Use of electromyographic biofeedback in rehabilitation following anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

BACKGROUND: Rehabilitation following anterior cruciate ligament (ACL) reconstruction surgery is essential to regain functionality and return to previous activity level. Electromyographic biofeedback may be an effective intervention for rehabilitation of patients following ACL surgery. OBJECTIVE: To synthesize the available evidence on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery. DESIGN: Systematic review with meta-analysis. DATA SOURCES: PubMed, EMBASE, CENTRAL and Epistemonikos were searched. ELIGIBILITY CRITERIA: Randomized clinical trials with patients undergoing ACL reconstruction surgery comparing biofeedback with a standard rehabilitation control group. DATA EXTRACTION AND DATA SYNTHESIS: Two authors selected articles and performed data extraction. The analysed outcomes were strength, function, pain, knee extension and balance. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. Results were combined through random-effects meta-analysis, reporting mean differences. RESULTS: Eight articles were included in the qualitative analysis, and four articles were included in the quantitative analysis. The interventions lasted between 4 and 12 weeks. Three studies evaluated the effect of biofeedback on quadriceps strength; of these, two studies showed a significant difference in favour of the biofeedback group. In addition, biofeedback was found to improve knee extension [standardized mean difference - 1.3, 95% confidence interval (CI) - 1.74 to -0.86] and balance (one study). There was no significant difference in Lysholm score (mean difference -6.21, 95% CI -17.51 to 5.08; I2 =59%) or pain between the biofeedback group and the control group. CONCLUSION: Electromyographic biofeedback in knee rehabilitation could be useful following ACL reconstruction surgery. KEY MESSAGES: SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42020193768).

Lesiones del plexo braquial en adultos: una revisión narrativa de la literatura / Brachial plexus injuries in adults: a narrative review of the literature

La patología traumática del plexo braquial comprende un amplio espectro de lesiones potencialmente devastadoras para la funcionalidad de los pacientes. El objetivo del presente trabajo es realizar una revisión narrativa de la literatura enfocada en el diagnóstico y estudio de las lesiones del plexo braquial en adultos, además de entregar nociones básicas sobre el manejo de esta compleja patología

Traumatic brachial plexus injuries comprise a wide spectrum of lesions that are potentially devastating to the functionality of the patients. The aim of the present review is to perform a narrative review of the literature focused on the diagnosis and study of brachial plexus injuries in adults, in addition to providing basic guidelines on the management of this complex pathology.

The influence of the CT scan in the evaluation and treatment of nondisplaced femoral neck fractures in the elderly.

BACKGROUND: The management of nondisplaced femoral neck fractures (FNFs) has evolved, with emphasis in radiographic features such as posterior displacement. However, the role of advanced imaging in this scenario is still not well defined. Therefore, our objective is to assess the impact of a computed tomography scan (CT) on interobserver agreement (IA) of fracture classification, posterior tilt measurement, and treatment decisions in nondisplaced FNF in elderly patients. METHODS: Eleven patients with a nondisplaced (Garden 1-2) FNF were assessed by six hip surgeons. On a first stage, fracture classification, posterior tilt, and treatment plan (fixation/arthroplasty) were determined only with clinical information and X-rays. On a second stage, a CT was added. The kappa coefficient ( κ) and intraclass correlation coefficient (ICC) were used to determine IA. RESULTS: IA for Garden classification was only slight in X-rays and with the addition of a CT, with a κ = 0.13 (0-0.28) and 0.18 (0.03-0.33), respectively. Conversely, posterior tilt measurement agreement was excellent in both schemes, with an ICC = 0.92 (0.83-0.98) and 0.92 (0.82-0.98). The IA for the proposed treatment was slight with X-rays ( κ = 0.44; 0.29-0.6), but moderate with the addition of a CT scan ( κ = 0.67; 0.52-0.82). Changes in surgical decision where made in 14 of 66 evaluations with an OR = 1.4 (0.62-3.2) for choosing an arthroplasty if a CT was used. CONCLUSION: IA for fracture classification and posterior tilt evaluation in nondisplaced FNF was not altered by the usage of a CT. There is improvement in treatment agreement when a CT scan is added to conventional imaging, with changes in treatment in 21% of cases.

Is platelet-rich plasma effective for osteoarthritis? / ¿Es efectivo el plasma rico en plaquetas para el tratamiento de la artrosis?

