Operative Treatment of Acute Patellar Tendon Ruptures

2020 ◽  
Vol 48 (11) ◽  
pp. 2686-2691
Author(s):  
James A. O’Dowd ◽  
David M. Lehoang ◽  
Rebecca R. Butler ◽  
David O. Dewitt ◽  
Raffy Mirzayan
Keyword(s):  
Medical Care ◽  
Patellar Tendon ◽  
Infection Rate ◽  
Primary Repair ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
Significant Difference ◽  
Transosseous Repair ◽  
Tendon Ruptures ◽  
The Mean

Background: The gold standard for patellar tendon repair is a transosseous technique. Suture anchor repair has gained popularity, with recent biomechanical studies demonstrating significantly less gap formation during cyclic loading and significantly higher ultimate failure loads as compared with transosseous repair. These findings have not been substantiated in a large clinical cohort. Purpose: To report demographic and epidemiologic data, clinical and surgical findings, and outcomes and complications of anchor and transosseous suture repairs of acute patellar tendon ruptures. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent a primary repair of a traumatic patellar tendon rupture within 45 days of injury between 2006 and 2016 were retrospectively reviewed. Surgery was performed at a multisurgeon (120 surgeons) multicenter (14 centers) community-based integrated health care system. Patient demographic information, repair type, complications, and time from surgery to release from medical care were recorded. Results: A total of 361 patients (374 knees) met our inclusion criteria. The mean age was 39.8 years (range, 9-86 years), and 91.7% were male. There were 321 transosseous and 53 anchor repairs. There was no significant difference in the mean age ( P = .27), sex ( P = .79), tourniquet time ( P = .93), or body mass index ( P = .78) between the groups. There was a significant difference in rerupture rate between transosseous and anchor repairs (7.5% vs 0%, respectively; P = .034). Based on logistic regression, transosseous repair had 3.24 times the odds of reoperation verseus anchor repair (95% CI, 0.757-13.895; P = .1129). The infection rate was 1.6% for transosseous repair and 7.5% for anchor repair ( P = .160). There was no difference in time to release from medical care: 18.4 weeks for anchor and 17.1 weeks for transosseous repairs ( P = .92). Conclusion: Anchor repair demonstrated a significant decrease in rerupture rate when compared with transosseous repair. There was no difference in reoperation rate, infection rate, or time to release from medical care.

Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases

2018 ◽  
Vol 46 (6) ◽  
pp. 1451-1458 ◽  
Author(s):  
Raffy Mirzayan ◽  
Daniel C. Acevedo ◽  
Jeffrey F. Sodl ◽  
Edward H. Yian ◽  
Ronald A. Navarro ◽  
...  
Keyword(s):  
Medical Care ◽  
Primary Repair ◽  
Reoperation Rate ◽  
Weight Lifting ◽  
Suture Repair ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Tendon Ruptures ◽  
The Mean ◽  
Triceps Tendon

Background: Distal triceps tendon ruptures are rare. The authors present a series of 184 surgically treated, acute, traumatic triceps tendon avulsions and compare the complications between those treated with anchors (A) versus transosseous (TO) suture repair. Hypothesis: No difference exists in the retear rate between TO and A repairs. Study Designed: Cohort study; Level of evidence, 3. Methods: All patients who underwent an open primary repair of a traumatic triceps tendon avulsion within 90 days of injury, between 2007 and 2015, were retrospectively reviewed. Surgeries were performed within a multisurgeon (75 surgeons), multicenter (14 centers), community-based integrated health care system. Patient demographic information, type of repair, complications, and time from surgery to release from medical care were recorded. Results: 184 triceps tears in 181 patients met the inclusion criteria. The mean age was 49 years (range, 15-83 years). There were 169 males. The most common mechanisms of injury were fall (56.5%) and weight lifting (19%). Mean time from injury to surgery was 19 days (range, 1-90 days); in 74.5% of cases, surgery was performed in 3 weeks or less. There were 105 TO and 73 A repairs. No significant difference was found between the two groups in the mean age ( P = .18), sex ( P = .51), completeness of tears ( P = .74), tourniquet time ( P = .455), and prevalence of smokers ( P = .64). Significant differences were noted between TO and A repairs in terms of reruptures (6.7% vs 0%, respectively; P = .0244), overall reoperation rate (9.5% vs 1.4%; P = .026), and release from medical care (4.3 vs 3.4 months; P = .0014), but no difference was seen in infection rate (3.8% vs 0%; P = .092). No difference was noted in release from medical care in patients who underwent surgery 3 weeks or less after injury compared with those undergoing surgery more than 3 weeks after injury (3.90 vs 4.09 months, respectively; P = .911). Conclusion: Primary repair of triceps ruptures with TO fixation has a significantly higher rerupture rate, higher reoperation rate, and longer release from medical care than does repair with A fixation. Implementation of suture anchors in triceps repairs offers a lower complication rate and earlier release from medical care.

