Effect of ascending and descending medial open wedge high tibial osteotomy on patella height and functional outcomes-a retrospective study.

BACKGROUND: High tibial osteotomy (HTO) is a popular joint-preserving option for medial compartmental osteoarthritis. However, this is associated with alterations in the patellar height (PH) and tibial slope (TS). This study aims to compare the effect of ascending (AMHTO) and descending medial opening wedge HTO (DMHTO) on patella height, posterior tibial slope and functional outcomes. MATERIAL AND METHODS: A retrospective study was conducted between February 2018 and July 2021. Patients with medial compartment osteoarthritis, varus alignment, and complete pre- and postoperative lateral and full-length anteroposterior radiographs were included. Pre- and postoperative radiological measurements include the Caton-Deschamps index (CDI), the mechanical axis deviation (MAD), and the posterior tibial slope. The functional outcomes were measured using the Oxford Knee Score (OKS), Lysholm Knee Score (LKS), and Tegner Activity Scale (TAS). The osteotomy union was checked with serial X-rays every 6 weeks till a satisfactory union was achieved. RESULTS: Fifty-eight patients were included in the study. Thirty-four (58%) patients received AMHTO, and 24 (42%) received DMHTO. There was no baseline difference in the demographic variables or functional scores between the two groups. The preoperative mean MAD of - 9.65° ± 3.67° was corrected significantly to + 0.08 ± 2.80° (varus -, valgus + , P = 0.034). A significant difference in preoperative and postoperative CDI of 0.93 ± 0.45 and 0.83 ± 0.27, respectively, was noted (P = 0.023). In the AMHTO group, a statistically significant decrease in PH from preoperative 1.03 ± 0.77 to 0.84 ± 0.12 was noted (P = 0.003). There was a significant improvement in functional outcomes between baseline and 9-month follow-up in both groups. There was no significant difference between the functional outcomes of the two groups at 9-month follow-up. CONCLUSION: The study confirmed our hypothesis that descending HTO caused less alteration in the patella height compared to ascending HTO. There is no significant difference in the functional outcomes between the groups. However, in patients with PFOA, and when attempting higher degree of correction through AMHTO, the possibility of worsening of symptoms due to change in PH must be considered.

"Platelet-rich plasma holds promise in management of rheumatoid arthritis"-systematic review.

The treatment of rheumatoid arthritis (RA) has been closely evolving with an understanding of disease pathogenesis with disease modifying anti-rheumatoid drugs (DMARDS) and Biologic DMARDS being the main stay. platelet rich plasma (PRP) has been the center of research in many specialties in the past decade. Its ability to stop and reverse inflammation have attracted researchers to try PRP in RA. A systematic review of studies on PRP in RA is lacking. The study protocol was prospectively registered in PROSPERO. Detailed search of Cochrane, Scopus, Medline, Embase, and Web of science databases were made to identify the relevant articles till Sep 2020 following Cochrane and PRISMA guidelines. Number of subjects, Animal model used, cell lines used for the study, method of induction of arthritis, PRP dose, concentration used, frequency of administration and clinical, histologic, and molecular changes from baseline following PRP use were extracted and analysed. Eight studies were included for the review. Four of these were in-vitro studies. Two were exclusive animal studies. One study analysed the effects of PRP in RA in both animal models (mice) and Hela cell lines. One study was a report of a series of patients of resistant RA treated with PRP. In the in vitro studies while platelets increase the migration and invasion of RA-FLS, they suppressed the inflammation on the whole. Available animal studies and the Human study have shown encouraging results. There has been no evidence of exacerbation of inflammation in these studies. The quantity and quality of literature on the effects of PRP in treating joint pathologies in RA is limited. Preclinical studies show decrease in disease activity with good safety profile. Invitro studies show suppression of inflammation. Thus, the available literature is encouraging towards the use of PRP in RA. Larger trials and molecular studies to understand the exact role of platelets in disease pathogenesis and treatment mechanisms are needed to decide the future course of PRP in RA.

"Only 50% of randomized trials have high level of confidence in arthroscopy and sports medicine"-a spin-based assessment.

