Efort Open Reviews最新文献

The long head of the biceps tendon (LHBT) has recently emerged as a therapeutic option for various shoulder pathologies. Synthetic materials and allografts have not shown sufficient resistance or favorable outcomes to restore rotator cuff native tissue properties, leading to consideration of using LHBT as biological augmentation. LHBT mimics adjacent structures, such as the rotator cuff, is easily accessible during surgery, and is a good source of live autologous cells for regenerative augmentation in rotator cuff repair, as a superior capsular reconstruction in irreparable cuff tears, in subscapularis augmentation in shoulder replacement and as a stabilizer in anterior shoulder instability. This narrative review aims to collect, synthesize and critically evaluate the literature on the use of the LHBT and its current applications in the field of shoulder surgery, improving the understanding of the terminology and consolidating the concepts related to the various procedures in shoulder surgery.

A comprehensive overview of current Asian joint arthroplasty registries, highlighting their strengths and weaknesses and providing a case for establishing registries nationwide, is given. Pertinent information required for the future establishment and improvement of Asian joint arthroplasty registries is given. Six registries in Asia were identified, with three, Indian Joint Registry, Japanese Orthopaedic Association National Registry and Pakistan National Joint Registry having developed official websites and published annual reports. The majority of both hip and knee surgeries in India and Pakistan were carried out on men, in contrary to Japan, where the majority of knee surgeries were conducted in women. Osteoarthritis was the primary indication for knee surgery, whereas osteonecrosis was the main indication for hip surgery in India and Pakistan, compared to osteoarthritis in Japan. Many countries in Asia have attempted to report data on joint arthroplasties, though little information on nationwide registries is available, with three countries - Japan, India and Pakistan - having made their joint registry data available to the public.

Purpose: We conducted a systematic review of all proposed classifications of tibial plateau fractures (TPFs) to facilitate comparison and identify the most effective reduction methods.

Methods: PubMed, Scopus, Embase, Web of Science and Cochrane Library databases were searched for all the articles involving the suggestion of a new method of TPF classification. The descriptions of classifications, along with their suggested management strategies, were recorded.

Results: Out of the 2,712 identified records, 69 were included in the study. Schatzker's and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications were the most frequently mentioned in the literature. The concept of a 'column' and posterior column fractures were introduced in 2010. Following this, posterior plateau fractures were further divided into posteromedial and posterolateral fractures. Proposed treatment approaches in most studies were based on the involved region and degree of displacement, while others considered fracture plane, deformity direction and type of fracture. The latest developments include the subclassification of the posterolateral column and consideration of associated injuries to the fibular head, eminentia, extensor mechanism and mechanical derangements along with the concept of the main deformity direction.

Conclusion: The understanding of TPF patterns, associated injuries, surgical approaches and fixation methods has evolved in a compelling stepwise manner. Currently, there is no gold standard classification that addresses fracture configuration, soft-tissue injuries, principal direction of deformity, central eminence avulsions, extensor mechanism disruptions and mechanical derangements, while maintaining a simple and reliable categorization. Therefore, employing individualized classification systems remains the most logical approach at present. This study offers invaluable assistance in this regard.

This review highlights the role of existing spasticity treatment methods in reducing muscle tone and improving function. The surgical methods today mainly include selective dorsal rhizotomy, selective neurotomy, intrathecal baclofen treatment (ITB), etc. These techniques (except ITB) can lower patients' muscular tone in the long term and improve function to some extent. The young procedures, contralateral C7 nerve transfer and T1 neurotomy, are still under research. ITB and nonsurgical treatment methods, botulinum toxin A (BoNT-A) and extracorporeal shockwave therapy (ESWT), can reduce muscle tone in the short term, but the long-term efficacy is unsatisfactory. In addition, the effects of improving function are relatively controversial. The economic cost of these treatment methods is also heavy for patients. In addition, some studies have reported that some kinds of electrical/magnetic stimulation can improve the patients' function. They can potentially be used as an adjunctive treatment for spasticity. According to current studies and our own experience, surgery methods (except ITB) are still recommended for patients, whose spasticity has a major detrimental influence on their everyday lives, taking into account patient benefits and cost-effectiveness. There are also some problems in the current research on spasticity treatment, such as incomplete guidelines and a relative lack of high-quality studies, which is what the doctors need to strive for. Further exploration is needed to find the treatment methods that can reduce muscle tone while improving patients' function to better benefit patients.

