Efort Open Reviews最新文献

This review presents a standardized, stepwise method for biplanar radiographic analysis of knee alignment, integrating both coronal and sagittal measurements for use in arthritic and non-arthritic knees. It critically compares leading classification systems, including the coronal plane alignment of the knee (CPAK) and the functional knee phenotype classifications. While CPAK provides a simplified 2D coronal model, the functional phenotype system offers a more granular, 3D approach that includes segmental deformities and has recently been expanded to incorporate laxity parameters. Sagittal plane parameters - including posterior tibial slope and femoral component flexion/extension - are essential for comprehensive alignment assessment. These factors influence implant positioning, knee kinematics, and postoperative function. The review outlines preferred measurement techniques, highlighting the value of long-leg weight-bearing radiographs and discussing the limitations and variability of 2D versus 3D imaging approaches. Incorporating both alignment and soft tissue behavior provides a more individualized approach to total knee arthroplasty planning and may lead to improved outcomes by better replicating native knee biomechanics.

Purpose: To evaluate the time taken to recover from arthroscopic rotator cuff repair (ARCR) in terms of pain and function, and to determine if there is an association with the size of the tear.

Methods: PubMed and EMBASE were searched according to preferred reporting items for systematic reviews and meta-analyses guidelines. The recovery pattern of clinical outcomes and range of motion (ROM) was reported narratively. The percentage of the total improvement at 3 months, 6 months, and 1 year was defined as the recovery rate (%) at each time point. The 2-year score was considered 100% recovery. Subgroup analysis based on tear size was performed.

Results: In total, 28 studies were included in this systematic review. Visual analog scale (VAS) pain score showed over 50% recovery at 3 months, while other clinical scores reached this threshold by 6 months. At 1 year, all clinical scores showed approximately 85% recovery. ROM worsened or showed minimal improvement at 3 months and significant improvement by 6 months or 1 year after ARCR. Tear size did not significantly affect clinical scores at any follow-up period (all P > 0.05).

Conclusion: All clinical scores including VAS pain score showed significant improvement at 3 or 6 months after ARCR. Especially, recovery of VAS pain score was faster compared to other clinical scores up to 6 months. ROM recovery slowly started at 6 months after ARCR. Recovery pattern was not different according to the tear size. It can give patients a better understanding of recovery after the operation.

Purpose: To synthesize and critically appraise the literature on long-term outcomes of proximal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years.

Methods: This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of proximal osteotomies of the M1 for non-inflammatory and non-degenerative HV at a minimum follow-up of 5 years were included. We found four eligible studies comprising four datasets, and all assessed proximal osteotomies with a mean follow-up that ranged from 8 to 18 years.

Results: The systematic search returned 7,918 records, of which 2,693 were duplicates, leaving 5,225 for screening. Of these, four studies were included, covering a total of 158 feet with a mean follow-up that ranged from 8 to 18 years. The pooled HVA following proximal osteotomies was 20.4° (CI: 11.3°-29.4°; I 2 = 95%), pooled IMA was 8.8° (CI: 3.3°-14.2°; I 2 = 98%), and pooled AOFAS was 82.1 (CI: 62.4-101.8; I 2 = 97%).

Conclusions: At a minimum follow-up of 8 years following proximal osteotomies of M1, the HVA was 20.4° and the IMA was 8.8°. Furthermore, the recurrence rates considering the various thresholds of HVA were 12% having >30°, 73% having >20°, and 13% if recurrence is a >10° increase in HVA.

Level of evidence: Meta-analysis, level IV.

Teardrop fractures of the cervical spine are characterized by a triangular-shaped fragment located in the anteroinferior corner of the vertebral body. Flexion-type teardrop fractures are highly unstable injuries resulting from a flexion-compression mechanism. A notable feature of these injuries is retrolisthesis of the vertebral body, which is often associated with a high risk of neurological compromise. The anterior approach is the most commonly used surgical treatment for flexion-type teardrop fractures. In contrast, extension-type teardrop fractures primarily affect the axis vertebral body and are generally stable injuries that can be treated nonoperatively.

Purpose: To quantify the response to intra-articular saline administration in terms of pain, function, and quality of life, with a focus on the evolution of placebo response over time and the identification of influencing factors on the placebo response to knee osteoarthritis injections.

Methods: After registration on PROSPERO, a systematic review was conducted following PRISMA guidelines to identify double-blind, placebo-controlled randomised clinical trials on intra-articular knee injections for knee osteoarthritis. The placebo response was evaluated through meta-analyses of VAS pain, WOMAC, KOOS, and responder rates at 1-, 3-, 6-, and 12-months on placebo arms of included trials. The evolution of placebo response over time was assessed, and meta-regression was conducted. Risk of bias and quality of evidence were assessed following Cochrane guidelines.

Results: From the initial 2,746 records, 73 articles on 5,895 patients were included. The meta-analysis demonstrated statistically and clinically significant improvements at the 1-, 3-, and 6-month follow-ups. At the 12-month follow-up, placebo response declined and was no longer clinically significant for some sub-scores. Responder rates exceeded 50% at 1-, 3-, and 6-months. The placebo response was stronger in studies with a higher proportion of female participants and in more recently published trials.

Conclusions: Placebo response to intra-articular injections is statistically and clinically significant in knee osteoarthritis for pain, function improvement, and patients' quality of life, with responses peaking at 4-8 months but evidence up to 12 months. Among influencing factors, female sex and recent publications seem to present stronger placebo responses, emphasising the importance of placebo-controlled trials to evaluate knee osteoarthritis treatments.

