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Cefuroxime-impregnated cement in knee arthroplasty effective in infection prevention340 primary total knee arthroplasties were performed with cementless fixation of the femoral component and cement fixation of the patellar and tibial components. The knees were randomized to receive cefuroxime-impregnated cement or cement without cefuroxime. Patients were followed-up for an average of 49 months. The rate of deep infection was significantly higher in the group without cefuroxime-impregnated cement.
Cefuroxime-impregnated cement in knee arthroplasty effective in infection prevention
Pedicle screw vs. hybrid construct for repair of adolescent idiopathic scoliosisData from 24 studies (RCTs and non-RCTs), including 1615 patients with adolescent idiopathic scoliosis, were pooled to determine the comparative efficacy of pedicle screw and hybrid construct instrumentation in posterior fusion. Pooled analysis indicated that both pedicle screws and hybrid constructs restored thoracic kyphosis, although the hybrid construct demonstrated comparatively favorable results. Further high-quality randomized controlled trials are needed to substantiate these findings.
Pedicle screw vs. hybrid construct for repair of adolescent idiopathic scoliosis
Kineflex-L and CHARITE artificial discs yield similar rates of clinical success at 2 years394 patients undergoing total disc replacement (TDR) were randomized to receive either the Kineflex-L or CHARITE artificial disc. A total of 63 non-randomized patients were also included in this study. The purpose of this trial was to compare these two discs with respect to rates of clinical success. Results over 24 months indicated that both the Kineflex-L and CHARITE artificial discs yielded statistically improved and similar rates of clinical success, re-operation, adverse events, operative time, blood loss, length of hospital stay, pain, disability and patient satisfaction over 24 months.
Kineflex-L and CHARITE artificial discs yield similar rates of clinical success at 2 years
Incision closure with surgical zipper versus subcuticular suture after spinal fusion90 female patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) surgery were randomized to incision closure with surgical zippers or subcuticular monocryl sutures. The purpose of this study was to investigate the safety and efficacy of these closure techniques. Patients were evaluated over 1 year, and the results demonstrated that incision closure using the surgical zipper provided significantly favorable outcomes of time to close incision, and comparable outcomes with regards to cosmetic appearance.
Incision closure with surgical zipper versus subcuticular suture after spinal fusion
Oral alendronate cannot yet be recommended for children with OI139 children and adolescents with moderate to severe osteogenesis imperfecta (OI) were randomized to evaluate the safety and efficacy of oral alendronate (ALN). The trial primarily focused on the assessment of lumbar spine bone mineral density (LS BMD) alongside several secondary critera/data: clinical, radiological, biochemical, and multiple bone-related measurements and fracture details. Results demonstrated that ALN, compared to a placebo, effectively increased LS areal BMD z-scores, was adequately tolerated, and efficiently inhibited the activity of bone absorption. However, limited effect of ALN was observed in clinical parameters.
Oral alendronate cannot yet be recommended for children with OI
Open-door vs. French-door laminoplasty for cervical compressive myelopathy92 patients with cervical compressive myelopathy who were scheduled to undergo cervical posterior compressive surgery were randomly assigned into 1 of 2 groups to determine the efficacy of French- and open-door laminoplasty. The results of the study indicated that French-door laminoplasty and open-door laminoplasty led to similar neurological recovery rates, but that French-door laminoplasty resulted in significantly greater range of motion and lordotic angle at 1 year after treatment.
Open-door vs. French-door laminoplasty for cervical compressive myelopathy
Socioeconomic status and patient preoperative factors: Significant effects on THA outcomes108 patients who underwent total hip arthroplasty (THA) were analyzed to examine the influence of socioeconomic data and preoperative patient data on THA outcomes. Participants were randomized to receive two different implant stems (Co-Cr stem or proximally coated titanium stem) and were assessed using several different measures of THA outcomes. Clinical outcomes did not differ between stem types. The study demonstrated that socioeconomic factors and patient preoperative date had a significant predictive effect on THA outcomes and called for further research on the subject.
