.

Childhood Obesity Increases the Risk of Failure in the Treatment of Distal Forearm Fractures.

BACKGROUND: Childhood obesity is a national problem that has gained significant attention in both the medical literature and the national media. Obesity in the adult population has been associated with increased failure of conservative treatments. Our hypothesis is that childhood obesity is associated with a loss of reduction after closed treatment of distal radius fractures. METHODS: A total of 157 patients with consecutive distal radius fractures who underwent closed reduction in the emergency department or the operating room were included from the office records of the sole pediatric orthopaedic subspecialist group in a metropolitan area from January 2011 to June 2012. All cases were initially treated with fiberglass casting with or without closed reduction. All patients completed the casting treatment and demonstrated radiographic union. Patients' age, weight, height, number of office visits, subsequent surgeries, and fracture angulation were recorded and analyzed. RESULTS: Sixty-six (42%) children were overweight (BMI>85th percentile) and 46 (29%) children met the criteria for obesity (BMI>95th percentile). Fourteen normal-sized children (12%) and 13 obese children (28%) required a reduction in the operating room after initial treatment, which was significant (P=0.02). Obese children needed significantly more visits requiring radiographs (P=0.004). Obese children were significantly less likely to have an initial perfect reduction in the emergency room (P=0.005). CONCLUSIONS: The results of closed reduction and casting for displaced distal radius fractures are typically excellent with few complications or risks. The present study supports the hypothesis that obesity results in a higher rate of malreduction and subsequent manipulations with closed reduction and casting. Close follow-up and early consideration for additional treatment in this patient population may help reduce the need for further manipulations. LEVEL OF EVIDENCE: Level III.