Are platelet concentrates an ideal biomaterial for arthroscopic rotator cuff repair? A meta-analysis of randomized controlled trials.

PURPOSE: The present study aims to conduct a meta-analysis of Level I evidence studies to investigate the efficacy of concomitant platelet concentrate (PC) used in arthroscopic rotator cuff repair. METHODS: We systematically searched electronic databases to identify randomized controlled trials (RCTs) evaluating the role of PC augmentation in arthroscopic rotator cuff repairs for patients with full-thickness tears. The search strategy followed the requirements in the Cochrane Library Handbook. The primary outcome was retearing of the rotator cuff. Functional outcomes were analyzed in terms of Constant score, specific Constant pain score, University of California, Los Angeles (UCLA) shoulder score, Simple Shoulder Test (SST) score, and American Shoulder and Elbow Surgeons (ASES) score. RESULTS: Seven studies with a total of 417 patients available at the latest follow-up reporting data about retears were analyzed in this meta-analysis. However, 4 studies with Constant scores (n = 237), 3 studies with UCLA scores (n = 168), 2 studies with Constant pain scores (n = 164), 2 studies with ASES scores (n = 101), and 2 studies with SST scores (n = 121) were analyzed. The retear rates and functional scores showed that there was no significant efficacy of PC application in arthroscopic rotator cuff repairs. CONCLUSIONS: This meta-analysis of high-level evidence suggests that PCs have no benefit regarding retear rate and overall clinical outcomes for the arthroscopic repair of full-thickness rotator cuff tears. LEVEL OF EVIDENCE: Level II, meta-analysis of randomized controlled trials.

Single-bundle versus double-bundle anterior cruciate ligament reconstruction: an up-to-date meta-analysis.

PURPOSE: The aim of this meta-analysis was to compare the results of arthroscopic single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: We systematically searched electronic databases to identify randomised controlled trials (RCTs) in which arthroscopic single-bundle was compared with double-bundle for ACL reconstruction. The search strategy followed the requirements of the Cochrane Library Handbook. The outcomes of these studies were analysed in terms of graft failures, Lysholm score, negative pivot-shift test, KT1000 arthrometer measurements, knee extensor and flexor peak torques, knee extension and flexion deficit, and subjective and objective International Knee Documentation Committee (IKDC) final score. Methodological quality was assessed and data were extracted independently. Standard mean difference (SMD) or odds ratio (OR) with 95 % confidence interval (CI) was calculated by a fixed effects or random effects model. Heterogeneity across the studies was assessed with the I-square and chi-square statistic. Forest plots were also generated. RESULTS: We identified 17 RCTs comprising 1,381 patients who were treated by arthroscopic single-bundle versus double-bundle ACL reconstruction. The results of meta-analysis of these studies showed that arthroscopic double-bundle reconstruction was associated with a lower risk of graft failures (P=0.002) and a lower rate of positive pivot-shift test (P<0.0001). Compared with single-bundle reconstruction, double-bundle reconstruction had a lower KT1000 arthrometer measurement (P<0.00001), a lower knee extension deficit (P=0.006) and a higher subjective IKDC score (P=0.03). There was no statistically significant difference between single-bundle and double-bundle reconstruction in Lysholm score (P=0.91), knee extensor peak torques (P=0.97), knee flexor peak torques (P=0.96), knee flexion deficit (P=0.30) and objective IKDC score (P=0.18). CONCLUSIONS: Considering the more favourable outcomes of graft failures, knee joint stability and knee joint function in double-bundle reconstruction, we concluded that arthroscopic double-bundle reconstruction should be considered as the primary treatment in ACL reconstruction.

[Early incision, decompression and screw fixation for the treatment of Lisfranc injuries with foot osteofascial compartment syndrome].