PURPOSE: Pioneering works on the quality appraisal of RCTs have recognized and addressed most of the issues that affect the RCT quality but some issues such as "Writers' bias" or "Spin" are yet to be sorted out. Spin, particularly in the abstracts, is a potential source of deception to the readers. The purpose of this study is to grade the RCTs of arthroscopy and sports medicine based on a spin in their abstracts, analyze the prevalence of spin, and explore methods to remove spin. METHODS: 250 recent RCTs from the top 5 arthroscopy and sports medicine journals were selected. Baseline data of the articles were collected. Consort Adherence Score (CAS) was calculated. The abstracts of the RCTs were graded using the Level Of Confidence (LOC) grading tool developed by the Orthopaedic Research Group. The association of the spin grade with other characteristics of the articles was analyzed. RESULTS: The median CAS for the included studies was 9 (IQR 8-10). It was found that only 49.6% (n = 124) articles had high LOC with no or one non-critical spin in the abstract. 20.8% (n = 52) had Moderate LOC with more than one non-critical spin. 19.6% (n = 49) had at least one critical spin and 10% (n = 25) had more than one critical flaw making their results have Low and Critically Low LOC, respectively. Of the ten variables analyzed in multivariate regression analysis, it was found that CAS was the only significant factor that determines the level of confidence in the abstract of RCTs CONCLUSION: Spin is prevalent in abstracts of sports medicine and arthroscopy journals with 50.4% having some form of spin. Grading the LOC of the RCTs based on spin is the necessity of the day for the readers. Only 49.6% of the RCTs had high LOC. Objective structuring of the abstracts would help eliminate spin in the future. LEVEL OF EVIDENCE: Level 1.

Risk-benefit analysis of wound drain usage in spine surgery: a systematic review and meta-analysis with evidence summary.

STUDY DESIGN: Systematic review, meta-analysis, evidence synthesis. OBJECTIVES: To analyse the literature evidence available to support the usage of wound drain in various scenarios of spine surgery and provide an evidence summary on the surgical practice. MATERIALS AND METHODS: We conducted independent and duplicate electronic database searches adhering to PRISMA guidelines in PubMed, Embase, and Cochrane Library till April 2020. Quality appraisal was done as per Cochrane ROB tool, and evidence synthesis was done as per GRADE approach. Five domains of spine surgery with associated key questions were identified. Evidence tables were generated for each question and critical appraisal done as per the GRADE approach. RESULTS: Twenty-three studies (9-RCTs, 4-prospective studies, 10-retrospective studies) were included. Analysis of studies in cervical spine either by anterior or posterior approach and single/multilevel thoracolumbar spinal surgeries did not show any evidence of reduction in surgical site infection (SSI) or haematoma formation with the use of drain. Deformity correction surgeries and surgeries done for trauma or tumour involving spine also did not find any added benefit from the use of wound drains despite increasing the total blood loss. CONCLUSION: Evidence from this review suggests that routine use of drain in various domains of spine surgery does not reduce the risk of SSI and their absence did not increase the risk of haematoma formation. The current best evidence is presented with its limitations. High-quality studies to address their use in spine surgeries in cervical, trauma, and tumour domains are required to further strengthen the evidence synthesised from available literature.

Pandemic response protocol of a non-frontline specialty in a multispecialty tertiary health care centre-a pilot model in orthopaedics.

BACKGROUND: 3,181,642 cases and 224,301 deaths in 212 regions of the world-this is the status of COVID-19 (Coronavirus Disease 2019) pandemic as of May 1, 2020. This pandemic has managed to overwhelm the health care system of the most advanced countries in the world. As the whole of the medical fraternity stands robed as health care professionals to fight against COVID-19, specialty emergencies like trauma continue to pester the already overburdened health care community. This situation calls for the need for a pandemic response protocol (PREP) in each specialty that helps the doctors to manage specialty emergencies without chaos and at the same time allowing them to play their part in pandemic management. CONCLUSION: PREP as an integrated pragmatic approach is essential in containing pandemics as they need international cooperation at various levels starting from knowledge sharing to monetary support. PREP which is in line with the WHO action plan, will be an essential minimum response of a non-frontline pandemic response specialty like orthopedics to combat and curtail the effects of a pandemic in a multispecialty tertiary health care centre.