Objective: Primary spondylodiscitis poses significant diagnostic and therapeutic challenges, with delayed diagnosis or improper treatment potentially resulting in severe complications. This systematic review aimed to summarize the latest diagnostic and therapeutic approaches for primary spondylodiscitis.

Methods: Adhering to PRISMA 2020 guidelines, we conducted a systematic literature review. PubMed was comprehensively searched for English-language original studies from January 1, 1990, to October 31, 2024. Structured queries combined keywords and MeSH terms relevant to spondylodiscitis, vertebral osteomyelitis, spinal infection, and associated treatments. Two reviewers independently screened titles, abstracts, and full texts, with manual bibliography searches as a supplement. A total of 147 articles were finally included.

Results: The literature indicates that diagnosis can be based on clinical suspicion, using serological, radiological, and microbiological tests. Newer methods such as metagenomics next-generation sequencing (mNGS) and positron emission tomography-computed tomography (PET-CT) can enhance diagnostic sensitivity and specificity. For confirmed cases, appropriate antibiotic therapy is crucial. Surgical treatment can benefit patients with neurological deficits, sepsis, spinal instability/deformity, epidural abscesses, or failed conservative treatment, accelerating recovery and reducing complications. Minimally invasive surgical approaches may also serve as an alternative to open surgery for select patients.

Conclusion: Although new technologies have improved diagnostic accuracy and treatment success rates for primary spondylodiscitis, establishing a robust staging system is vital to ensure patients receive effective, evidence-based treatment options.

Hip pain can be caused by extra-articular conditions such as subspine impingement, iliopsoas impingement, and ischiofemoral impingement. These syndromes are frequently secondary to underlying pathologies involving the hip joint or lumbar spine. While most cases are managed conservatively through activity modification and physiotherapy, surgical intervention is considered for refractory cases. Imaging, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) is crucial for diagnosing these conditions, as clinical symptoms can be nonspecific. CT scans help identify predisposing factors such as acetabular morphology, femoral version, and acetabular version, while MRI is useful for ruling out other conditions and detecting soft tissue pathology. Although positive treatment outcomes are generally observed, there are variations in results and procedures, and long-term follow-up studies are lacking. Complications of the treatments are a concern, but most reported complications are minor in nature.

Purpose: The surgical reconstruction of the medial patellofemoral ligament (MPFL) is a commonly used treatment for recurrent patellar dislocations. A surgical method which is frequently used is the dynamic reconstruction of the MPFL (dMPFLr), which involves attaching the released end of a hamstring muscle to the medial patella using a pulley. The aim of this systematic review and meta-analysis is to evaluate the evidence of this method in terms of patient-reported outcomes, the rate of recurrent instabilities, and other complications.

Methods: MEDLINE® and Web of Science™ were used to identify eligible studies. We used a random-effects meta-analysis to estimate the pooled rates of the Kujala scores, rates of recurrent instabilities, and complication rates.

Results: A total of 1,087 studies were screened for eligibility. Six studies, comprising a total of 267 treated knees, met the inclusion criteria and were included. All the publications included were retrospective analyses (level of evidence III). The random-effects model showed an overall mean postoperative Kujala score of 86.74 (95% CI: 79.37-94.11; heterogeneity: I 2 = 94%), a recurrent instability rate of 13% (95% CI: 9-18%; heterogeneity: I 2 = 0%), and additional complications mentioned at a rate of 9% (95% CI: 5-16%; heterogeneity: I 2 = 0%).

Conclusion: Although good results are achieved with regard to the patient-reported outcomes and complication rates, there is a high rate of recurrent instabilities. Despite these results, dMPFLr can be considered an option for the treatment of skeletally immature patients, as it avoids the need for intraoperative fluoroscopy and the risk of epiphyseal joint injury due to femoral fixation.

The normal functioning of the shoulder is characterized by the harmonious coordination between the glenohumeral joint and the scapulothoracic complex, a phenomenon commonly referred to as scapulohumeral rhythm (SHR). Reverse total shoulder arthroplasty (rTSA) shoulders exhibit distinct kinematics compared to normal shoulders. Reduced scapulohumeral rhythm (SHR) in rTSA shoulders implies a greater reliance on scapulothoracic motion over glenohumeral motion for arm elevation. Dynamic analyses suggest heightened scapulothoracic movement after rTSA, implying alterations in rotational movements across various planes. Utilization of reliable tools to measure preoperative scapulothoracic motion and forecast postoperative SHR in rTSA may improve functional results. Posture types and scapulothoracic orientation play an important role in optimal implant configuration and positioning, as well as clinical outcome, and should therefore be considered during patient selection, preoperative planning, and implantation of an rTSA. Recognizing the static position and kinematic changes of the scapulothoracic joint is vital for postoperative rehabilitation and optimizing outcomes in rTSA patients.

Purpose: To conduct a meta-analysis of clinical studies evaluating the efficacy and safety of arthroscopic and open surgery for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocation using a suture button.

Methods: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted the literature searches based on preferred reporting items from systematic reviews and meta-analyses. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies comparing arthroscopic and open surgery for the treatment of acute high-grade ACJ dislocation using a suture button. Constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, operation time, and occurrence of complications were analyzed.

Results: Five studies comprising a total of 198 patients were included in this study. The findings revealed that, in comparison to open fixation, arthroscopic fixation resulted in longer surgical durations. However, there were no significant differences between the two techniques in terms of constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, or the occurrence of complications.

Conclusions: Based on current evidence, arthroscopic fixation demonstrates comparable postoperative outcomes to open fixation, albeit with longer surgical durations. With ongoing technological advancements and refinement of surgical techniques, the efficiency and accessibility of arthroscopy are expected to improve, potentially solidifying its role as a superior choice in the future.