Socioeconomic status and patient preoperative factors: Significant effects on THA outcomes
Cemented THR: superior short term and comparable long term results to uncemented THR9 RCTs, examining 778 patients, that compared cemented total hip replacement (THR) to uncemented THR were analyzed to determine a superior procedure in terms of revision rate and other secondary outcomes. This meta-analysis/systematic review presented findings that indicated cemented surgery for THR demonstrated comparable results to uncemented THR as measured by implant survival, and contributed to improved short term pain scores. A poor correlation between radiographic and clinical findings was observed and the study called for further uniform standard studies to validate these findings.
Cemented THR: superior short term and comparable long term results to uncemented THR
Minimally invasive THA presents risk of transient lateral femoral cutaneous nerve palsyData from 16 non RCTs and 12 RCTs (2849 hips) of variable quality were analyzed to determine whether minimally invasive surgery (MIS) is superior to a conventional exposure for total hip arthroplasty (THA), when comparing short and long-term outcomes. This systematic review/meta-analysis pooled study data and compared clinical outcomes: Harris Hip Score, WOMAC score, and Oxford hip score, along with radiological and complication outcomes. The results of this analysis found that MIS does not perform significantly better for any outcome and presents with increased risk of iatrogenic nerve injury during the procedure.
Minimally invasive THA presents risk of transient lateral femoral cutaneous nerve palsy
Local antibiotics added to routine regimen limits infection after IM for tibia fractureEvidence from 21 studies (14 Retrospective or Case Studies; 6 RCTs; 1 Review) was identified using two distinct searches to evaluate the addition of locally-delivered antibiotics to prophylactic administration of systemic antibiotics in order to further limit incidence of infection of tibial fractures fixed intramedullary nailing. The evidence presented in this systematic review and meta-analysis indicated that local antibiotics as adjunctive prophylactic therapy demonstrated lower absolute rates of infection for all tibia fracture severities. Severe fracture (GAIII) patients experienced a decrease in infection rate from 14.4% to 2.4% when local antibiotics were added. Risk of deep wound infection increased with severity of fracture, but was notably limited in patients treated with additional local antibiotics, compared to systematic antibiotics only (9% increase compared to 31% respectively with increasing severity).
Local antibiotics added to routine regimen limits infection after IM for tibia fracture
Shoulder stiffness: Anteroinferior release similar with & without posterior release77 patients with rotator cuff tear and concomitant shoulder stiffness were randomized to receive arthroscopic anterior interior capsular release either with or without extended posterior capsular release. The purpose was to determine if extended posterior capsular release provides additional benefits in range of motion and clinical outcome. Results indicated significant improvements from baseline to last follow-up in the outcomes of forward flexion, external rotation with 90 deg abduction, external rotation at side, internal rotation, visual analog pain scores, ASES scores, and SST scores. No between-group differences, however, were observed for any outcome.
Shoulder stiffness: Anteroinferior release similar with & without posterior release
TKA: Mini-midvastus approach yields better short-term outcomes vs. parapatellar approach18 randomized controlled trials (937 patients; 1093 TKAs) comparing the mini-midvastus and parapatellar approaches in patients undergoing total knee arthroplasty (TKA) were included in this meta-analysis. The purpose of this review was to compare these two treatment approaches with respect to postoperative pain, function and complications. Pooled data indicated that, although associated with a significantly longer operative time, the mini-midvastus approach yielded significantly better pain scores and range of motion at 1-2 weeks post-operation, compared to the parapatellar approach. Furthermore, both groups exhibited similar Knee Society Scores, rates of lateral retinacular release, blood loss, straight leg raise, hospital stay and postoperative complications.
