Does concomitant meniscus repair and meniscectomy show different efficacy in anterior cruciate ligament reconstruction? A systematic review and meta-analysis.

Aims: Currently, it is advised to perform meniscal repair instead of meniscectomy in certain cases of primary anterior cruciate ligament reconstruction (ACLR). However, the level of evidence is low. Therefore, this study aimed to compare the effectiveness of meniscectomy and meniscus repair in addition to ACLR. Methods: The systematic search was conducted in three online databases (EMBASE, MEDLINE, and Cochrane) from inception until October 2021 for the literature on primary ACLR and concomitant meniscal surgery. Eligible studies compared the following outcomes between meniscal repair and meniscectomy groups: the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, International Knee Documentation Committee (IKDC) score, and KT-arthrometer examinations. Lastly, we calculated pooled mean differences (MDs) with 95 % confidence intervals (CIs) from the change between pre- and post-intervention values. Results: Of 10,565 studies, 22 met the inclusion criteria, with a follow-up between 6 and 43 months. We found no difference when comparing the KOOS subscale changes-only in the KOOS pain subscale (MD = -1.6; CI: -2.48, -0.72). However, these results were not clinically significant. We analyzed the lateral and media meniscal injuries separately and concluded the same results regarding KOOS changes. We found no significant differences in the Lysholm score change (MD = -2.61; CI: -5.51, 0.29), changes in IKDC score (MD = 1.08; CI: -4.05, 6.21) or the change for the KT-arthrometer side-to-side difference (MD = -0.50; CI: -1.06, 0.06). Conclusion: Based on our result, we did not find a clinically significant difference between meniscus repair and meniscectomy during primary ACLR regarding patient-reported outcomes in a short-term follow-up. Translational potential: Our research supports the prompt integration of findings into clinical practice for treating meniscus injuries during ACL reconstruction. We recommend considering both meniscus repair and meniscectomy, as the available data indicate their effectiveness. Further studies are necessary to assess the long-term impacts, particularly on osteoarthritis, and to identify patient subgroups that may benefit most from each technique.

Domain-specific cognitive impairment in multiple sclerosis: A systematic review and meta-analysis.

OBJECTIVE: Methods of cognitive measurements in multiple sclerosis (MS) are not standardized. We aimed to identify the prevalence of cognitive domain-specific impairment (DSI) in MS by using subtests of the Brief Repeatable Battery of Neuropsychological Tests (BRB-N) with analyzing different cutoff values. METHODS: The systematic review and meta-analysis were registered on PROSPERO (ID: CRD42021287004). The systematic literature search was performed via PubMed, Embase, and CENTRAL on 24 October 2021. Inclusion criteria were adults of different MS subtypes (CIS, RRMS, PPMS, and SPMS) with the condition of distinct DSI measured by BRB-N. Pediatric MS, computerized versions of BRB-N, and patients receiving steroids were excluded. Primary outcome was pooled prevalence rates of impaired patients within each cutoff and MS subtype, with 95% confidence interval, I-squared statistics for heterogeneity, and chi-squared test for subgroup differences. Risk of bias was assessed using the "JBI Quality Assessment Tool for Prevalence Studies." RESULTS: In 48 eligible observational studies (n = 3431 patients), the three most prevalent thresholds were the 2.0 SD and 1.5 SD below the mean of normative values, and the score below the fifth percentile of the normative values. A progressively increasing worsening of the overall DSI was observed from CIS, moving toward RRMS, PPMS, and SPMS. INTERPRETATION: Cognitive impairment is observed in all MS phenotypes, with varying degrees. Due to several potential influencing factors, our comprehensive literature review has not revealed consistent findings, and we, therefore, recommend considering a more sophisticated, "individual referencing" approach, acknowledging the diverse clinical and sociodemographic characteristics among populations and disparities in cognitive testing.

Improved body composition decreases the fat content in non-alcoholic fatty liver disease, a meta-analysis and systematic review of longitudinal studies.

Background: Based on cross-sectional studies, there is a link between body composition parameters and steatosis in non-alcoholic fatty liver disease (NAFLD). However, whether long-term changes in different body composition parameters will result in NAFLD resolution is unclear. Therefore, we aimed to summarize the literature on longitudinal studies evaluating the association between NAFLD resolution and body composition change. Methods: Based on the recommendations of the Cochrane Handbook, we performed a systematic search on September 26th, 2021, in three databases: Embase, MEDLINE (via PubMed), and Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies reported on patients with NAFLD (liver fat >5%) and examined the correlation between body composition improvement and decrease in steatosis. We did not have pre-defined body composition or steatosis measurement criteria. Next, we calculated pooled correlation coefficient (r) with a 95% confidence interval (CI). Furthermore, we narratively summarized articles with other statistical methods. Results: We included 15 studies in our narrative review and five in our quantitative synthesis. Based on two studies with 85 patients, we found a pooled correlation coefficient of r = 0.49 (CI: 0.22-0.69, Spearman's correlation) between the change of visceral adipose tissue and liver steatosis. Similarly, based on three studies with 175 patients, the correlation was r = 0.33 (CI: 0.19-0.46, Pearson's correlation). On the other hand, based on two studies with 163 patients, the correlation between subcutaneous adipose tissue change and liver steatosis change was r = 0.42 (CI: 0.29-0.54, Pearson's correlation). Furthermore, based on the studies in the narrative synthesis, body composition improvement was associated with steatosis resolution. Conclusions: Based on the included studies, body composition improvement may be associated with a decrease in liver fat content in NAFLD. Systematic review registration: Identifier: CRD42021278584.