OE Best of 2015

Welcome to the Best of OrthoEvidence 2015, where we have compiled a list of the best evidence published in 2015 based on popularity, quality (Risk of Bias and Detsky Score), and input from OE's Editorial Board. View the 10 best reports, or browse the best evidence by specialty!




Top 10 Reports

Synopsis: A comprehensive review and network meta-analysis was conducted looking at the complication rates requiring reoperation for all stabilization techniques for open tibial shaft fractures (Gustilo Types I – IIIB). Treatments evaluated were plate fixation, external fixation (by any method), reamed and unreamed intramedullary nailing, and Ender intramedullary nailing. Fourteen trials including Read More »
Author verified Level 1 Meta Analysis
Synopsis: 390 patients who had undergone primary unilateral total knee replacement were randomized to receive either a monitored home exercise program or usual rehabilitation care following surgery. This was done to determine whether a home exercise program provided inferior rehabilitation to standard care. The Western Ontario Read More »
Author verified Level 2 RCT
Synopsis: 270 patients (350 knees) undergoing primary total knee arthroplasty due to osteoarthritis were randomized to undergo surgery with or without patellar resurfacing. The purpose of this study was to compare Knee Society scores, incidence of revision and patient-reported satisfaction results of the two techniques up to 2 or 10 years postoperatively. The results of Read More »
Level 2 RCT
Synopsis: 461 patients with dorsally displaced distal radius fractures were randomized to undergo either volar locking-plate fixation or K-wire fixation. This study aimed to prove, through comparison, the null hypothesis that Patient-Reported Wrist Evaluation (PRWE) scores do not vary between treatments. The primary outcome Read More »
Author verified Level 2 RCT
Synopsis: 250 patients with displaced proximal humerus fracture were randomized to surgical management, with either internal fixation or hemiarthroplasty, or conservative management with sling immobilization. The purpose of this study was to compare treatment methods based on outcome of the Oxford Shoulder Score, as well as the incidence of complications. Follow-up was conducted Read More »
Author verified Level 2 RCT
Synopsis: 250 patients with chronic plantar fasciitis were included in the study. Patients were randomized to receive treatment with focused extracorporeal shock wave therapy (EWST) or a placebo treatment in order to determine the efficacy of the intervention. Primary outcomes of Read More »
Author verified Level 1 RCT
Synopsis: 648 amateur male Dutch soccer players were randomized to undergo regular training, either alone, or with an additional protocol involving a Nordic hamstring exercise (NHE). The purpose of the trial was to assess the effectiveness of the NHE in reducing the incidence of hamstring injuries in this population, as well as its effectiveness in reducing the severity of the injuries. Findings indicated that Read More »
Level 2 RCT
Synopsis: 229 patients with unilateral or bilateral and mild-moderate knee osteoarthritis (Kellgren-Lawrence Grade 2-3) were included in this study to determine the comparative efficacy of extended-release triamcinolone acetonide compared to immediate-release triamcinolone acetonide. Patients were randomized into 1 of 3 groups receiving extended-release triamcinolone acetonide (10, 40 or 60 mg) or to the control group receiving 40 mg of immediate-release triamcinolone acetonide. Mean daily pain Read More »
Level 1 RCT
Synopsis: 314 patients who underwent multilevel thoracolumbar spinal surgery followed by the use of a postoperative drain were randomized to either receive antibiotic prophylaxis for 24 hours, or for the entire duration the drain was in place. The purpose of the study was to compare infection rates between these groups within 1 year of surgery. Results indicated that Read More »
Level 2 RCT
Synopsis: 2551 patients with an open fracture of the extremity were included in this randomized, 2 by 3 factorial design trial to investigate the effects of irrigation pressure and solution on reoperation rates. The patients were randomized to receive irrigation with either soap or saline at high, low, or very low pressure. After a 12 Read More »
Author verified Level 1 RCT