Maximum outcome with minimal resources: report of a multiligamentous knee injury managed with 'modified confluent tunnel technique'.

Multiligamentous knee injuries (MLKIs) are rare and challenging to manage in many aspects. The injury requires prompt diagnosis, reconstruction of multiple ligaments, and management of associated neurovascular injuries. Another important aspect that surgeons should consider is resource availability. Successful management of a case of MLKI using the cost-effective 'modified confluent tunnel technique' is described in this case report. We used confluent tunnels for intra- and extra-articular ligament reconstructions at the femoral side. We incorporated the weave technique for medial collateral ligament (MCL) reconstruction, and Larson's technique for posterolateral corner (PLC) reconstruction in this construct, and augmented the anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction with the remaining PLC and MCL grafts, respectively. This was cost-effective and resulted in good functional outcomes. The technique also helped us to avoid tunnel convergence which is an expected complication in MLKI surgeries.

Metabolomics in Osteoarthritis Knee: A Systematic Review of Literature.

Introduction: Osteoarthritis (OA) is a common degenerative disorder of the synovial joints and is usually an age-related disease that occurs due to continuous wear and tear of the cartilage in the joints. Presently, there is no proven medical management to halt the progression of the disease in the early stages. The purpose of our systematic review is to analyze the possible metabolites and metabolic pathways that are specifically involved in OA pathogenesis and early treatment of the disease. Materials and Methods: The articles were collected from PubMed, Cochrane, Google Scholar, Embase, and Scopus databases. "Knee", "Osteoarthritis", "Proteomics", "Lipidomics", "Metabolomics", "Metabolic Methods", and metabolic* were employed for finding the articles. Only original articles with human or animal OA models with healthy controls were included. Results: From the initial screening, a total of 458 articles were identified from the 5 research databases. From these, 297 articles were selected in the end for screening, of which 53 papers were selected for full-text screening. Finally, 50 articles were taken for the review based on body fluid: 6 urine studies, 15 plasma studies, 16 synovial fluid studies, 11 serum studies, 4 joint tissue studies, and 1 fecal study. Many metabolites were found to be elevated in OA. Some of these metabolites can be used to stage the OA Three pathways that were found to be commonly involved are the TCA cycle, the glycolytic pathway, and the lipid metabolism. Conclusion: All these studies showed a vast array of metabolites and metabolic pathways associated with OA. Metabolites like lysophospholipids, phospholipids, arginine, BCCA, and histidine were identified as potential biomarkers of OA but a definite association was not identified, Three pathways (glycolytic pathway, TCA cycle, and lipid metabolic pathways) have been found as highly significant in OA pathogenesis. These metabolic pathways could provide novel therapeutic targets for the prevention and progression of the disease. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-024-01169-5.

GOLDIC Therapy Holds Promise as an Orthobiologic Agent: A Systematic Review of the Literature.

Introduction: Orthobiologic agents play a significant role in regenerative medicine. The quest for newer and more effective Orthobiologic agents is never-ending, leading to the evolution of more reformed products. GOLDIC (GOLD Induced cytokine) is a recently evolving Orthobiologic agent developed by conditioning autologous serum with gold particles. We aim to collate the available evidence on GOLDIC and provide a systematic literature review. Materials and methods: Using Cochrane and PRISMA guidelines literature search was done for GOLDIC. After duplicate removal and exclusions, 62 articles were scrutinized, of which 8 articles qualified for full-text review. A risk-of-bias assessment of the included studies was done. Results: All articles showed standardized preparation methods of GOLDIC and uniformity in the number of doses administered, except one study. Reproducible results were noted like an increase in plasma gelsolin and improved KOOS, WOMAC, and VAS scores. Conclusion: GOLDIC has the potential to be a significant Orthobiologic modality considering its standardized preparation techniques, method of administration, and uniformly reproducible outcome measures. However, further high-quality evidence is needed to analyze the clinical efficiency and safety profile of GOLDIC. Systematic review registration: INPLASY202350027 [https://doi.org/10.37766/inplasy2023.5.0027].

