Effectiveness of Platelet-rich Plasma in Partial-thickness Rotator Cuff Tears: a meta-analysis.

IMPORTANCE: Partial-thickness rotator cuff tears (PTRCTs) commonly affect overhead athletes, leading to a decline in sports performance. Platelet-rich plasma (PRP) is being explored as an alternative treatment modality for individuals with PTRCTs, to reduce discomfort and enhance functional recovery. We conducted a systematic review study of randomized controlled clinical trials to determine the effectiveness of PRP in treating PTRCTs. AIM: To determine the effectiveness of PRP in treating PTRCTs. EVIDENCE REVIEW: We conducted a comprehensive literature search for randomized controlled trials (RCTs) that compared the effectiveness of PRP with eccentric exercise and placebo injections as treatments for PTRCTs. We searched databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The Visual analog scale (VAS) score, American shoulder and elbow surgeon (ASES) score, and Constant-Murley score (CMS) were utilized as outcome measures. Statistical analysis was performed using RevMan 5.3 software. FINDINGS: Our meta-analysis included 12 studies involving 762 patients. At six weeks post-treatment, the PRP group had significantly higher VAS scores compared to the control group, indicating improvement (Standard mean difference (SMD), -2.04 [95% Confidence interval (CI), -4.00 to -0.08], I2 =97%, P-value =0.04). Patients who received PRP showed statistically significant improvements in VAS scores at 3 months and 6 months follow-up (SMD, -1.78 [95% CI, -3.03 to -0.52], I2 =96%, P-value =0.005) (SMD, -2.26 [95% CI, -3.77 to -0.76], I2 =97%, P-value =0.003). A statistically significant difference was also observed in VAS scores at the long-term 1-year follow-up (SMD, -2.27 [95% CI, -4.07 to -0.47]; I2 =98%; P-value =0.031). There were statistically significant differences in ASES scores and CMS scores in the short-term (SMD, 1.21 [95% CI, 0.19 to 2.24], I2 =96%, P-value =0.02) (SMD, 2.01 [95% CI, 0.14 to 3.88], I2 =97%, P-value =0.04). However, in the long-term ASES and CMS scores did not show any statistical significance (SMD, 2.06 [95% CI, -0.54 to 4.65], I2 =99%, P-value=0.12) (SMD, 4.36 [95% CI, -5.48 to 14.21], I2 =99%, P-value=0.39). CONCLUSIONS AND RELEVANCE: Our findings suggest that PRP treatment is effective in reducing pain for individuals with PTRCTs, providing benefits in the short term and long term. However, its impact on functional recovery appears somewhat constrained and doesn't endure over time. Additionally, significant heterogeneity exists among studies, encompassing variations in PRP composition and control group treatments. Consequently, we conclude that compelling evidence for symptom improvement in PTRCT patients following PRP treatment remains elusive. LEVEL OF EVIDENCE: Level I.

Comparison of Time Taken in Conventional versus Active Robotic-Assisted Total Knee Arthroplasty.

Background: Computer- and robotic-assisted total knee replacement procedures have been shown to improve the accuracy of the implant size. It also allows dynamic confirmation of the implant and limb alignment during total knee arthroplasty (TKA). The major inhibition of the arthroplasty surgeon in adapting to the robotic-assisted TKA (RA-TKA) is the extra time spent during the registration process and milling of the bone with the robot. The aim of the study was to ascertain the extra time spent during these 2 steps as compared to the conventional TKA (C-TKA). Methods: It is a prospective study involving 30 patients each in the conventional TKA and RA-TKA operated by the same surgical team. The patients were given a choice between the C-TKA and RA-TKA and consecutive 30 cases in each group were studied by an independent observer. In the C-TKA group, the time for the application of appropriate zigs and execution of the bone cuts and soft-tissue release was recorded whereas in the RA-TKA group, the time taken for fixation of the tibial and femoral arrays and bone registration and bone milling with robot and required soft-tissue release was measured. Results: The preoperative patient characteristics were the same in both groups. The time taken in the C-TKA and RA-TKA groups was 24.77 ± 1.92 minutes and 25.03 ± 3.27 minutes, respectively, which is statistically insignificant (p = 0.709). Conclusions: The study findings show that RA-TKA does not take additional time than C-TKA.

Analysis of robot-specific operative time and surgical team anxiety level and its effect on alignment during robot-assisted TKA.

