scholarly journals Level of Evidence for the Treatment of Chronic Noninsertional Achilles Tendinopathy

2021 ◽  
pp. 193864002110012
Author(s):  
Mikaela J. Peters ◽  
Kellen Walsh ◽  
Chris Day ◽  
Alastair Younger ◽  
Peter Salat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Techniques ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Flexor Hallucis Longus Transfer ◽  
Minimally Invasive Surgical ◽  
Gastrocnemius Recession ◽  
Evidence Grade ◽  
Design And Methods

Background Noninsertional Achilles tendinopathy affects both athletes and sedentary individuals, and its incidence is rising. Conservative management is the mainstay of treatment, but a variety of operative techniques have been described to treat recalcitrant cases. We seek to outline the current available evidence for surgical management of noninsertional Achilles tendinopathy. Study design and methods A systematic review was performed using the MEDLINE and EMBASE databases, and all articles were reviewed by at least 2 authors. Each article was assigned a level of evidence in accordance with the standards of Journal of Bone and Joint Surgery. The available data were reviewed and a level of evidence was assigned to each intervention of interest, based on the revised classifications of Wright. Results and conclusion A total of 46 articles met inclusion and exclusion criteria. There is fair evidence (grade B) in support of open debridement with 1 level II study, 1 level III study, and 8 level IV studies. There is fair evidence (grade B) in support of arthroscopic or minimally invasive surgical techniques. There is poor evidence (grade C) in support of flexor hallucis longus transfer, longitudinal tenotomy, peritenolysis, gastrocnemius recession, and plantaris excision. There is insufficient evidence (grade I) to provide a recommendation about other surgical treatment methods for noninsertional Achilles tendinopathy. Levels of Evidence: Level III: Systematic review

Surgical Treatment of Insertional Achilles Tendinopathy: A Systematic Review

2020 ◽  
Vol 110 (5) ◽  
Author(s):  
Ruth Moen ◽  
Jacob R. Hagenbucher ◽  
Andrew B. Shinabarger
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Scoring Systems ◽  
Tendon Injury ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Inclusion Criteria ◽  
Gastrocnemius Recession ◽  
Tendon Autograft ◽  
Insertional Achilles Tendinopathy

Background Insertional Achilles tendinopathy is a common complaint among patients. Oftentimes, conservative treatment is inadequate, and surgical treatment is required. However, there is no published consensus regarding surgical intervention in reference to insertional Achilles tendinopathy. Methods The purpose of this systematic review was to evaluate the surgical management of insertional Achilles tendinopathy and report which surgical procedures provide the greatest pain reduction and improvement in functional outcome. A review of PubMed, OVID, Google Scholar, and Cochrane Controlled Trials Register was performed using a defined search strategy and inclusion criteria. Results Of 2,863 articles identified using the defined strategy, 20 met the inclusion criteria (three prospective and 17 retrospective). Operative interventions included Achilles tendon debridement, reattachment with suture anchors, reconstruction with flexor hallucis longus tendon autograft or bone-patellar tendon autograft, and gastrocnemius recession. All of the studies, regardless of intervention, showed generalized improvement after surgery. Wide variation in outcome scoring systems prevented direct comparison between studies and interventions. Conclusions This systematic review did not identify a superior treatment for insertional Achilles tendinopathy but rather found that the surgical treatment should be based on the extent of tendon injury.

Endoscopic Flexor Hallucis Longus Transfer for Achilles Noninsertional Tendinopathy: Description of Surgical Technique and Functional Outcomes

2020 ◽  
pp. 193864001989591
Author(s):  
Juan Bernardo Gerstner G ◽  
Ian Winson ◽  
Jimmy Campo ◽  
Michael Swords ◽  
Juan Camilo Medina ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Case Series ◽  
Functional Results ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Flexor Hallucis Longus Transfer ◽  
The Mean ◽  
American Orthopaedic

Background. The transfer of the flexor hallucis longus (FHL) tendon is an established treatment for replacing a dysfunctional Achilles tendon. Objectives. (1) Describe a new technique for endoscopic FHL transfer for noninsertional Achilles tendinopathy and (2) describe the functional outcomes and complications after endoscopic and open FHL transfer. Materials and Method. Retrospective study of patients who underwent open or endoscopic FHL transfer between 2014 and 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. Results. We included 18 endoscopic FHL transfers and 24 open FHL transfers. The mean age of endoscopic and open procedures was 47.5 years (range 25-77 years) and 61.2 years (range 43-72 years), respectively. An improvement on the average AOFAS of 52.8% (31.9 points) was observed in the endoscopy group during the follow-up from the baseline. The mean improvement in AOFAS score for the open group was 41.4% (24.5 points). Four and 7 cases reported complications in the endoscopy and open FHL transfer groups, respectively. Conclusion. While both procedures were effective in treating noninsertional Achilles tendinopathy, the described arthroscopic treatment led to a greater improvement in the AOFAS score and is slightly less prone to lasting complications. Level of Evidence: Level IV: Case series

