MUSCULOSKELETAL SURGERY最新文献

Lateral ankle sprains are a common injury that can result in morbidity in terms of pain and time away from work or sport. Although it is typically self-resolving, treatments to expedite or enhance healing may be beneficial. One modality utilized by health care practitioners is the injection of therapeutic compounds. The purpose of this study is to determine the impact of injections of local anesthetics, platelet-rich plasma (PRP), and hyaluronic acid (HA) on patients with lateral ankle sprains. Systematic Review; Level of evidence 3. A comprehensive literature search was conducted in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library on December 17th, 2024, by the Health Sciences Research Librarian. A total of 10 studies were included. 5 pertained to local anesthetic injections and demonstrated a favorable impact on recovery time. 3 manuscripts used PRP with 2 of the 3 finding improvements in the intervention group relative to the control up to 24 weeks from the injury. 2 manuscripts pertained to hyaluronic acid injections and one of the studies found relative improvements compared to the control in terms of pain control. Injections of PRP, hyaluronic acid, and local anesthetics may be able to improve recovery time and pain control for lateral ankle sprains; however, there remains a need for high-quality research to make recommendations for clinical practice.

Medial Tibial Stress Syndrome (MTSS) is an overuse pathological condition, characterized by pain and tenderness along the posteromedial border of the tibia. The duration and severity of symptoms, in some cases, may lead to marked functional impairment and undermine athletic performance.There is a lack of consensus across literature regarding several aspects of MTSS. The purpose of this narrative review is to synthesize current evidence and highlight key elements related to MTSS.Findings indicate that MTSS is a multifactorial condition involving periosteal traction, bone overload and impaired remodeling. Epidemiological data are heterogeneous, but MTSS remains prevalent among athletes and military personnel. Multiple intrinsic and extrinsic risk factors contribute to its onset. Diagnosis is primarily clinical, supported by imaging. Conservative management, consisting of rest, anti-inflammatory medications and physiotherapy, remains the cornerstone, while the evidence for surgical intervention is limited and methodologically weak.

Purpose: We aimed to compare the accuracy of robotic Total Knee Arthroplasty (TKA) intraoperative cuts between Computed Tomography image-based MAKO and imageless ROSA.

Methods: We retrospectively analysed registry data for patients who underwent imaged-based MAKO and imageless ROSA robotic TKA. Two reviewers independently radiographically measured the coronal alignment of the implants in relation to the mechanical axis at 3 months post-operation. These were compared to the planned intraoperative robotic cuts.

Results: One hundred sixty-one patients underwent MAKO and 110 ROSA TKA. Intraclass correlation for radiographic readings was 0.88 to 0.96. When comparing the variability between intraoperative planned alignment and 3 months postoperative, MAKO femur showed no statistically significant difference (- 0.1° ± 0.8° vs. - 0.1° ± 1.2°, p = 0.12) and likewise no difference for tibia (- 0.9° ± 1.2° vs. - 0.6° ± 1.3°, p = 0.60). However, for ROSA, its femur showed statistically significant difference (- 1.2° ± 1.0° vs. - 0.7° ± 1.3°, p < 0.01), likewise for tibia (- 0.4° ± 0.9° vs. - 0.2° ± 1.4°, p < 0.01). The variability from intraoperation to 3 months postoperative was significantly different between MAKO and ROSA for femur (0.0° ± 1.0° vs. 0.4° ± 1.1°, p < 0.01), but was not statistically significant for tibia (0.3° ± 0.1° and 0.1° ± 1.1°, p = 0.26). There was a significant difference with a larger proportion of femur implant that deviated < 1º from intraoperative plan in MAKO compared to ROSA (62.1% and 37.2% respectively, p < 0.01). At the tibia component, there was no statistically significant difference in the proportion of the extent of deviation (p = 0.73).

Conclusion: There was statistically significant variability in coronal alignment between intraoperative plan and postoperative 3 months in the imageless robotic system at both femur and tibia components. The extent of variability between the imageless and CT-image based systems in femur was also statistically significant. There was also a larger proportion of implant deviation of > 1º in the femur component in imageless robotic system. Nevertheless, the overall extent of the deviation between the intraoperative plan and the postoperative position was < 0.5º. Future studies may be performed to determine whether this would translate into any clinical significance.

