Management of Patellar Instability: A Network Meta-analysis of Randomized Control Trials

2021 ◽  
pp. 036354652110200
Author(s):  
Eoghan T. Hurley ◽  
Christopher A. Colasanti ◽  
Delon McAllister ◽  
Bogdan A. Matache ◽  
Michael J. Alaia ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Recurrence Rate ◽  
Patellar Instability ◽  
Soft Tissues ◽  
Nonoperative Management ◽  
Meta Analysis ◽  
Mean Difference ◽  
Mpfl Reconstruction ◽  
Lower Recurrence Rate ◽  
Kujala Score

Background: Multiple surgical options exist for the treatment of patellar instability; however, the most common procedures involve either a reconstruction of the medial patellofemoral ligament (MPFL) or a repair/plication of the MPFL and medial soft tissues. Purpose: To perform a network meta-analysis of the randomized controlled trials (RCTs) in the literature to compare MPFL reconstruction, MPFL repair, and nonoperative management for patellar instability. Study Design: Systematic review and network meta-analysis; Level of evidence, 1. Methods: The literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RCTs comparing MPFL reconstruction, MPFL repair, and nonoperative management for patellar instability were included. Clinical outcomes included recurrent instability (including both dislocations and subluxations), redislocation, and Kujala score. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using the statistical software R. The treatment options were ranked using P scores. Results: There were 13 RCTs with a total of 789 patients, all with a minimum follow-up of 24 months. There were 150 patients treated using MPFL reconstruction, 353 treated using MPFL repair, and 286 treated nonoperatively. Overall, MPFL reconstruction had the highest P score (0.9967) and resulted in a significantly lower recurrence rate than did MPFL repair (odds ratio [OR], 0.42; 95% CI, 0.07-0.72) and nonoperative management (OR, 0.09; 95% CI, 0.03-0.32). In addition, MPFL repair resulted in a significantly lower recurrence rate than did nonoperative management (OR, 0.42; 95% CI, 0.25-0.70). MPFL reconstruction had the highest P score (0.9651) and resulted in a significantly higher Kujala score than did nonoperative management (mean difference, 10.45; 95% CI, 0.41-20.49) but not MPFL repair (mean difference, 0.15; 95% CI, 0.03-0.68). Subgroup analysis revealed that MPFL reconstruction had the highest P score for all outcomes in those with first-time dislocation. Conclusion: The current study demonstrated that MPFL reconstruction results in the lowest rate of recurrent patellar instability and best functional outcomes as measured using the Kujala score.

Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability

2021 ◽  
pp. 036354652110377
Author(s):  
Jong-Min Kim ◽  
Jae-Ang Sim ◽  
HongYeol Yang ◽  
Young-Mo Kim ◽  
Joon-Ho Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Patellar Instability ◽  
Medial Patellofemoral Ligament ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Functional Failure ◽  
Radiological Parameters ◽  
Recurrent Patellar Instability

