Utility of Percutaneous Ultrasonic Tenotomy for Tendinopathies: A Systematic Review

Context: Chronic tendinopathy is a challenging problem that can lead to significant disability and limitation in not only athletics but also activities of daily living. While there are many treatment techniques described for this overuse injury, no single modality has been proven superior to all others. With recent advances in medical technology, percutaneous ultrasonic tenotomy (PUT) for tendinosis has gained traction with promising results. Objective: To examine the data published on PUT for treatment of tendinopathy, analyze the outcomes of the procedure, including duration of pain relief and patient-reported outcomes, and assess the rate of complications associated with the procedure. Data Sources: PubMed, MEDLINE, EMBASE, and Google Scholar. Study Selection: The following combination of keywords was entered into the electronic search engines: ultrasonic tenotomy, ultrasound tenotomy, Tenex, and ultrasonic percutaneous tenotomy. The search results were screened for studies relevant to the topic. Only English-language studies were considered for inclusion. Studies consisting of level 4 evidence or higher and those involving human participants were included for more detailed evaluation. Level of Evidence: Level 4. Data Extraction: Articles meeting the inclusion criteria were sorted and reviewed. Type of tendinopathy studied, outcome measures, and complications were recorded. Both quantitative and qualitative analyses were performed on the data collected. Results: There were a total of 7 studies that met the inclusion criteria and quality measures—5 studies involving the treatment of elbow tendinopathy and 1 study each involving the management of Achilles tendinopathy and plantar fasciitis. PUT resulted in decreased pain/disability scores and improved functional outcome scores for chronic elbow tendinopathy and plantar fasciitis. Results for Achilles tendinopathy showed modest improvement in the short term, but long-term data are lacking. Conclusion: PUT is a minimally invasive treatment technique that can be considered in patients with tendinopathy refractory to conservative treatment measures. Further higher quality studies are necessary to accurately assess the comparative effectiveness of this treatment modality.

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Comparative Effectiveness of Alternative Dosing Regimens of Hyaluronic Acid Injections for Knee Osteoarthritis: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119861545 ◽

2019 ◽

Vol 11 (5) ◽

pp. 461-466

Author(s):

Kathryn McElheny ◽

Brett Toresdahl ◽

Daphne Ling ◽

Keith Mages ◽

Irfan Asif

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Cost Effectiveness ◽

Knee Osteoarthritis ◽

English Language ◽

Single Injection ◽

Data Extraction ◽

Consistent Difference ◽

Level Of Evidence ◽

Patient Reported

Context: Viscosupplementation is widely used for management of knee osteoarthritis. Many formulations of hyaluronic acid (HA) are available, ranging from a single injection to a series of up to 5 injections per treatment. Objective: To compare efficacy between single and multiple HA injection formulations. Data Sources: MEDLINE, EMBASE, Cochrane, Web of Science, Scopus databases were all searched. Study Selection: Full-text prospective randomized and nonrandomized controlled human trials, cohort studies, and cost-effectiveness evaluations in the English language comparing different injection regimens of viscosupplementation were included. Study Design: Systematic review. Level of Evidence: Level 1. Data Extraction: Data were collected using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Four databases were searched by a librarian and the principal investigator, identifying 6196 articles for screening. Results: Eleven studies met the inclusion criteria. Of the studies comparing single- with multiple-injection formulations of HA for treatment of knee osteoarthritis, there was no consistent difference in patient-reported outcomes. Furthermore, 5-injection formulations do not appear to be superior to 3-injection formulations. Conclusion: There are limited head-to-head trials comparing viscosupplementation formulations that differ based on number of injections, and in particular, there is a paucity of trials evaluating single-injection formulations. Based on the currently available data, there appears to be similar efficacy with the possibility for greater cost-effectiveness and less patient inconvenience with single-injection formulations.