TKA: Mini-midvastus approach yields better short-term outcomes vs. parapatellar approach
Anatomic double-bundle ACL reconstruction offers less knee laxity than single-bundleFifteen randomized controlled trials and prospective comparative studies were included in this meta-analysis which compared knee kinematics and graft failure rates between anatomic single-bundle anterior cruciate ligament (ACL) reconstruction and anatomic double-bundle ACL reconstruction. Pooled estimates of knee laxity (side-to-side and antero-posterior laxity) demonstrated significantly better outcome with anatomic double-bundle reconstruction, although no significant differences were found in pivot-shift, Lachman, and anterior drawer tests. Rate of graft failure also did not significantly differ between single- and double-bundle reconstructions. It has yet to be determined if these differences in laxity result in clinically meaningful improvements in patient important outcomes.
Anatomic double-bundle ACL reconstruction offers less knee laxity than single-bundle
Deltoid split vs. deltopectoral approach for the treatment of humeral fractures120 patients, >18 years of age, with displaced proximal humeral fractures were randomly assigned into 1 of 2 groups to compare the surgical efficacy of a deltoid split approach to a deltopectoral approach. The results of the study indicated that complications and reoperation rates were statistically similar between the two intervention methods. Constant scores at final follow up improved in both groups, but were not significantly different between them. Pain at final follow up was also found to be comparable between interventions. Loss to follow-up dropped statistical power to 68%, limiting the strength of the findings.
Deltoid split vs. deltopectoral approach for the treatment of humeral fractures
Multimodal physical therapy versus sham for patients with hip osteoarthritis102 patients with hip osteoarthritis were randomized to either an active or sham physical therapy program. The purpose of this study was to investigate the efficacy of a multimodal physical therapy program. Patients performed 10 supervised sessions over 13 weeks under a physical therapist, and were to continue with home regimens for 6 months afterwards. The results demonstrated improvement in pain and function within both groups, although no significant differences between them. Of note, adverse events, although mild in severity, were more frequent in patients allocated to the active physical therapy program.
Multimodal physical therapy versus sham for patients with hip osteoarthritis
ACL reconstruction leads to increased risk of osteoarthritis in the operated knee164 patients who had sustained a traumatic ACL injury causing instability and who were previously healthy in the contralateral knee were randomly assigned into 1 of 2 groups to determine the effect of ACL reconstruction on the development of OA in the operated knee. Patients were treated with either a semitendinosus tendon graft or a bone-patellar tendon-bone graft. The results of the study indicated that ACL reconstruction lead to a significant increase in the development of OA in the operated knee (14 years after surgical intervention). Osteoarthritis of the medial compartment was the most common case of OA following ACL reconstruction, and was also the most common form of OA in the contralateral knee. No difference was apparent between graft types in terms of occurrence of OA. Meniscus resection and BMI were found to be major risk factors for OA of the medial compartment.
ACL reconstruction leads to increased risk of osteoarthritis in the operated knee
More accurate anteversion of acetubular components placed with patient-specific guides36 patients undergoing total hip arthroplasty were randomized to undergo acetabular component placement using either patient-specific instrumentation (PSI) or standard mechanical guides. The purpose was to evaluate whether the use of PSIs resulted in more accurate positioning of the acetabular cup with respect to preoperative planned angles of anteversion and abduction. CT assessment postoperatively demonstrated more accurate positioning of the acetabular component with respect anteversion, although no significant differences between groups were noted in abduction. Effect of PSI on anteversion was more pronounced when the posterior surgical approach was used as opposed to the direct lateral approach.
More accurate anteversion of acetubular components placed with patient-specific guides
Cervical disc arthroplasty yields better mid- to long-term clinical outcomes versus ACDF5 randomized controlled trials comparing cervical disc arthroplasty (CDA) to anterior cervical discectomy and fusion (ACDF) were included in this meta-analysis. The purpose of this study was to compare these two treatment approaches with respect to rates of adjacent segment disease (ASD), pain, disability, and quality of life in the mid- to long-term. Pooled data revealed that rates of ASD were similar between groups. CDA yielded significantly more favourable results with respect to rates of re-operation and neurological success, as well as improvements in disability, neck and arm pain, and Short Form-36 physical component scores. Rates of heterotopic ossification (HO) ranged from 3.2%-17% in the CDA group and HO was not reported in any patient in the ACDF group.