OBJECTIVE: To explore clinical effect of early incision and decompression combined with screw fixation in treating Lisfranc injury and foot osteofascial compartment syndrome. METHODS: Clinical data of 5 patients with Lisfranc injury and foot osteofascial compartment syndrome were retrospective analysized from January 2017 to December 2018, including 4 males and 1 female, aged from 19 to 62 years old. All patients were suffered from closed injuries. The time from injury to treatment ranged from 1 to 14 h. According to Myerson classification, 1 patient was type A, 1 patient was type B, and 3 patients were type C. All patients were performed early incision decompression and screw fixation. Maryland foot functional scoring standard at 12 months after opertaion was used to evaluate clinical effect. RESULTS: All patients were followed up for 10 to 48 months. All fractures were achieved bone union, and healing time ranged from 3 to 9 months. All metatarsal and tarsal joints were reached to anatomical reduction. No infection, osteomyelitis, loosening or breaking of internal fixation occurred. Postopertaive Maryland foot function score at 12 months was from 44 to 97, and 2 patients got excellent result, 2 good, and 1 poor. CONCLUSION: Early incision and decompression with screw fixation for the treatment of Lisfranc injury and foot osteofascial compartment syndrome, which has advantages of simple opertaion, thoroughly decompression, screw fixation does not occupy space, stable decompression and fixation, and could receive satisfied clinical effect.

Surgical or nonsurgical treatment for nontraumatic rotator cuff tears: Study protocol clinical trial.

BACKGROUND: The optimal treatment for symptomatic, nontraumatic rotator cuff tear is unknown. The primary aim of this randomized controlled trial is to compare functional improvement after surgical and conservative treatment of nontraumatic rotator cuff tears. METHODS: This is a single-centre, randomized clinical trial with a follow-up of 12 months. Patients older than 18 years with magnetic resonance imaging - confirmed nontraumatic rotator cuff tears that are suitable for either surgery or nonsurgery treatment is enrolled. The primary outcome is Constant score. Secondary outcome measures include visual analog scale (VAS) score, patient satisfaction, and American Shoulder and Elbow Surgeons (ASES) score. All scores are assessed by an independent observer who is blinded to the allocation of groups. RESULTS: The study will provide much needed data on surgical vs nonsurgical treatment for nontraumatic rotator cuff tears. Results of this study may help patients, clinicians, and policy makers assess the pivotal question on comparative effectiveness of surgery vs nonsurgical for rotator cuff tears. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5442).

[Preparation and biocompatibility of a novel strontium-containing calcium sulfate].

OBJECTIVE: To prepare a novel strontium-containing calcium sulfate and assess its and biocompatibility. METHODS: A novel strontium-containing α-calcium sulfate hemihydrate (Sr-caS) bone substitute as prepared with hydrothermal reaction and examined for X-ray diffraction (XRD), Fourier transform infrared (FTIR) and thermogravimetric differential scanning calorimetric (TG-DSC) patterns. The biocompatibility of the material was evaluated by in vitro cytotoxicity test in L-929 cells, hemolysis test of blood, and in vivo implantation test in SD rats. RESULTS: The XRD spectra of the prepared Sr-CaS powder highlighted 3 strong characteristic peaks of α-CaSO4 at 14.63°, 25.72° and 29.80° with a strontium-specific peak at 24.78°. The FTIR patterns of Sr-CaS resembled those of CaS. TG-DSC results showed that the material contained a non-evaporable water content of 6.03%. In vitro cytotoxicity test in L-929 cells suggested that the material had a class 1 cytotoxicity, and the hemolysis rate of its aqueous extract was 4.3%. The material implanted in the muscular tissues of SD rats maintained a steady state in the surrounding tissues. CONCLUSION: This strontium-containing calcium sulfate material we prepared shows an excellent biocompatibility for potential use as a novel artificial bone material.

Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis.