Adapting to robotic-assisted (RA) total knee arthroplasty (TKA) is hindered by the surgeon's fear of extra time. The main purpose of this study was to determine the robot's operative time, and the secondary goals were to assess the surgical team's anxiety, implant location and size, and limb alignment. From February to April 2022, 40 participants participated in prospective research. The study included primary Cuvis joint active RA-TKA patients for end-stage arthritis, but conversion of unicompartmental knee arthroplasty to TKA, and patients with prior knee surgery were excluded. The active RA-TKA surgical time included surgeon-dependent and surgeon-independent/active robot time. The surgeon's anxiety was measured using the state-trait anxiety inventory (STAI). The implant size/position and limb alignment were checked by post-operative weight-bearing lateral, anteroposterior, and full-length scanograms. Operative time specifically related to active RA-TKA was higher in the first 10 cases as against 10-20, 20-30 and 30-40 cases which was observed to lower from cohort 2. A similar trend was observed for the surgical team's anxiety levels which seem to lower from cohort 2 (case 10-20). Cumulative experience of active RA-TKA showed no effect on the precision of implant alignment/ size, limb alignment and complications. The study showed progressive improvement in the surgical anxiety scores and reduction in operating time indicating the proficiency gained by the surgical team. Further no learning curve was involved in achieving the implant positioning and sizing, limb alignment with the absence of complications.

Platelet-rich plasma in chronic Achilles tendinopathy.

INTRODUCTION: Achilles tendinopathy [AT] is a functional problem characterised by swelling and pain above the Achilles tendon insertion region. In individuals with AT, PRP or platelet-rich plasma can be used as an alternative modality of treatment with an aim to lessen the discomfort and enhance functional recovery. We assessed the available data supporting the effectiveness of PRP in treating chronic AT. MATERIALS AND METHODS: We did a literature search for randomised controlled trials [RCTs] that contrasted the effectiveness of PRP with that of eccentric exercise and placebo injections as treatment for AT in databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The Visual analogue scale [VAS] score, Victorian Institute of Sports Assessment-Achilles [VISA-A] score, and Achilles tendon thickness were used to measure the results. We used the RevMan 5.3.5 software for statistical analysis. RESULTS: We included five RCTs in this meta-analysis. There was no significant difference in the VISA-A between the PRP and placebo groups at 12 weeks, 24 weeks and 1 year after treatment. However, at 6 weeks after treatment, PRP exhibited better efficacy than the placebo treatment. Two studies in our meta-analysis included VAS scores and tendon thickness. There was no significant difference in VAS scores at 6 weeks and 24 weeks after treatment. However, VAS scores at 12 weeks and tendon thickness were significantly different. CONCLUSION: PRP injection is an effective treatment for chronic AT. It has a unique potential for increasing function and reducing discomfort in AT patients.

Efficacy of the Pre-operative Three-Dimensional (3D) CT Scan Templating in Predicting Accurate Implant Size and Alignment in Robot Assisted Total Knee Arthroplasty.

Background: Nearly 20% of Total knee Arthroplasty patients remain dissatisfied. This is a major concern in twenty-first century arthroplasty practice. Accurate implant sizing is shown to improve the implant survival, knee balance and patient reported outcome. Aim of the current study is to assess the efficacy of pre-operative three-dimensional (3D) CT scan templating in a robot-assisted TKA in predicting the correct implant sizes and alignment. Materials and methods: Prospectively collected data in a single center from 30 RA-TKAs was assessed. Inclusion criterion was patients with end stage arthritis (both osteoarthritis and rheumatoid arthritis) undergoing primary TKA. Patients undergoing revision TKA and patients not willing to participate in the study were excluded. Preliminary study of ten patients had indicated almost 100% accuracy in determining the implant size and position. Sample size was estimated to be 28 for 90% reduction in implant size and position error with α error of 0.05 and beta error of 0.20 with power of study being 80. Post-operative radiographs were assessed by an independent observer with respect to implant size and position. The accuracy of femoral and tibial component sizing in the study was compared with the historic control with Chi-squared test. The p value < 0.05 was considered significant. Results: The pre-operative CT scan 3D templating accuracy was 100% (30 out of 30 knees) for femoral component and 96.67% (29 out of 30 knees) for tibial component. The implant position and limb alignment was accurate in 100% of patients. The accuracy of femoral component and tibial component sizing is statistically significant (Chi-squared test, p value 0.0105 and 0.0461, respectively). Conclusion: The study results show the effectiveness of pre-operative 3 D CT scan planning in predicting the implant sizes and implant positioning. This may have a potential to improve the implant longevity, clinical outcomes and patient satisfaction.

Non-Isthmic Spondylolysis Imaging Features: A Case Report.