Flexor Hallucis Longus Transfer for Repair of Chronic Achilles Tendinopathy

2003 ◽  
Vol 24 (9) ◽  
pp. 673-676 ◽  
Author(s):  
Robert Z. Tashjian ◽  
John Hur ◽  
Raymond J. Sullivan ◽  
John T. Campbell ◽  
Christopher W. DiGiovanni
Keyword(s):  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Flexor Hallucis Longus Transfer ◽  
Chronic Achilles Tendinopathy

scholarly journals Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes

Cartilage ◽  
2019 ◽  
pp. 194760351987085 ◽  
Author(s):  
Anthony Fiegen ◽  
Devin P. Leland ◽  
Christopher D. Bernard ◽  
Aaron J. Krych ◽  
Jonathan D. Barlow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Reported Outcomes ◽  
Glenohumeral Joint ◽  
Meta Analysis ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Cartilage Defects ◽  
Imaging Findings ◽  
Level Of Evidence ◽  
Patient Reported

Objective To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects. Design A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected. Results Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty. Conclusions In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients. Level of Evidence Level IV.

A Systematic Review of Definitive Treatment for Inverted Papilloma Attachment Site and Associations With Recurrence

2021 ◽  
pp. 019459982110519
Author(s):  
Monica S. Trent ◽  
Khodayar Goshtasbi ◽  
Lily Hui ◽  
John A. Gerka Stuyt ◽  
Nithin D. Adappa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Frozen Section ◽  
Surgical Techniques ◽  
Attachment Site ◽  
Inverted Papilloma ◽  
Definitive Treatment ◽  
Recurrence Rates ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Choice Of Technique

Objective Inverted papilloma (IP) is the most common benign neoplasm of the nasal cavity with known risk of recurrence. There is no standardized approach to definitive treatment for attachment sites. This systematic review aims to determine whether surgeon choice of technique differs by anatomic attachment site and whether different surgical techniques contribute to reduced rates of recurrence. Data Sources PubMed and Ovid Medline. Review Methods A systematic review was conducted for studies reporting on IP. Those that included IP recurrence rates and primary tumor attachment site were reviewed. Results Of 122 published studies, 14 met eligibility criteria, representing 585 patients and a recurrence rate of 5.8%. The maxillary sinus (50.9%) was the most common primary attachment site, and the sphenoid sinus was associated with the highest rate of recurrence (10.4%). The most utilized technique included debulking the tumor, removing mucosa over the attachment site, and drilling the underlying bone. The most common Krouse stage represented was T3 (53.3%). No single technique predicted a propensity for recurrence, but certain techniques are favored depending on IP attachment site. Finally, frozen sections to obtain evidence of clear margins intraoperatively significantly reduced rates of recurrence (3.4% vs 7.3%, P = .045). Conclusion Based on the current literature, the most common technique to address site of attachment involves resecting mucosa and drilling the tumor base. Choice of technique appears to differ for various sites of attachment. Use of intraoperative frozen section analysis appears to be associated with decreased recurrence overall. Level of Evidence 3.

scholarly journals The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Eyal Ben-Arie ◽  
Pei-Yu Kao ◽  
Yu-Chen Lee ◽  
Wen-Chao Ho ◽  
Li-Wei Chou ◽  
...  
Keyword(s):  
Systematic Review ◽  
External Rotation ◽  
Meta Analysis ◽  
Frozen Shoulder ◽  
Pain Reduction ◽  
Shoulder Function ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Evidence Grade

Background. Frozen shoulder (FS) is associated with pain, reduced range of motion (ROM), and shoulder function. The condition occurs in 2–5% of the population, and it is especially common around the age of 50 years. FS symptoms will recover after 1–4 years. Many patients turn to acupuncture in order to alleviate the FS symptoms. Objective. In this review, we will investigate the efficiency of acupuncture as a FS treatment. Methods. A literature search of acupuncture and FS-related keywords was performed in the following databases: PubMed, Cochrane Library, Embase, and Web of Science. Thirteen publications were included for a systematic review, and a meta-analysis was done using the following measurements: visual analogue scale (VAS) for pain, Constant-Murley Shoulder Outcome Score (CMS) for shoulder function, and active shoulder ROM including flexion, abduction, and external rotation. The Cochrane Collaboration’s risk of bias tool and quality of evidence GRADE recommendations and STRICTA 2010 were used to grade the included publications. Results. A meta-analysis on VAS pain score showed significant pain reduction, restoring CMS shoulder function, and flexion ROM in favor of acupuncture versus the control. In external rotation and abduction ROM, a meta-analysis was not significant. The most used acupoints are Jian Yu (LI15) and Jian Liao (TB14). Conclusions. The results indicate that acupuncture could be safe and effective for pain reduction, restoring shoulder function, and restoring flexion ROM for FS patients in the short term and midterm. However, the level of evidence was very low. More high-quality and longer studies are needed in order to robust the evidence.

