scholarly journals Rehabilitation following meniscal repair: a systematic review

2018 ◽  
Vol 4 (1) ◽  
pp. e000212 ◽  
Author(s):  
Robert C Spang III ◽  
Michael C Nasr ◽  
Amin Mohamadi ◽  
Joseph P DeAngelis ◽  
Ara Nazarian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Clinical Studies ◽  
Weight Bearing ◽  
Meniscal Repair ◽  
Rehabilitation Protocol ◽  
Early Motion ◽  
Accelerated Rehabilitation ◽  
Rehabilitation Protocols ◽  
Meta Analyses

ObjectiveTo review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery.Methods and data sourcesFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies.ResultsSeventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair.ConclusionsThere is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.

Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review

2016 ◽  
Vol 45 (7) ◽  
pp. 1687-1697 ◽  
Author(s):  
Kevin O’Donnell ◽  
Kevin B. Freedman ◽  
Fotios P. Tjoumakaris
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Significant Variation ◽  
Clinical Success ◽  
Meniscal Repair ◽  
Postoperative Rehabilitation ◽  
Treatment Groups ◽  
Rehabilitation Protocols ◽  
Outcome Scores ◽  
The Ideal

Background: Current postoperative rehabilitation protocols after isolated meniscal repair vary widely. No consensus exists with regard to the optimal amount of weightbearing, range of motion, or speed at which the patient progresses through the rehabilitation phases. Confounding factors including concomitant ligamentous or cartilaginous injuries have made studying isolated meniscal tears problematic. Purpose: To systematically review and evaluate the influence of range of motion and weightbearing status during the postoperative rehabilitation period after isolated meniscal repair on clinical efficacy and outcome scores. Study Design: Systematic review. Methods: A search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials was conducted. The selection criteria for inclusion were English-language in vivo clinical studies reporting on isolated meniscal repairs utilizing an arthroscopically assisted technique that outlined the postoperative rehabilitation protocol and included at least a 2-year follow-up. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, tear type, repair technique, postoperative protocol details, clinical failures, and outcome scores were extracted from the eligible studies. Rehabilitation protocols were divided into “accelerated,” “motion restricted,” “weight restricted,” and “dual restricted” according to the limitations placed on the treatment groups. Results: Fifteen studies, containing 17 different treatment groups, met the inclusion criteria. The 2 accelerated groups, 2 motion-restricted groups, 4 weight-restricted groups, and 9 dual-restricted groups showed similar efficacy in terms of clinical success and postoperative outcome scores. Early range of motion and weightbearing status showed no influence over clinical outcomes. Of the 17 groups, 13 reported a greater than 70% clinical success rate with significant variation in the tear type, fixation technique, and postoperative restrictions. Conclusion: Early range of motion and immediate postoperative weightbearing appear to have no detrimental effect on the chances for clinical success after isolated meniscal repair. Significant variation exists between postoperative protocols, with no current consensus on the ideal parameters for weightbearing and range of motion. Studies reporting outcomes regarding isolated meniscal repair are limited. Future research should include determining the ideal combination of weightbearing and range of motion for specific tear types.

Current Concepts on Accelerated ACL Rehabilitation

1994 ◽  
Vol 3 (4) ◽  
pp. 304-318 ◽  
Author(s):  
Mark S. De Carlo ◽  
Kecia E. Sell ◽  
K. Donald Shelbourne ◽  
Thomas E. Klootwyk
Keyword(s):  
Range Of Motion ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Extension ◽  
Autogenous Bone ◽  
Second Phase ◽  
Rehabilitation Protocol ◽  
Rehabilitation Programs ◽  
Accelerated Rehabilitation ◽  
Patient Will

It is well established that intra-articular anterior cruciate ligament reconstruction with autogenous bone-patellar tendon-bone graft provides satisfactory long-term stability. However, the rehabilitation programs employed following this surgical procedure have been a topic of considerable debate. This paper describes an accelerated rehabilitation protocol that is divided into four phases. The first phase encompasses the preoperative period, during which the patient will work to decrease swelling and restore range of motion and strength. The second phase involves Weeks 1 and 2 following surgery, with the patient emphasizing immediate terminal knee extension and weight bearing. The final two phases involve improving lower extremity strength and full return to daily and athletic activities. This accelerated rehabilitation protocol has resulted in an earlier return of range of motion and strength without compromising ligamentous stability.