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Promoting Diet and Physical Activity in Nurses

American Journal of Health Promotion ◽

10.4278/ajhp.141107-lit-562 ◽

2016 ◽

Vol 31 (1) ◽

pp. 19-27 ◽

Cited By ~ 21

Author(s):

Luciana Torquati ◽

Toby Pavey ◽

Tracy Kolbe-Alexander ◽

Michael Leveritt

Keyword(s):

Physical Activity ◽

English Language ◽

Data Extraction ◽

Student Nurses ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Data Synthesis ◽

Diet And Physical Activity ◽

Data Source

Objective. To systematically review the effectiveness of intervention studies promoting diet and physical activity (PA) in nurses. Data Source. English language manuscripts published between 1970 and 2014 in PubMed, Scopus, CINAHL, and EMBASE, as well as those accessed with the PICO tool, were reviewed. Study Inclusion and Exclusion Criteria. Inclusion criteria comprised (1) nurses/student nurses working in a health care setting and (2) interventions where PA and/or diet behaviors were the primary outcome. Exclusion criteria were (1) non–peer-reviewed articles or conference abstracts and (2) interventions focused on treatment of chronic conditions or lifestyle factors other than PA or diet in nurses. Data Extraction. Seventy-one full texts were retrieved and assessed for inclusion by two reviewers. Data were extracted by one reviewer and checked for accuracy by a second reviewer. Data Synthesis. Extracted data were synthesized in a tabular format and narrative summary. Results. Nine (n = 737 nurses) studies met the inclusion criteria. Quality of the studies was low to moderate. Four studies reported an increase in self-reported PA through structured exercise and goal setting. Dietary outcomes were generally positive, but were only measured in three studies with some limitations in the assessment methods. Two studies reported improved body composition without significant changes in diet or PA. Conclusions. Outcomes of interventions to change nurses’ PA and diet behavior are promising, but inconsistent. Additional and higher quality interventions that include objective and validated outcome measures and appropriate process evaluation are required.

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Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A Multicenter Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546519845346 ◽

2019 ◽

Vol 47 (7) ◽

pp. 1670-1678 ◽

Cited By ~ 5

Author(s):

Mario Hevesi ◽

Christopher Bernard ◽

David E. Hartigan ◽

Bruce A. Levy ◽

Benjamin G. Domb ◽

...

Keyword(s):

Hip Arthroscopy ◽

Labral Repair ◽

Harris Hip Score ◽

Treatment Technique ◽

High Grade ◽

Acetabular Cartilage ◽

Level Of Evidence ◽

Cartilage Lesions ◽

Patient Reported ◽

Grade 3

Background: Hip arthroscopy is becoming more advanced and commonly performed. However, significant controversy exists regarding whether high-grade acetabular cartilage lesions should be treated with debridement/abrasion or microfracture. In addition, patients treated with microfracture are subject to extended protected weightbearing rehabilitation to mitigate risk of subchondral plate fracture and to protect fibrocartilage tissue formation. Purpose: To determine the midterm patient-reported outcomes and failure rate of patients with grade 3 and 4 acetabular labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from November 2008 to April 2016 were reviewed for patients aged <55 years with unipolar ALAD grade 3 and 4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using the visual analog pain scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) to determine predictors of outcomes and failure. Results: A total of 113 hips in 110 patients (66 males, 44 females; mean age, 34.5 ± 1.1 years) undergoing debridement/abrasion (n = 82) or microfracture (n = 31) were followed for a mean of 4.9 years (range, 2.0-8.5 years). Lesion size was not statistically different between the debridement/abrasion (1.3 ± 1.0 cm2) and microfracture cohorts (1.4 ± 1.0 cm2) ( P = .47). Patients undergoing debridement/abrasion achieved 3.6-point mean improvements in VAS ( P < .01), 21.2-point improvements in mHHS ( P < .01), and 25.4-point improvements in HOS-SSS ( P < .01), which were not significantly different from those observed in microfracture patients ( P≥ .20). The 5-year rate of survival free of revision surgery was 84.0% in the debridement/abrasion group and 85.6% in the microfracture group ( P = .78). The cartilage treatment technique was found not to be predictive of revision risk during both univariate (hazard ratio [HR], 1.01; P = .98) and multivariate (HR, 0.93; P = .90) analysis accounting for patient age, lesion grade, and acetabular coverage. Conclusion: Patients undergoing debridement/abrasion of high-grade unipolar acetabular cartilage lesions demonstrate similar outcome scores and revision rates compared with those of patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon to optimize recovery while maintaining established positive outcomes after hip arthroscopy.