Background: No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity–trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Purpose: To compare the clinical outcomes between MPFL reconstruction and MPFL reconstruction with TTO for patients who have patellar instability with a TT-TG distance of 15 to 25 mm. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed 81 patients who underwent surgical treatment using either MPFL reconstruction or MPFL reconstruction with TTO for recurrent patellar instability with a TT-TG distance of 15 to 25 mm; the mean follow-up was 25.2 months (range, 12.0-53.0 months). The patients were divided into 2 groups: isolated MPFL reconstruction (iMPFL group; n = 36) performed by 2 surgeons and MPFL reconstruction with TTO (TTO group; n = 45) performed by another 2 surgeons. Clinical outcomes were assessed using the Kujala score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity score. Radiological parameters, including patellar height, TT-TG distance, patellar tilt, and congruence angle were compared between the 2 groups. Functional failure based on clinical apprehension sign, repeat subluxation or dislocation, and subjective instability and complications was assessed at the final follow-up. We also compared clinical outcomes based on subgroups of preoperative TT-TG distance (15 mm ≤ TT-TG ≤ 20 mm vs 20 mm < TT-TG ≤ 25 mm). Results: All of the clinical outcome parameters significantly improved in both groups at the final follow-up ( P < .001), with no significant differences between groups. The radiological parameters also showed no significant differences between the 2 groups. The incidence of functional failure was similar between the 2 groups (3 failures in the TTO group and 2 failures in the iMPFL group; P = .42). In the TTO group, 1 patient experienced a repeat dislocation postoperatively and 2 patients had subjective instability; in the iMPFL group, 2 patients had subjective instability. The prevalence of complications did not differ between the 2 groups ( P = .410). In the subgroup analysis based on TT-TG distance, we did not note any differences in clinical outcomes between iMPFL and TTO groups in subgroups of 15 mm ≤ TT-TG ≤ 20 mm and 20 mm < TT-TG ≤ 25 mm. Conclusion: MPFL reconstruction with and without TTO provided similar, satisfactory clinical outcomes and low redislocation rates for patients who had patellar instability with a TT-TG distance of 15 to 25 mm, without statistical difference. Thus, our findings suggest that iMPFL reconstruction is a safe and reliable treatment for patients with recurrent patellar dislocation with a TT-TG distance of 15 to 25 mm, without the disadvantages derived from TTO.

scholarly journals Cardiovascular drugs and COVID-19 clinical outcomes: a living systematic review and meta-analysis

2021 ◽  
Author(s):  
Innocent Asiimwe ◽  
Sudeep Pushpakon ◽  
Richard Turner ◽  
Ruwanthi Kolamunnage-Dona ◽  
Andrea Jorgensen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Disease Severity ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cardiovascular Drugs ◽  
Mean Difference ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality

Aims: To continually evaluate the role of cardiovascular drugs in COVID-19 clinical outcomes. Methods: Eligible publications were identified from >500 databases on 1-Nov-2020. One reviewer extracted data with 20% of the records independently extracted/evaluated by a second reviewer. Results: Of 52,735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most-reported drugs were angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with positive COVID-19 status (OR 1.14, 95% CI 1.00–1.31). Among COVID-19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76, 1.34–2.32), disease severity (OR 1.41, 1.27–1.56) and all-cause mortality (OR 1.22, 1.12–1.33) but not hospitalization length (mean difference -0.27, -1.36; 0.82 days). After adjustment, ACEI/ARB exposure was not associated with positive COVID-19 status (OR 0.92, 0.71–1.19), hospitalization (OR 0.93, 0.70–1.24), disease severity (OR 1.05, 0.81–1.38), or all-cause mortality (OR 0.85, 0.71–1.01). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with positive COVID-19 status (OR 0.93, 0.79–1.09), hospitalization (OR 0.84, 0.58–1.22), hospitalization length (mean difference -0.14, -1.65; 1.36 days), disease severity (OR 0.92, 0.76–1.11) while it decreased the odds of dying (OR 0.76, 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias. Conclusion: Cardiovascular drugs are not associated with poor COVID-19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed.

Effectiveness of High Tibial Osteotomy with or without Other Procedures for Medial Compartment Osteoarthritis of Knee: An Update Meta-Analysis

2020 ◽  
Author(s):  
Ru-Zhan Yao ◽  
Wei-Qiang Liu ◽  
Liang-Zhi Sun ◽  
Ming-Dong Yu ◽  
Guang-Lin Wang
Keyword(s):  
Pain Relief ◽  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Meta Analysis ◽  
Mean Difference ◽  
Control Group ◽  
Tibial Osteotomy ◽  
Beneficial Effects ◽  
Magnetic Resonance Imaging Mri