Internet of Things enabled open source assisted real-time blood glucose monitoring framework.

Regular monitoring of blood glucose levels is essential for the management of diabetes and the development of appropriate treatment protocols. The conventional blood glucose (BG) testing have an intrusive technique to prick the finger and it can be uncomfortable when it is a regular practice. Intrusive procedures, such as fingerstick testing has negatively influencing patient adherence. Diabetic patients now have an exceptional improvement in their quality of life with the development of cutting-edge sensors and healthcare technologies. intensive care unit (ICU) and pregnant women also have facing challenges including hyperglycemia and hypoglycemia. The worldwide diabetic rate has incited to develop a wearable and accurate non-invasive blood glucose monitoring system. This research developed an Internet of Things (IoT) - enabled wearable blood glucose monitoring (iGM) system to transform diabetes care and enhance the quality of life. The TTGOT-ESP32 IoT platform with a red and near-infrared (R-NIR) spectral range for blood glucose measurement has integrated into this wearable device. The primary objective of this gadget is to provide optimal comfort for the patients while delivering a smooth monitoring experience. The iGM gadget is 98.82 % accuracy when used after 10 hours of fasting and 98.04 % accuracy after 2 hours of breakfast. The primary objective points of the research were continuous monitoring, decreased risk of infection, and improved quality of life. This research contributes to the evolving field of IoT-based healthcare solutions by streaming real-time glucose values on AWS IoT Core to empower individuals with diabetes to manage their conditions effectively. The iGM Framework has a promising future with the potential to transform diabetes management and healthcare delivery.

Adhesive Capsulitis of Hip-A Systematic Review of Literature.

Introduction: Adhesive capsulitis is clinically characterized by the gradual progressive painful loss of active and passive motion caused by the formation of adhesions of the joint capsule. Adhesive Capsulitis of the Hip (ACH) is not a well-explored clinical condition when compared to adhesive capsulitis of shoulder because of the underdiagnosis and rarity of this condition. Materials and Methods: Cochrane, Scopus, Pubmed, Embase, and Web of Science databases were searched for original studies on ACH till December 2021 following Cochrane and PRISMA guidelines. Year of publication, authors, number of cases, baseline characteristics of the studies, causes described, presentation, associated conditions, method of diagnosis, treatment to be given, functional outcomes, and complications was extracted from each study. Results: 16 articles were included in this review. 3 of the included studies were retrospective case-control studies, 6 were case series and the remaining 7 were case reports. A total of 224 ACH cases were recorded. Pain and stiffness of the hips were the most common clinical features. Investigations like serology, radiograph, and MRI have been used to rule out other conditions. Arthrography has been used to confirm the diagnosis in 7 studies. Spontaneous recovery is expected in one to two years. Management has been in the form of physiotherapy, intra-articular injection, and arthroscopy. Conclusion: Literature on ACH is limited because of the rarity of the condition. The disease has a favorable prognosis with the possibility of spontaneous recovery. Physiotherapy has been the first line of management. Intractable cases require surgical intervention. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00808-z.

The Modified PROMT Score: A Better Prognosticative Tool to Assess Traumatic Meniscal Tear Reparability.

Background: Considering various factors that influence meniscal repairability, Ortho One PROMT score (OPS) was proposed in 2019. With an increased understanding of factors influencing meniscal repair and by analysis of OPS predictions and repair results, a modified PROMT score (MPS) has been formulated. The objective of this study is to assess the superiority of MPS over OPS. Methods: Age, chronicity, and pattern of tears were found to be important contributors to false-negative results of OPS. Considering these factors, MPS was designed. A prospective, double-blinded study was conducted between November 2020 and May 2021. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and accuracy of both scores were calculated. Receiver Operating Characteristic (ROC) curve was plotted. Results: Of 133 meniscal tears, 100 met the inclusion criteria. In predicting meniscal repairability, OPS demonstrated sensitivity and specificity of 90.32% and 83.33% medially and 64.71% and 79.41% laterally. MPS had sensitivity and specificity of 96.77% and 88.89% medially and 82.35% and 88.24% laterally. Both scores showed good statistical significance (p < 0.05) in predicting meniscal reparability. For medial meniscus repairability, area under the ROC curve was 0.868 for OPS and 0.928 for MPS. For lateral repairability, the area under the curve was 0.721 for OPS and 0.853 for MPS. Conclusion: MPS will serve as a simple and more effective tool for surgeons to predict meniscal repairability, thus enhancing their pre-surgical preparedness. This tool will also help surgeons to realistically counsel their patients and to achieve optimal patient.