Arthroplasty

Synopsis: 16 randomized controlled trials were included in this meta-analysis examining the effect of tourniquet release prior to, or following, wound closure on operative blood loss and incidence of complications during total knee arthroplasty (TKA). Perioperative, postoperative and total blood loss, rate of major and minor complications, and operative time were assessed. The results of Read More »
Level 1 Meta Analysis
Synopsis: One hundred patients scheduled for total knee arthroplasty under spinal anaesthesia and preoperative single-shot femoral nerve block were randomized to receive either continuous femoral nerve block with 0.125% bupivacaine for 48 hours after arrival to the postanaesthesia care unit, or to placebo saline. The purpose of this study was to evaluate the analgesic effect of continuous femoral nerve block as compared with placebo saline after total knee arthroplasty. Upon follow-up for Read More »
Author verified Level 1 RCT
Synopsis: 270 patients (350 knees) undergoing primary total knee arthroplasty due to osteoarthritis were randomized to undergo surgery with or without patellar resurfacing. The purpose of this study was to compare Knee Society scores, incidence of revision and patient-reported satisfaction results of the two techniques up to 2 or 10 years postoperatively. The results of Read More »
Level 2 RCT
Synopsis: 99 patients were randomized to receive either a fixed-bearing or mobile-bearing total knee arthroplasty. The goal of this study was to determine the effects of the implant designs on outcomes as measured up to an average of 4 years after surgery. Outcome measures included Read More »
Author verified Level 1 RCT
Synopsis: 11 randomized control trials, with a minimum of 4 years follow-up, comparing arthroplasty (either total hip arthroplasty or hemiarthroplasty) to internal fixation for the treatment of displaced femoral neck fractures were included for analysis. The primary purpose of the study was to determine whether treatment with arthroplasty resulted in long-term differences in mortality and/or re-operation risk compared to internal fixation. Secondary outcomes included Read More »
Level 1 Meta Analysis
Synopsis: 100 patients with radiographically confirmed moderate to severe knee osteoarthritis were randomized to receive either total knee replacement (TKR) followed by nonsurgical treatment or the same nonsurgical treatment alone. The purpose of the study was to compare pain, function and quality of life between the two groups to determine if greater results can be achieved when surgery is combined with nonsurgical treatment. The results demonstrated Read More »
Author verified Level 2 RCT

Foot & Ankle

Synopsis: 50 patients with bilateral moderate-severe hallux valgus undergoing operative treatment were randomized to be treated with distal Chevron osteotomy or proximal Chevron osteotomy. Both procedures were performed with an additional distal soft-tissue release procedure. Follow-up for clinical Read More »
Level 2 RCT
Synopsis: 60 patients diagnosed with acute Achilles tendon rupture and conservatively treated through early mobilization and were randomized to undergo either early weightbearing or non-weightbearing protocols. The purpose of this study was to evaluate the impact of a weightbearing protocol on the recovery of ankle biomechanics when compared to a non-weightbearing protocol. Passive tension in Read More »
Author verified Level 2 RCT
Synopsis: One hundred and fifty patients who underwent Achilles tendon rupture repair surgery were randomized to receive either intermittent pneumatic compression (IPC) for six hours a day under an orthosis (Aircast XP Walker, DJO LLC) for two weeks, or standard treatment in a plaster cast without IPC. The purpose of this study was to determine the effects of IPC on rates of deep vein thrombosis (DVT.) The findings of this study demonstrated IPC to be an effective treatment to reduce incidence of DVT at two-weeks postoperatively compared to patients in a plaster cast without IPC. However, following the Read More »
Author verified Level 2 RCT
Synopsis: 250 patients with chronic plantar fasciitis were included in the study. Patients were randomized to receive treatment with focused extracorporeal shock wave therapy (EWST) or a placebo treatment in order to determine the efficacy of the intervention. Primary outcomes of Read More »
Author verified Level 1 RCT

Hand & Wrist

Synopsis: 461 patients with dorsally displaced distal radius fractures were randomized to undergo either volar locking-plate fixation or K-wire fixation. This study aimed to prove, through comparison, the null hypothesis that Patient-Reported Wrist Evaluation (PRWE) scores do not vary between treatments. The primary outcome Read More »
Author verified Level 2 RCT
Synopsis: Four randomized controlled trials were included in this meta-analysis to determine the efficacy of vitamin C in prevention of complex regional pain syndrome (CRPS) after distal radius fracture. A total of 810 patients were identified from the selected studies. Results indicated that Read More »
Author verified Level 1 Meta Analysis
Synopsis: 114 patients with unstable distal radius fractures were randomized to undergo either external fixation (EF) with adjuvant pins, or volar locking plate (VLP) fixation. The purpose of the study was to compare clinical and radiographic outcomes between VLP fixation and EF fixation. In the primary Read More »
Level 2 RCT
Synopsis: 128 patients suffering from carpal tunnel syndrome and scheduled to undergo surgical treatment were randomized to receive either an open or endoscopic release technique. This study presents the results of an extended follow-up (12.8 +/- 1.2 years), completed after the original 5-year study. The purpose was Read More »
Level 2 RCT

Metabolic Disorders

Synopsis: 19 randomized controlled studies, with a total of 6759 patients, were included in this meta-analysis investigating the role of vitamin K2 in postmenopausal women with osteoporosis. The purpose of the study was to compare bone mineral density, and incidence of fractures, as well as adverse events in patients taking oral vitamin K2 supplements and those not. Results indicated a Read More »
Level 1 Meta Analysis
Synopsis: 181 elderly women with osteoporosis or bone fractures were randomized to receive either one 5-mg dose of zoledronic acid or placebo intravenously. The purpose of this study was to determine whether zoledronic acid was safe and effective for improving bone mineral density in frail elderly women with osteoporosis. Hip and spine Read More »
Author verified Level 1 RCT

