Primary Allograft ACL Reconstruction in Skeletally Immature Patients—A Systematic Review of Surgical Techniques, Outcomes, and Complications

2018 ◽  
Vol 32 (07) ◽  
pp. 673-685
Author(s):  
Ajaykumar Shanmugaraj ◽  
Darren de SA ◽  
Matthew M. Skelly ◽  
Andrew Duong ◽  
Nicole Simunovic ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acl Reconstruction ◽  
Full Range ◽  
Young Patients ◽  
Surgical Techniques ◽  
Postoperative Outcomes ◽  
Bone Block ◽  
High Risk Population ◽  
Skeletally Immature ◽  
Inclusion Criteria

AbstractThe purpose of this systematic review is to ascertain the risk profile of allografts in primary anterior cruciate ligament reconstruction (ACLR) of skeletally immature patients. Three databases (PubMed, EMBASE, and MEDLINE) were searched for articles addressing primary ACLR in skeletally immature patients (i.e., open femoral and tibial physes). Inclusion criteria encompassed the use of allograft tissue with available postoperative outcomes data. The methodological index for non-randomized studies (MINORS) was used to assess all studies. Descriptive statistics such as means, 95% confidence intervals and standard deviations are presented where applicable. A total of 3,852 studies were screened, with 9 studies of a total of 406 skeletally immature patients (mean age 14.9 ± 1.2 years) satisfying inclusion criteria. The majority (98%) of included patients underwent complete transphyseal ACLR. Where specified, allograft options included Achilles tendon (AT) (66.5%), tibialis anterior tendon (7.6%), bone–patellar tendon (2.5%), and fascia lata (1.0%). The use of a bone block for the AT was reported in one patient (0.2%). Postoperatively, and where specified, patients achieved full range of motion (12.1%), had good Lysholm scores of 94 to 100 (8.1%), and a return to preinjury level athletic participation of 82.9% (8.4%). Complications (13.3%) included graft failures (7.9%), nonrevision reoperation (4.7%), and a combined leg length discrepancy and angular (valgus and extension) deformity (0.2%). There were no reported incidences of disease transmission. Although failure rates of primary allograft ACL reconstruction are acceptable compared with other studies of mainly autograft use in this young, high-risk population, there was a very low rate of clinically significant physeal damage. However, the relatively low quality of the included studies limits the ability to recommend routine use of allograft for ACLR in the skeletally immature patient. More robust studies with long-term follow-up data are necessary to better ascertain the influence of allograft choice on postoperative outcomes for these young patients. This is a Level IV study, systematic review of Levels III and IV studies.

Anatomically Contoured Anterior Plating for Isolated Tibiotalar Arthrodesis: A Systematic Review

2017 ◽  
Vol 10 (4) ◽  
pp. 352-358 ◽  
Author(s):  
Nicholas Kusnezov ◽  
John C. Dunn ◽  
Logan R. Koehler ◽  
Justin D. Orr
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Posttraumatic Arthritis ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Tibiotalar Arthrodesis ◽  
Anterior Plating

Introduction. We performed a systematic review of the published literature to characterize patient demographic, surgical techniques, and functional outcomes to elucidate the complication and revision rates following isolated tibiotalar arthrodesis with anatomically contoured anterior plating. Methods. A comprehensive literature search was performed. Inclusion criteria were peer-reviewed studies in English, after 1990, at least 10 patients, and reporting clinical outcomes following contoured anterior plating and with follow-up of at least 80% and 1 year. Primary outcomes were fusion rate, time to fusion, return to activities, satisfaction, and functional outcome scores. Complication rates, reoperation, and revision were also extracted. Results. Eight primary studies with 164 patients met the inclusion criteria. The average sample size was 21 ± 10.0 patients and average age was 49.2 years with 61.6% male. Posttraumatic arthritis (49.4%) was the most common operative indication, followed by primary osteoarthrosis (18.9%). The average follow-up was 21.1 months. At this time, 97.6% of patients went on to uneventful union at a weighted average time of 18.7 weeks postoperatively. AOFAS scores improved significantly ( P < .05). 25% complication rate was reported with wound complication (7.9%) and hardware irritation (6.7%) most common. Overall, 21.3% of patients underwent reoperation; 4 for revision arthrodesis following nonunion. Conclusion. Isolated tibiotalar arthrodesis utilizing anatomically contoured anterior plating demonstrates excellent clinical and functional outcomes at short-term follow-up. Overall, 97.6% of patients went on to fusion and functional outcomes consistently improved following surgery. Furthermore, while one-quarter of patients experienced complications, wound complications were relatively uncommon and less than one-quarter of these required surgical intervention. Levels of Evidence: Level IV: Systematic Review

