Effectiveness of surgical treatments on healing of cartilage and function level in patients with osteochondral lesions of the tibial plafond: A systematic review

Background: Osteochondral lesions of the tibial plafond (OLTPs) remain less common than osteochondral lesions of the talus (OLTs), but recognition of the condition has increased. Purpose: To systematically evaluate the literature on lesion locations and treatment outcomes of OLTPs, whether in isolation or in combination with OLTs. Study Design: Systematic review; Level of evidence, 4. Methods: A search was performed using the PubMed, Embase, and CINAHL databases for studies on lesion locations or with imaging or treatment outcomes of OLTPs. Case reports and reports based on expert opinion were excluded. Lesion locations as well as outcome measure results were aggregated. The Methodological Index for Non-randomized Studies score was used to assess methodological quality when applicable. Results: Included in this review were 10 articles, all published in 2000 or later. Most studies were evidence level 4, and the mean Methodological Index for Non-randomized Studies score was 8.6 (range, 8-10). Overall, 174 confirmed OLTP cases were identified, and the mean patient age was 38.8 years. Of the 157 lesions with confirmed locations, the most common was central-medial (32/157; 20.4%). Of 6 studies on treatment outcomes, all but 1 evaluated bone marrow stimulation techniques. Microfracture of small lesions (<150 mm2) was the most common treatment utilized. Imaging and functional outcomes appeared favorable after treatment. The data did not support differences in outcomes between isolated OLTPs and OLTPs with coexisting OLTs. Conclusion: Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. Microfracture of small lesions was the most common treatment utilized, and clinical and magnetic resonance imaging results were favorable, although data were heterogeneous. Areas for future research include the following: the effect of patient factors and additional pathologies on outcomes; larger or deeper lesion treatment; more direct comparisons of outcomes between kissing or coexisting lesions and isolated lesions; and head-to-head comparison of treatments, such as microfracture, bone marrow–derived cell transplantation, and osteochondral autografts/allografts.

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Osteochondral Lesions of the Tibial Plafond: A Systematic Review

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00149 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0014

Author(s):

James J. Butler ◽

Kevin Rosas ◽

Eoghan T. Hurley ◽

John G. Kennedy

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Poor Quality ◽

Cochrane Library ◽

Osteochondral Lesions ◽

Level Of Evidence ◽

Quality Of Evidence ◽

Tibial Plafond ◽

Meta Analyses

Category: Ankle; Sports; Trauma Introduction/Purpose: Osteochondral lesions of the talus (OLTs) account for the majority of osteochondral lesions (OCLs) of the tibiotalar joint, with osteochondral lesions of the tibial plafond (OLTP) being less commonly reported. The purpose of this systematic review was to evaluate the topographical characteristics of OLTPs, and outcomes following surgical intervention. Methods: A systematic review of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting clinical data for OLTPs were included. The level and quality of evidence of the included studies was evaluated using the Modified Coleman Methodology Score. Results: Nineteen studies with 395 OLTPs were included. Overall, 75.9% of OLTPs were associated with a traumatic history and/or previous ankle sprain. OLTPs were most commonly located in the centromedial region of the tibial plafond (30.4%), with the fewest number of OLTPs found in the anterolateral region of the tibial plafond (3.9%). In total, 46.9% of OLTPs were associated with co-existing osteochondral lesions of the talus. Microfracture was the most frequently utilised surgical technique amongst the included studies, and reported good clinical outcomes at mid-term follow up. Four studies were level of evidence II and 15 studies were level of evidence IV. Conclusion: This systematic review has found that osteochondral lesions of the tibial plafond are not a rare clinical finding in the setting of ankle trauma and are often associated with co-existing osteochondral lesions of the talus. Clinical outcomes following arthroscopic intervention appear to produce good results in the mid-term, but the low level of evidence, poor quality of evidence, marked heterogeneity and underreporting of the data confounds any recommendation based on this systematic review.

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Mesenchymal Stem Cells in the Treatment of Cartilage Defects of the Knee: A Systematic Review of the Clinical Outcomes

The American Journal of Sports Medicine ◽

10.1177/0363546520986812 ◽

2021 ◽

pp. 036354652098681

Author(s):

Monketh Jaibaji ◽

Rawan Jaibaji ◽

Andrea Volpin

Keyword(s):

