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INTRODUCTION: Venous thromboembolism (VTE) is a major concern following total knee arthroplasty (TKA). The optimal pharmacological prophylaxis remains, however, controversial. The present investigation compared several non-vitamin K antagonist oral anticoagulants commonly employed as VTE prophylaxis following TKA. A Bayesian network meta-analysis was conducted to compare apixaban, aspirin, dabigatran, edoxaban, enoxaparin, fondaparinux, and rivaroxaban. The outcomes of interest were to compare the rate of deep venous thrombosis (DVT), pulmonary embolism (PE), and major and minor haemorrhages. METHODS: This study was conducted according to the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions. In March 2024, PubMed, Web of Science, and Google Scholar were accessed with no time constraints. All randomised controlled trials (RCTs) comparing two or more drugs for the prevention of VTE following TKA were considered for inclusion. RESULTS: Data from 29,678 patients were collected. Of them, 67% (19,884 of 29,678 patients) were women. The mean age of the patients was 66.8 ± 2.8 years, and the mean BMI was 29.2 ± 1.5 kg/m2. There was comparability in age, sex, and BMI at baseline. Apixaban 5 mg, dabigatran 220 mg, and rivaroxaban 10 mg were the most effective in reducing the rate of DVT. Apixaban 5 mg, enoxaparin 60 mg, and rivaroxaban 40 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, rivaroxaban 10 mg, and apixaban 10 mg were associated with the lowest rate of major haemorrhages. Apixaban 5 mg and 20 mg, and dabigatran 220 mg were associated with the lowest rate of minor haemorrhages. CONCLUSION: Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following TKA. LEVEL OF EVIDENCE: Level I, network meta-analysis of RCTs.
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BACKGROUND: Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications. METHODS: This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible. RESULTS: Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3). CONCLUSION: Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic review.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Epífises , Humanos , Reconstrução do Ligamento Cruzado Anterior/métodos , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Epífises/cirurgia , Adolescente , Volta ao Esporte , Desempenho Atlético/fisiologia , Medidas de Resultados Relatados pelo Paciente , Instabilidade Articular/cirurgia , Instabilidade Articular/prevenção & controleRESUMO
BACKGROUND: Several clinical investigations have compared different pharmacologic agents for the prophylaxis of venous thromboembolism (VTE). However, no consensus has been reached. The present investigation compared enoxaparin, fondaparinux, aspirin and non-vitamin K antagonist oral anticoagulants (NOACs) commonly used as prophylaxis following total hip arthroplasty (THA). A Bayesian network meta-analysis was performed, setting as outcomes of interest the rate of deep venous thrombosis (DVT), pulmonary embolism (PE) and major and minor haemorrhages. METHODS: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. All randomised controlled trials (RCTs) comparing two or more drugs used for the prophylaxis of VTE following THA were accessed. PubMed, Web of Science and Google Scholar databases were accessed in March 2023 with no time constraint. RESULTS: Data from 31,705 patients were extracted. Of these, 62% (19,824) were women, with age, sex ratio, and body mass index (BMI) being comparable at baseline. Apixaban 5 mg, fondaparinux, and rivaroxaban 60 mg were the most effective in reducing the rate of DVT. Dabigatran 220 mg, apixaban 5 mg, and aspirin 100 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, ximelagatran 2 mg and aspirin 100 mg were associated with the lowest rate of major haemorrhages, while rivaroxaban 2.5 mg, apixaban 5 mg and enoxaparin 40 mg were associated with the lowest rate of minor haemorrhages. CONCLUSION: Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following THA. Level of evidence Level I, network meta-analysis of RCTs.
