Local corticosteroid injection versus physical therapy for the treatment of carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials.

The comparative effect of commonly used conservative treatments for carpal tunnel syndrome remained controversial. The purpose of this study was to compare the clinical effect of local corticosteroid injection and physical therapy for the treatment of carpal tunnel syndrome. A systematic literature search of PubMed, EMBASE, and Cochrane library was conducted to identify relevant randomized clinical trials published before 21st Mar 2023. Two independent reviewers assayed quality of included studies using the Cochrane collaboration risk of bias tool. Relevant data were extracted and pooled analyses were conducted. Outcome measurements included Boston Carpal Tunnel Syndrome Questionnaire, visual analogue scale and some electrophysiology tests, while the former two were set as the primary outcomes. Subgroup analysis and sensitive analysis were performed and publication bias was evaluated. Heterogeneity among the included studies was examined using the I2 statistic. After selection, 12 studies were identified eligibility for inclusion. Only one study was found to have a high risk of bias. Pooled data of primary outcomes did not show any differences between treatments, and subgroup analysis supported the results. However, patients treated with local corticosteroid injection showed better improvement in distal motor latency (p = 0.002) and compound muscle action potential (p = 0.04). Some studies failed to pass the sensitive analysis, indicating the related analysis might be not so stable. A slight publication bias was observed in subgroup analysis of function scales, among three publication bias test. In conclusion, compared to physical therapy, local corticosteroid injection might have better treatment effects on carpal tunnel syndrome.

Efficacy and Safety of Hyaluronic Acid Intra-articular Injection after Arthroscopic Knee Surgery: A Systematic Review and Meta-analysis.

OBJECTIVE: Hyaluronic acid (HA) intra-articular injection after arthroscopic knee surgery has been widely applied but its efficacy and safety remain controversial. The aim of this systematic review is to analyze the efficacy and safety of HA intra-articular injection after arthroscopic knee surgery, and to compare the efficacy of HA with different molecular weights. METHODS: We conducted a systematic literature search in PubMed, Embase, Google scholar and the Cochrane library from inception to 16 September 2022 for English-written articles, in order to identify randomized controlled trials that evaluated the clinical efficacy and/or safety of HA intra-articular injection after arthroscopic knee surgery. Then we meta-analyzed the outcomes of patients given intra-articular HA injections postoperatively and control patients. We also evaluated the influence of HA with different molecular weights. In every calculation, sensitive analysis was performed. The visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events were selected as the primary outcome measurements, while Lysholm, International Knee Documentation Committee (IKDC) and Tegner score were selected as the secondary outcome measurements. Publication bias of every outcome was evaluated using egger test. RESULTS: Fifteen studies involving 951 knees were included and 12 of them were used to performed the meta-analysis. The results showed no significant difference between the HA group and control group according to VAS, whether assessed at less (P = 0.90) or more than 6 months (P = 0.55). Besides, there were no statistical differences between the HA group and control group according to subgroup analysis (Ps = 0.77, 0.91 and 0.81 in anterior cruciate ligament reconstruction, meniscectomy and overall groups, respectively). Compared to control group, the overall effect of WOMAC score showed no significant differences (P = 0.25), nor did in two subgroups (P = 0.37 and P = 0.22). Outcomes measured by Lysholm (P = 0.13), IKDC (P = 0.86) and Tegner (P = 0.42) scores showed no significant differences, either. The analysis of the risk of adverse events indicated no increase in HA groups (P = 0.06). We found no significant differences between high- and low-molecular-weight HA at 6 (P = 0.96) or 12 months (P = 0.93) postoperatively. Two studies failed to pass the sensitive analysis and the reasons were discussed detailly and acceptable publication bias was observed. CONCLUSIONS: Although HA injection after arthroscopic knee surgery is safe, the available evidence does not support its efficacy in pain relief and functional recovery. Therefore, the application of HA injection after arthroscopic knee surgery is not recommended.