scholarly journals Variability of United States Online Rehabilitation Protocols for Proximal Hamstring Tendon Repair

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711875511 ◽  
Author(s):  
Harry M. Lightsey ◽  
David E. Kantrowitz ◽  
Hasani W. Swindell ◽  
David P. Trofa ◽  
Christopher S. Ahmad ◽  
...  
Keyword(s):  
United States ◽  
Range Of Motion ◽  
Tendon Repair ◽  
Hamstring Tendon ◽  
Search Term ◽  
Postoperative Rehabilitation ◽  
Professional Literature ◽  
Rehabilitation Protocol ◽  
Rehabilitation Protocols ◽  
Proximal Hamstring

Background: The optimal postoperative rehabilitation protocol following repair of complete proximal hamstring tendon ruptures is the subject of ongoing investigation, with a need for more standardized regimens and evidence-based modalities. Purpose: To assess the variability across proximal hamstring tendon repair rehabilitation protocols published online by United States (US) orthopaedic teaching programs. Study Design: Cross-sectional study. Methods: Online proximal hamstring physical therapy protocols from US academic orthopaedic programs were reviewed. A web-based search using the search term complete proximal hamstring repair rehabilitation protocol provided an additional 14 protocols. A comprehensive scoring rubric was developed after review of all protocols and was used to assess each protocol for both the presence of various rehabilitation components and the point at which those components were introduced. Results: Of 50 rehabilitation protocols identified, 35 satisfied inclusion criteria and were analyzed. Twenty-five protocols (71%) recommended immediate postoperative bracing: 12 (34%) prescribed knee bracing, 8 (23%) prescribed hip bracing, and 5 (14%) did not specify the type of brace recommended. Fourteen protocols (40%) advised immediate nonweightbearing with crutches, while 16 protocols (46%) permitted immediate toe-touch weightbearing. Advancement to full weightbearing was allowed at a mean of 7.1 weeks (range, 4-12 weeks). Most protocols (80%) recommended gentle knee and hip passive range of motion and active range of motion, starting at a mean 1.4 weeks (range, 0-3 weeks) and 4.0 weeks (range, 0-6 weeks), respectively. However, only 6 protocols (17%) provided specific time points to initiate full hip and knee range of motion: a mean 8.0 weeks (range, 4-12 weeks) and 7.8 weeks (range, 0-12 weeks), respectively. Considerable variability was noted in the inclusion and timing of strengthening, stretching, proprioception, and cardiovascular exercises. Fifteen protocols (43%) required completion of specific return-to-sport criteria before resuming training. Conclusion: Marked variability is found in both the composition and timing of rehabilitation components across the various complete proximal hamstring repair rehabilitation protocols published online. This finding mirrors the variability of proposed rehabilitation protocols in the professional literature and represents an opportunity to improve patient care.

scholarly journals Survival Rate and Prosthetic and Sinus Complications of Zygomatic Dental Implants for the Rehabilitation of the Atrophic Edentulous Maxilla: A Systematic Review and Meta-Analysis

Biology ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 601
Author(s):  
David Gutiérrez Muñoz ◽  
Caterina Obrador Aldover ◽  
Álvaro Zubizarreta-Macho ◽  
Héctor González Menéndez ◽  
Juan Lorrio Castro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Survival Rate ◽  
Dental Implants ◽  
Clinical Studies ◽  
Meta Analysis ◽  
Case Series ◽  
P Value ◽  
High Survival ◽  
Meta Analyses ◽  
Prosthetic Complications