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Artroplastia de Quadril , Tromboembolia Venosa , Feminino , Humanos , Masculino , Artroplastia de Quadril/efeitos adversos , Aspirina/uso terapêutico , Enoxaparina/uso terapêutico , Fibrinolíticos/uso terapêutico , Fondaparinux/uso terapêutico , Hemorragia/induzido quimicamente , Metanálise em Rede , Rivaroxabana/uso terapêutico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controleRESUMO
INTRODUCTION: Micro RNAs (miRNAs) are short non-coding RNAs that act primarily in posttranscriptional gene silencing, and are attracting increasing interest in musculoskeletal conditions. SOURCE OF DATA: Current scientific literature published in PubMed, Google Scholar, Embase and Web of Science databases. AREAS OF AGREEMENT: Recently, the potential of miRNAs as biomarkers for diagnosis and treatment of meniscal injuries has been postulated. AREAS OF CONTROVERSY: Evaluation of the role of miRNAs in patients with meniscal tears is still controversial. GROWING POINTS: A systematic review was conducted to investigate the potential of miRNA in the diagnosis and management of meniscal damage. AREAS TIMELY FOR DEVELOPING RESEARCH: Intra-articular injection of microRNA-210 in vivo may represent a potential innovative methodology for the management of meniscal injuries. Characterization of the miRNAs expression in the synovial fluid could lead to the development of better early diagnosis and management strategies for meniscal tears.
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Traumatismos do Joelho , MicroRNAs , Humanos , Artroscopia/métodos , Injeções Intra-Articulares , Meniscos TibiaisRESUMO
PURPOSE: Following posterior cruciate ligament (PCL) rupture, autografts and allografts are routinely used for its reconstruction. This study investigated the efficacy and safety of allografts for primary PCL reconstruction, comparing them to autografts in terms of patient-reported outcome measures (PROMs), functional tests, and complications. METHODS: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus were accessed in October 2022. All the clinical studies investigating the outcomes of primary PCL reconstruction using allografts, or comparing the outcomes of allografts versus autografts, were accessed. The outcomes of interests were: instrumental laxity, range of motion (ROM), Telos stress radiography, drawer test, International Knee Documentation Committee (IKDC), Tegner Activity Scale, and the Lysholm Knee Scoring Scale. Data on complications were also recorded. RESULTS: A total of 445 patients were included. The mean follow-up was 45.2 ± 23.8 months. The mean age of the patients was 30.6 ± 2.2 years. The time span between the injury and surgical intervention was 12.9 ± 10 months. Overall, 28% (125 of 445 patients) were women. Good baseline comparability was found between the two cohorts. No difference was found in terms of Lysholm Score, ROM, Tegner Scale, IKDC, arthrometer laxity, drawer test, and Telos stress radiography. No difference was found in the rates of anterior knee pain and revision. CONCLUSION: Allografts can be considered a suitable alternative to autografts for PCL reconstruction. LEVEL OF EVIDENCE: III.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Reconstrução do Ligamento Cruzado Posterior , Ligamento Cruzado Posterior , Humanos , Feminino , Adulto , Masculino , Autoenxertos/cirurgia , Aloenxertos , Transplante Homólogo , Traumatismos do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Resultado do Tratamento , Ligamento Cruzado Posterior/cirurgiaRESUMO
PURPOSE: It is unclear whether the results of arthroscopic partial meniscectomy (APM) are comparable to a structured physical therapy (PT). This systematic review investigated efficacy of APM in the management of symptomatic meniscal damages in middle aged patients. Current available randomised controlled trials (RCTs) which compared APM performed in isolation or combined with physical therapy versus sham arthroscopy or isolated physical therapy were considered in the present systematic review. METHODS: This systematic review was conducted according to the 2020 PRISMA statement. All the level I RCTs which investigated the efficacy of AMP were accessed. Studies which included elderlies with severe OA were not eligible, nor were those in which APM was combined with other surgical intervention or in patients with unstable knee or with ligaments insufficiency. The risk of bias was assessed using the software Review Manager 5.3 (The Nordic Cochrane Collaboration, Copenhagen). To rate the quality of evidence of collected outcomes, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used. RESULTS: Data from 17 studies (2037 patients) were collected. 48.5% (988 of 2037 patients) were women. The mean age of the patients was 52.7 ± 3.9 years, the mean BMI 27.0 ± 1.3 kg/m2. The current evidence suggests no difference in functional PROMs (quality of the evidence: high), clinical PROMs (quality of the evidence: high), pain (quality of the evidence: high), quality of life (quality of the evidence: high), physical performance measures (quality of the evidence: moderate), and OA progression (quality of the evidence: moderate). CONCLUSIONS: The benefits of APM in adults with degenerative and nonobstructive meniscal symptoms are limited. The current evidence reports similarity in the outcome between APM and PT. Further long-term RCTs are required to investigate whether APM and PT produce comparable results using validated and reliable PROMs. Moreover, future RCTs should investigate whether patients who might benefit from APM exist, clarifying proper indications and outcomes. High quality investigations are strongly required to establish the optimal PT regimes. LEVEL OF EVIDENCE: Level I.