Arthroscopic ankle arthrodesis (AAA) has been performed for 40 years for end-stage ankle osteoarthritis. Along with open ankle arthrodesis (OAA) and total ankle replacement (TAR), it forms one arm of the triumvirate of commonly performed procedures for this condition. The aim of this article is to review the state of the art for AAA and compare outcomes with OAA and TAR. This narrative review of the literature traces the development of this technique through case series and systematic reviews. Traditional OAA techniques carry a nonunion rate of 11%, necessitating revision surgery in most cases. As individual and communal experience of AAA has grown, the range of pathology and deformity successfully corrected by this technique has developed. There is evidence that AAA offers greater and more rapid union rates, with reduced hospital stay and better long-term outcomes. However, the technique requires mature surgical skills and still carries a significant complication rate. No single procedure is suitable for all patients. AAA can be seen as the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity, either within the talocrural joint or hindfoot or patients with systemic and/or local comorbidities that would benefit from minimal disturbance to the soft-tissue envelope. However, in older patients, the presence of concomitant hindfoot osteoarthritis or significant deformity, TAR and OAA remain valuable procedures in the foot and ankle surgeon's armamentarium.

Purpose: The objective was to investigate the consistency in cumulative revision rates (CRRs) for a selection of total hip arthroplasty cups and stems across national/regional hip arthroplasty registries worldwide.

Methods: Ten cups and ten stems from total hip systems were randomly selected. Two frequently used implants across registries were added, totalling 11 cups and 11 stems. CRRs and 95% CIs were extracted from the latest annual registry reports using these implants. CRRs were pooled for each cup or stem, and differences between cup-stem combinations and between registries were investigated.

Results: CRRs were available for ten cups and eight stems from eight registries, totalling 552,148 cups and 727,447 stems. Follow-up was 1-20 years. The 5-year CRR pooled for all cups was 2.9% (95% CI: 2.3-3.6) and for all stems, 3.0% (95% CI: 2.4-3.8). Homogeneous (consistent) CRRs with respect to both associated implant and country were observed for two cups and three stems. Significant differences in CRR were identified in one cup by associated implant only, in one cup by registry only, and in two cups and four stems for both. Sparse data prevented evaluation of four cups and one stem.

Conclusion: Registries' annual reports provide a large amount of publicly available information on CRRs of specific implants. These CRRs can be synthesised to improve the assessment of implant performance over time. Our CRR analysis represents a promising approach to detect implants with a consistent low- or high-risk pattern across registries.

Objective: To investigate the efficacy of autologous bone marrow mesenchymal stem cell (BMSC) transplantation in patients with spinal cord injury (SCI) using meta-analysis, aiming to provide evidence-based guidance for clinical practice.

Methods: Electronic databases such as PubMed, Web of Science, Cochrane Library and Embase were searched. Studies comparing the therapeutic effects of autologous BMSC transplantation and rehabilitation therapy on patients with SCI were included. The pooled effect size of autologous BMSC transplantation on the American Spinal Injury Association (ASIA) scores was calculated using the random- or fixed-effects model.

Results: A total of seven eligible studies involving 288 patients with SCI were included in this study. The meta-analysis results showed that autologous BMSC transplantation significantly improved ASIA sensory scores (mean difference (MD): 8.80; 95% confidence interval (CI): 5.93, 11.67), ASIA motor scores (MD: 7.94; 95% CI: 2.05, 13.83), ASIA grade improvement (odds ratio (OR): 4.88; 95% CI: 2.48, 9.61) and somatosensory evoked potential improvement (OR: 3.34; 95% CI: 1.54, 7.25). This study did not find a statistically significant positive effect of autologous BMSC transplantation on bladder function and adverse events.

Conclusion: The therapeutic efficacy of autologous BMSC transplantation is encouraging, but further multicentre, large-sample, prospective studies are still needed.