The aim of this systematic review and meta-analysis was to analyze and compare the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Materials and methods: We conducted a systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Four databases were consulted during the literature search: Pubmed–Medline, Scopus, Embase, and Web of Science. After eliminating duplicate articles and applying the inclusion criteria, 46 articles were selected for the qualitative analysis and 32 for the quantitative analysis. Results: Four randomized controlled trials, 19 prospective clinical studies, 20 retrospective studies, and 3 case series were included in the meta-analysis. Conventional dental implants failure (n = 3549) were seen in 2.89% (IC-95% 1.83–3.96%), while zygomatic dental implants failure (n = 1895) were seen in 0.69% (IC-95% 0.21–1.16%). The measure of the effect size used was the Odds Ratio, which was estimated at 2.05 with a confidence interval of 95% between 1.22 and 3.44 (z test = 2.73; p-value = 0.006). The failure risk of conventional dental implants is 2.1 times higher than that of zygomatic dental implants. Slight heterogeneity was determined in the meta-analysis between 23 combined studies (Q test = 32.4; p-value = 0.070; I2 = 32.1%). Prosthetic complications were recorded in 4.9% (IC-95% 2.7–7.3%) and mild heterogeneity was observed in a meta-analysis of 28 combined studies (Q test = 88.2; p-value = 0.001; I2 = 69.4%). Sinus complications were seen in 4.7% (IC-95% 2.8–6.5%) and mild heterogeneity was observed in a meta-analysis of 32 combined studies (Q test = 75.3; p-value = 0.001; I2 = 58.8%). Conclusions: The high survival rate and low prosthetic and sinus complications related to zygomatic dental implants suggest the use of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla.

scholarly journals Results of the Use of Accelerated Rehabilitation Protocols after Surgery in Patients with Cystic Pancreatic Formations Undergoing Resection and Resection-Draining Interventions

2020 ◽  
Vol 13 (3) ◽  
pp. 167-176
Author(s):  
Andrey Petrovich Koshel ◽  
Evgenij Drozodv ◽  
Sergey Sergeevich Klokov ◽  
Tat'yana Dibina ◽  
Oksana E Kusakina
Keyword(s):  
Perioperative Management ◽  
Total Duration ◽  
Control Group ◽  
Gastrointestinal Function ◽  
Rehabilitation Protocol ◽  
Number Of Patients ◽  
Accelerated Rehabilitation ◽  
Rehabilitation Protocols ◽  
Hospital Bed ◽  
Experimental Group

Introduction. The number of patients with cystic formations of the pancreas has increased significantly recently. Some of the patients need open or minimally invasive surgery. The implementation of ERAS (Enhanced recovery after surgery) protocols has been proved to be effective in orthopedics, bariatric and colorectal surgery. However, safety and feasibility of implementation of accelerated rehabilitation protocols in patients with cystic formations of the pancreas who underwent resection and resection-drainage interventions have not been sufficiently studied.The aim of the study was to assess the effectiveness and safety of implementation of the developed accelerated rehabilitation protocol in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions.Material and methods. This research is a retrospective-prospective, single-center study. The study included 110 patients with cystic formations of the pancreas of various etiologies. All patients were divided into two groups: the control group consisted of 55 patients, their perioperative management was carried out according to standard protocols, and the experimental group consisted of 55 patients, their perioperative management was carried out according to the accelerated rehabilitation protocol developed in the clinic. All patients included in the study were exposed to surgery: resection and resection-draining interventions in various modifications were performed.Results. Patients in the studied groups were comparable by gender, age, body mass index, ASA score, preoperative albumin level. No statistically significant differences were found in the duration of the operation, intraoperative blood loss, or the frequency of blood transfusions. The overall complication rate was significantly lower in the experimental group compared with the control group (38,2% versus 58,2%, p = 0,03). Postoperative recovery of the gastrointestinal function was also faster in the experimental group. Thus, in the experimental group, the average time to the gas discharge was 2,1 0,8 days; in the control group - 3,1 1,1 days (p = 0,01); the average time to the first stool was 3,2 1,9 and 4,2 1,2 days, respectively (p 0,001). The total duration of the postoperative hospital bed per day was significantly lower in the experimental group compared with the control group (11,8 7,7 vs 16,2 13,2 days, respectively, p = 0,02).Conclusions. The study demonstrated safety and effectiveness of implementation of accelerated rehabilitation protocols in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions. Implementation of the protocols allows reducing the duration of the postoperative hospital bed per day, incidence rate of complications, and also accelerating the gastrointestinal function recovery.

scholarly journals Improvement of semen parameters after coil embolization of varicoceles: a systematic review