POSTED: THIS WEEK
Cervical disc arthroplasty yields better mid- to long-term clinical outcomes versus ACDF
Povidone-iodine soaks: no additional benefit following drainage of hand abscesses100 patients who were scheduled to receive treatment for their hand abscesses were randomly assigned into 1 of 2 groups to determine the effect povidone-iodine soaks had on the outcomes of hand infections that occurred following operative drainage. Patients were either treated with a daily povidone soak (3 times a day) or simply received a daily dressing change with sterile gauze and orthosis. The results of the 6 week investigation indicated that povidone soak treatment did not deferrer significantly in the number operations required by patients, and that the soak treatment also had no effect on hospital stay length, number of readmissions, or reoperation numbers.
POSTED: THIS WEEK
Povidone-iodine soaks: no additional benefit following drainage of hand abscesses
CDR and ACDF similarly cost-effective in the treatment of DDD209 patients with cervical radiculopathy due to single level cervical degenerative disc disease (DDD) were randomized to undergo cervical arthroplasty (CDR) or anterior cervical discectomy and fusion (ACDF) in a previous investigational device exemption (IDE) trial. A cost-effectiveness analysis (CEA) was performed on data from the previous trial to discern the most cost-efficient treatment for cervical DDD. Cost effectiveness was based on Short-Form 36 (SF-36) data collected from the original trial. Health State Utility was calculated based on SF-36 data collected over 2 years. The evidence presented in this study demonstrated that both cervical arthroplasty (CDR) and anterior cervical discectomy and fusion (ACDF) incurred comparable costs in the treatment of degenerative disc disease.
POSTED: THIS WEEK
CDR and ACDF similarly cost-effective in the treatment of DDD
Intravenous metamizole has a greater analgesic efficacy than paracetamol following THA94 patients scheduled to undergo total hip arthroplasty were randomized to receive patient-controlled morphine paired with either intravenous metamizole or paracetamol as the postoperative analgesic regimen. The purpose of this study was to compare these two pharmacological interventions with respect to analgesic efficacy over the first 24 postoperative hours. Results indicated that patients in the metamizole group experienced significantly less pain and consumed significantly less morphine when compared to those in the paracetamol group. Patient sex, body weight and intraoperative blood loss were not significantly associated with postoperative pain in either study group. There was a significant negative correlation between patient age and postoperative pain in the paracetamol group only.
POSTED: THIS WEEK
Intravenous metamizole has a greater analgesic efficacy than paracetamol following THA
The effect of patella denervation on patient satisfaction and function following TKA126 patients who were scheduled to undergo primary TKA due to osteoarthrosis were randomly assigned into 1 of 2 groups: a patella denervation group and a standard TKA group. The purpose was to determine the effect of patella denervation during the TKA procedure over 2 years postoperatively. The results of the study indicated that pain scores for anterior knee pain were significantly better in the denervation group at 3 months, although significance was lost at 12- and 24-month follow ups. Patients who received denervation treatment reported significantly higher satisfaction with treatment at 24 months. Flexion range was reported significantly improved in patients who received treatment with denervation as well. No significant improvements in validated knee outcome measurements were found in patients who received denervation of their patella.
POSTED: THIS WEEK
The effect of patella denervation on patient satisfaction and function following TKA
Knee OA: Dietary support, knee exercise, or no treatment do not limit disease progression192 obese patients with knee osteoarthritis (OA) who underwent a rigorous 16 week exercise program were randomized to receive dietary support, knee exercise, or no further treatment in order to investigate the effect of therapy on OA disease progression. Patients were monitored over 52 additional weeks using magnetic resonance imaging (MRI). The evidence presented in this study indicated that dietary support, knee exercise, or no further treatment demonstrated similar cartilage loss, synovitis, and effusion over 52 weeks of monitoring. Dietary support patients demonstrated the least amount of weight regain and exhibited higher compliance.