Facial Plates in Phalanx Fracture-Non-Union of Great Toe - A Case Report.

Introduction: Phalanx fractures of the lower limb have high rates of union when manage conservatively. Case Report: A 26-year-old male with fracture of great toe proximal phalanx fracture which was initially managed conservatively with buddy strapping, who missed follow-up and presented late to outpatient department at 6 months with persistence of pain and difficulty in weight bearing. Here, we treated the patient with L-facial plate (2.0 system). Conclusion: Fracture non-union of proximal phalanx can be managed surgically with L- facial plates and screw and bone grafting which will provide full weight bearing and walk normally without any pain and with adequate range of movements.

Total elbow arthroplasty for active primary tuberculosis of the elbow: a curious case of misdiagnosis.

The incidence of musculoskeletal tuberculosis (TB) is on the rise due to the current Acquired Immunodeficiency Syndrome (AIDS) pandemic. Spine is the most common osseous site, followed by other joints. TB identified in the elbow accounts for 2%-5% of skeletal TB cases, which are secondary to pulmonary TB. Primary elbow TB is rare. We report a case of primary TB of the elbow which had a negative synovial biopsy. A 46-year-old right-hand dominant female patient with chronic pain and disability of the right elbow was diagnosed with chronic non-specific arthritis based on an arthroscopic synovial biopsy. The case was diagnosed retrospectively as active TB from bone cuts post total elbow arthroplasty. Anti-tuberculosis treatment (ATT) was given postoperatively for 12 months. The patient reported good functional outcomes at 3 years of follow-up. Such atypical presentations of osteoarticular TB are challenging to diagnose. Therefore, particularly in endemic areas, clinicians should be careful before excluding such a diagnosis even after a negative biopsy. Further research should investigate whether active TB of small joints such as the elbow can be treated with ATT, and early arthroplasty should be a focus of this research.

Custom Mega Prosthesis in a Rare case of Epithelioid Hemangioendothelioma of Proximal Tibia - A Case Report.

Introduction: Lytic lesions of the proximal tibia include a plethora of differential diagnoses. The most common ones are the Giant cell tumor, fibrous dysplasia, adamantinoma, chondromyxoid fibroma, and osteoblastoma. The rarer ones include vascular tumors such as hemangioma and hemangioendothelioma. A systematic line of investigations is essential to pick up the right diagnosis especially in case of rarer conditions. In this background, we present a case of lytic lesion of the proximal tibia which turned out to be epitheloid hemangioendothelioma (EHE). Case Report: A 37-year-old female presented with pain and swelling in the left knee for 2 years. On examination, the patient had a 3 × 4 cm firm, non-tender, and well-defined swelling on the anterolateral aspect of the proximal tibia. X-ray showed a lytic lesion of the proximal tibia. Magnetic resonance imaging was suggestive of a giant cell tumor. However, the biopsy revealed a rare diagnosis of epithelioid hemangioendothelioma. Conclusion: The patient was managed with wide excision. In a young adult, arthrodesis may not be the best option; hence, we reconstructed the joint with a custom mega prosthesis (CMP). At 3 years follow-up, our patient had no signs of recurrence. To our best knowledge, this is the first report on the use of CMP in a case of EHE.

#OrthoTwitter: Blending Information, Education, and Entertainment Online.