Osteoarthritis

Synopsis: 13 studies investigating the structural effects of substances believed to possess chondroprotective properties were included in this systematic review to determine whether patients with knee osteoarthritis (OA) would experience a delay in the progression of the disease. Treatments evaluated in this study included: oral glucosamine, chondroitin, nonsteroidal anti-inflammatory drugs (NSAIDs), polyunsaturated fatty acids, S-adenosylmethionine, avocado and soybean unsaponifiable fractions, methylsulfonylmethane, vitamins (C, D, and E), intra-articular hyaluronic acid injections, and platelet-rich plasma (PRP). The findings indicated Read More »
Author verified Level 3 Meta Analysis
Synopsis: 229 patients with unilateral or bilateral and mild-moderate knee osteoarthritis (Kellgren-Lawrence Grade 2-3) were included in this study to determine the comparative efficacy of extended-release triamcinolone acetonide compared to immediate-release triamcinolone acetonide. Patients were randomized into 1 of 3 groups receiving extended-release triamcinolone acetonide (10, 40 or 60 mg) or to the control group receiving 40 mg of immediate-release triamcinolone acetonide. Mean daily pain Read More »
Level 1 RCT
Synopsis: 192 patients with unilateral osteoarthritis or chondropathy of the knee were randomized to receive 3 intra-articular injections of either hyaluronic acid or platelet-rich plasma. The purpose of the study was to compare the two treatments in terms of clinical results up to 12 months after treatment in this patient population. Results indicated significant Read More »
Author verified Level 1 RCT
Synopsis: 100 patients with knee osteoarthritis not eligible for total knee replacement were randomly assigned to either a 12-week non-surgical program (MEDIC treatment), consisting of neuromuscular exercise, educational sessions, insoles, diet changes, and pain medication, or to usual care with educational pamphlets. The purpose of this study was to determine the effects of a multi-modal non-surgical treatment on patient pain, function, and quality of life. Patients enrolled in Read More »
Author verified Level 2 RCT

Physical Therapy & Rehab

Synopsis: 60 patients with mechanical neck pain were included in this study in one of three groups: Maitland mobilization with exercise, Mulligan mobilization with exercise, and just exercise. The purpose of the study was to compare these three interventions in terms of VAS pain, range of motion (ROM), and Neck disability index (NDI). Following 6 weeks Read More »
Author verified Level 1 RCT
Synopsis: 390 patients who had undergone primary unilateral total knee replacement were randomized to receive either a monitored home exercise program or usual rehabilitation care following surgery. This was done to determine whether a home exercise program provided inferior rehabilitation to standard care. The Western Ontario Read More »
Author verified Level 2 RCT
Synopsis: 135 patients with non-specific chronic low back pain (LBP) were randomized to undergo anodal transcranial direct current stimulation (tDCS) or sham tDCS, each with cognitive behavioural management (CBT). The purpose of this study was to examine the effects of tDCS and CBT in patients with non-specific chronic LBP, and provide follow-up at 4, 12, and 24 weeks treatment. The findings from Read More »
Author verified Level 2 RCT

Shoulder & Elbow

Synopsis: 8 randomized controlled trials were included in this meta-analysis evaluating the efficacy of platelet-rich plasma on patients undergoing arthroscopic full-thickness rotator cuff repair. Rate of retear, incidence of complications and functional outcomes, including pain, strength and range of motion were assessed. The results of Read More »
Author verified Level 1 Meta Analysis
Synopsis: 250 patients with displaced proximal humerus fracture were randomized to surgical management, with either internal fixation or hemiarthroplasty, or conservative management with sling immobilization. The purpose of this study was to compare treatment methods based on outcome of the Oxford Shoulder Score, as well as the incidence of complications. Follow-up was conducted Read More »
Author verified Level 2 RCT
Synopsis: 22 studies, which included a total of 2280 participants with lateral epicondylitis, were analyzed in this meta-analysis with the purpose of comparing the effectiveness of conservative treatments to no treatment. Outcomes of interest included overall improvement, need for escape interventions, outcome scores, and improved grip strength over intermediate follow-up. The results revealed Read More »
Author verified Level 2 Meta Analysis
Synopsis: 56 patients (58 shoulders), with rotator cuff (RC) tear and acromioclavicular (AC) joint arthritis were randomized to two groups that either underwent RC repair with distal clavicle resection, or isolated RC repair without distal clavicle resection. AC joint tenderness, the American Shoulder and Elbow Surgeons score, the Constant shoulder score, Visual analog scale (VAS), range of motion, patient satisfaction and MRI were among outcomes evaluated at 2 year follow-up. Results indicated that Read More »
Level 2 RCT