POSTED: THIS WEEK
Knee OA: Dietary support, knee exercise, or no treatment do not limit disease progression
Additional manual mobilization reduced pain due to knee OA when compared to exercise alone21 randomized control studies examining the use of strength training, exercise therapy, and exercise therapy with passive, manual mobilization in adult patients with knee osteoarthritis were examined in this meta-analysis. This study was undertaken to determine the comparative efficacy of these three treatment methods. The results form this analysis suggest that pain outcomes can be reduced with the addition of manual mobilization to exercise therapy. However, there were no differences in physical function measures between the three groups. Further research is required to determine the long term effects of physiotherapy with manual mobilization.
POSTED: THIS WEEK
Additional manual mobilization reduced pain due to knee OA when compared to exercise alone
Phonophoresis of piroxicam significnatly reduces pain in severe knee OA46 patients with severe to mild knee osteoarthritis were randomized to 2 weeks treatment of either phonophoresis (PhP), using ultrasound and 0.5% piroxicam gel, or to ultrasound treatment alone (UT). The study investigated the effects of phonophoresis in improving knee function and pain, by promoting the absorption of non-steroidal anti-inflammatory drug (NSAID) using an ultra-sound. Post-treatment Visual Analog Scale (VAS) pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores significantly reduced in PhP group compared to ultrasound only. Total WOMAC, representing functional improvement, also improved over time, but did not differ between the two groups.
POSTED: THIS WEEK
Phonophoresis of piroxicam significnatly reduces pain in severe knee OA
Physiotherapy functional restoration in the treatment of post-acute LBP16 trials were selected to study the effects of physiotherapy functional restoration (PFR), consisting of exercise and cognitive-behavioural interventions, compared to other treatments or placebo in patients with post-acute low back pain. Outcomes of interest included pain, function, and sick leave. There was moderate to high quality evidence for small but statistically signficant effects favouring PFR to advice for pain and fuction. Low to moderate evidence suggested no difference between PFR and other single treatments.
POSTED: THIS WEEK
Physiotherapy functional restoration in the treatment of post-acute LBP
Manual therapy effective in treating subacromial impingement syndrome77 patients with shoulder pain due to supraspinatus tendinopathy participated in therapy programs to determine the optimal treatment for tendinopathy due to subacromial impingement. The three therapies included manual therapy along with glenohumeral and scapulothoracic exercises, supervised exercises and home-based exercises. The results show minimal benefits when examining individual outcomes such as function, pain, range of motion and muscle strength; however, the overall effect of combined manual therapy is significantly better than the exercise therapies.
POSTED: THIS WEEK
Manual therapy effective in treating subacromial impingement syndrome
Operative vs. nonoperative treatment of complex proximal humeral fracturesSix randomized control trials were included in the meta-analysis investigating the efficacy between operative and nonoperative treatment for complex 3- and 4-part humeral fractures. Overall, outcomes were similar between operative and nonoperative treatment, with few differences noted in functional outcome up to 24 months. Operative management required more additional surgery than did nonoperative treatment, and implants demonstrated a significant rate of penetration into joint spaces. Upon sub-group analyses for these findings, differences were in large part due to open reduction and internal fixation; hemiarthroplasty in the subgroup analyses was found to be statistically similar to nonoperative treatment.
POSTED: THIS WEEK
Operative vs. nonoperative treatment of complex proximal humeral fractures
Efficacy of cervical corpectomy with preserved posterior vertebral wall178 cases of cervical spondylotic myelopathy (CSM) underwent either cervical corpectomy with preserved posterior vertebral wall (CPW) or conventional corpectomy (CC). Results indicated that the CPW procedure resulted in significant decreases in blood loss and surgery time compared to the CC group at the 6-month follow-up and is an effective method in treating CSM in patients indicative of this study.