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Menisco , Osteoartrite do Joelho , Lesões do Menisco Tibial , Pessoa de Meia-Idade , Feminino , Humanos , Adulto , Masculino , Meniscectomia/métodos , Osteoartrite do Joelho/cirurgia , Artroscopia/métodos , Lesões do Menisco Tibial/cirurgiaRESUMO
BACKGROUND: Femoroacetabular impingement (FAI) is common among the active and young population. The present study analysed the rate of return to sport, related influencing factors, and the sport activity level according to the Hip Outcome Score - Sport-Specific Subscale (HOS-SSS). METHODS: The literature search was performed in December 2020. All clinical trials investigating HOS-SSS and/or return to sport after arthroscopic treatment for FAI were considered for inclusion. The outcomes of interest were to analyse the rate of return to sport and the sport activity level according to the HOS-SSS in patients who underwent arthroscopic osteoplasty for FAI. RESULTS: Data from 41 studies (4063 procedures) were retrieved. A total of 88.75% (581 of 655) of patients returned to sports within a mean of 37.4 ± 16.5 months. The HOS-SSS score improved from 45.0 ± 10.6 to 73.1 ± 9.5 (P < 0.0001) at last follow-up. The following baseline characteristics evidenced positive association with post-operative activity level: lighter weight (P = 0.01), younger age (P = 0.001), Tönnis angle grade I (P = 0.009), greater HHS (P = 0.01), NAHS (P < 0.0001) and HOS-ADL (P = 0.01). CONCLUSION: Arthroscopic treatment for FAI resulted in excellent results in terms of return to sport. Moreover, lighter weight and younger age, greater HHS, NAHS, HOS-ADL at baseline were positively associated with post-operative sport activity level. LEVEL OF EVIDENCE: IV, systematic review.
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Impacto Femoroacetabular , Humanos , Atividades Cotidianas , Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Estudos Retrospectivos , Volta ao Esporte , Resultado do TratamentoRESUMO
BACKGROUND: Several hip preserving techniques have been described for the management of osteonecrosis of the femoral head (ONFH). This systematic review identified prognostic factors in the treatment of ONFH that are associated with treatment failure and conversion to total hip arthroplasty (THA). MATERIAL AND METHODS: This study followed the PRISMA guidelines. The literature search was conducted in November 2021. All clinical trials comparing two or more treatments for femoral head osteonecrosis were accessed. A multivariate analysis was performed to investigate the association between baseline characteristics and the surgical outcome. A multiple linear model regression analysis through the Pearson Product-Moment Correlation Coefficient (r) was used. RESULTS: Data from 88 articles (6112 procedures) were retrieved. Female gender was associated with increased time to THA (P = 0.03) and reduced rate of THA (P = 0.03). Longer symptom duration before treatment was associated with shorter time to failure (P = 0.03). Increased pre-treatment VAS was associated with reduced time to failure (P = 0.03) and time to THA (P = 0.04). Reduced pre-treatment hip function was associated with increased rate of THA (P = 0.02) and failure (P = 0.005). Patient age and BMI, aetiology, time from surgery to full weight bearing and the side did not show evidence of a statistically significant association with the surgical outcome. CONCLUSION: Male gender, longer symptom duration before treatment, higher VAS scores, and lower HHS scores were negative prognostic factors after treatment for osteonecrosis of the femoral head.