Systematic Review ◽

Stem Cells ◽

Mesenchymal Stem Cells ◽

Stem Cell ◽

Mesenchymal Stem Cell ◽

Osteochondral Lesions ◽

Common Source ◽

Significant Heterogeneity ◽

Osteochondral Defects

Background: Osteochondral lesions are a common clinical problem and their management has been historically challenging. Mesenchymal stem cells have the potential to differentiate into chondrocytes and thus restore hyaline cartilage to the defect, theoretically improving clincal outcomes in these patients. They can also be harvested with minimal donor site morbidity. Purpose: To assess the clinical and functional outcomes of mesenchymal stem cell implantation to treat isolated osteochondral defects of the knee. A secondary purpose is to assess the quality of the current available evidence as well as the radiological and histological outcomes. We also reviewed the cellular preparation and operative techniques for implantation. Study Design: Systematic review. Methods: A comprehensive literature search of 4 databases was carried out: CINAHL, Embase, MEDLINE, and PubMed. We searched for clinical studies reporting the outcomes on a minimum of 5 patients with at least 12 months of follow-up. Clinical, radiological, and histological outcomes were recorded. We also recorded demographics, stem cell source, culture technique, and operative technique. Methodological quality of each study was assessed using the modified Coleman methodology score, and risk of bias for the randomized controlled studies was assessed using the Cochrane Collaboration tool. Results: Seventeen studies were found, encompassing 367 patients. The mean patient age was 35.1 years. Bone marrow was the most common source of stem cells utilized. Mesenchymal stem cell therapy consistently demonstrated good short- to medium-term outcomes in the studies reviewed with no serious adverse events being recorded. There was significant heterogeneity in cell harvesting and preparation as well as in the reporting of outcomes. Conclusion: Mesenchymal stem cells demonstrated a clinically relevant improvement in outcomes in patients with osteochondral defects of the knee. More research is needed to establish an optimal treatment protocol, long-term outcomes, and superiority over other therapies. Registration: CRD42020179391 (PROSPERO).

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Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review

Craniomaxillofacial Trauma & Reconstruction ◽

10.1177/19433875211026432 ◽

2021 ◽

pp. 194338752110264

Author(s):

Sean A. Knudson ◽

Kristopher M. Day ◽

Patrick Kelley ◽

Pablo Padilla ◽

Ian X. Collier ◽

...

Keyword(s):

Systematic Review ◽

Surgical Planning ◽

Average Length ◽

Case Series ◽

Retrospective Case ◽

Oral Nutrition ◽

Microsurgical Reconstruction ◽

Virtual Surgical Planning ◽

And Function ◽

Ballistic Trauma

Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.

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Plant-Based Dietary Patterns, Body Composition, Muscle Strength and Function in Middle and Older Age: A Systematic Review

The journal of nutrition health & aging ◽

10.1007/s12603-021-1666-7 ◽

2021 ◽

Author(s):

Hilaria Hin Lam Chan ◽

R. V. Ribeiro ◽

S. Haden ◽

V. Hirani

Keyword(s):

Systematic Review ◽

Body Composition ◽

Muscle Strength ◽

Dietary Patterns ◽

Older Age ◽

And Function

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Effects of electromyographic biofeedback interventions for shoulder pain and function: Systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215521990950 ◽

2021 ◽

pp. 026921552199095

Author(s):

Danilo Harudy Kamonseki ◽

Letícia Bojikian Calixtre ◽

Rodrigo Py Gonçalves Barreto ◽

Paula Rezende Camargo

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Confidence Interval ◽

Shoulder Pain ◽

Meta Analysis ◽

Quality Of Evidence ◽

Electromyographic Biofeedback ◽

Mean Differences ◽

And Function

Objective: To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain. Design: Systematic review of controlled clinical trials. Literature search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020. Study selection criteria: Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized. Data synthesis: The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis. Results: Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48). Conclusion: Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.

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The Association Between Sarcopenia and Postoperative Outcomes Among Older Adults With Hip Fracture: A Systematic Review

Journal of Applied Gerontology ◽

10.1177/07334648211006519 ◽

2021 ◽

pp. 073346482110065

Author(s):

Ming-Hsiu Chiang ◽

Yi-Jie Kuo ◽

Yu-Pin Chen

Keyword(s):

Systematic Review ◽

Older Adults ◽

Hip Fracture ◽

Postoperative Mortality ◽

Clinical Event ◽

High Morbidity ◽

Adverse Health Outcomes ◽

Age Related ◽

Study Selection ◽

And Function

Hip fracture is a serious clinical event with high morbidity and mortality. Sarcopenia is characterized by age-related loss of muscle mass and function, leading to several adverse health outcomes. In this systematic review, no limitation criteria were used for study selection and 327 studies were identified in the initial search. Of these, 11 studies comprising a total of 2,314 patients were selected. The overall proportion of older adults with hip fracture having sarcopenia was 44%, with a disparity of approximately 10% between men and women. Most studies have indicated that older adults with sarcopenia had poorer postoperative functional recovery than those without sarcopenia; the association between sarcopenia and high postoperative mortality or long hospital stay was heterogeneous. Well-organized studies with longer follow-up periods are warranted.

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Physical and functional performance assessment in pediatric oncology: a systematic review

Pediatric Research ◽

10.1038/s41390-021-01523-5 ◽

2021 ◽

Author(s):

Regine Söntgerath ◽

Julia Däggelmann ◽

Sabine V. Kesting ◽

Corina S. Rueegg ◽

Torge-Christian Wittke ◽

...