POSTED: THIS WEEK
Efficacy of cervical corpectomy with preserved posterior vertebral wall
Interlaminar or transforaminal MI versus open MD for lumbar disc herniation sciaticaEvidence from 29 studies (n=4472), including 16 RCTs and 13 non-RCTs, was reviewed and, where possible, pooled to evaluate outcomes associated with 2 minimally invasive techniques (MI) and a conventional open microdiscectomy (MD) in the treatment of sciatica due to lumbar disc herniation. 21 studies compared interlaminar minimally invasive discectomy (ILMI) against MD, and estimates suggested that ILMI reduced blood loss and hospital stay, although no difference in clinical outcome. Clinical outcome was similar between transforaminal MI (TFMI) discectomy and MD. Additional high-quality evidence is needed in the comparisons of these three surgical techniques for the treatment of sciatica from disc herniation.
POSTED: THIS WEEK
Interlaminar or transforaminal MI versus open MD for lumbar disc herniation sciatica
Allograft for pes planus lateral column lengthening viable alternative to autograft31 patients (33 feet) with acquired pes planus were randomized to undergo operative treatment for stage II posterior tibial tendon insufficiency (PTTI). Lateral column lengthening was performed with a bone graft from the iliac crest obtained either through allograft or autograft procedures. Results showed that at the 12-week follow-up, union was achieved in both groups. Allograft of the iliac crest appeared to be a viable alternative to autograft procedures, leading to decreased risk of morbidity and costs, as seen in autograft surgeries.
POSTED: THIS WEEK
Allograft for pes planus lateral column lengthening viable alternative to autograft
Hematoma block: effective alternative for fracture reduction in distal radius fractures96 patients with displaced distal radius fractures were placed into 1 of 2 treatment groups to test the efficacy of hematoma block when compared to intravenous general anesthesia in the reduction of displaced distal radius fractures. Results showed that hematoma block is just as effective in the reduction of distal radius fractures as general intravenous anesthesia, but that overall treatment time is shorter when using hematoma block.
Hematoma block: effective alternative for fracture reduction in distal radius fractures
Imageless computer-assisted TKA superior in mechanical alignment & short-term function21 randomized controlled trials analyzing a total of 1713 knees were included in this meta-analysis comparing radiographic alignment and functional outcome between imageless computer-assisted (CAS) TKA to conventional TKA. Results indicated significantly better mechanical alignment and significantly higher Knee Society Scores in favour of CAS over control groups. Femoral component alignment was significantly better with CAS, but tibial component alignment was comparable with conventional TKA. Operative time was significantly longer with CAS compared to conventional methods.
Imageless computer-assisted TKA superior in mechanical alignment & short-term function
Denosumab and teriparatide significantly improves BMD in patients with osteoporosis94 postmenopausal women, >45 years of age, who had been diagnosed with osteoporosis and who were at high risk for fracture, were randomly assigned into 1 of 3 treatment groups to determine the long term effect (24 months) a combination of denosumab and teriparatide had on hip and spine BMD. Patients either received a combined drug treatment of denosumab and teriparatide, or intervention with denosumab or teriparatide alone. At 24 months, lumbar spine, femoral neck, and total hip BMD was significantly higher in the combination group when compared to the single dose groups. Spine and hip BMD continued to increase in the second year in all groups, but no difference in the rate at which BMD increased was noted during the second year follow up (12 to 24 months). Serum C-telopeptide and N-terminal propeptide of type 1 procollagen were suppressed in similar amounts in the denosumab and combination groups. Serum osteocalcin decreased by a significantly greater amount in the denosumab group than in the combination group.
Denosumab and teriparatide significantly improves BMD in patients with osteoporosis
Delayed LMWH lowers bleeding while maintaining DVT prophylaxis in TKA210 patients undergoing primary total knee arthroplasty were randomized to administration of low-molecular-weight heparin (enoxaparin) started at either 12 hours or 24 hours after wound closure. The purpose of this study was to determine the effect of delayed LMWH administration (24h) on bleeding and the incidence of deep vein thrombosis after TKA compared to standard administration (12h). Over the first 72 postoperative hours, total blood loss was significantly lower in the delayed administration group, leading to a significantly lower incidence of transfusion and major bleeding events. There was no significant difference in the incidence of deep vein thrombosis observed between groups.