AbstractTo improve the long-term outcomes of high tibial osteotomy (HTO) for gonarthritis, many cartilage repair procedures appeared, but their effects were controversial. To evaluate the efficacy of cartilage repair procedures during HTO for gonarthritis, we performed this update meta-analysis. We performed the system retrieval for clinical trials using various databases and then pooled the outcomes of the included studies. Fifteen studies were involved. The pooled results indicated that there were no significant differences in Kellgren and Lawrence (KL) scale (mean difference [MD] = 0.02, 95% confidence interval [CI] = −0.01 to 0.06, p = 0.24), the femorotibial angle (MD = 0.06, 95% CI = −0.04 to 0.16, p = 0.22), and magnetic resonance imaging (MRI) outcomes (MD = 12.53, 95% CI = −2.26 to 27.32, p = 0.10) of patients in experimental group than control. The subgroup analysis showed that the clinical outcomes of abrasion arthroplasty (AA) were worse than control group (standardized mean difference [SMD] −2.65, 95% CI = −3.67 to −1.63, p < 0.001), while mesenchymal stem cells (MSCs) injection improved the clinical outcomes (SMD = 2.37, 95% CI = 1.25–3.50, p < 0.001). There were significant differences between the two groups in arthroscopic (SMD = 1.38, 95% CI = 0.82–1.94, p < 0.001) and histologic results (relative risk [RR] = 1.77, 95% CI = 1.36–2.29, p < 0.001). The pain relief (MD = 0.17, 95% CI = −3.26 to 3.61, p = 0.92) and operative complications (RR = 1.42, 95% CI = 0.83–2.42; p = 0.19) of the two groups had no significant differences. Our analysis supports that concurrent cartilage repair procedures might improve arthroscopic and histologic outcomes, but they have no beneficial effect on clinical outcomes, radiograph, MRI, and pain relief. The concurrent procedures do not increase the risk of operative complication. Furthermore, MSC has some beneficial effects on clinical outcomes, while AA might play an opposite role.

scholarly journals Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis

2017 ◽  
Vol 10 (4) ◽  
pp. 335-339 ◽  
Author(s):  
Waleed Brinjikji ◽  
Robert M Starke ◽  
M Hassan Murad ◽  
David Fiorella ◽  
Vitor M Pereira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Procedure Time ◽  
Weighted Mean ◽  
First Pass ◽  
Number Of Passes

Background and purposeFlow arrest with balloon guide catheters (BGCs) is becoming increasingly recognized as critical to optimizing patient outcomes for mechanical thrombectomy. We performed a systematic review and meta-analysis of the literature for studies that compared angiographic and clinical outcomes for patients who underwent mechanical thrombectomy with and without BGCs.Materials and methodsIn April 2017 a literature search on BGC and mechanical thrombectomy for stroke was performed. All studies included patients treated with and without BGCs using modern techniques (ie, stent retrievers). Using random effects meta-analysis, we evaluated the following outcomes: first-pass recanalization, Thrombolysis In Cerebral Infarction (TICI) 3 recanalization, TICI 2b/3 recanalization, favorable outcome (modified Rankin Scale (mRS) 0–2), mortality, and mean number of passes and procedure time.ResultsFive non-randomized studies of 2022 patients were included (1083 BGC group and 939 non-BGC group). Compared with the non-BGC group, patients treated with BGCs had higher odds of first-pass recanalization (OR 2.05, 95% CI 1.65 to 2.55), TICI 3 (OR 2.13, 95% CI 1.43 to 3.17), TICI 2b/3 (OR 1.54, 95% CI 1.21 to 1.97), and mRS 0–2 (OR 1.84, 95% CI 1.52 to 2.22). BGC-treated patients also had lower odds of mortality (OR 0.52, 95% CI 0.37 to 0.73) compared with non-BGC patients. The mean number of passes was significantly lower for BGC-treated patients (weighted mean difference −0.34, 95% CI−0.47 to −0.22). Mean procedure time was also significantly shorter for BGC-treated patients (weighted mean difference −7.7 min, 95% CI−9.0to −6.4).ConclusionsNon-randomized studies suggest that BGC use during mechanical thrombectomy for acute ischemic stroke is associated with superior clinical and angiographic outcomes. Further randomized trials are needed to confirm the results of this study.