Keyword(s):

Systematic Review ◽

Muscle Strength ◽

Physical Performance ◽

Cardiorespiratory Fitness ◽

Pediatric Cancer ◽

Motor Performance ◽

Performance Test ◽

Functional Mobility ◽

Cancer Type ◽

And Function

Abstract Background Research indicates reduced physical performance from diagnosis into survivorship of pediatric cancer patients. However, there is no systematic information or guideline available on the methods to assess physical performance and function in this population. The purpose was to systematically compile and describe assessments of physical performance and function in patients and survivors of pediatric cancer, including cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait and motor performance test batteries. Methods We searched the databases PubMed, SPORTDiscus, and Cochrane Database and performed abstract and full-text selection of 2619 articles according to the Cochrane Handbook of Systematic Reviews. Information on patients characteristics, assessments, information on validity and reliability, and relevant references was extracted. Results In summary, 63 different assessments were found in 149 studies including 11639 participants. Most studies evaluated cardiorespiratory fitness and muscle strength with the majority conducted off treatment. Some outcomes (e.g. speed) and diagnoses (e.g. neuroblastoma) were severely underrepresented. With the exception of gait, leukemia patients represented the largest group of individuals tested. Conclusions Insufficient data and patient heterogeneity complicate uniform recommendations for assessments. Our results support researchers and practitioners in selecting appropriate assessment to meet their specific research questions or individual daily practice needs. Impact This systematic review includes 149 studies and provides a comprehensive summary of 63 assessments to evaluate cardiorespiratory fitness, muscle strength, speed, balance, flexibility, functional mobility, gait or motor performance test batteries in patients and survivors of pediatric cancer. We present the most studied fields within the pediatric cancer population, which are cardiorespiratory fitness and muscle strength, off treatment phase, and leukemia patients. We propose research priorities by identification of subgroups in terms of cancer type, phase of treatment, and outcome of interest that are underrepresented in studies currently available.

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Is Bisphosphonate-Related Osteonecrosis of the Jaw an Infection? A Histological and Microbiological Ten-Year Summary

International Journal of Dentistry ◽

10.1155/2014/452737 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 24

Author(s):

A. M. Hinson ◽

C. W. Smith ◽

E. R. Siegel ◽

B. C. Stack

Keyword(s):

Systematic Review ◽

Disease Severity ◽

Large Scale ◽

Clinical Signs ◽

Signs And Symptoms ◽

Osteonecrosis Of The Jaw ◽

Multifactorial Disease ◽

Clinical Signs And Symptoms ◽

Surgical Treatments

The role of infection in the etiology of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is poorly understood. Large-scale epidemiological descriptions of the histology and microbiology of BRONJ are not found in the literature. Herein, we present a systematic review of BRONJ histology and microbiology (including demographics, immunocompromised associations, clinical signs and symptoms, disease severity, antibiotic and surgical treatments, and recovery status) validating that infection should still be considered a prime component in the multifactorial disease.

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Surgical treatment of rectovaginal fistulas (systematic literature review)

Hirurg (Surgeon) ◽

10.33920/med-15-2104-03 ◽

2021 ◽

pp. 30-48

Author(s):

Andrei Anatolevich Mudrov ◽

Aleksandr Yur’evich Titov ◽

Mariyam Magomedovna Omarova ◽

Sergei Alekseevich Frolov ◽

Ivan Vasilevich Kostarev ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

High Recurrence Rate ◽

Surgical Interventions ◽

Rectovaginal Fistulas ◽

Surgical Treatments

Despite the large number of available surgical interventions aimed at the treatment of rectovaginal fistulas, the results of their use remain extremely disappointing, associated with the high recurrence rate of the disease reaching 80 %, as well as the lack of a single tactic to minimize the risk of anal incontinence and the need for colostomy. Objective: to conduct a systematic literature review in order to summarize information related to the rectovaginal fistulas surgery. The systematic review includes the results of an analysis of 97 clinical trials selected from 756 publications found in databases. Inclusion criteria: a full-text article, the presence of at least 5 patients in the study, as well as data on the outcome of surgery. Clinical trials with different surgical treatments were identified and classified into the following categories: elimination of the rectovaginal septal defect with a displaced flap (rectal and vaginal); Martius surgery; gracilis muscle transposition; transperineal procedure; abdominal procedure including endoscopic and laparoscopic methods; use of biological or biocompatible materials. Treatment outcomes vary significantly from 0 % to > 80 %. None of the studies were randomized. Due to the low quality of the identified studies, comparison of results and meta-analysis conduction were not possible. Conclusion: as a result of the systematic review, data for the analysis and development of any strategic and tactical algorithms for the treatment of RVF were not obtained. The most important questions still remain open: what and when surgical method to choose, is it necessary to form a disconnecting stoma?

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