Delayed LMWH lowers bleeding while maintaining DVT prophylaxis in TKA
Unilateral vs. bilateral screw fixation in degenerative lumbar diseases12 studies (n=865; 9 RCTs, 1 prospective, 2 retrospective) were included in this meta-analysis comparing the clinical outcomes between unilateral pedicle screw fixation to bilateral pedicle screw fixation in the treatment of degenerative lumbar diseases. Pooled results demonstrated bilateral fixation led to a significantly higher rate of successful fusion with, but was also associated with significantly higher intraoperative blood loss and operative time. The latter two results, were however, heterogeneous. Pooled results for clinical outcome measures (JOA, VAS, ODI, SF-36), total complications, and hospital stay were comparable between groups.
Unilateral vs. bilateral screw fixation in degenerative lumbar diseases
TLIF suggested to be not cost-effective compared to intrumented PLF in cLBP100 patients with chronic low back pain were randomized to undergo either transforaminal lumbar interbody fusion (TLIF) or posterolateral fusion (PLF). The purpose of the current study was to evaluate the cost-utility and cost-efficacy of TLIF relative to PLF. Data on primary health care costs, secondary health care costs, and production loss costs over the first 2 postoperative years were used for the analysis. Overall, no significant differences in costs were noted between groups, although total cost was higher with TLIF (59863€ vs. 55200€). As clinical outcome was found to not differ, cost-effective acceptability curves using QALYs and the Oswetry Disability Index did not demonstrate cost-effectiveness of TLIF compared to PLF.
TLIF suggested to be not cost-effective compared to intrumented PLF in cLBP
FIFA11+ programme reduced incidence of overall injury in male youth soccer players416 male youth football (soccer) players in Africa were randomized to evaluate the injury-prevention efficacy of the FIFA11+ programme, when compared against routine training over 6 months. Players were evaluated primarily based on time-loss injury to players, injuries by type of exposure (match or training) and all injuries to lower extremities (LE), along with further injury analysis. The evidence presented in this trial demonstrated that FIFA11+ players sustained an overall reduction rate of injury of 41%, and a reduction in lower extremity injury of 48%. Injury incidence was significantly lowered in FIFA11+ players compared to those in the control group with the exception of injury sustained during training- which was similar between groups. Other evaluated outcomes such as injury by body location, mechanism, and severity indicated no significant differences between groups but FIFA11+ players exhibited better results.
FIFA11+ programme reduced incidence of overall injury in male youth soccer players
Arthroscopic simulators distinguish between novice and expert orthopaedic trainees13 studies, consisting of randomized control trials and validation studies, were selected to investigate the role of arthroscopic simulators in improving the surgical skills of users. Systematic review revealed that the simulators discriminated between novice and expert trainees, but not between novice and intermediate trainees on completion time of a simulated task. This analysis did not conclusively determine whether simulator training improves the surgical skills of orthopaedic residents.
Arthroscopic simulators distinguish between novice and expert orthopaedic trainees
Knee OA: Superior scores for pain and Lequesne Index for TENS compared to Hyaluronic acid54 patients with moderate to severe knee osteoarthritis (OA) were randomized to receive transcutaneous electric nerve stimulation (TENS) with silver spike electrodes (SSP) or intra-articular hyaluronic acid injections, in order to compare the success of each treatment over 3 months post-treatment. Patients were assessed for pain using the visual analog scale (VAS) and for functional disability using the Lequesne index. The study found that TENS treatment for knee OA achieved superior scores for pain at the 2 week follow-up, and for functional disability at the 2 week and final 3 month follow-ups. The TENS groups also displayed superiority for the secondary assessments of range of knee motion (ROM), walking, patient-global assessment, and disability.