Purpose: Delirium is common following hip fracture surgery. Red blood cell transfusion (RBCT), which is frequently needed in this population, has been inconsistently associated with incident delirium in previous studies. This study aims to investigate whether RBCT in patients undergoing hip fracture surgery is associated with increased risk of post-operative delirium, and to identify potential risk factors that might influence this association.

Materials and methods: We conducted a retrospective observational study of all hip fracture patients who underwent surgery between November 1 2020 and February 28 2022. Delirium was diagnosed based on DSM V criteria, and assessed daily. The need of perioperative RBCT, and the number of units transfused, were recorded.

Results: A total of 364 participants with a mean age of 84 years were included. Delirium was recorded in 49 (14%) patients, while 88 (24%) required RBCT. In logistic regression, RBCT was associated with delirium (OR = 3.88, 95% CI = 1.23-12.24), after adjusting. An increasing number of RB units transfused was associated with increased probability of delirium (P for linear trend = .013).

Conclusions: Clinicians should carefully consider the indications for RBCT in hip fracture patients. Further studies are needed to confirm these results, and to investigate the potential mechanisms underlying this association.

Purpose: Pain management after total hip arthroplasty (THA) is crucial for patient recovery and satisfaction. Various analgesic techniques exist, including the pericapsular nerve group (PENG) block and local infiltration analgesia (LIA). This study aims to compare the efficacy of PENG and LIA in postoperative pain management following THA.

Methods: A random-effects meta-analysis of randomized controlled trials (RCTs) comparing PENG and LIA in primary THA was conducted. A systematic search of MEDLINE, Embase, Cochrane Library, and SCOPUS was performed up to October 24, 2024. Pain scores, opioid consumption, and secondary outcomes such as complications and postoperative nausea and vomiting (PONV) were analysed.

Results: Four RCTs were included, with 128 patients receiving PENG and 130 receiving LIA. Demographics, including age, BMI, ASA status, and surgery duration, were comparable. Pain scores at 6, 12, 24, and 48 h were higher in the PENG group but not statistically significant. At 24 h, cumulative opioid consumption was higher in the LIA group [4.23 mg (95% CI: 0.50-7.96) vs. 3.97 mg (95% CI: 0.24-7.70)] though not statistically significant (p = 0.92). At 48 h, PENG had higher cumulative opioid consumption [6.78 mg (95% CI: 1.04-12.52) vs. 6.18 mg (95% CI: 0.91-11.45)] though not statistically significant (p  = 0.88). Secondary outcomes, including overall complication rates and PONV, showed no significant differences.

Conclusions: PENG and LIA are comparable in terms of their effectiveness post THA. LIA is non-inferior to PENG in terms of postoperative pain scores, cumulative opioid consumption, overall complication rates and rates of PONV.

Calcaneus fractures are severe injuries often resulting from traumatic falls or motor vehicle accidents. Surgical treatment through open reduction and internal fixation (ORIF) is considered the standard approach for displaced intra-articular calcaneal fractures (DIACFs), but it is associated with many complications. Our study aimed to review the current literature available on primary subtalar arthrodesis (PSA) as a first-line treatment for DIACFs, mostly Sanders type IV. In this study, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed, MEDLINE and the Cochrane Library. This review included articles where primary arthrodesis was performed in calcaneal fractures, with or without associated implants. Nine articles were included in the review. The total population comprised 184 patients with 192 calcaneal fractures. The mean age was 44.9 ± 6.9 years old. The mean follow-up period was 30.28 ± 15.29 months when reported. The mean time to surgery was 13.33 ± 7.02 days from injury. All studies reported a good fusion rate (between 94 and 100%) and an average fusion time of 4.05 ± 2.19 months. The mean American Orthopedic Foot & Ankle Society (AOFAS) score was 71.26 ± 8, and the mean Visual Analog Scale (VAS) score for pain was 3.26 ± 0.91. Primary arthrodesis of the subtalar joint for treating DIACFs, mostly Sanders type IV, provides good results due to the avoidance of further procedures, reduced postoperative pain, and a high rate of bony union. However, success heavily depends on factors such as patient comorbidities and addressing hindfoot deformity. Further studies with larger patient populations and more standardized protocols are necessary to draw definitive conclusions about the best management strategies for DIACFs. Systematic review, level III of evidence.