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Necrose da Cabeça do Fêmur , Adulto , Feminino , Humanos , Masculino , Artroplastia de Quadril , Necrose da Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/terapia , Modelos Lineares , Análise Multivariada , Prognóstico , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Following anterior cruciate ligament (ACL) tears, both repair and reconstruction may be performed to restore joint biomechanics and proprioception. The present study compared joint laxity, patient-reported outcome measures (PROMs), and rate of failure following primary repair versus reconstruction for ACL ruptures. METHODS: This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Google scholar, Embase, and Web of Science were accessed in September 2022. All the clinical investigations comparing repair versus reconstruction for primary ACL tears were accessed. Studies reporting data on multiple ligament injuries settings were not eligible. RESULTS: Data from eight articles (708 procedures) were collected. The mean length of the follow-up was 67.3 ± 119.4 months. The mean age of the patients was 27.1 ± 5.7 years. Thirty-six percent (255 of 708 patients) were women. The mean body mass index (BMI) was 24.3 ± 1.1 kg/m2. The mean time span from injury to surgery was 36.2 ± 32.3 months. There was comparability at baseline with regards to instrumental laxity, Lachman test, International Knee Document Committee (IKDC), and Tegner Scale (P > 0.1). Similarity between ACL reconstruction and repair was found in IKDC (P = 0.2) and visual analog scale (VAS) satisfaction (P = 0.7). The repair group demonstrated greater mean laxity (P = 0.0005) and greater rate of failure (P = 0.004). CONCLUSION: ACL reconstruction may yield greater joint stability and lower rate of failure compared with surgical repair. Similarity was found in PROMs. LEVEL OF EVIDENCE: III.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Humanos , Feminino , Adulto Jovem , Adulto , Masculino , Articulação do Joelho , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Instabilidade Articular/cirurgiaRESUMO
INTRODUCTION: Chondral defects of the knee are common and their treatment is challenging. SOURCE OF DATA: PubMed, Google scholar, Embase and Scopus databases. AREAS OF AGREEMENT: Both autologous matrix-induced chondrogenesis (AMIC) and membrane-induced autologous chondrocyte implantation (mACI) have been used to manage chondral defects of the knee. AREAS OF CONTROVERSY: It is debated whether AMIC and mACI provide equivalent outcomes for the management of chondral defects in the knee at midterm follow-up. Despite the large number of clinical studies, the optimal treatment is still controversial. GROWING POINTS: To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up. AREAS TIMELY FOR DEVELOPING RESEARCH: AMIC may provide better outcomes than mACI for chondral defects of the knee. Further studies are required to verify these results in a clinical setting.
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Doenças das Cartilagens , Cartilagem Articular , Doenças das Cartilagens/cirurgia , Cartilagem Articular/cirurgia , Condrócitos , Condrogênese , Humanos , Articulação do Joelho/cirurgia , Transplante Autólogo , Resultado do TratamentoRESUMO
INTRODUCTION: Corticosteroid-induced osteoporosis (CIO) is the most common type of secondary osteoporosis, leading to fractures, and increased morbidity and mortality. SOURCE OF DATA: Pubmed, EMBASE, Scopus and Google Scholar databases. AREAS OF AGREEMENT: Prolonged glucocorticoids administration leads to secondary osteoporosis. AREAS OF CONTROVERSY: The optimal management for CIO is controversial. GROWING POINTS: The present study compared bone mineral density, fractures and adverse events in patients undergoing treatment with risedronate, alendronate, zoledronate, denosumab or etidronate for CIO. AREAS TIMELY FOR DEVELOPING RESEARCH: For selected patients with CIO, alendronate performed better overall. These results must be interpreted within the limitations of the present study. LEVEL OF EVIDENCE: I, Bayesian network meta-analysis of randomized clinical trials.