BACKGROUND: Twitter has become a part of every medical field, including orthopaedics. #OrthoTwitter is the hashtag commonly used for orthopaedic-related tweets. Researchers have assessed the impact of Twitter in orthopaedics, but no study has evaluated the individual tweets under #OrthoTwitter. The purpose of the present study was to determine the nature of the content and interactions under #OrthoTwitter and to analyze the usefulness of #OrthoTwitter. METHODS: After a pilot study, an analysis of #OrthoTwitter tweets was conducted from May 1, 2021, to June 30, 2021. Data were extracted in 2 stages. In Stage I, data were manually extracted at 8 p.m. IST (Indian Standard Time) on alternate days. In Stage II, data were collected using the web-scraping tool Octoparse. Data were analyzed on the basis of 3 characteristics-topic, purpose, and format of the tweet-with each characteristic comprising 10, 6, and 7 categories, respectively. An association analysis was performed using SPSS software. RESULTS: One thousand and twenty-three tweets were analyzed. Five hundred and fifty-three (54%) of the 1,023 tweets were from orthopaedic surgeons and 123 (12%) were from orthopaedic residents. Medical students aspiring to be orthopaedic surgeons contributed 31 tweets (3%). #OrthoTwitter was also used by non-orthopaedic departments, most frequently radiology. Tweets that were educational or informative were the most common, as compared with tweets of other purposes. Two hundred and forty-six (24%) of the 1,023 tweets were educational (e.g., discussions of cases or journals) and 368 (36%) were informative (e.g., conference announcements and advertisements). Notable tweet subcategories included those related to COVID-19 (71 tweets; 7%), those of a motivational nature (41 tweets; 4%), and those containing some type of graphic content (644 tweets; 63%), for the topic, purpose, and format characteristics, respectively. We noted significantly more likes for tweets with an educational purpose (p = 0.017) and for tweets with images (p < 0.001). We also noted a significant number of retweets of educational tweets (p < 0.001). CONCLUSIONS: #OrthoTwitter provides a unique environment in which education, news, collegial interaction, social responsibility, and entertainment thrive, making Twitter a virtual community. Tweets with an educational purpose and those that included images generated more interactions. Orthopaedic surgeons should consider using #OrthoTwitter in their orthopaedic-related tweets for a broader reach.

Current concepts review in the management of subscapularis tears.

Subscapularis (SSc) is the prime internal rotator of shoulder. It is the most powerful rotator cuff muscle, maintaining the anterior force couple of shoulder. The tears in SSc as any other rotator cuff muscles might result from a traumatic event or more commonly from intrinsic degeneration. With the advent and widespread use of shoulder arthroscopy, SSc tears, which were once considered as "forgotten or hidden lesions" are now being increasingly recognized. Isolated SSc tears are relatively rare. They occur in combinations. Clinically internal rotation can be near normal because of the compensation provided by other internal rotators. It is not uncommon for patients with SSc tear to be normal on routine physical examination. The Bear Hug test (BHT) has high sensitivity and accuracy in the diagnosis of SSc tear. The combined use of BHT with Belly Press Test has been found optimal for diagnosis. US is an accurate and reliable method for diagnosing SSc tears and outperformed MRI in diagnosing partial-thickness SSc tears. The MRI is currently the most advanced imaging available for diagnosis. The specificity is up to 100%. However, the sensitivity is between 36 and 40%. The earliest classification system for SSc tears was by Fox et al. The commonly used classification is by Lafosse et al. The recent system by Yoo et al. is based on the insertion of SSc. The comma sign is gaining importance not only in arthroscopic diagnosis but also in MRI identification and repair of SSc. The mode of management is mainly arthroscopic. The techniques of repair of SSc are continuously progressing. However, there is no clear consensus on the double vs single-row repairs, biceps tendon management, and the role of coracoplasty. Future research must focus on these areas. Reserve shoulder arthroplasty is reserved for salvage in older age groups. Tendon transfers are performed in young active individuals with irreparable tears.

Past, Present and Future of Arthroscopic Research: A Scientometric Analysis of Research Frontiers in Arthroscopy.