OBJECTIVE: The aim of this study was to compare the effect of operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients regarding clinical results, complications, and additional surgeries. METHODS: Six electronic databases (Medline, Embase, Clinical, Ovid, Biosos, and Cochrane Central Register of Controlled Trials) were systematically searched to identify randomized controlled trials (RCTs). Eligible RCTs published between 1960-2012 comparing operative vs. nonoperative treatment of comminuted proximal humeral fractures were included. Trial quality was assessed using the modified Jadad scale. Data from included studies were pooled with the use of fixed-effects and random-effects models with mean difference and risk ratios for continuous and dichotomous variables, respectively. Sensitivity analysis was performed to account for bias in patient selection. RESULTS: Six studies matched the selection criteria, reporting on 287 patients. One hundred fourty-four patients (50.17%) were managed nonoperatively, 20 patients (6.97%) underwent tension band fixation, 55 patients (19.16%) were treated with locked plate, and 68 patients (23.69%) underwent hemiarthroplasty. Mean follow-up ranged from 12-50 months. Results showed no significant difference in post-treatment Constant scores and DASH scores, but conservative treatment showed superior results compared to operative treatment using EQ-5D™. Compared with operative treatment, nonoperative treatment led to significantly fewer complications and additional surgeries. Findings from subgroup analyses remained consistent with these outcomes when compared to nonoperative treatment with tension band fixation, locked plate fixation, and hemiarthroplasty. CONCLUSION: Compared with operative treatment for closed comminuted proximal humeral fractures in elderly patients, conservative treatment can effectively reduce the risk of additional surgeries and complications. However, there is no statistical difference between operative and nonoperative treatment in terms of clinical outcomes.

Efficacy and safety of single-dose local infiltration of analgesia in total knee arthroplasty: a meta-analysis of randomized controlled trials.

PURPOSE: To examine the efficacy and safety of single-dose local infiltration of analgesia (LIA) for post-operative pain relief in total knee arthroplasty (TKA) patients. METHODS: A systematic electronic literature search (up to Aug 2013) was conducted to identify the RCTs that address the efficacy and safety of single-dose LIA in the pain management after TKA. Subgroup analysis was conducted to determine changes of visual analog score (VAS) values at six different postoperative time points. Weighted mean differences or relative risks with accompanying 95% confidence intervals were calculated and pooled using a random effect model. RESULTS: Eighteen trials involving 1858 TKA patients met the inclusion criteria. The trials were liable to medium risk of bias. The VAS values at postoperative 2h, 4h, 6h, 12h, 24h, and 48h per patient were significantly lower in the LIA group than in the placebo group, and the former group also had less morphine consumption and better early functional recovery including range of motion, time to straight leg raise and 90° knee flexion than the latter group. No significant difference in length of hospital stay or side effects was detected between the two groups. CONCLUSIONS: The current evidence shows that the use of single-dose LIA is effective for postoperative pain management in TKA patients, with satisfactory short-term safety. More high-quality RCTs with long-term follow-ups are required for examining the long-term safety of single-dose LIA. LEVEL OF EVIDENCE: I, II.

A novel resorbable strontium-containing α-calcium sulfate hemihydrate bone substitute: a preparation and preliminary study.

Distraction osteogenesis after aggrieved bone segment resections is promising in the treatment of bone tumors and osteomyelitis. However, there is ambiguity with regard to the optimal choice of bone substitute, with biodegradability and excellent bone repair performance constituting key requirements. The purpose of this study was to develop a novel resorbable strontium-containing α-calcium sulfate hemihydrate (Sr-CaS) bone substitute to provide an alternative option for surgeons that better meets these requirements. The Sr-CaS was prepared using co-precipitation and hydrothermal methods and analyzed using x-ray diffraction (XRD), Fourier transform infrared (FTIR) scanning and thermogravimetric differential scanning calorimeter (TG-DSC) patterns. Cytotoxicity by tetrazolium bromide (MTT), sub-acute toxicity and hemolysis tests were performed to assess the initial biocompatibility of the new bone substitute. Radiographic analysis, micro-CT measurements and histological observation were used to evaluate the bone repair ability in rat tibia bone defects. The XRD and FTIR patterns of Sr-CaS were both very similar to CaS and the product had comparable characteristics similar to α-CaS as demonstrated by TG-DSC. Cytotoxicity of the substitute was class 1 (no cytotoxicity) and hemolysis was 4.3% (no hemolysis). Sub-acute toxicity was not seen after a 14 day evaluation. The substitute was radio-opaque. The empty group exhibited the lowest levels of both bone mineral densities (BMD) and bone volume/total volume (BV/TV) of the defects when compared to all other groups. The two Sr-CaS groups resulted in significantly greater BMDs and BV/TV of the defect compared to the CaS only group. However, there was no significant difference between the 5% and 10% Sr-CaS groups. The Sr-CaS was resorbable with satisfactory biocompatibility. The doped strontium ions enhanced the bone repair performance of CaS in a rat model and the new substitute demonstrated promising results for clinical use.