Knee OA: Superior scores for pain and Lequesne Index for TENS compared to Hyaluronic acid
Cross-education training improves strength and ROM after unilateral distal radius fractureFifty-one women, older than 50 years of age, with a unilateral distal radius fracture were randomized to standard rehabilitation or standard rehabilitation plus cross education strength training to compare training effects on strength and mobility of the fractured limb. Cross-education is a term for neural adaptation defined by increased strength or functional performance of the affected limb after unilateral training of the contralateral unaffected limb. The fractured hand demonstrated significantly better hand grip peak force strength and range of motion at wrist flexion/extension than the control at 12 weeks. No differences were seen by 26 weeks in peak force strength, ROM (flexion/extension; supination/pronation) or in Patient Rated Wrist Evaluation questionnaires.
Cross-education training improves strength and ROM after unilateral distal radius fracture
Combined sciatic nerve/lumbar plexus block: effective but tedious preoperative anesthetic50 patients, between 50-90 years old, with an ASA score of 2-3 who were scheduled to receive surgery due to various lower extremity pathologies, were placed in 1 of 2 treatment groups to test the effectiveness of various forms of anesthesia before surgery: The first group, named the spinal anesthesia group, received a common spinal anesthesia before treatment, while the second group, named the Combined sciatic nerve/lumbar plexus block (CSLPB) group, was given a combined sciatic nerve/lumbar plexus block before surgery began. Results showed that while both preoperative methods are effective in terms of lower extremity orthopedic surgery, CSLPB preparation takes a significantly longer than the standard SA treatment. Surgeons and patients showed no preference to either surgery.
Combined sciatic nerve/lumbar plexus block: effective but tedious preoperative anesthetic
Chemonucleolysis: An effective treatment of sciatica100 patients aged 18 to 64 years, with typical signs of sciatica, and that had undergone at least 4 months of conservative treatment were randomly assigned into 1 of 2 treatment groups to compare the effectiveness of surgery and chemonucleolysis. The Chemonucleolysis group, which treated patients with an injection that dissolved the soft center and protruding portion of the disc which was causing the sciatica, or the surgery group, which had the soft disc herniation removed in patients through conventional surgical methods. The results showed no difference between the groups in terms of efficacy of treatment, or complications (at 1 year, 23-13 year, and 24-27 year follow up).It should be noted that the manufacturing of Chemonucleolysis was ceased in 2001. Based on the results of this trial the authors advocate for restoration of its availability, as it may be beneficial to patients and provide an alternative treatment option.
Chemonucleolysis: An effective treatment of sciatica
No evidence of superiority using custom-made vs. pre-fabricated splints in TMC arthrosis119 patients with clinically diagnosed trapeziometacarpal (TMC) joint arthrosis (62 of which completed the study) were randomized to wear either a customized 3.2 mm-thick thermoplast hand-based thumb spica splint, or a pre-fabricated neoprene splint to determine if superiority exists between the two types. Results indicated that, although both splint types improved pain, grip strength and pinch strength, they did not improve DASH scores at a mean follow-up of 9 +/- 9 weeks. In addition, one splint type was not superior over the other in terms of physical function.
No evidence of superiority using custom-made vs. pre-fabricated splints in TMC arthrosis
General anesthesia for TKA presents better postoperative results than spinal anesthesiaOne hundred and twenty patients, between the ages of 45 and 85 years, scheduled to undergo total knee arthroplasty were randomly assigned into one of two groups to compare the postoperative effect of modern general anaesthetic to spinal anaesthetic. Results demonstrated that participants who received modern general anaesthetic treatment experienced significantly less pain postoperatively, less nausea and dizziness, and required less morphine following treatment than patients who received a spinal anaesthetic. Subjects who received spinal anesthesia were found to be more likely to request a different method of anesthesia for a subsequent treatment
General anesthesia for TKA presents better postoperative results than spinal anesthesia
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The use of physiotherapy for cervical radiculopathy compared to surgery.
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