Arthroscopic versus open treatment for femoroacetabular impingement: A systematic review and meta-analyses.

BACKGROUND: Femoroacetabular impingement (FAI) is a common cause of hip pain and restricted range of motion in young adults and athletes. This study aims to compare clinical results and complications between patients treated for FAI who underwent either arthroscopic or open treatment. METHODS: The 7 studies were acquired from PubMed, Medline, Embase, and Cochrane Library. The data were extracted analyzed by RevMan5.3. Mean differences (MDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. The Newcastle-Ottawa Scale were used to assess risk of bias. RESULTS: Seven observational studies were assessed. The methodological quality of the trials indicated a low risk of bias. The pooled results of the modified Harris Hip Score (mHHS), the Non-Arthritic Hip Score (NAHS), the Visual Analogue Scale (VAS), and satisfaction rate showed that the differences were not statistically significant between arthroscopic treatment (AT) and open treatment (OT). The difference of postoperative alpha angle was statistically significant, and OT was more effective [MD = 3.08, 95% confidence interval (95% CI) = 1.45-4.70, P = .0002]. The difference of postoperative internal rotation angle was statistically significant, and OT had better internal rotation angle (MD = -3.21, 95% CI = -6.14 to -0.28, P = .03). However, the difference of complications was statistically significant and AT achieved better result than OT (OR = 0.41, 95% CI = 0.22-0.74, P =0.003). CONCLUSION: AT had comparable effect and lower complications than OT, but had less improvement in alpha angle and internal rotation angle.

Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis.

BACKGROUND: Olecranon fracture (OF) is a common upper limb fracture, and the most commonly used techniques are still tension band wiring (TBW) and plate fixation (PF). The aim of the current study is to discuss whether TBW or PF technique of internal fixation is better in the treatment of OFs, using the method of meta-analysis. METHODS: The eligible studies were acquired from PubMed, CNKI, Embase, Cochrane Library, and other sources. The data were extracted by two of the coauthors independently and were analyzed by RevMan5.3. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale were used to assess risk of bias. RESULTS: Thirteen studies including 1 RCT and 12 observational studies were assessed. Our meta-analysis results showed that both in RCT and observational studies, there were no significant differences between the two groups in disabilities of the arm, shoulder and hand (DASH) (SMD = 0.07, 95% CI = -0.32 to 0.46, p = 0.73), improvement rate (OR = 0.76, 95% CI = 0.48-1.22, p = 0.26), range of motion (ROM), operation time (SMD = -0.51, 95% CI = -1.17 to 0.14, p = 0.12) and blood loss (SMD = -0.97, 95% CI = -2.06 to 0.11, p = 0.08). The overall estimate of complications indicated that the pooled OR was 2.61 (95% CI = 1.65-4.14, p < 0.0001), suggesting that the difference was statistically significant. We also compared the outcomes of patients with mayo type IIA OFs treated by TBW and PF in DASH and ROM and found no differences. CONCLUSIONS: Both TBW and PF interventions had treatment benefit in OFs. The current study reveals that there are no significant differences in DASH, improvement rate, ROM, operation time, and blood loss between TBW and PF for OFs. Due to the less complications, we recommend the PF approach as the optical choice for OFs. More high-quality studies are required to further confirm our results.

Open versus endoscopic in situ decompression in cubital tunnel syndrome: A systematic review and meta-analysis.

OBJECTIVE: We conducted this systematic review and meta-analysis to compare the clinical efficacy and safety between open and endoscopic in situ decompression surgery methods for cubital tunnel syndrome (CuTS). METHODS: PubMed, Medline, Embase, Cochrane Library and CNKI were searched for eligible studies. The data were extracted by two of the coauthors (WL, BYF) independently and were analyzed using RevMan statistical software, version 5.1. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the risk of bias. RESULTS: Seven studies were included for systematic review, and six studies were included for meta-analysis. The CuTS patients received open in situ decompression (OISD) or endoscopic in situ decompression (EISD). A pooled analysis of postoperative Bishop score showed that the difference was not statistically significant between the EISD group and the OISD group (RR = 0.99, 95% CI = 0.88-1.12, P = 0.88). The overall estimate of postoperative satisfaction between the EISD group and the OISD group was not found to be significant (RR = 0.98, 95% CI = 0.89-1.08, P = 0.70). The overall estimate of complications (RR = 0.88, 95% CI = 0.24-3.29, P = 0.85) suggested that the difference was not statistically significant. CONCLUSIONS: EISD and OISD for treating CuTS have equivalent efficacy for postoperative clinical improvement, whereas the incidences of complications of endoscopic surgical procedure were also same as those with the open surgical procedure. In situ decompression (especially EISD, with minor intraoperative trauma) could be treated as a valuable alternative to treat CuTS.