scholarly journals Early Results of Patients With Recurrent Patellar Instability Treated With MPFL Reconstruction

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Ömer Naci Ergin ◽  
Mehmet Ekinci ◽  
Fuat Bilgili ◽  
Yücel Bilgin ◽  
Mehmet Aşık
Keyword(s):  
Patellar Dislocation ◽  
Patellar Instability ◽  
Mpfl Reconstruction ◽  
Activity Score ◽  
Vas Score ◽  
Early Results ◽  
Kujala Score ◽  
Patient Reported ◽  
Recurrent Patellar Instability

Introduction: MPFL reconstruction is an evidence-based and successful technique in treating patients with recurrent patellar instability without alignment problems or who have not yet undergone skeletal maturity for distal realignment surgery. Aim: The aim of this study is to report early results of patients who underwent MPFL reconstruction Method: 21 patients with lateral patellar instability who were treated with MPFL reconstruction using hamstring autogrefts in our clinic between 2012 and 2013 were evaluated. Mean age was 18.8 (8-32). Average age of first patellar dislocation was 13 (5-18). Patients’ history of complaints, pre and postoperative knee ROMs, patellofemoral pain scales, and patellofemoral instabilities were evaluated. These evaluations were done using Kujala score, İKDC (International Knee Documentation Committee) score, KOS(Knee Outcome Survey Activities Of Daily Living Score) score, Tegner activity score and VAS score. Results: 86% of our patient reported getting better with the surgery. The mean follow up was 25,2 months.Median Kujala score rose from 71 preop to 96 postop(p<0.05) and median İKDC score rose from 72 to 95(p<0.05). VAS score decreased from 3.4 to 1.2. KOS score was on average 83. Tegner activity score of our patients which was 2.57 preoperatively increased to 4.71. Only one patient had a decreased range of flexion (10 degrees on terminal flexion) and only one patient had persisting recurrent patellar dislocation (%4). The failure to treat this patient was attributed to his concurrent patologies consisting of patella alta, trochlear dysplasia and patellofemoral malalignment. Conclusion: MPFL reconstruction with hamstring autograft for treating patellar instability seems to be an effective surgical option according to early results. For late term results further follow-up is needed.

Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review

2019 ◽  
Vol 11 (5) ◽  
pp. 489-496 ◽  
Author(s):  
Xiaoxi Zhang ◽  
Qiao Zuo ◽  
Haishuang Tang ◽  
Gaici Xue ◽  
Pengfei Yang ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Recurrence Rate ◽  
Complication Rate ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Lower Recurrence Rate ◽  
Significant Difference ◽  
Favorable Clinical Outcome ◽  
Ruptured Intracranial Aneurysms