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Corticosteroides , Osteoporose , Corticosteroides/efeitos adversos , Alendronato/efeitos adversos , Teorema de Bayes , Conservadores da Densidade Óssea/efeitos adversos , Denosumab/efeitos adversos , Ácido Etidrônico/efeitos adversos , Glucocorticoides/efeitos adversos , Humanos , Metanálise em Rede , Osteoporose/induzido quimicamente , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Ácido Risedrônico/efeitos adversos , Ácido Zoledrônico/efeitos adversosRESUMO
OBJECTIVES: We aimed to determine whether GS can help to plan and rearrange the treated side by using IMUs to measure the joint angle of the hip, knee, and ankle. We hypothesized that the kinematics in healthy individuals for both sides are approximately equal during walking. METHODS: IMUs were used to measure the joint angles of 25 healthy participants during walking. The participants performed the 10-meter walk test. The normalized symmetry index (SInorm) was used to calculate the symmetry of joint angles for the hip, knee, and ankle throughout the gait cycle. RESULTS: The SInorm demonstrated high symmetry between both legs; and the ranges were -1.5% and 1.1% for the hip, -3.0% and 3.1% for the knee, and -12% and 9.2% for the ankle joint angle throughout the gait cycle. CONCLUSION: The SInorm provides strong information that can be helpful in the planning process for the surgeries. Further, the IMUs system gives the possibility to measure the patients before their surgeries and use their data to plan and rearrange for the operated side.
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Artroplastia do Joelho , Articulação do Tornozelo , Fenômenos Biomecânicos , Marcha , Humanos , Articulação do Joelho/cirurgia , CaminhadaRESUMO
INTRODUCTION: While the effects of VBT on coronal parameters have been investigated in various studies, this has not yet been the case for sagittal parameters. This is of particular relevance considering that VBT does not allow direct correction of the sagittal profile. Thus, we investigated the effects of VBT on sagittal parameters in patients with adolescent idiopathic scoliosis. MATERIALS AND METHODS: Retrospective, 2-Center study. Patients who underwent VBT and presented a 2-years follow-up were included. The differences in sagittal parameters were evaluated, along with modifications of sagittal profile following Abelin-Genevois' classification. RESULTS: Data from 86 patients were obtained. Mean Cobb angle was 52.4 ± 13.9° at thoracic level and 47.6 ± 14.3° at lumbar level before surgery, and 28.5 ± 13.6 and 26.6 ± 12.7° at the 2-year follow-up, respectively. Mean thoracic kyphosis increased from 28.3 ± 13.8 to 33 ± 13°, the lumbar lordosis (LL) was unvaried (from 47.5 ± 13.1 to 48.4 ± 13.5°), PT decreased from 9.4 ± 8.5 to 7.4 ± 6.1°, the sagittal vertical axis SVA decreased from 4.5 ± 31.4 to - 3.6 ± 27.9 mm. No kyphotic effect on LL in patients who underwent lumbar instrumentation was observed. Before surgery, 39 patients had a type 1 sagittal profile, 18 were type 2a, 14 type 2b and 15 type 3. Postoperatively, 54 were type 1, 8 were 2a, 13 were 2b and 11 were type 3. CONCLUSIONS: VBT positively influences sagittal parameters and does not have a kyphotic effect on LL.