Spine

Synopsis: 47 patients (18-68 years old) with thoracolumbar burst fracture without neurological damage were randomized to either operative or nonoperative treatment. Patients were followed-up clinically and radiologically from 17 to 22 years. At final follow-up, Read More »
Author verified Level 2 RCT
Synopsis: 145 patients with lumbosacral radicular pain secondary to a herniated disc or spinal stenosis for less than 4 years where randomized to receive either epidural steroid injection plus placebo pills or sham injection plus gabapentin. Average leg pain was assessed over 3 months to evaluate whether an epidural steroid injection or gabapentin is a better treatment for lumbroscral radicular pain. Both treatments resulted Read More »
Author verified Level 2 RCT
Synopsis: 65 elderly patients with chronic low back pain were randomly treated with either pregabalin or tramadol/acetaminophen for 4 weeks. The purpose was to compare the efficacy of these treatments on neuropathic pain. Results indicated similar Read More »
Level 2 RCT
Synopsis: 23 randomized controlled trials (RCTs) were included in this systematic review to determine the efficacy of caudal, lumbar interlaminar, and transforaminal epidural injection techniques in the treatment of lumbar disc herniation. Findings indicated that Read More »
Author verified Level 2 Meta Analysis
Synopsis: 314 patients who underwent multilevel thoracolumbar spinal surgery followed by the use of a postoperative drain were randomized to either receive antibiotic prophylaxis for 24 hours, or for the entire duration the drain was in place. The purpose of the study was to compare infection rates between these groups within 1 year of surgery. Results indicated that Read More »
Level 2 RCT
Synopsis: 100 patients diagnosed with osteoporotic vertebral compression fractures (VCF) were randomized to receive either vertebroplasty or balloon kyphoplasty. The purpose of the study was to compare the clinical outcomes between these two procedures over a 5 year period. There were no Read More »
Level 2 RCT

Sports Medicine

Synopsis: 9 studies (6 randomized controlled trials (RCT) and 3 quasi-randomized trials) with a total of 402 patients were included in this analysis to identify and analyze postoperative rehabilitation methods following Achilles tendon (AT) repair. Two early postoperative function rehabilitation regimens (within 2 weeks after AT repair) were compared to immobilization after AT repair: early weightbearing with an ankle motion exercise regimen, and isolated early ankle motion exercises without early weightbearing. Pooled results demonstrated Read More »
Author verified Level 1 Meta Analysis
Synopsis: 129 patients with an anterior cruciate ligament (ACL) tear and undergoing surgical reconstruction were recruited for this randomized control trial. Patients were randomized to undergo 4 strand hamstring tendon reconstruction with either a semitendinosus (ST) autograft alone or in combination with a gracilis (G) autograft in the effort to evaluate differences in clinical outcomes resultant of the two techniques. Results demonstrated no Read More »
Author verified Level 1 RCT
Synopsis: 7 randomized controlled trials (402 patients) were included in this meta-analysis assessing the clinical outcomes over 2 years, between operative and conservative management for acute primary patellar dislocation. No differences between treatments were found for patient satisfaction, while significant differences were noted in Tegner score and redislocation rate favoring surgical treatment. Surgical treatment achieved Read More »
Level 1 Meta Analysis
Synopsis: 648 amateur male Dutch soccer players were randomized to undergo regular training, either alone, or with an additional protocol involving a Nordic hamstring exercise (NHE). The purpose of the trial was to assess the effectiveness of the NHE in reducing the incidence of hamstring injuries in this population, as well as its effectiveness in reducing the severity of the injuries. Findings indicated that Read More »
Level 2 RCT

Trauma

Synopsis: A comprehensive review and network meta-analysis was conducted looking at the complication rates requiring reoperation for all stabilization techniques for open tibial shaft fractures (Gustilo Types I – IIIB). Treatments evaluated were plate fixation, external fixation (by any method), reamed and unreamed intramedullary nailing, and Ender intramedullary nailing. Fourteen trials including Read More »
Author verified Level 1 Meta Analysis
Synopsis: 184 patients were randomized to receive either an Early Rehabilitation Intervention (ERI) or a Brief Educational Intervention (BEI) for road traffic injuries. The goal of this study was to determine the best return to work or usual activities for patients of varying risk levels for mental health disorders. The results of Read More »
Author verified Level 2 RCT
Synopsis: 2551 patients with an open fracture of the extremity were included in this randomized, 2 by 3 factorial design trial to investigate the effects of irrigation pressure and solution on reoperation rates. The patients were randomized to receive irrigation with either soap or saline at high, low, or very low pressure. After a 12 Read More »
Author verified Level 1 RCT