The Effect of Intra-articular Injection of Hyaluronic Acid in Frozen Shoulder: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Frozen shoulder (FS) is a common progressive disorder that causes restricted motion and refractory pain undermining quality of life. Intra-articular hyaluronic acid (HA) injection is a widely adopted conservative therapy relieving symptomatic FS, whereas the effect of which were contradictory and unclear in current literatures. The aim of the present study is to investigate whether intra-articular HA administration facilitates symptomatic pain relief and functional improvements in patients diagnosed with shoulder FS. METHODS: The PubMed, Embase, Cochrane Library electronic databases and Google scholar were searched, from inception to 15th Jan 2022. Randomized controlled trials (RCTs) comparing intra-articular HA administration with any other non-surgical treatment in patients with FS were included. Risk of bias was evaluated using the Cochrane risk-of-bias tool and meta-analyses were undertaken to pool the data of visual analog scale for pain, range of motion (ROM) in external rotation, abduction, and flexion, as well as Shoulder Pain and Disability Index (SPADI), Constant score and American Shoulder and Elbow Surgeons (ASES). RESULTS: The present study included 7 RCTs involving 504 patients. The results provided no support for superior pain control in patients undergoing HA injection compared with any other treatment (p = 0.75). Furthermore, HA group failed to exert superior improvements to other treatments in ROM concerning abduction (p = 0.69) and flexion (p = 0.33). However, HA injection was observed to facilitate functional recovery in external rotation (p = 0.003). In addition, the pooled data showed a significant higher SPADI score in control group than in HA group (p = 0.01), while no statistical significance between two groups was observed in Constant score (p = 0.36) and ASES (p = 0.76). CONCLUSIONS: The current meta-analysis suggested that HA is a beneficial treatment procedure in improving the ROM of the shoulder for patients with FS, whereas the effect in relieving pain may be equal to the existing therapy. In conclusion, Intra-articular HA injection is recommended for FS patients.

Defining the role of TT-TG and TT-PCL in the diagnosis of lateralization of the Tibial tubercle in recurrent patellar dislocation.

BACKGROUND: The radiological indicators can help doctors determine whether to make tibial tubercle transfer. But which indicator is better is still in question. METHODS: 117 knees in 103 patients who had undergone patellar surgery and 60 knees in 58 patients who had no history of patellar dislocation from 2014 to 2019 were analyzed. Significant differences of tibial tubercle-trochlear groove (TT-TG) on CT and tibial tubercle-posterior cruciate ligament (TT-PCL) on MRI between the case group and the control group were estimated by an unpaired t test. Significant differences between TT-TG on CT and TT-TG on MRI were estimated by a paired t test. The correlation between TT-PCL on MRI and tibial width was estimated by Pearson test. Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were measured to assess the diagnostic accuracy of TT-TG and TT-PCL on MRI. RESULTS: The intraclass correlation coefficient (ICC) for TT-TG between CT and MRI evaluated by two raters was were 0.566. When comparing TT-TG on CT with that on MRI, the mean difference was 2.5 mm (p< 0.001). The mean TT-TG difference on CT between the case group and the control group was 5.3 mm, which was significantly bigger than the mean TT-PCL difference on MRI of 1.2 mm(p< 0.001). AUC of TT-TG on CT and TT-PCL were 0.838 and 0.580 (P< 0.001). TT-PCL correlated with tibial width (r=0.450, P< 0.001). CONCLUSION: A statistically significance and a fair ICC proved that TT-TG could not be used interchangeably. The bigger mean difference between the case group and the control group and better AUC proved that TT-TG on CT might be an indicator more suitable for measuring the lateralization of the tibial tubercle. And TT-PCL should be considered as an individual parameter because of the significant correlation between TT-PCL and tibial width.

The Effect of Irreducible Dislocation on Functional Outcomes in Knees With Multiligament Injuries: A Matched-Cohort Analysis.