The use of antibiotic prophylaxis in hip arthroscopy is under-reported and lacks evidence-based guidelines: a systematic review and survey

2017 ◽  
Vol 3 (2) ◽  
pp. 105-109
Author(s):  
Seper Ekhtiari ◽  
Chloe E Haldane ◽  
Darren de SA ◽  
Nicole Simunovic ◽  
Ivan H Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Prophylaxis ◽  
Hip Arthroscopy ◽  
Postoperative Infection ◽  
Practice Patterns ◽  
Surgical Techniques ◽  
High Volume ◽  
Prophylactic Antibiotics ◽  
Infection Rates ◽  
Level Of Evidence

ImportanceHip arthroscopy is an increasingly common orthopaedic procedure with postoperative infection rates<5%. With the growing challenge of antibiotic resistance and rising healthcare costs, it is important to establish whether antibiotic prophylaxis is routinely used in hip arthroscopy, and whether it is necessary.ObjectiveThe objectives of this review were to (1) report current practice patterns with regard to antibiotic prophylaxis for hip arthroscopy and (2) present the available evidence regarding the use of antibiotic prophylaxis in hip arthroscopy.Evidence reviewThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in the execution and reporting of this study. The databases MEDLINE, EMBASE and PubMed were searched and screened in duplicate. Data regarding patient demographics, surgical indications, surgical techniques, use of antibiotic prophylaxis and adverse events were collected. Study quality was assessed in duplicate using Methodological Index for Non-Randomised Studies criteria. A survey was distributed to high-volume hip arthroscopists to gauge their practice patterns. Data were analysed and presented using descriptive statistics.FindingsNine studies of primarily level IV evidence (78%) and of fair quality were included. Overall, 592 patients (652 hips; 56.2% male) were included in the review, with a mean age of 40.6 years. Notably, 1069 otherwise eligible studies were excluded from this review because they did not report on their use (or lack thereof) of prophylactic antibiotics. Overall, 390 patients received routine antibiotic prophylaxis, 160 patients did not and 42 patients received prophylaxis only if an implant was used. Only three infections were reported among 652 operations, with all infections from studies that routinely used antibiotic prophylaxis. The survey had a 60% response rate (21/35), and revealed that 81% of respondents routinely provide prophylactic antibiotics, most commonly preoperative intravenous cefazolin (66.7%). The most common postoperative antibiotic was cephalexin.Conclusions and relevanceAntibiotic prophlyaxis use in hip arthroscopy is very under-reported. Routine prophylaxis was the most common practice pattern in both the literature and the survey. Overall, postoperative infection rates are extremely low. Future studies are required to prospectively assess the role of antibiotic prophylaxis in hip arthroscopy.Level of evidenceLevel IV, systematic review of level III and IV studies

scholarly journals Historical analysis of the diagnosis and management of femoroacetabular impingement prior to the year 2000: a systematic review

2020 ◽  
Author(s):  
Tushar Tejpal ◽  
Ajaykumar Shanmugaraj ◽  
Jeffery Kay ◽  
Nicole Simunovic ◽  
Olufemi R Ayeni
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Complication Rate ◽  
Groin Pain ◽  
Periacetabular Osteotomy ◽  
Surgical Techniques ◽  
Historical Analysis ◽  
Level Of Evidence ◽  
Surgical Dislocation ◽  
Year 2000

Abstract This systematic review aims to assess the diagnosis, indications and treatment of femoroacetabular impingement (FAI) prior to the year 2000 and to determine if historical concepts remain applicable today. PUBMED, MEDLINE and EMBASE were searched for literature evaluating the diagnosis/treatment of FAI prior to 2000. Cadaver/non-human, non-English and review studies were excluded. Quality assessment was performed using the Methodological Index for Non-Randomized Studies. Nine studies comprising 307 patients [315 hips; mean age of 32.6 ± 2.4 years (range, 12–58)] were included. Patients reported groin pain. Magnetic resonance arthrography (MRA; n = 76) and the anterior impingement test (AIT) (n = 88) were used to diagnose impingement. Surgical dislocation with a trochanteric flip osteotomy (n = 237) and Bernese periacetabular osteotomy (n = 40) were common treatments. Pain and range of motion improved for patients. Overall complication rate was 35% (n = 99), with heterotopic ossification (n = 79) most commonly reported. Prior to 2000, there was low quantity and quality of research on the diagnosis/management of FAI. Diagnostic evaluation was primarily through clinical examination (i.e. groin pain and AIT). MRA was occasionally used to detect labral degeneration; however, utilization of computed tomography (CT) and diagnostic injections were not reported. Surgical dislocation and osteotomies of the acetabulum yielded desirable short-term clinical outcomes with a moderate complication rate. No study reported using arthroscopy for FAI management prior to 2000. Clinicians today can learn from historical principles (i.e. clinical diagnosis of FAI, management with surgical correction of femoral head–neck offset) while applying novel techniques (i.e. CT, injections, arthroscopic surgical techniques and rehabilitation) to improve patient outcomes. Level of Evidence: IV (systematic review of III and IV evidence).

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. 

Sign in / Sign up

Export Citation Format

Share Document