scholarly journals Trans-osseous versus Anchor Repair of Acute Patellar Tendon Ruptures

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0013
Author(s):  
James A. O’Dowd ◽  
David Lehoang ◽  
Rebecca K. Butler ◽  
David De Witt ◽  
Raffy Mirzayan
Keyword(s):  
Medical Care ◽  
Patellar Tendon ◽  
Primary Repair ◽  
Knee Surgery ◽  
Common Mechanism ◽  
P Value ◽  
Suture Repair ◽  
Operation Rate ◽  
Significant Difference ◽  
Tendon Ruptures

Objectives: Patellar tendon ruptures are relatively uncommon injuries. They require prompt diagnosis and surgical repair to restore the extensor mechanism of the knee. The gold standard procedure is a suture repair of the tendon, passed through trans-osseous tunnels, and tying of the sutures on the superior pole of the patella. Suture anchors have gained popularity with a recent cadaveric study demonstrating significantly less gap formation during cyclic loading and significantly higher ultimate failure loads. We present the largest series of patellar tendon repairs and compare the clinical outcomes and complications of trans-osseous (TO) and anchor (A) repair types. Methods: All patients who underwent a primary repair of a traumatic patellar tendon rupture within 45 days of injury, between 2007 and 2016, were retrospectively reviewed. Surgeries were performed at a multi-surgeon (114 surgeons), multi-center (13 centers) community-based integrated health care system. Patients with prior knee surgery, use of graft, patellar debridement for tendonitis, inferior pole avulsion fracture, concurrent knee surgery with other procedures were excluded. Patient demographic information, repair type, complications, and time from surgery to release from medical care were recorded. Results: 361 patients (374 knees) met our inclusion criteria. 13 had bilateral repairs during our study period and an additional 8 had a contralateral repair prior to our study period, for a bilateral incidence at 5.8%. The average age was 39.8 years (9 to 86 years). There were 341 males (94.5%). The most common mechanism of injury was basketball (47%), fall (19.5%), football (5.0%), and soccer (4.8%). Average time from injury to surgery was 6.3 days (range: 1- 45 days). There were 321 TO and 53 A repairs. There was no significant difference in the mean age (P=0.27), gender (P=0.79), tourniquet time (P=0.93), or BMI (P=0.78) between the two groups. There was a significant difference in re-rupture between (24 of 321) TO (7.5%) and (0 of 53) A (0%) (P=0.034). Using logistic regression, we found that TO had 3.244 times the odds of re-operation as those with A (95% CI: 0.757, 13.895. p-value: 0.1129) but did not reach signficance. The infection rate was 7.5% for A and 1.6% for TO (P= 0.160). There was no difference in time to release from medical care, 18.4 weeks for and 17.1 weeks (P=0.92). Conclusion: Compared to Anchors, primary repair of patellar tendon ruptures with trans-osseous repair had a significantly higher re-rupture rate, but there was no difference in re-operation rate, infection, or release from medical care.

scholarly journals Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879074 ◽  
Author(s):  
Robert C. Spang ◽  
Daniel B. Haber ◽  
Brendin R. Beaulieu-Jones ◽  
Kristen L. Stupay ◽  
George Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Football League ◽  
Treatment Method ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Specific Performance ◽  
Incomplete Healing ◽  
Bony Healing ◽  
The Mean ◽  
Career Performance

Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls ( P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

2020 ◽  
Vol 48 (9) ◽  
pp. 2081-2089
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Domingo Luis Muscolo ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Bone Block ◽  
Return To Sports ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean ◽  
Anterior Glenohumeral Instability

Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation ( P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points ( P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up ( P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points ( P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

Changes in the Rate of Postoperative Flexor Tendon Rupture in Patients with Distal Radius Fractures