INTRODUCTION: Despite varied non-surgical alternatives for the treatment of osteoarthritis, many patients remain symptomatic. In the last decade, the use of intra-articular platelet-rich plasma (PRP) has been proposed as an option. However, there is controversy about its clinical benefit and safety. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. CONCLUSIONS: We identified twelve systematic reviews including four studies overall, of which all corresponded to randomized trials. We concluded that intra-articular injection of platelet-rich plasma might slightly decrease joint pain and improve patient satisfaction,vut it is not clear whether it has any effect on functionality because the certainty of the evidence is very low. As for the adverse effects, if they exist, they would be non-severe and self-limited.

INTRODUCCIÓN: El manejo no quirúrgico de la artrosis es variado y los pacientes que la padecen muchas veces persisten sintomáticos a pesar de intentar múltiples alternativas no quirúrgicas. En la última década, se ha planteado el uso de plasma rico en plaquetas intraarticular como alternativa, sin embargo, existe controversia sobre su eficacia clínica y seguridad. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos doce revisiones sistemáticas que en conjunto incluyen cuatro estudios primarios, correspondientes a ensayos aleatorizados. Concluimos que la inyección intraarticular de plasma rico en plaquetas podría disminuir levemente el dolor articular, podría mejora la satisfacción del paciente, y no está claro si tiene algún efecto sobre la funcionalidad porque la certeza de la evidencia es muy baja. En cuanto a los efectos adversos, de existir, serían no severos y autolimitados.

Is pulsed ultrasound an alternative for osteoarthritis? / ¿Es el ultrasonido de onda pulsátil una alternativa en el tratamiento de la artrosis?

INTRODUCTION: Many osteoarthritis patients persist symptomatic despite nonsurgical treatment. Pulsed ultrasound might be a viable alternative for such cases, but its real clinical relevance remains unclear. METHODS: A literature review was conducted in Epistemonikos, the largest database for sys-tematic reviews in health that compiles multiple sources, including MEDLINE, EMBASE, and Cochrane, among others. Relevant data were extracted, and infor-mation from the primary studies was reanalyzed. A subsequent meta-analysis was conducted, and summary of findings tables were constructed using the GRADE methodology. RESULTS AND CONCLUSIONS: Six systematic reviews including eight randomized trials were identified. In conclusion, it is not clear whether pulsed ultrasound improves functionality, and it might slightly decrease pain but the certainty of the evidence is low.

INTRODUCCIÓN: Un gran número de pacientes que padece artrosis se mantiene sintomático a pesar del tratamiento no quirúrgico. Se ha planteado que el uso de ultrasonido terapéutico de onda pulsátil sería una alternativa de tratamiento no quirúrgico de la artrosis, sin embargo, no está clara su real utilidad. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos seis revisiones sistemáticas que en conjunto incluyen ocho ensayos aleatorizados. Concluimos que no está claro si el ultrasonido de onda pulsátil lleva a una mejoría funcional en artrosis, y que podría llevar a una disminución de escasa cuantía en el dolor en artrosis, pero la certeza de la evidencia es baja.

Is duloxetine an alternative in the treatment of osteoarthritis? / ¿Es la duloxetina una alternativa en el tratamiento de la artrosis?

INTRODUCTION: Many osteoarthritis patients continue to present symptoms despite nonsurgical treatment. Duloxetine might be a viable alternative for such cases, but real clinical relevance remains unclear. METHODS: A literature review was conducted in Epistemonikos, the largest database for systematic reviews in health that compiles multiple sources, including MEDLINE, EMBASE, and Cochrane, among others. Relevant data were extracted, and information from the primary studies was reanalyzed. A subsequent meta-analysis was conducted, and summary of findings tables were constructed using the GRADE methodology. RESULTS AND CONCLUSIONS: Four systematic reviews including four randomized trials, were identified. In conclusion, while duloxetine slightly improves pain and functionality in osteoarthritis patients, its use is associated with frequent adverse side effects. Therefore, the benefit/risk balance appears unfavorable.

INTRODUCCIÓN: Muchos pacientes con artrosis persisten con síntomas a pesar del tratamiento no quirúrgico. Se ha planteado el uso de duloxetina en estos casos, sin embargo, no está clara su real utilidad clínica. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyen cuatro estudios aleatorizados. Concluimos que la duloxetina produce una leve mejoría del dolor y la funcionalidad en pacientes con artrosis, pero se asocia a efectos adversos frecuentes, por lo que el balance entre beneficios y riesgos probablemente no es favorable.