A SYSTEMATIC REVIEW OF COMPLICATIONS AND RECURRENCE RATE OF ARTHROSCOPIC RESECTION OF VOLAR WRIST GANGLION

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 475-480 ◽  
Author(s):  
Carlos Henrique Fernandes ◽  
Cesar Dario Oliveira Miranda ◽  
João Baptista Gomes dos Santos ◽  
Flavio Faloppa
Keyword(s):  
Systematic Review ◽  
Recurrence Rate ◽  
Operative Procedure ◽  
Arthroscopic Surgery ◽  
Surgical Techniques ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Level I ◽  
English Articles ◽  
Midcarpal Joint

The purpose of this systematic review is to determine the incidence of complications and the recurrence rate of a volar wrist ganglion following arthroscopic resection. We performed a systematic review of English and non-English articles using Google Scholar, Medline, and Web of Knowledge. Articles were screened for study inclusion by three independent reviewers using the terms "arthroscopic treatment of volar wrist ganglion" and "arthroscopic resection of volar wrist ganglion". Inclusion criteria: (1) level I–V evidence, (2) documentation of the number of wrists subjected to surgery, (3) documentation of surgical techniques used on wrists, and (4) documentation of surgical or post-surgical complications and recurrence rate of a volar wrist ganglion after arthroscopic resection. A complication was defined as an adverse outcome that was directly related to the operative procedure. Between 2001 and 2012, 13 articles met the inclusion criteria. Two articles were excluded and 11 were reviewed. A total of 232 wrists underwent arthroscopic surgery with 14 recurrences. The recurrence rate ranged from 0 to 20%, with mean of 6.03%. There were 16 (6.89%) complications. There was no connection with the ganglion in six wrists, three haematomas, three cases of neuropraxia of the dorsal radial nerve, two partial lesions of the median nerve, and two lesions of a branch of the radial artery. Patients did not have a decrease in the arc range of motion. Treatment of volar ganglia of the midcarpal joint was technically difficult and associated with a higher number of complications. In general, arthroscopic resection results in fewer complications and lower recurrence rates than an open surgical approach, but there is no clear evidence of such an advantage for arthroscopic resection of a volar wrist ganglion. Additional prospective, controlled clinical trials will be essential to address this important issue.

Surgical management of acquired anterior glottic web: a systematic review

2019 ◽  
Vol 133 (10) ◽  
pp. 867-874
Author(s):  
J M Fussey ◽  
D Borsetto ◽  
S Pelucchi ◽  
A Ciorba
Keyword(s):  
Systematic Review ◽  
Mitomycin C ◽  
Outcome Measures ◽  
Surgical Management ◽  
Medical Literature ◽  
Surgical Techniques ◽  
Success Rates ◽  
Inclusion Criteria ◽  
Significant Challenge ◽  
Anterior Glottic Web

AbstractBackgroundAcquired anterior glottic web poses a significant challenge to laryngologists given its propensity to recur following treatment, and there are a wide variety of described techniques.MethodsA systematic review of the medical literature was undertaken in order to identify all articles pertaining to the management of acquired anterior glottic web.ResultsThirteen studies meeting the inclusion criteria were identified and analysed. All were retrospective series, with varying surgical techniques and outcome measures. Only two studies reported on the use of topical mitomycin C.ConclusionMucosal graft techniques and keel placement appear to improve success rates, but both carry risks and disadvantages. Based on the available evidence, the use of topical agents such as mitomycin C cannot be recommended in the management of acquired anterior glottic web.

scholarly journals Minimally invasive surgical techniques in clinical crown lengthening: A systematic review