Purpose: Active research in arthroscopy in all its domains has been transcending into evidence-backed clinical practice over years. A look-back at the research developments in arthroscopy using scientometry for the past thirty years will help the researchers identify what has been investigated so far, and what needs to be done in the future. Methods: We used the Web of Science-core collection database as the source for data retrieval. We used CiteSpace (5.7.R1) for scientometric and visualization analysis Visualization of the structure, regularity, and distribution of research domains in the arthroscopy was done with the analysis of the article co-citation data to mine the knowledge clustering and citation space distribution. We also analyzed the co-occurrence between the additional research units such as cooperation among authors, institutions, and countries in the field of arthroscopy. Results: We recovered 383 RCTs and 11,853 non-RCT articles in the field of arthroscopy from the global literature of 15,766 arthroscopy-related publications from 1990 to 2019. Research co-operation group with the top contribution to the arthroscopic literature was from BG Domb, MJ Philippon, and SJ Nho for non-RCT articles and Casati A, Pluta A, and Lund B for RCTs. Weaker collaboration exists among the institutions globally, but the network of domestic institutions seemed stronger in co-institution analysis. USA and England have been the pioneers in research particularly the RCTs. The current hotspots were around the outcome analysis, particularly in the knee and shoulder pathologies. In the hip the main area of focus was the Femoro-Acetabular Impingement (FAI). The other areas of arthroscopy remain relatively less explored. Conclusions: Research in arthroscopy is rapidly progressing. Poor international collaboration, the concentration of research only in certain areas of arthroscopy, and conduction of most RCTs only by certain institutes seem to be gross problems in arthroscopic research. Setting up of an International authoritative body for arthroscopic research is the way forward for arthroscopy. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00586-0.

Analysis of Spin in RCTs of Spine Surgery Using ORG-LOC Grading Tool.

Background: Even in highly credible research models, such as randomised control trials (RCTs), many pitfalls do exist that a practitioner must be aware of, to get the actual sense of the research. The one such pitfall that is much more common but ironically less explored is the Writers' bias or the spin. Particularly in the abstracts, it is a potential source of deception to the readers. Methods: We selected 250 recent RCTs from the top 5 spine journals. Baseline data and CONSORT Adherence Score (CAS) were collected. Abstracts of the RCTs were graded using the level of confidence (LOC) grading tool developed by the Orthopaedic Research Group. All possible associations of spin were studied to assess the significance. Results: The median CAS was 11 (IQR 10-12). Only 47.6% (n = 119) articles had High LOC with no or one non-critical spin in abstract. 12.4% (n = 31) had Moderate LOC and 28% (n = 70) had Low LOC. The rest had Critically Low LOC with more than one critical spin. Of the variables analyzed in multivariate regression analysis, only CAS had a (negative) correlation with the LOC of the abstracts. Conclusions: Spin-based grading of RCTs is the need of the hour to aid readers to interpret the true essence of research papers. 40% of the RCTs in top spine journals had low to critically low LOC. Objective structuring of abstracts with adherence to CONSORT guidelines is the way forward to prevent spin.

Does the Intradiscal Injection of Platelet Rich Plasma Have Any Beneficial Role in the Management of Lumbar Disc Disease?

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: We performed this meta-analysis to evaluate whether intradiscal Platelet Rich Plasma(PRP) injection has any beneficial role in the management of lumbar disc disease. METHODS: We conducted independent and duplicate electronic database searches including PubMed, Embase, and Cochrane Library till September 2020 for studies investigating the role of intradiscal PRP in the management of lumbar disc disease. The analysis was performed in the R platform using OpenMeta[Analyst] software. RESULTS: 13 studies including 2 RCTs, 5 prospective, and 6 retrospective studies involving 319 patients were included in the meta-analysis. A single-arm meta-analysis of the included studies showed a beneficial effect of the intervention in terms of pain relief outcomes like VAS score (p < 0.001), pain component of SF-36 (p = 0.003) while such improvement was not seen in functional outcome measures like ODI score (p = 0.071), the physical component of SF-36 (p = 0.130) with significant heterogeneity noted among the included studies. No structural improvement in magnetic resonance imaging was observed (p = 0.106). No additional procedure-related adverse events were noted in the included studies (p = 0.662). CONCLUSION: There is a paucity of high-quality studies to give conclusive evidence on the benefits of intradiscal PRP for lumbar disc disease. Although intradiscal PRP injection has shown some beneficial effect in controlling pain for lumbar disc disease, we could not find structural or functional improvement from the included studies. Hence, we recommend large double-blind double-arm randomized controlled studies to analyze the benefits of the intervention being analyzed.