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Cifose , Lordose , Escoliose , Fusão Vertebral , Adolescente , Seguimentos , Humanos , Cifose/cirurgia , Lordose/diagnóstico por imagem , Lordose/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Corpo VertebralRESUMO
PURPOSE: The literature concerning the effects of scoliosis correction on pulmonary function (PF) is scarce and solely related to spinal fusion. Vertebral body tethering (VBT) represents a new option for scoliosis correction; however, its effects on PF have not yet been investigated. As VBT is a fusion-less technique that does not limit the dynamics of the chest wall, it is expected not to have a negative impact on PF despite the anterior surgical approach. METHODS: We analyzed the PF preoperatively and compared it with the PF at 6-weeks, 6-months and 12-monthts postoperatively. Considered parameters were total lung capacity (TLC), forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) expressed as percentages. A change of more than 10% was considered clinically significant. RESULTS: Before VBT, overall TLC, FEV1 and FVC measured 98 ± 15%, 85 ± 16% and 91 ± 17%, respectively. Six weeks after surgery, all parameters were comparable to the preoperative values (TLC 96 ± 17%, FEV1 84 ± 14%, FVC 90 ± 16%) and remained so at the last follow-up (TLC 99 ± 15%, FEV1 89 ± 9%, FVC 86 ± 9). While a reduction in FEV1 and FVC was observed at 6-weeks and 6-months in patients with thoracic or double curves compared to thoracolumbar curves, no significant differences were observed at the 12-months follow-up. CONCLUSIONS: VBT does not cause a reduction in PF values at a short-term follow-up.
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Cifose , Escoliose , Fusão Vertebral , Adolescente , Volume Expiratório Forçado , Humanos , Estudos Retrospectivos , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Corpo Vertebral , Capacidade VitalRESUMO
PURPOSE: There is a paucity of studies on new vertebral body tethering (VBT) surgical constructs especially regarding their potentially motion-preserving ability. This study analyses their effects on the ROM of the spine. METHODS: Human spines (T10-L3) were tested under pure moment in four different conditions: (1) native, (2) instrumented with one tether continuously connected in all vertebrae from T10 to L3, (3) additional instrumented with a second tether continuously connected in all vertebrae from T11 to L3, and (4) instrumented with one tether and one titanium rod (hybrid) attached to T12, L1 and L2. The instrumentation was inserted in the left lateral side. The intersegmental ROM was evaluated using a magnetic tracking system, and the medians were analysed. Please check and confirm the author names and initials are correct. Also, kindly confirm the details in the metadata are correct. The mentioned information is correct RESULTS: Compared to the native spine, the instrumented spine presented a reduction of less than 13% in global ROM considering flexion-extension and axial rotation. For left lateral bending, the median global ROM of the native spine (100%) significantly reduced to 74.6%, 66.4%, and 68.1% after testing one tether, two tethers and the hybrid construction, respectively. In these cases, the L1-L2 ROM was reduced to 68.3%, 58.5%, and 38.3%, respectively. In right lateral bending, the normalized global ROM of the spine with one tether, two tethers and the hybrid construction was 58.9%, 54.0%, and 56.6%, respectively. Considering the same order, the normalized L1-L2 ROM was 64.3%, 49.9%, and 35.3%, respectively. CONCLUSION: The investigated VBT techniques preserved global ROM of the spine in flexion-extension and axial rotation while reduced the ROM in lateral bending.