Effect of treadmill exercise timing on repair of full-thickness defects of articular cartilage by bone-derived mesenchymal stem cells: an experimental investigation in rats.

OBJECTIVE: Current medical practice for the treatment of articular cartilage lesions remains a clinical challenge due to the limited self-repair ability of articular cartilage. Both experimental and clinical researches show that moderate exercise can improve articular cartilage repair process. However, optimal timing of moderate exercise is unclear. We aimed to evaluate the effect of timing of moderate treadmill exercise on repair of full-thickness defects of articular cartilage. DESIGN: Full-thickness cartilage defects were drilled in the patellar groove of bilateral femoral condyles in a total of 40 male SD rats before they were randomly assigned into four even groups. In sedentary control (SED) group, no exercise was given; in 2-week (2W), 4-week (4W) and 8-week groups, moderate treadmill exercise was initiated respectively two, four and eight weeks after operation. Half of the animals were sacrificed at week 10 after operation and half at week 14 after operation. Femoral condyles were harvested for gross observation and histochemical measurement by O'Driscoll scoring system. Collagen type II was detected by immunohistochemistry and mRNA expressions of aggrecan and collagen type II cartilage by RT-PCR. RESULTS: Both 10 and 14 weeks post-operation, the best results were observed in 4W group and the worst results appeared in 2W group. The histochemistry scores and the expressions of collagen type II and aggrecan were significantly higher in 4W group than that in other three groups (P<0.05). CONCLUSIONS: Moderate exercise at a selected timing (approximately 4 weeks) after injury can significantly promote the healing of cartilage defects but may hamper the repair process if performed too early while delayed intervention by moderate exercise may reduce its benefits in repair of the defects.

Mini-incision versus standard incision total hip arthroplasty regarding surgical outcomes: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: It remains controversial whether mini-incision (MI) benefits patients in total hip arthroplasty (THA). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of MI on surgical and functional outcomes in THA patients. METHODS: A systematic electronic literature search (up to May 2013) was conducted to identify RCTs comparing MI with standard incision (SI) THA. The primary outcome measures were surgical and functional outcomes. According to the surgical approach taken, MI THA patients were divided into four subgroups for sub-group meta-analysis. Standardized mean differences (SMDs) or risk differences (RDs) with accompanying 95% confidence intervals (CIs) were calculated and pooled using a fixed-effect or random-effect model according to the heterogeneity. RESULTS: A total of 14 RCTs involving THA 1,174 patients met the inclusion criteria. The trials were medium risk of bias. The overall meta-analysis showed MI THA reduced total blood loss (95% CI, -201.83 to -21.18; p=.02) and length of hospital stay ( 95% CI, -0.67 to -0.08; p=.01) with significant heterogeneity. However, subgroup meta-analysis revealed posterior MI THA had perioperative advantages of reduced surgical duration ( 95% CI, -8.45 to -2.67; P<.001), less blood loss ( 95% CI, -107.20 to -1.73; P=.04) and shorter hospital stay ( 95% CI, -0.74 to -0.06; p=.002) with low heterogeneity. There were no significant differences between MI and SI THA groups in term of pain medication dose, functional outcome (HHS), radiological outcome or complications (P>.05, respectively). CONCLUSIONS: Although no definite overall conclusion can be arrived at on whether MI THA is superior to SI THA, posterior MI THA clearly result in a significant decrease in surgical duration, blood loss and hospital stay. It seems to be a safe minimally invasive surgical procedure without increasing the risk of component malposition or complications.