2021 ◽  
Vol 20 ◽  
Author(s):  
Sergio Quilici Belczak ◽  
Vanessa Stefaniak ◽  
Leonardo Garcia Góes ◽  
Felipe Coelho Neto ◽  
Walter Jr. Boim de Araújo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Studies ◽  
Cost Effective ◽  
Semen Parameters ◽  
Semen Parameter ◽  
Cost Effective Method ◽  
Prisma Statement ◽  
Meta Analyses ◽  
The Impact

Abstract This systematic review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including clinical studies in which one of the outcomes was semen parameter improvement after varicocele embolization using coils only. The objective of the review was to assess the evidence on the role of embolization using coils alone for semen parameter improvement in men with varicocele, since embolization using coils is the most cost-effective method of varicocele repair. Study quality was assessed using the methodological index for non-randomized studies (MINORS). Out of six retrospective and two prospective observational or comparative clinical studies involving 701 patients, semen concentration improved significantly in all five studies that assessed this parameter. Mean semen motility improved significantly in seven studies. The impact of embolization on semen density could not be analyzed.

scholarly journals Evaluating mesenchymal stem cell therapy for sepsis with preclinical meta-analyses prior to initiating a first-in-human trial

eLife ◽  
2016 ◽  
Vol 5 ◽  
Author(s):  
Manoj M Lalu ◽  
Katrina J Sullivan ◽  
Shirley HJ Mei ◽  
David Moher ◽  
Alexander Straus ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Studies ◽  
Meta Analysis ◽  
Systematic Review Methodology ◽  
Experimental Conditions ◽  
Human Trial ◽  
Mesenchymal Stem Cell Therapy ◽  
Threats To Validity ◽  
Meta Analyses

Evaluation of preclinical evidence prior to initiating early-phase clinical studies has typically been performed by selecting individual studies in a non-systematic process that may introduce bias. Thus, in preparation for a first-in-human trial of mesenchymal stromal cells (MSCs) for septic shock, we applied systematic review methodology to evaluate all published preclinical evidence. We identified 20 controlled comparison experiments (980 animals from 18 publications) of in vivo sepsis models. Meta-analysis demonstrated that MSC treatment of preclinical sepsis significantly reduced mortality over a range of experimental conditions (odds ratio 0.27, 95% confidence interval 0.18–0.40, latest timepoint reported for each study). Risk of bias was unclear as few studies described elements such as randomization and no studies included an appropriately calculated sample size. Moreover, the presence of publication bias resulted in a ~30% overestimate of effect and threats to validity limit the strength of our conclusions. This novel prospective application of systematic review methodology serves as a template to evaluate preclinical evidence prior to initiating first-in-human clinical studies.

scholarly journals Is Immediate Weight Bearing Safe for Lateral Malleolus Fracture after Surgery?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0016
Author(s):  
Young Rak Choi ◽  
Sang-June Lee ◽  
Jaehyung Lee ◽  
Seung-Hwan Park
Keyword(s):  
Return To Work ◽  
Weight Bearing ◽  
Lateral Malleolus ◽  
Initiation Point ◽  
Rehabilitation Protocol ◽  
Ankle Motion ◽  
Significant Difference ◽  
Rehabilitation Protocols ◽  
Motion Exercise ◽  
Hospital Stays

Category: Trauma; Ankle Introduction/Purpose: Isolated lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for the weight bearing has not been standardized. In the present study, we investigated the prognostic difference between the immediate and delayed weight bearing on isolated lateral malleolus fractures. Methods: Retrospectively, the medical records of matched 50 and 41patients in the immediate and delayed weight-bearing groups were reviewed. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate. In the immediate weight-bearing group (IWB), tolerable weight bearing (i.e., that can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise were permitted in both groups since postoperative day. Radiographic assessment data and the clinical outcomes were reviewed. Results: There were no significant differences noted in the radiographic assessments and complications between the two groups. Significant differences of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed(5.7 vs. 8.0 days, 6.0 vs. 8.0 days in the IBW and DWB groups, respectively). In FAOS, there was a significant difference in the sport factor evaluated at postoperative 3 months(75.5 vs 68.5, respectively). Conclusion: There were no significant differences between the two groups in the postoperative radiological outcome and complications. And benefits of shortening the return to work and hospital stays of IWB rehabilitation protocol were confirmed. Conclusively, immediate weight bearing is recommended in patients with isolated lateral malleolus fracture, following anatomical reduction and firm fixation through surgery.

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