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Escoliose , Fenômenos Biomecânicos , Humanos , Vértebras Lombares/cirurgia , Amplitude de Movimento Articular , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Corpo VertebralRESUMO
PURPOSE: The primary outcome of interest of this study was to determine the frequency, location, and extent of chondral injuries and medial patellofemoral ligament (MPFL) tears, along with the rate of loose bodies, in the knee after acute primary patellar dislocation. The secondary outcome of interest was to conduct a multivariate analysis to investigate whether the presence of pathoanatomic abnormalities, including structural differences in the knees of the patients, is associated with the features of the lesions. METHODS: Patients who underwent magnetic resonance imaging after primary acute patellar dislocation were identified from our institutional databases. We analyzed a total of 175 magnetic resonance imaging scans of patients aged between 14 and 25 years who were eligible for inclusion. RESULTS: Chondral damage to the medial facet of the patella was present in 36 patients; patellar crest, 78 patients; and lateral patellar facet, 28 patients. One patient presented with chondral defects in the medial trochlear facet, whereas 118 patients showed chondral defects in the lateral trochlear facet. Loose bodies were present in 142 patients. A total of 161 patients (92%) showed MPFL damage. The patellar portion was affected in 119 patients. Of the patients, 28 showed a partially damaged MPFL (<50%), 42 showed MPFL damage greater than 50%, and 49 presented with a complete tear of the MPFL. MPFL lesions were observed on the femoral side in 42 patients. Fourteen patients presented with an avulsion fracture on the patellar side; 28 patients, on the femoral side. CONCLUSIONS: The MPFL was injured in 92% of 175 patients after a first-time acute patellar dislocation. Chondral damage was most frequent at the patellar crest, followed by the lateral femoral epicondyle. No association was found between patella alta, the sulcus angle, the Q angle, the tibial tubercle-trochlear groove distance, trochlear and patellar dysplasia, and soft-tissue damage. LEVEL OF EVIDENCE: Level IV, retrospective cohort study.
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Doenças das Cartilagens , Ligamentos Colaterais , Instabilidade Articular , Luxação Patelar , Ligamento Patelar , Articulação Patelofemoral , Adolescente , Adulto , Doenças das Cartilagens/patologia , Humanos , Instabilidade Articular/patologia , Articulação do Joelho/diagnóstico por imagem , Ligamentos Articulares/lesões , Imageamento por Ressonância Magnética/métodos , Patela/lesões , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/patologia , Articulação Patelofemoral/diagnóstico por imagem , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: Both mobile (MB) and fixed (FB) bearing implants are routinely used for total knee arthroplasty (TKA). This meta-analysis compared MB versus FB for TKA in terms of implant positioning, joint function, patient reported outcome measures (PROMs), and complications. It was hypothesised that MB performs better than FB implants in primary TKA. METHODS: This meta-analysis was conducted according to the 2020 PRISMA statement. In February 2022, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the randomized clinical trials (RCTs) comparing mobile versus fixed bearing for primary TKA were considered. RESULTS: Data from 74 RCTs (11,116 procedures) were retrieved. The mean follow-up was 58.8 (7.5 to 315.6) months. The MB group demonstrated greater range of motion (ROM) (P = 0.02), Knee Society Score (KSS) score (P < 0.0001), and rate of deep infections (P = 0.02). No difference was found in implant positioning: tibial slope, delta angle, alpha femoral component angle, gamma femoral component angle, beta tibial component angle, tibiofemoral alignment angle, posterior condylar offset, radiolucent lines. No difference was found in duration of the surgical procedure. No difference was found in the following PROMs: Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), function and pain subscales of the KSS score. No difference was found in the rate of anterior knee pain, revision, aseptic loosening, fractures, and deep vein thrombosis. CONCLUSION: There is no evidence in support that MB implants promote greater outcomes compared to FB implants in primary TKA. LEVEL OF EVIDENCE: Level I.
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Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Articulação do Joelho , Dor , Amplitude de Movimento Articular , Resultado do TratamentoRESUMO
PURPOSE: This study updates the current evidence on the role of allografts versus autografts for medial patellofemoral ligament (MPFL) reconstruction in patients with patellofemoral instability. METHODS: The study was performed according to the PRISMA guidelines. In March 2021, a literature search in the main online databases was performed. Studies reporting quantitative data concerning primary MPFL reconstruction using an allograft were considered for inclusion. The Coleman Methodology Score was used to assess the methodological quality of the selected articles. RESULTS: Data from 12 studies (474 procedures) were retrieved. The mean follow-up was 42.2 (15-78.5) months. The mean age was 21.1 ± 6.2 years. 64.9% (285 of 439) of patients were female. At the last follow-up, the Tegner (p < 0.0001), Kujala (p = 0.002) and the Lysholm (p < 0.0001) scores were minimally greater in the autografts. The similarity was found in the rate of persistent instability sensation and revision. The allograft group evidenced a lower rate of re-dislocations (p = 0.003). CONCLUSION: Allografts may represent a feasible alternative to traditional autograft for MPFL reconstruction in selected patients with patellofemoral instability. Allograft tendons yielded similar PROMs, rates of persistent instability, and revision. Allograft reconstructions tended to have modestly lower re-dislocation rates. LEVEL OF EVIDENCE: IV.