Knee needle arthroscopy (NA) represents a minimally invasive diagnostic and therapeutic approach for managing a variety of knee joint pathologies. This innovative technique, characterized by a thin, flexible, needle-like device, offers a less invasive alternative to conventional arthroscopy (CA), enabling outpatient procedures with reduced postoperative pain, faster recovery, and minimal scarring. This systematic review examines the current applications, diagnostic accuracy, clinical outcomes, and patient benefits of needle arthroscopy. Studies reveal that NA demonstrates comparable diagnostic efficacy to CA and superior accuracy to MRI for intra-articular knee pathology, particularly in meniscal injuries and anterior cruciate ligament assessments. NA facilitates real-time visualization and interventions under local anesthesia, promoting cost-efficiency and patient satisfaction. Despite its advantages, there are challenges such as limited visualization and technical proficiency. While NA emerges as a promising modality in knee diagnostics and treatment, further large-scale clinical trials are essential to validate its long-term efficacy, safety, and broader applications.

Background: Knee osteoarthritis (OA) is a common degenerative condition that significantly affects quality of life. Total Knee Arthroplasty (TKA) is an effective treatment for end-stage OA, but recovery can be challenging. Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative care and improve outcomes.

Methods: This prospective cohort study evaluated the impact of ERAS protocols on 300 patients undergoing primary TKA. Patients were divided into an ERAS group (n = 150) and a traditional care group (n = 150). ERAS included preoperative education, multimodal analgesia, early mobilization, and multidisciplinary care. Primary outcomes were postoperative pain, length of hospital stay (LOS), and complication rates. Secondary outcomes included functional recovery and patient satisfaction.

Results: The ERAS group had significantly shorter LOS (3 vs. 7 days, P = 0.01) and lower blood transfusion rates (21.3% vs. 36.7%, P = 0.01). Postoperative pain scores were consistently lower in the ERAS group (P = 0.01-0.04). Functional recovery, measured by Knee Society Score, and patient-reported outcomes were significantly better in the ERAS group at 3, 6, 12, and 24 months (P < 0.01).

Conclusion: ERAS protocols significantly improve outcomes in TKA, reducing hospital stays and enhancing patient satisfaction and recovery, supporting their broader use in orthopaedic surgery.

Introduction: Previously published literature from our institution found that patients with a fragility hip fracture were estimated to have a 4-10% risk of sustaining a second contralateral hip fracture. A follow-up, multi-centre study found that 1 in 11 (9.1%) patients sustained a contralateral hip fracture within three years of index hip fracture. Previous studies have examined the anatomic geometry of the hip joint as a risk factor for hip fractures. Our study aimed to establish a relationship between the neck-shaft angle (NSA) of the contralateral hip in patients who had already suffered a hip fragility fracture in terms of timing to second hip fracture.

Methods: A 7-year, single-institution, retrospective cohort study of patients that presented with a second contralateral fragility hip fracture from 2013 to 2019 were reviewed. Inclusion criteria were all patients 60 years old and above who suffered a second contralateral hip fracture. Exclusion criteria were all patients who were aged less than 60 years old, high-energy injuries or those who suffered peri-prosthetic fractures. The NSA was calculated by measuring the intersection of the femoral neck axis and the femoral shaft axis of the hip. Age, gender, surgery type and American Society of Anaesthesiologists Physical Status Classification (ASA) score were also examined.

Results: Ninety-four patients were suitable for analysis. NSA ranged from 113 to 146.5 degrees with an average of 130.2 degrees. Female patients had an average NSA of 129.7 degrees compared to 131.3 degrees in male patients. Average time to second hip fracture was 3.5 years, ranging from 0.08 years (29 days) to 20 years (7326 days). There was a 2.3:1 ratio of female-to-male presentations. Patient age ranged from 60 to 100 years old. The largest age group included patients aged 80-89 years, with 38 patients (28 females and 10 males). Correlation analysis performed showed no statistical significance between NSA and timing of second contralateral hip fracture with a p value of 0.235. There was an association between fracture type, specifically intracapsular hip fractures, and time to second hip fracture, but this was not statistically significant (p value 0.052).

Conclusion: There is no statistically significant association between femoral NSA and time to second fragility hip fracture. As we have excluded NSA as an independent risk factor, further studies may now be carried out to look for other potential predictors of timing to second hip fracture.