Clinical Outcomes in Prospective versus Retrospective Studies on Arthroscopic Bankart Repair: A Systematic Review.

BACKGROUND: The majority of the current literature on arthroscopic Bankart repair is retrospective and discrepancies exist regarding clinical outcomes including recurrent instability and return to play amongst studies of different levels of evidence. PURPOSE: The purpose of this study is to perform a systematic review of the literature to compare the outcomes of prospective and retrospective studies on arthroscopic Bankart repair. METHODS: A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" with all results being analyzed via strict inclusion and exclusion criteria. Three independent investigators extracted data and scored each included study based on the 10 criteria of the Modified Coleman Methodology Score (CMS) out of 100. A chi-square test was performed to assess if recurrent instability, revision, return to play, and complications are independent of prospective and retrospective studies. RESULTS: One hundred ninety-three studies were included in the analysis with 53 prospective studies and 140 retrospective in design. Encompassing a total of 13,979 patients and 14,019 surgical procedures for Bankart repair for shoulder instability. The rate of re-dislocation in the prospective studies was 8.0% vs. 5.9% in retrospective (p < 0.001). The rate of recurrent subluxation in the prospective studies was 3.4% vs. 2.4% in retrospective (p = 0.004). The rate of revision was higher in retrospective studies at 4.9% vs. 3.9% in prospective studies (p = 0.013) There was no significant difference in terms of overall rate to return to play in prospective and retrospective studies was 90% and 91%, respectively (p=0.548). The overall rate of complications in the prospective cohort was 0.27% and 0.78% in the retrospective studies (p = 0.002). CONCLUSION: The overall rates of recurrent dislocations, subluxations are higher in prospective studies compared to retrospective studies. However, rates of revision were reportedly higher in retrospective studies. Complications after arthroscopic Bankart repair are rare in both prospective and retrospective studies, and there was no difference in rates of return to play.

Estimates of Golf-Related Upper Extremity Injuries in the United States: A 10-Year Epidemiology Study (2011-2020).

BACKGROUND: Golf is one of the most popular sports in the United States (US) and is played by participants of all ages and skill level. Given the popularity and sport-specific demands on the upper torso, golf poses a considerable risk for upper extremity (UE) injuries. Therefore, the aim of the current study was to (1) determine the incidence rate of UE golf injuries presenting to emergency departments (EDs) in the US, (2) determine the most commonly injured body parts and mechanisms of injury, and (3) compare current injury epidemiology with previous trends in the literature. HYPOTHESIS: Male sex, bimodal age extremes (young and elderly), and utilization of golf carts (vs walking) are associated with a higher incidence of golf-related UE injuries. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: The National Electronic Injury Surveillance System (NEISS) is a statistically validated injury surveillance system that collects data from ED visits as a representative probability sample of hospitals in the US. We queried the NEISS for the years 2011 to 2020 to examine the following variables for golf-related UE injuries: sociodemographic, diagnosis, body part, and mechanism of injury. RESULTS: From 2011 to 2020, there were a total of 1862 golf-related UE injuries presenting to participating EDs, which correlates to an estimated 70,868 total injuries. Overall, male golf players were disproportionately affected (69.2%) versus female golf players (30.8%) and the most commonly injured age groups were those aged >60 and 10 to 19 years. The most common injuries included fractures (26.8%), strains/sprains (23.4%), and soft tissue injuries (15.9%). The joints injured most frequently were the shoulder (24.8%), wrist (15.6%), and joints in the hand (12.0%). The most common mechanisms of injury were cart accidents (44.63%), falling/tripping (29.22%), and golf club swinging/mechanics (10.37%). CONCLUSION: Golf-related UE injuries can be acute or due to chronic overuse. Male athletes >60 years of age were the population most commonly presenting to the ED with a golf-related injury. Further, the shoulder, forearm, and wrist were most commonly injured. These findings are consistent with previous epidemiological trends in the literature. Interventions to reduce the incidence of injury should be sport-specific and focus primarily on equipment and golf cart safety and swing modification to optimize the biomechanical function of the UEs. CLINICAL RELEVANCE: Our findings indicate that golf-related injury prevention programs should target UE injuries, particularly among young (<19) and older (>60 years) golfers with poor swing mechanics.

Intramedullary nailing vs. open reduction-internal fixation for humeral shaft fractures: a meta-analysis of randomized controlled trials.

BACKGROUND: The purpose of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare outcomes following intramedullary nailing (IMN) vs. open reduction-internal fixation (ORIF) for humeral shaft fractures. METHODS: A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RCTs comparing IMN and ORIF for humeral shaft fractures were included. Clinical outcomes were compared using RevMan. P < .05 was considered statistically significant. RESULTS: Ten RCTs with 512 patients were included. Overall, 8.4% of patients treated with IMN and 6.4% of patients treated with ORIF had nonunion (P = .57, I2 = 0%), with a significantly faster time to union with IMN (10 weeks vs. 11.9 weeks, P < .05). There was no significant difference in the rate of reoperation (11.6% in IMN group vs. 7.6% in ORIF group, P = .26) or radial nerve palsy (2.8% in IMN group vs. 4.2% in ORIF group, P = .58). A lower rate of infection was noted with IMN (1.2% vs. 5.3%, P < .05). Additionally, there was a lower operative time with IMN (61 minutes vs. 88 minutes, P < .05). CONCLUSIONS: The Level I evidence in the literature does not show a significant difference in rates of union, reoperation, or radial nerve palsy between IMN and ORIF for humeral shaft fractures. Overall, treatment with IMN results in a lower infection rate, less operative time, and a modestly quicker time to union. The optimal treatment strategy for humeral shaft fractures may be best informed by fracture pattern and surgeon preference.