The piriformis muscle (PM) is important for posture and preventing falls. It is a key landmark for hip surgery. The PM function is reported to be increasingly important for improving total hip arthroplasty (THA) outcomes and reducing complications. This scoping review aims to map and summarize the literature on the anatomy and function of the PM and the outcomes of clinical studies on THA preserving the PM to improve readers' understanding and identify areas for further research. A scoping review following the PRISMA guidelines was conducted using PubMed and Scopus from their inception until June 2023. We used the search term 'piriformis' or 'PM' to include all PM-related studies. Two independent reviewers screened abstracts and full texts to select key aspects of PM anatomy and function and the main clinical THA studies reporting outcomes on PM preservation. Fifty-seven studies published between 1980 and 2023 met our inclusion criteria. During hip surgery, the PM anatomy, including its origin and insertion, muscle belly, and relation to other short hip rotators and the sciatic nerve, can vary greatly, making it difficult to recognize. The current literature on PM-preserving THA and hemiarthroplasty clinical studies is limited. It suggests potential benefits in terms of hip stability, dislocation risk, and functional outcomes compared to no PM preservation in short-term follow-up. Identifying and preserving the PM during hip surgery may be difficult due to its variable anatomy and its relation to surrounding structures. Although the literature supporting PM preservation potentially indicates better outcomes, further high-level research studies are needed.

Clinicians, scientists and regulators do not use a common set of definitions and terminology to classify and code periprosthetic tissue reactions to wear debris of arthroplasty implants and a limited granularity is present to allow early identification of associated adverse events. Adverse local tissue reactions (ALTRs) is an umbrella term, which has been used in particular for periprosthetic tissue reactions to metal wear debris. In this review, it has been extended to all implant materials and adverse reaction to metallic debris as a subset of ALTR caused by or associated with metallic particulate debris. The high variability in the terminology of ALTRs used by national arthroplasty registries, various coding systems and clinicians impedes their accurate reporting and interpretation, crucial for evaluating the reasons for implant failure and revision arthroplasty. Histopathological examination of periprosthetic soft tissue and bone uses standardized criteria for the diagnoses of reactions to wear particles, significantly contributing to their understanding and refining their interdisciplinary terminology. This review critically analyzes the current gap in coding ALTRs due to arthroplasty implants' wear in national registries and classification systems of adverse events and the use of key terms. A comprehensive unified lexicon and classification system grounded on evidence-based histopathological analyses is proposed, implementing the following findings. (a) Pseudotumor is a descriptive term for ALTR, which cannot be used for codification. (b) Metallosis is a term lacking quantitative and qualitative determination and thus not a codifiable term for ALTR. (c) Aseptic lymphocyte dominant vasculitis-associated lesion (ALVAL) should not be used due to absence of histological findings diagnostic of vasculitis. (d) Metal delayed hypersensitivity and metal allergy should be codified as separate categories of adverse events. (e) ALTR is to be classified in due consideration of definition of predominant lymphocytic or predominant macrophage infiltrate. (f) Granulomatous reaction should be reserved to sarcoid-like, immune granulomas separated from the macrophage infiltrate with/without foreign body giant cell reaction. (g) Macrophage infiltrate containing particulate wear debris with or without lymphocytic component associated with macrophage induced osteolysis/aseptic loosening should be considered as a type of ALTR.

Purpose: Total hip arthroplasty (THA) is performed commonly for various end-stage diseases of the hip joint. However, the likelihood of a subsequent contralateral THA (cTHA) after primary unilateral index THA (iTHA) remains insufficiently defined, with reported rates of 13-29.1% after 5 years and 8.7-54% after 10 years of follow-up. This review aims to determine the long-term likelihood over time of cTHA after iTHA.

Methods: Systematic review of the literature with meta-analysis, including any clinical study published until July 2022, evaluating or documenting the likelihood over time of cTHA after iTHA, independently of the etiology. Excluded were cTHA within 12 months. A total of 21 studies, including 1,456,071 patients, who subsequently received 249,117 cTHA, were analyzed. Kaplan-Meier analysis was performed, weighting data on sample size, considering death as competing risk.

Results: At 5 years after iTHA, likelihood of cTHA was 17.8% (95% confidence interval 12.3-23.3%). At 10 years, this likelihood increased to 22.7% (16.1-29.4%), with a marginal subsequent increase. The likelihood increased slightly considering death as competing risk.

Conclusion: Nearly every fourth THA patient will require cTHA within 10 years. The likelihood of cTHA in this review appears to fall within the lower third of previously published ranges. However, most cTHA are required within the first years. Our findings suggest that the likelihood of requiring cTHA within the initial 10 years is approximately twice as high as the likelihood of requiring revision of the iTHA.