2020 ◽  
Vol 9 (10) ◽  
pp. e579108256
Author(s):  
Alick Brianne Ribeiro Silva ◽  
Herbert Alves ◽  
Vinícius Lopes Lazarino ◽  
Yohanna Mayanne Lima do Nascimento ◽  
Luis Fellipe Moraes Castello ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Surgical Planning ◽  
Alveolar Bone ◽  
Surgical Techniques ◽  
Cochrane Collaboration ◽  
Functional Results ◽  
Inclusion Criteria ◽  
Minimally Invasive Surgical ◽  
Crown Lengthening

The surgical procedure for the clinical crown lengthening, aims for an aesthetic or functional form to compensate for the reabsorption of the alveolar bone tissue caused by the invasion of the biological space. The conditions that must be taken into account during surgical planning are related to an excessive gingival exposure, altered passive eruption and lack of height of the dental element for restorative purposes. The objective of this systematic review was to evaluate in the scientific literature the minimally invasive surgical techniques used to clinical crown lengthening. A systematic review of the literature was performed using the databases, Science Direct, Embase, Cochrane Collaboration Library, and PubMed/MEDLINE. The search strategy provided a total of 157 studies. After selection, five articles met all the inclusion criteria and were included in this systematic review. Studies have shown that conventional surgical techniques for clinical crown lengthening are presented as an effective approach that promotes good aesthetic and functional results. However, they have some limitations. After evaluating the minimally invasive surgical techniques included in this systematic review, it was possible to infer that they presented satisfactory results in the soft and hard tissue contouring, with no complications and dissatisfaction being observed by the patients. 

scholarly journals 1165 Reporting Patient Selection in Robotic Cholecystectomy: Less than IDEAL? A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Biggs ◽  
L Dixon ◽  
T Brankin-Frisby ◽  
F Dewi ◽  
A Torkington ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Selection ◽  
New Technologies ◽  
Surgical Techniques ◽  
Common Bile Duct Stones ◽  
Definitive Treatment ◽  
Biliary Disease ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Robotic Cholecystectomy

Abstract Introduction Laparoscopic cholecystectomy is the gold standard definitive treatment option for benign biliary disease. There has been increasing interest in novel robotic surgical techniques; robotic cholecystectomy (RC) represents the most recent innovation in the management of gallstones. The IDEAL Collaboration has provided guidance for the rigorous and comprehensive reporting of surgical innovations, despite this, transparency in patient selection has been limited. We aimed to assess the reporting of patient selection in studies reporting RC. Method A collaborative, systematic review was conducted in accordance with the PRISMA guidance to identify all published studies reporting RC. Study specific inclusion and exclusion criteria were detailed in a protocol. Results Searches identified 1425 abstracts; 90 papers were included for data extraction. Inclusion criteria were reported in 38 (42%) studies. The most frequently cited were age (20%), aetiology (20%), presence of symptoms (16%) and comorbidities (10%). Forty-nine (54%) studies reported exclusion criteria. Numerous and variably reported exclusion criteria were reported; acute cholecystitis (26%), previous abdominal surgery (25%), comorbidity (17%), pregnancy (13%), common bile duct stones (13%) and pancreatitis (10%) among others. Seven reported no exclusion criteria. Three reported numbers of patients who declined RC. Conclusions Patient selection criteria were inconsistently reported and when present lacked standardisation. Concern persists around patients being “cherry picked” for inclusion in studies reporting innovative robotic surgical procedures, making interpretation and applicability of results impossible. Standardised inclusion criteria are needed to enable greater transparency and reproducibility to ensure the safe adoption of new technologies into clinical practice.

scholarly journals Pediatric Anterior Cruciate Ligament Reruptures Are Related to Lower Functional Scores at the Time of Return to Activity: A Prospective, Midterm Follow-up Study

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988888 ◽  
Author(s):  
Diego Costa Astur ◽  
João Victor Novaretti ◽  
Elton Luiz Borges Cavalcante ◽  
Adilson Goes ◽  
Camila Cohen Kaleka ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Study Patient ◽  
Skeletally Immature ◽  
Functional Scores ◽  
Anterior Cruciate ◽  
Return To Activity