Pain associated psychological distress is more strongly associated with shoulder pain and function than tear severity in patients undergoing rotator cuff repair.

Background: Psychological distress has been associated with declining shoulder function in patients with rotator cuff tears (RCTs). Thus, we aimed to 1) evaluate the absence or presence of differences in shoulder pain, function, or pain-associated psychological distress in patients with increasing RCT severity and 2) assess whether psychological distress is associated with shoulder pain and function while adjusting for RCT severity. Methods: Consecutive patients who underwent rotator cuff repair and completed the optimal screening for prediction of referral and outcome (OSPRO) survey from 2019 to 2021 were included. OSPRO is composed of 3 domains that estimate pain associated psychological distress (negative mood, negative coping, and positive coping). Demographics, tear characteristics, and three patient reported outcomes (PRO), including the visual analog scale (VAS), Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were collected. Patients were analyzed with analysis of variance and chi-square tests and stratified based on severity of RCTs into three groups: partial-thickness, small-to-medium full-thickness, and large-to-massive full-thickness tear. Linear regression analysis was used to evaluate the association between OSPRO scores and PROs, adjusting for severity of RCT. Results: Eighty-four patients were included: 33 (39%) had partial-thickness, 17 (20%) had small-to-medium full-thickness, and 34 (41%) had large-to-massive tears. Regarding PROs and psychological distress, there were no significant differences amongst the three cohorts. In contrast, multiple significant associations between psychological distress and PROs were found. Within the negative coping domain, fear avoidance dimensions demonstrated the strongest correlation to PROs: fear-avoidance behavior for physical activity (ASES Beta -0.592, P < .001; VAS 0.357, P < .001) and work (ASES Beta -0.442, P < .001; VAS 0.274, P = .015). Several other dimensions within the negative coping, negative mood, and positive coping domains also demonstrated significant associations to PROs. Discussion: These findings suggest that in patients undergoing arthroscopic rotator cuff repair, preoperative psychological distress can more strongly influence patient perception of shoulder pain and diminished shoulder function than RCT severity.

Comparison of the performance of the dry eye questionnaire (DEQ-5) to the ocular surface disease index in a non-clinical population.

OBJECTIVE: To compare the performance of the dry eye questionnaire (DEQ-5) with the Ocular Surface Disease Index (OSDI) and further validate the DEQ-5 questionnaire. METHODS: A population-based cross-sectional study conducted in Ghana. OSDI and DEQ-5 questionnaires were administered to participants. Cronbach's alpha was used to evaluate the reliability of the OSDI and DEQ-5 questionnaires. Analysis of variance was used to evaluate the discriminant validity of DEQ-5. Concurrent validity was evaluated using the Spearman correlation analysis. A receiver operating characteristic (ROC) curve was generated to describe the sensitivity and specificity of the DEQ-5 questionnaire for diagnosis of dry eye symptoms. Cohen Kappa was used to evaluate agreement between the two questionnaires. RESULTS: The reliability of the overall OSDI and DEQ-5 scores were 0.919 and 0.819 respectively. The mean (SD) DEQ-5 scores for asymptomatic, mild, moderate and severe dry eye symptoms as defined by the OSDI grading were 3.05 (2.73), 5.13 (3.69), 7.65 (3.30) and 9.77 (4.16) respectively. There was a statistically significant correlation between total OSDI and total DEQ-5 scores (rs = 0.649, p < 0.0001). The area under the curve (AUC) of the ROC curve for DEQ-5 was 0.835 (95 % CI: 0.796 - 0.875). A DEQ-5 threshold of 5.5 yielded maximum sensitivity (0.712) and specificity (0.827). The Cohen kappa using a the DEQ-5 total score threshold of 5.5 was K = 0.539 (p < 0.0001). CONCLUSION: In conclusion, performance of the DEQ-5 questionnaire in discriminating symptoms of dry eye is comparable to the OSDI questionnaire. The DEQ-5 questionnaire is a valid measure of dry eye symptoms and can be used as a dry eye symptoms assessment tool in both clinical and epidemiological studies.

Association between diabetes and keratoconus-a systematic review and meta-analysis.

PURPOSE: To assess the association between diabetes mellitus and keratoconus. METHODS: PubMed, Google Scholar, Web of Science, and Scopus databases were searched for literature on the association between diabetes and keratoconus. The last literature search was conducted on April 4, 2021. A secondary form of the literature search was conducted by manually scanning the reference list of retrieved eligible articles. Included studies were cohort, case-control, or cross-sectional study design that used odds ratio or risk ratio to evaluate the relationship between keratoconus and diabetes. Egger's test was used to assess the presence of publication bias. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale. RESULTS: Nine studies (six case-control and three cohort studies) published between 2000 and 2021 were included. The total number of keratoconus patients and controls were 27,311 and 53,732. respectively. Meta-analysis revealed no significant association between diabetes mellitus and keratoconus; the pooled odds ratio was 0.87 (95% confidence interval: 0.66-1.14; p = 0.314). There was significant heterogeneity (Q (df = 7) = 33.36, p < 0.001;I2 = 79.01, p < 0.001). Age of participants (p < 0.0001), study design (p < 0.001), and sample size (p = 0.024) were significant sources of heterogeneity. There was no evidence of publication bias. CONCLUSION: The current meta-analysis revealed no significant association between diabetes mellitus and keratoconus. Well-designed longitudinal prospective studies are, however, needed to investigate any association between diabetes mellitus and keratoconus.