2020 ◽  
Vol 25 (04) ◽  
pp. 481-488
Author(s):  
Rui Hirasawa ◽  
Eichi Itadera ◽  
Seiji Okamoto
Keyword(s):  
Distal Radius ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Major Complication ◽  
Significant Difference ◽  
Flexor Tendon Rupture ◽  
Tendon Ruptures ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: Flexor tendon rupture is a major complication after volar locking plating for distal radius fracture (DRF). Few studies have investigated changes in the rate of postoperative flexor tendon rupture in patients with DRFs. The present study aimed to investigate the changes in the rate of postoperative flexor tendon rupture and to assess plate placement and reduction positions. Methods: We retrospectively reviewed patients in whom more than 24 months had passed since DRF surgery. The patients were interviewed by telephone. Forty-nine patients (50 fractures; 2007–2009) from institution A were included in group 1 and 81 patients (84 fractures; 2013–2016) from institution B were included in group 2. The DRF surgery method was similar between the two groups. The rate of flexor tendon rupture, Soong classification grade, and radiological index (i.e., volar tilt [VT], radial inclination [RI], and ulnar variance [UV]) were statistically investigated in both groups. Results: Patient epidemiology was not significantly different between the two groups. The flexor tendon rupture rates were 2% and 0% in groups 1 and 2, respectively, without a significant difference. With regard to the Soong grade, 44 fractures were grade 2 and 6 were grade 1 in group 1, whereas 18 were grade 2, 38 were grade 1, and 28 were grade 0 in group 2, with a significant difference (p < 0.05). With regard to the radiological index, the mean VT values were 5° and 11° in groups 1 and 2, respectively, with a significant difference (p < 0.05). However, RI and UV showed no significant difference. Conclusions: Plate placement and reduction positions, which are risk factors for flexor tendon ruptures after DRFs, have improved recently when compared with previous findings. With these changes, the rate of flexor tendon rupture is presumed to have decreased.

scholarly journals Type 2 Myocardial Infarction in Acute Medical Care

2016 ◽  
Vol 01 (04) ◽  
pp. 021-024
Author(s):  
K. Sateesh ◽  
Stitha Pragna ◽  
Y Raju
Keyword(s):  
Myocardial Infarction ◽  
Medical Care ◽  
Oxygen Demand ◽  
Type Ii ◽  
Men And Women ◽  
Upper Limit ◽  
Significant Difference ◽  
The Mean ◽  
Acute Medical Care

AbstractBackground: Type 2 myocardial infarction (MI) is defined as MI secondary to ischemia due to either increased oxygen demand or decreased supply. It is seen in conditions other than coronary artery disease (CAD) contributes to an imbalance between myocardial oxygen supply and/or demand. Little is known about patient characteristics and clinical outcomes.Methods: A retrospective analysis was performed in patients who were admitted in acute medical care with symptoms suggestive of myocardial ischemia and enzymatic elevation from January 2015 to December 2015. Patients with slight elevation (above the upper limit of normal) of CK-MB were included in the study and compared the clinical and laboratory profile between men and women.Results: This survey includes a total of 54 patients, Out of which complete details were available in 41 patients (M:23; F:18). The mean age was 42.61. The common causes of type-II MI were Infectious (M:9 (39.1%), F:10 (55.6%) followed by haematological disorders (M:3 (13%), F:5 (27.7%). The mean CK-MB was 28.00. The mean CPK was 122.5. There was no hypotension, renal failure at the time of admission. One patient had in-hospital mortality out of all patients, whose primary diagnosis was septicaemia with shock who had normal CPK, elevated CK-MB and elevated NT pro BNP levels. Patients with type-II MI were not referred for coronary interventions and managed conservatively.Conclusions: There is no significant difference in the risk for type 2 MI between men and women. Clinical suspicion and diagnosis of type 2 MI is crucial in acute medical care setting, as the mortality can be reduced with adequate management of underlying condition. The threshold of biomarker levels should be low (above the upper limit of normal in symptomatic ischemia) to label type 2 MI contrary to the third universal definition of MI.

Syndactyly release: a comparison of skin graft versus graftless techniques in the same patient

2019 ◽  
Vol 44 (8) ◽  
pp. 845-849 ◽  
Author(s):  
Angela A. Wang ◽  
Douglas T. Hutchinson
Keyword(s):  
Visual Analogue Scale ◽  
Skin Graft ◽  
Analogue Scale ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Tourniquet Time ◽  
The Mean ◽  
Scar Score

Syndactyly release may be done by skin graft or graftless techniques. We prospectively examined bilateral syndactyly releases in the same patient at one operation. The grafted side was randomized and the contralateral side was done graftless. Fourteen patients had surgery at a mean age of 27 months (range 7–166). The mean follow-up was 52 months (range 6–111). The mean tourniquet time was 97 minutes (range 66–135) for graft and 84 minutes (55–120) for graftless. The mean finger abduction was 57° (32°–80°) for graft and 54° (38°–80°) for graftless. The mean web creep score was 1.2 (0–3) for graft and 2.1 (0–3) for graftless. The mean scar score was 1.9 (1–3) bilaterally. The mean parents’ visual analogue scale for graft cosmesis was 7.1 (5–9) and 6.2 (4.3–8) for graftless. The surgeon’s visual analogue scale for graft was 7.9 (6.4–9.5) and 6.2 (4–8.7) for graftless. The therapist’s visual analogue scale was 7.9 (6.5–10) and 6.4 (4.7–8) for graftless. Although there is a longer tourniquet time with grafting, there may be advantages in appearance and web creep. Level of evidence: II

Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries

2016 ◽  
Vol 37 (12) ◽  
pp. 1317-1325 ◽  
Author(s):  
Onur Kocadal ◽  
Mehmet Yucel ◽  
Murad Pepe ◽  
Ertugrul Aksahin ◽  
Cem Nuri Aktekin
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Functional Evaluation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Suture Button ◽  
Fixation Group ◽  
Significant Difference ◽  
The Mean

Background: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Methods: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. Results: There was a statistically significant decrease in the degree of fibular rotation ( P = .03) and an increase in the upper syndesmotic area ( P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area ( P = .02) and distal tibiofibular volumes ( P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Conclusion: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Intra operative assessment of the coronal balance in spinal deformity surgery : a technical note and retrospective study

2021 ◽  
Vol 87 (1) ◽  
pp. 175-179
Author(s):  
Thibault Dewilde ◽  
Sebastiaan Schelfaut ◽  
Sven Bamps ◽  
Matthias Papen ◽  
Pierre Moens
Keyword(s):  
Retrospective Study ◽  
Case Series ◽  
Technical Note ◽  
Coronal Alignment ◽  
Level Of Evidence ◽  
Coronal Balance ◽  
Scoliotic Deformity ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Obtaining a spine that is well balanced after fusion for scoliotic deformity is primordial for the patients’ quality of life. A simple T-shaped instrument combined with standard intraoperative fluoroscopy can be of great help to evaluate the coronal alignment quickly. The aim of this study was to evaluate if a T-shaped device could predict the postoperative coronal balance. Before finalization of the rod fixation, the balance was checked by verifying the relationship between the T-shaped instrument and the upper instrumented vertebra (UIV), and final adjustments were made to correct the coronal balance. A retrospective study was conducted on 48 patients who underwent surgery to correct scoliotic deformity. Intraoperative and postoperative coronal alignment was measured independently by two observers. The mean intraoperative horizontal offset measured between T-shaped instrument and the center of the UIV was 1,69mm to the right with a standard deviation (SD) of 12,43 mm. On postoperative full spine radiographs, the mean offset between the centra sacral vertical line and the center of the UIV was 2,44mm to the left with a SD of 13,10mm. There is no significant difference in coronal balance between both measurements (p=0,12). With this technique we were able to predict the postoperative coronal balance in all but one patient (97,92%). We conclude that the use of a simple T-shaped instrument can provide adequate intraoperative assessment of coronal balance in correcting scoliotic deformity. Level of evidence : IV – case series

scholarly journals Dural tear repair surgery comparative analysis: a stitch in time saves nine

2021 ◽  
Author(s):  
Charles Taylor ◽  
Amad Khan ◽  
Emad Shenouda ◽  
Nicholas Brooke ◽  
Ali Nader-Sepahi
Keyword(s):  
Infection Rate ◽  
Primary Closure ◽  
Neurological Symptoms ◽  
Dural Tear ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Repair Method ◽  
Operative Outcomes ◽  
Significant Difference ◽  
Dural Tears

Abstract Purpose A dural tear is a common iatrogenic complication of spinal surgery associated with a several post-operative adverse events. Despite their common occurrence, guidelines on how best to repair the defect remain unclear. This study uses five post-operative outcomes to the compare repair methods used to treat 106 dural tears to determine which method is clinically favourable. Methods Data were retrospectively collected from Southampton General Hospital’s online databases. 106 tears were identified and grouped per repair method. MANOVA was used to compare the following five outcomes: Length of stay, numbers of further admissions or revision surgeries, length of additional admissions, post-operative infection rate and dural tear associated neurological symptoms. Sub-analysis was conducted on patient demographics, primary vs non-primary closure and type of patch. Minimal clinically important difference (MCID) was calculated via the Delphi procedure. Results Age had a significant impact on patient outcomes and BMI displayed positive correlation with three-fifth of the predefined outcome measures. No significant difference was observed between repair groups; however, primary closure ± a patch achieved an MCID percentage improvement with regards to length of original stay, rate of additional admissions/surgeries and post-operative infection rate. Artificial over autologous patches resulted in shorter hospital stays, fewer readmissions, infections and neurological symptoms. Conclusion This study reports primary closure ± dural patch as the most efficient repair method with regards to the five reported outcomes. This study provides limited evidence in favour of artificial over autologous patches and recommends that dural patches be used in conjunction with primary closure. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

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