Background: Skeletally immature patients show a higher rate of anterior cruciate ligament (ACL) reruptures. A better understanding of the risk factors for an ACL rerupture in this population is critical. Purpose/Hypothesis: The objective of this study was to analyze preoperative, intraoperative, and postoperative characteristics of pediatric patients undergoing ACL reconstruction and determine the relationship of these factors with an ACL rerupture. It was hypothesized that patients with worse activity scores and knee function at the time of return to activity would have a higher rate of ACL reruptures at midterm follow-up. Additionally, it was hypothesized that most ACL reruptures would occur before age 20 years in the study population. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 65 skeletally immature patients (age <16 years) with ACL ruptures underwent reconstruction with a quadruple hamstring tendon graft between 2002 and 2016. Of these patients, 52 were available for the study. Patient characteristics, surgical details, Tegner and Lysholm scores, and ACL reconstruction outcomes were recorded. Patients were analyzed and compared according to ACL rerupture occurrence. Results: Of the 52 patients, 18 (34.6%) experienced an ACL rerupture after reconstruction. The majority of reruptures (77.8%) occurred before age 20 years. There were 2 patients who sustained ACL reruptures during the rehabilitation period before they returned to activity. The majority of reruptures occurred after 12 months (83.2%), with 66.6% occurring after 24 months. Upon returning to activity between 6 and 9 months postoperatively, patients who ended up with intact ACL grafts reported 69% higher mean Tegner scores ( P = .006) and 64% higher mean Lysholm scores than patients who sustained ACL reruptures ( P < .001). Within the limits of this study, we could identify no statistical relationship between the rate of ACL reruptures and different sport types, surgical techniques, or associated injuries ( P > .05). Conclusion: Skeletally immature patients who underwent ACL reconstruction and sustained ACL reruptures had lower Tegner and Lysholm scores upon returning to activity than patients without ACL reruptures. In addition, most ACL reruptures occurred in patients younger than 20 years (77.8%) and after 24 months postoperatively (66.6%).

The Role of Selective Peripheral Neurectomy in the Treatment of Upper Limb Spasticity

2018 ◽  
Vol 23 (02) ◽  
pp. 181-191 ◽  
Author(s):  
Li Yenn Yong ◽  
Charis H.L. Wong ◽  
Mark Gaston ◽  
Wee Leon Lam
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Upper Limb ◽  
Surgical Techniques ◽  
Controlled Trials ◽  
Neurosurgical Procedures ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
Limb Spasticity ◽  
Peripheral Neurectomy

Background: Management of upper limb spasticity remains challenging. Selective peripheral neurectomy (SPN) is a relatively recent intervention for cases refractory to medical therapy. The aim of this study was to conduct a systematic review looking at the efficacy and outcomes of SPN, in order to clarify the patient selection criteria and surgical technique. Methods: A search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Open Grey and CINAHL was conducted. Inclusion criteria included studies comparing pre- and post-operative outcomes for SPN, neurectomy, fasciculotomy and upper limb spasticity. Results: Only case series were reported with no randomised controlled trials found. 7 studies met the inclusion criteria with a total of 174 patients. A meta-analysis was not possible due to the degree of baseline heterogeneity. All studies had no control arm for comparison of outcomes, with a high risk of bias due to poor internal and external validity, as well as design and performance bias. Surgical techniques differ vastly between studies, with percentage of fascicles ablated between 30–80% and length of neurectomy between 5–10 mm. Some advocated removing end branches while others performed fascicular SPN proximally. 13 patients underwent orthopaedic or neurosurgical procedures, which are both confounding factors. All studies reported an improvement in spasticity although functional outcomes were reported with non-standardized measures. Recurrence rates were reported to be 0–16.1% (mean 3.72%). Conclusions: From this systematic review, SPN appeared to be a useful technique in selected cases, but overall no firm conclusions can be drawn regarding the best surgical technique, or the extent of functional improvement.

scholarly journals Subtalar Distraction Arthrodesis for the Treatment of Subtalar Arthritis and Severe Hindfoot Deformity: A Systematic Review

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Amanda N. Fletcher ◽  
Jordan L. Liles ◽  
Gregory F. Pereira ◽  
John Steele ◽  
Samuel B. Adams
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Weighted Average ◽  
Wound Complications ◽  
Bone Block ◽  
Inclusion Criteria ◽  
Operative Techniques ◽  
Radiographic Outcomes ◽  
Subtalar Arthritis

