RESUMEN
Background: While the literature suggests a correlation between posterior tibial slope and sagittal stability of the knee, there is a lack of consensus relating to how to measure the slope, what a normal slope value would be, and which critical values should guide extra surgical treatment. We performed a systematic literature review looking at the posterior tibial slope and cruciate ligament surgery. Our aims were to define a gold standard measurement technique of posterior tibial slope, as well as determining its normal range and the important values for consideration of adjuncts during cruciate ligament surgery. Methods: Electronic searches of MEDLINE (PubMed), CINAHL, Cochrane, Embase, ScienceDirect, and NICE in June 2020 were completed. Inclusion criteria were original studies in peer-reviewed English language journals. A quality assessment of included studies was completed using the Methodological Index for Non-Randomized Studies (MINORS) Criteria. Results: Two-hundred and twenty-one papers were identified; following exclusions 34 papers were included for data collection. The mean MINORS score was 13.8 for non-comparative studies and 20.4 for comparative studies, both indicating fair to good quality studies. A large variation in the posterior tibial slope measurement technique was identified, resulting in a wide range of values reported. A significant variation in slope value also existed between different races, ages and genders. Conclusion: Cautiously, the authors suggest a normal range of 6-12º, using the proximal tibial axis at 5 and 15 cms below the joint. We suggest 12º as a cut-off value for slope-reducing osteotomy as an adjunct to revision ligament reconstruction.
RESUMEN
PURPOSE: To determine in what way the proposed simulation-based intervention (SBI) is an effective intervention for use in basic arthroscopic skills training. METHODS: Twenty candidates were recruited and grouped according to experience. Performance metrics included the time to activity completion, errors made, and Global Rating Scale score. Qualitative data were collected using a structured questionnaire. RESULTS: Performance on the SBI differed depending on previous arthroscopic training received. Performance on the simulator differed between groups to a statistically significant level regarding time to completion. A difference was also present between participants with no previous training and those with previous training when assessed using the Global Rating Scale. The SBI was deemed acceptable, user-friendly, and realistic. Participants practicing at the expert level believe that such an SBI would be beneficial in developing basic arthroscopic skills. CONCLUSIONS: The results of this study provide evidence that the use of an SBI consisting of a benchtop workstation, laptop viewing platform, 30° arthroscope, and defined performance metrics can detect differences in the level of arthroscopic experience. This format of SBI has been deemed acceptable and useful to the intended user, increasing the feasibility of introducing it into surgical training. CLINICAL RELEVANCE: This study adds to the existing body of evidence supporting the potential benefits of benchtop SBIs in arthroscopic skills training. Improved performance on such an SBI may be beneficial for the purpose of basic arthroscopic skills training, and we would support the inclusion of this system in surgical training programs such as those developed by the Arthroscopy Association of North America and American Board of Orthopaedic Surgery.
RESUMEN
BACKGROUND: Tennis elbow is a common condition with a variety of treatment options, but little is known about which of these options specialists choose most commonly. Corticosteroid injections in tennis elbow may reduce pain in the short-term but delay long-term recovery. We have undertaken a UK-wide survey of upper limb specialists to assess current practice. METHODS: Cross-sectional electronic survey of current members of the British Elbow and Shoulder Society (BESS) and the British Society for Surgery of the Hand (BSSH). RESULTS: 271 of 1047 eligible members responded (25.9%); consultant surgeons constituted the largest group (232/271, 85%). 131 respondents (48%) use corticosteroid injections as their first-line treatment for tennis elbow. 206 respondents (77%) believed that corticosteroid injections are not potentially harmful in the treatment of tennis elbow, while 31 (11%) did not use them in their current practice. In light of recent evidence of the potential harmful effects of corticosteroid therapy, 136 (50%) had not changed their practice while 108 (40.1%) had reduced or discontinued their use. 43 respondents (16%) reported having used platelet-rich plasma injections. CONCLUSIONS: Recent high-quality evidence that corticosteroids may delay recovery in tennis elbow appears to have had a limited effect on current practice. Treatment is not uniform among specialists and a proportion of them use platelet-rich plasma injections.