BACKGROUND: Most cases of bicruciate knee dislocation (KD) with associated posteromedial disruption (KD-IIIM) are reducible, but some cannot be reduced by closed reduction because of soft tissue incarceration. PURPOSE: To compare the clinical characteristics and functional outcomes of KD-IIIM injuries in patients with or without incarceration of soft tissue requiring open or arthroscopic reduction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This retrospective cohort study of patients with KD was conducted between January 2013 and December 2017 at a single large institution. We applied a 1:2 matching ratio between patients with irreducible KD-IIIM injuries (irreducible group; n = 14) and those with reducible KD-IIIM injuries (control group; n = 28). There were 13 patients in the irreducible group and 25 in the control group who completed follow-up (≥2 years) and were included in our analysis. The efficacy of treatment in patients with KD was evaluated based on range of motion, the Tegner score, the Lysholm score, and the International Knee Documentation Committee (IKDC) score. RESULTS: At the end of follow-up, the mean Tegner score was 4.5 (range, 4-6), the mean Lysholm score was 79.2 (range, 60-95), and the mean IKDC score was 78.6 (range, 60.9-95.4) in the irreducible group. The respective results in the control group were 4.6 (range, 3-8), 83.1 (range, 39-100), and 80.6 (range, 42.5-96.6). These scores did not differ significantly between the 2 groups. Similarly, mean range of motion was similar between groups (irreducible, 118.1°; control, 124.8°). In the irreducible group, the acute subgroup showed significantly higher Lysholm and IKDC scores than the chronic subgroup, while the acute and chronic subgroups in the control group showed no significant differences in these respective outcome scores. CONCLUSION: In the present study, the treatment of irreducible KD led to similar functional outcomes compared with reducible KD. However, the treatment of chronic irreducible KD led to worse outcomes compared with acute irreducible KD, and therefore, urgent reduction is recommended in these patients.

[Research progress in anterolateral ligament of knee].

OBJECTIVE: To review research progress in the anterolateral ligament (ALL) of knee, and provide a clinical reference for diagnosis and treatment of ALL injury. METHODS: The literature on the diagnosis and treatment of ALL injury was widely reviewed. The incidence, anatomy, biomechanics, injury mechanism, and treatment status of ALL were summarized. RESULTS: The ALL contributes to the effect of controlling the internal rotation and anterior translation of the tibia, which affects the axial migration of the knee. ALL injury can be diagnosed according to the signs and MRI examination. Currently, no consensus exists for the surgical indications of ALL injury, but most surgeons tend to perform ALL reconstruction in patients requiring anterior cruciate ligament (ACL) reconstruction or revision surgery with higher pivot-shift tests. At present, various techniques have been used for ALL reconstruction, and there is no optimal technique. In addition, the long-term effectiveness of ALL reconstruction is unclear due to the lack of high-quality studies and long-term postoperative follow-up. CONCLUSION: The ALL contributes to maintaining knee stability, and the ALL reconstruction technique and its effectiveness still need further research.

Torn discoid lateral meniscus is associated with increased medial meniscal extrusion and worse articular cartilage status in older patients.

PURPOSE: To compare the clinical, imaging, and arthroscopic characteristics of the torn discoid lateral meniscus (TDLM) in patients greater than 40 years of age with matched controls. METHODS: One hundred and ninety-four older patients (211 knees) who underwent arthroscopic surgery for a TDLM were consecutively recruited (Group 1). Another 211 age- and sex-matched controls with a torn semilunar lateral meniscus were included in this study (Group 2). Statistical analyses were used to determine the differences in the clinical, imaging, and arthroscopic characteristics between the two groups. RESULTS: In our series, more severe medial meniscal extrusion on magnetic resonance imaging was present in Group 1 than in Group 2 and more serious osteoarthritic changes were observed in both the medial and lateral compartments in Group 1. Under the same conditions, chondral lesions in the knee were more serious in Group 1 than in Group 2 when patients were subgrouped according to the presence of a horizontal tear or complex tear. CONCLUSIONS: In the present study, older patients with a torn discoid lateral meniscus exhibited greater and more severe medial meniscal extrusion and more serious osteoarthritis. Therefore, knees with a discoid lateral meniscus displaying medial meniscal extrusion should be monitored carefully with long-term follow-up, because a medial meniscal extrusion may increase the risk of progression to degenerative osteoarthritis of the medial compartment. Regarding the clinical relevance, these findings will be helpful in further revealing that a torn discoid lateral meniscus may affect not only the cartilage in the lateral compartment but also the cartilage in the medial compartment and medial meniscal extrusion. LEVEL OF EVIDENCE: III.