Assuntos
Luxações Articulares , Instabilidade Articular , Luxação Patelar , Articulação Patelofemoral , Procedimentos de Cirurgia Plástica , Adolescente , Adulto , Aloenxertos , Autoenxertos/cirurgia , Feminino , Humanos , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Masculino , Luxação Patelar/cirurgia , Articulação Patelofemoral/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto JovemRESUMO
BACKGROUND: The present systematic review investigated return to sport, patient reported outcome measures (PROMs), complications and subsequent progression to total hip arthroplasty (THA) in patients undergoing arthroscopic labral repair for FAI. MATERIAL AND METHODS: Following the PRISMA statement, the literature search was performed in February 2021. The outcomes of interest were: rate of return to sport, modified Harris Hip Score (mHHS), the subscales Activities of Daily Living and Sport-Specific Subscale of the Hip Outcome Score (HOS-ADL and HOS-SSS, respectively). Complications, revision surgeries and progression to total hip arthroplasty were recorded. RESULTS: Data from 210 procedures were retrieved. The mean follow-up was 34.0 (24.0-42.5) months. The mean age of the patients was 32.0 (20.0-47.0) years, while the mean BMI was 20.9 (20.1-21.7) kg/m2. 52.8% (111 of 210 patients) were women. At 24-month follow-up, 100% of the patients had returned to sport. At a mean of 34 months follow-up, the mean mHHS increased by 25.5% (P = 0.02), the mean HOS-ADL by 23.0% (P = 0.03), the mean HOS-SSS by 32.8% (P = 0.001). No complications were observed. The rate of revision was 4.3% (9 of 210 procedures). At a mean of 37.9 ± 7.5 months, 1.9% of patients (4/210) underwent THA. CONCLUSION: Arthroscopic labral refixation for FAI yields reliably positive clinical outcomes, with a low rate of revision and conversion to THA.
Assuntos
Impacto Femoroacetabular , Atividades Cotidianas , Adulto , Artroscopia/métodos , Feminino , Impacto Femoroacetabular/complicações , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
INTRODUCTION: There is controversy about the role of minimally invasive surgery (MIS) for total hip arthroplasty (THA). The present study aimed to investigate whether a MIS approach has a positive impact on the outcome of THA via the Watson-Jones anterolateral approach. Clinical scores and radiological findings of minimally and standard invasive exposures were evaluated and compared. METHODS: The present study was conducted according to the STROBE statement. Patients operated between 2017 and 2018 in two different orthopaedic institutions was performed. Patients with symptomatic coxarthrosis reducing considerably patient's quality of life were asked to participate in the present study. Patients were divided into two THA groups: MIS and standard invasive surgery (SIS). Surgical procedures were performed in by two experienced surgeons via the Watson-Jones approach. RESULTS: Data from 140 patients were collected (70 patients for each group) at two years follow-up. Leg length discrepancy was greater in the MIS cohort (P = 0.01). The Stiffness subscale of the WOMAC score resulted minimally increased in the SIS group (P = 0.03). The overall WOMAC score and the other subscales resulted similar between the two groups. Femoral offset, acetabular offset, cup orientation, cup inclination, VAS resulted similar between the two cohorts. Only a case of revision in the SIS group was reported. CONCLUSION: THA via the Watson-Jones approach achieves short terms excellent results. Surgery performed via a MIS approach does not provide any superior outcome compared to the SIS in terms of radiographic findings and clinical scores at two years follow-up.