Introduction: The leading cause of low back pain in our country like India in children and in adolescent has been found to be lumbar spondylolysis. This affects approximately 6-8% of adults in the general population which includes a large number of asymptomatic cases. The main cause in this disease is found to be that of fatigue features which are found in 10% of young adults during heavy labor work, sports, and athletic activities. Case Report: A 25-year-old, left hand dominant, cricket player was referred to Dr. DY Patil Hospital and Research Centre, Pimpri, Pune with complaint of low back pain while playing cricket with no neurological symptoms. His symptoms started 6 months back to this visit and have worsened despite conservative treatment with medications and rehabilitation. No obvious line was seen on the X-rays, but a right non-isthmic spondylolysis was noted at L5 on computed tomography scan. Based on our imaging findings and clinical examination, we made a diagnosis of non-isthmic spondylolysis. As the patient desired an early return to activity, we did not aim for bone union and provided pain relieving treatment which included temporary wearing of soft brace. As a result his pain improved. Conclusion: In our case, the fracture type is more coronally oriented compared with a fracture line in typical spondylolysis. Furthermore, lifting weights transmit a force from the upper limb to lower limbs, it is likely that high loading causes this type of fracture. From a view of biomechanics, reducing extension loading should be an effective means in the treatment of this type of fracture.

Early Results of Bone-Conserving High Flexion Posterior-Stabilized Total Knee System in Indian Population.

Background: A number of total knee arthroplasty (TKA) systems are used across a variety of markets in which outcome will be influenced by patient factors, surgical technique and implant characteristics. The aim of the current study was to report the early functional results of a primary TKA system in support of the component design characteristics adapted for achieving increased functional expectations of the patients. Materials and Methods: A prospective, continuous series of 304 primary posterior-stabilized (PS) TKAs were performed in 208 patients by a single surgeon. Inclusion criterion was patients undergoing primary TKA with Freedom Total Knee system and willing to participate in the study. Exclusion criteria were patients undergoing revision TKA, patients not willing to participate and patients who were lost to follow-up. Patients were clinically and radiologically assessed for a minimum of 5 years post-operatively. Oxford Knee score (OKS) and range of motion (ROM) were assessed for the entire study population and by gender. Results: There were no patients who were lost to follow-up. Two patients (Two knees) required incision and secondary suturing for superficial skin wound complication. At minimum 5-year follow-up, there was no radiographic evidence of component loosening/failure. Clinical evaluation at 5 years post-operatively showed statistically significant increase in the OKS and ROM as compared to pre-operative values (OKS pre-operative 19.27 ± 1.86, post-operative 38.76 ± 1.5, p value < 0.001, ROM pre-operative 94.57 ± 3.49, post-operative 127.69 ± 3.65, p value < 0.001). There was no statistically significant difference in the clinical outcome between male and female genders as well as between unilateral and bilateral TKA. Conclusion: The study showed encouraging early results for the bone-conserving high flexion TKA system in 208 patients at minimum 5-year follow-up. The adapted design characteristics for improved functional expectations are confirmed in this reported Indian population study group cohort. Further continued evaluation is warranted for this primary TKA system across Indian and other ethnic population.

An early experience of the use of dual mobility cup uncemented total hip arhroplasty in young patients with avascular necrosis of the femoral head.

Introduction: THA (Total hip arthroplasty) in advanced grade (grade 4) avascular necrosis (AVN) is a challenge to the treating surgeon as it affects young patients who have high functional demands and increased dislocation risk. The aim of the study was to evaluate the efficacy, survivorship, and dislocation rate of uncemented dual mobility cups (DMC) in advanced grade IV AVN young patients. Methods: Retrospective cohort study involving 204 DMC THA for advanced grade IV AVN from January 2013 to December 2015. The sample size of the study was estimated to be 188 hips with an α error of 0.05 and ß error of 0.2. Inclusion criterion was patients less than 55 years of age with advanced grade IV AVN. Patients >55 years of age, patients diagnosed with primary osteoarthritis of the hip and hip fracture were excluded from the study. 172 patients (32 with bilateral & 140 with unilateral affection) with 204 DMC THA were evaluated clinically by Harris Hip Score (HHS) and radiologically at a follow up of 60 months. P value < 0.05 was considered significant. Results: Mean age of the patients was 42.5 ± 5.3. Preoperative HHS was 50.6 ± 10.5. Postoperative HHS at 5 years follow up was 96.4 ± 2.6. None of the operated patient had any dislocation episode or had undergone hip revision surgery (statistically significant against historical control of 2%, p value = 0.042). The radiological evaluation at 5 years showed no signs of radiolucent lines, periprosthetic osteolysis, polyethylene wear and signs of displacement or migration of the DMC. Cumulative survivorship rate at 5 years follow up was 100% without any revision/dislocation. Conclusion: Use of DMC THA in young, advanced grade IV AVN patients was found to be a reliable option showing excellent early functional results with no dislocation. Ongoing follow up of this cohort is required to confirm the maintenance of these excellent functional results at follow up in the long term.