PurposeTo compare the safety and efficiency of stent assisted coiling (SAC) with non-SAC for the management of ruptured intracranial aneurysms.MethodsA meta-analysis that compared SAC with coiling alone and balloon assisted coiling was conducted by database searching. The primary outcomes of this study were immediate occlusion and progressive thrombosis rate, overall perioperative complication rate, and angiographic recurrence. Secondary outcomes included mortality at discharge, hemorrhagic and ischemic complications, and favorable clinical outcome at discharge and at follow-up.ResultsEight retrospective cohort studies with 1408 ruptured intracranial aneurysms (SAC=499; non-SAC=909) were included. The SAC group tended to show a lower immediate complete occlusion rate than the non-SAC group (54.3% vs 64.2%; RR 0.90; 95% CI 0.83 to 0.99; I2=17.4%) and achieved a significantly higher progressive complete rate at follow-up (73.4% vs 61.0%; RR 1.30; 95% CI 1.16 to 1.46; I2=40.5%) and a lower recurrence rate (4.8% vs 16.6%; RR 0.28; 95% CI 0.16 to 0.50; I2=0.0%). With respect to safety concerns, overall perioperative complications in the SAC group were significantly higher (20.2% vs 13.1%; RR 1.70; 95% CI 1.36 to 2.11; I2=0.0%). However, no significant difference was found for mortality rate at discharge (6.3% vs 6.2%; RR 1.29; 95% CI 0.86 to 1.94; I2=0.0%), or favorable clinical outcome rate at discharge (73.4% vs 74.2%; RR 0.95; 95% CI 0.88 to 1.02; I2=12.1%) and at follow-up (85.6% vs 87.9%; RR 0.98; 95% CI 0.93 to 1.02; I2=0.0%; P=0.338).ConclusionsSAC has a lower recurrence rate than non-SAC. Nevertheless, further validation by well designed prospective studies is warranted for determining whether stents improve angiographic outcome without an increased complication rate or unfavorable clinical outcome.

scholarly journals C.01 Endoscopic versus open microvascular decompression of trigeminal neuralgia: a systematic review and comparative meta-analysis

2018 ◽  
Vol 45 (s2) ◽  
pp. S13-S14
Author(s):  
N Zagzoog ◽  
A Attar ◽  
R Takroni ◽  
M Alotaibi ◽  
K Reddy
Keyword(s):  
Hearing Loss ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Clinical Outcomes ◽  
Recurrence Rate ◽  
Microvascular Decompression ◽  
Meta Analysis ◽  
Facial Paresis ◽  
Number Of Patients ◽  
Comparative Review

Background: Microvascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia with positive clinical outcomes. Fully endoscopic microvascular decompression (E-MVD) has been proposed as a minimally invasive, effective alternative, but a comparative review of the two approaches in the literature has not been conducted. Methods: We performed a meta-analysis comparing patient outcome rates and complications for both techniques. From a pool of 1,039 studies, 22 articles were selected for review: 12 open MVD and 10 E-MVD. The total number of patients was 6,734. Results: Good pain relief was achieved in 81% of MVD and 88% of E-MVD patients, with a mean recurrence rate of 14% and 9% respectively. Average rates of complications in MVD versus E-MVD included facial paresis or weakness, 9%, 3%; -hearing loss, 4%, 1%; cerebrospinal leak, both 3%; cerebellar damage and infection, 2%, <1%; and mortality <1%, 0% respectively. Conclusions: The reviewed literature revealed similar clinical outcomes with respect to pain relief for both approaches. Recurrence rate and incidence of complications, notably facial paresis and hearing loss were higher for MVD. We concluded that E-MVD appears to offer at least as good a surgical outcome as MVD, with possibly a shorter operative time, smaller craniectomy and lower recurrence rates.

Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

2019 ◽  
Vol 47 (6) ◽  
pp. 1323-1330 ◽  
Author(s):  
Elliot Sappey-Marinier ◽  
Bertrand Sonnery-Cottet ◽  
Padhraig O’Loughlin ◽  
Herve Ouanezar ◽  
Levi Reina Fernandes ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Kujala Score ◽  
The Mean ◽  
Recurrent Patellar Instability

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.

Patellar Redislocation Rates and Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction: Suture Anchor Versus Double Transpatellar Tunnel Fixation

2018 ◽  
Vol 47 (5) ◽  
pp. 1254-1262 ◽  
Author(s):  
Jae-Won Heo ◽  
Kyung-Han Ro ◽  
Dae-Hee Lee
Keyword(s):  
Clinical Outcomes ◽  
Patient Reported Outcomes ◽  
Medial Patellofemoral Ligament ◽  
Suture Anchor ◽  
Meta Analysis ◽  
Mpfl Reconstruction ◽  
Fixation Methods ◽  
Patient Reported ◽  
The Mean ◽  
Redislocation Rate