Category: Hindfoot; Trauma Introduction/Purpose: Subtalar distraction arthrodesis (SDA) was developed as a means of treating the symptoms of subtalar arthritis. Despite almost 30 years of research in this field, many controversies still exist regarding SDA. The objectives of this study were (1) to conduct a systematic review of clinical outcomes following SDA, (2) to assess the demographics, indications, and surgical technique used, (3) to assess the clinical and radiographic outcomes of this procedure and its role in improving function, (4) to provide treatment recommendations based on the best available literature, and (5) to identify knowledge deficits that require further investigation. Methods: MEDLINE and EMBASE were queried with an end date of January 1, 2018 using the keywords The keywords used for this search included ‘‘subtalar,’’ ‘‘talar,’’ ‘‘talus,’’ ‘‘bone,’’ ‘‘block,’’ ‘distraction,’ ‘arthrodesis,’ ‘fusion,’ ‘arthritis,’ ‘arthrosis,’ ‘calcaneus,’ ‘calcaneal,’ ‘fracture,’ ‘malunion,’ ‘deformity,’ and ‘‘clinical outcome,’’ alone and in various combinations using the Boolean operator ‘‘AND.’’ Data abstraction was performed by two independent reviewers. Inclusion criteria for the articles were (1) English language, (2) peer-reviewed clinical studies with evidence levels I to IV, (3) with at least five patients, (4) reporting clinical and/or radiographic outcomes of SDA. Data collected included: demographics, operative techniques, radiographic measures, clinical and functional outcomes, and complications. The level of evidence for each study was assessed according to the method described by Wright et al. Methods followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Twenty-five studies matched the inclusion criteria (2 Level III and 23 Level IV studies) including 492 feet in 467 patients. The most common indication for SDA was late complications of calcaneus fractures. Many different operative techniques have been described, and there is no proven superiority of one method over the other. The most commonly reported complications were nonunion, hardware prominence, wound complications, and sural neuralgia. All studies showed both radiographic and clinical improvement at the last follow-up visit compared with the preoperative evaluation. Pooled results (12 studies, 237 patients) demonstrated improved American Orthopaedic Foot & Ankle Society ankle hindfoot scores with a weighted average of 33 points of improvement. Conclusion: Subtalar bone block arthrodesis provides good clinical results at short-term and midterm follow-up, with improvement in ankle function as well as acceptable complication and failure rates. These consistent clinical outcomes throughout the literature, despite different lengths of followup periods, suggest that the functional results do not deteriorate with time. Higher confidence recommendations for SDA require longer follow-up, clear indications and treatment protocols, standardized clinical and radiographic outcome measures, and direct comparison or stratification of results based on graft type and other operative techniques. [Table: see text]

scholarly journals Clinical Behavior of Short Dental Implants: Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (10) ◽  
pp. 3271 ◽  
Author(s):  
Andrea Torres-Alemany ◽  
Lucía Fernández-Estevan ◽  
Rubén Agustín-Panadero ◽  
José María Montiel-Company ◽  
Carlos Labaig-Rueda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Inclusion Criteria ◽  
Marginal Bone Loss ◽  
Short Implants ◽  
Edentulous Patients ◽  
Meta Analyses ◽  
The Impact

Short implants are an increasingly common alternative to other surgical techniques in areas where bone availability is reduced. Despite the advantages they offer, a variety of biological repercussions have been described in the literature that can even lead to the loss of these. The aim of this systematic review and meta-analysis was to analyze the impact of the use of short implants on their survival and on peri-implant bone loss, evaluating the influence that length, diameter, and crown-to-implant ratio (C/I) have on these parameters. This systematic review was based on guidelines proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An electronic search was conducted using terms related to the use of short implants in partially or totally edentulous patients. A total of five databases were consulted in the literature search: PubMed, Embase, Cochrane, Scopus, and Web of Science. After eliminating the duplicate articles and assessing which ones met the inclusion criteria, 15 articles were included for the qualitative analysis and 14 for the quantitative study. Through meta-analysis, the percentage of implant loss and peri-implant bone loss was estimated. Relating these parameters to length, diameter, and C/I ratio, no significant differences have been found for implant loss (values of p = 0.06, 0.10, and 0.9, respectively for length, diameter, and C/I ratio), nor for peri-implant bone loss (values of p = 0.71, 0.72, and 0.36, respectively for length, diameter, and C/I ratio). In conclusion, the use of short implants does not seem to have a significant influence on marginal bone loss or the survival rate of implants.

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