Background: Few studies to date have compared clinical outcomes in patients who have undergone medial patellofemoral ligament (MPFL) reconstruction using the suture anchor and double transpatellar tunnel fixation methods. This meta-analysis therefore compared the clinical results, including the patellar redislocation rate and improvement in functional scores, of suture anchor and double transpatellar tunnel fixation. Hypothesis: The recurrence rate and improvement in functional outcomes after surgery would be similar using the suture anchor and double transpatellar tunnel fixation methods. Study Design: Meta-analysis. Methods: Studies evaluating MPFL reconstruction using either the suture anchor or double transpatellar tunnel technique for patellar site fixation were included if they reported the patellar redislocation rate after surgery and/or validated patient-reported outcomes such as the Kujala and Lysholm scores. Results: Twenty-one studies were included in this meta-analysis. The mean patellar redislocation rates were similar using the suture anchor (3.2% [95% CI, 1.6%-6.2%]) and double transpatellar tunnel (3.4% [95% CI, 2.1%-5.4%]) techniques ( P = .879). The mean improvement in the Kujala score from before to after MPFL reconstruction was greater using the suture anchor (37.2 [95% CI, 31.1-43.4]) method than the double transpatellar tunnel method (28.7 [95% CI, 21.2-36.1]) ( P = .018). However, the mean improvement in the Lysholm score did not differ significantly using the 2 techniques. Conclusion: The patellar redislocation rate did not differ significantly in patients who underwent MPFL reconstruction using the suture anchor and double transpatellar tunnel fixation methods. The suture anchor fixation method, however, resulted in a greater degree of improvement in patient-reported outcomes.

scholarly journals Effects of Hot Balloon vs. Cryoballoon Ablation for Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Meta-Regression

2021 ◽  
Vol 8 ◽  
Author(s):  
Xinyi Peng ◽  
Xiao Liu ◽  
Hongbo Tian ◽  
Yu Chen ◽  
Xuexun Li
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Pulmonary Veins ◽  
Mean Difference ◽  
Cochrane Library ◽  
Cryoballoon Ablation ◽  
Procedure Time ◽  
Increased Risk

Background: Balloon-based catheter ablations, including hot balloon ablation (HBA) and cryoballoon ablation (CBA), have rapidly emerged as alternative modalities to conventional catheter atrial fibrillation (AF) ablation owing to their impressive procedural advantages and better clinical outcomes and safety. However, the differences in characteristics, effectiveness, safety, and efficacy between HBA and CBA remain undetermined. This study compares the characteristic and prognosis differences between HBA and CBA.Methods: Electronic search was conducted in six databases (PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov, and medRxiv) with specific search strategies. Eligible studies were selected based on specific criteria; all records were identified up to June 1, 2021. The mean difference, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated to evaluate the clinical outcomes. Heterogeneity and risk of bias were assessed using predefined criteria.Results: Seven studies were included in the final meta-analysis. Compared with CBA, more patients in the HBA group had residual conduction and required a higher incidence of touch-up ablation (TUA) [OR (95% CI) = 2.76 (2.02–3.77), P = 0.000]. The most frequent sites of TUA were the left superior pulmonary veins (PVs) in the HBA group vs. the right inferior PVs in the CBA group. During HBA surgery, the left and right superior PVs were more likely to have a higher fluid injection volume. Furthermore, the procedure time was longer in the HBA group than in the CBA group [weighted mean difference (95% CI) = 14.24 (4.39–24.09), P = 0.005]. Patients in the CBA group could have an increased risk of AF occurrence, and accepted more antiarrhythmic drug therapy; however, the result was insignificant.Conclusions: HBA and CBA are practical ablation approaches for AF treatment. Patients who received HBA had a higher incidence of TUA and longer procedure time. Clinical outcomes during the mid-term follow-up between HBA and CBA were comparable.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259487, identifier: CRD42021259487.

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