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The Progression of Hemophilic Arthropathy: The Role of Biomarkers

International Journal of Molecular Sciences ◽

10.3390/ijms21197292 ◽

2020 ◽

Vol 21 (19) ◽

pp. 7292

Author(s):

Gianluigi Pasta ◽

Salvatore Annunziata ◽

Alberto Polizzi ◽

Laura Caliogna ◽

Eugenio Jannelli ◽

...

Keyword(s):

Clinical Practice ◽

English Language ◽

Hemophilia A ◽

Data Extraction ◽

A Priori ◽

Inclusion Criteria ◽

Hemophilic Arthropathy ◽

Study Selection ◽

Potential Use

Background: Hemophilia A and B are X-linked congenital bleeding disorders characterized by recurrent hemarthroses leading to specific changes in the synovium and cartilage, which finally result in the destruction of the joint: this process is called hemophilic arthropathy (HA). This review highlights the most prominent molecular biomarkers found in the literature to discuss their potential use in the clinical practice to monitor bleeding, to assess the progression of the HA and the effectiveness of treatments. Methods: A review of the literature was performed on PubMed and Embase, from 3 to 7 August 2020. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: English language, available full text and articles published in peer-reviewed journal. In addition, further articles were identified by checking the bibliography of relevant articles and searching for the studies cited in all the articles examined. Results: Eligible studies obtained at the end of the search and screen process were seventy-three (73). Conclusions: Despite the surge of interest in the clinical use of biomarkers, current literature underlines the lack of their standardization and their potential use in the clinical practice preserving the role of physical examination and imaging in early diagnosis.

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Can Orthopaedics become the Gold Standard for Reproducibility? A Roadmap to Success

10.1101/715144 ◽

2019 ◽

Author(s):

Ian A. Fladie ◽

Sheridan Evans ◽

Jake Checketts ◽

Daniel Tritz ◽

Brent Norris ◽

...

Keyword(s):

Empirical Data ◽

Orthopaedic Surgery ◽

English Language ◽

Data Extraction ◽

Data Availability ◽

Data Sets ◽

Level Of Evidence ◽

Pubmed Search ◽

Peer Reviewers ◽

Research Findings

AbstractBackgroundScientific research is replete with poor accessibility to data, materials, and protocol, which limits the reproducibility of a study. Transparency with regard to materials, protocols, and raw data sets enhances reproducibility by providing the critical information necessary to verify, replicate, and resynthesize research findings. The extent to which transparency and reproducibility exist in the field of orthopaedics is unclear. In our study, we aimed to evaluate transparency and reproducibility-related characteristics of randomly sampled publications in orthopaedic journals.MethodsWe used the National Library of Medicine catalog to identify English language and MEDLINE-indexed orthopaedic journals. From the 74 journals meeting our inclusion criteria, we randomly sampled 300 publications using a refined PubMed search that were published between January 1, 2014, and December 31, 2018. Two investigators were trained for data extraction and analysis. Both investigators were blinded and independently extracted data from the 300 studies.ResultsOur initial search yielded 68,102 publications, from which we drew a random sample of 300 publications. Of these 300 publications, 286 were screened for empirical data and 14 were inaccessible. For analysis purposes, we excluded publications without empirical data. Of the 182 with empirical data, 13 studies (7.1%) included a data availability statement, 9 (4.9%) reported materials were available, none (0.0%) provided analysis scripts, 2 (1.1%) provided access to the protocol used, 5 (2.7%) were preregistered, and only 2 (1.1%) provided a statement about being a replicated study.ConclusionsComponents necessary for reproducibility are lacking in orthopaedic surgery journals. The vast majority of publications did not provide data or material availability statements, protocols, or analysis scripts, and had no preregistration statements. Intervention is needed to improve reproducibility in the field of orthopaedics. The current state of reproducibility in orthopaedic surgery could be improved by combined efforts from funding agencies, authors, peer reviewers, and journals alike.Level of EvidenceN/A

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Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120961406 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096140 ◽

Cited By ~ 1

Author(s):

Chih-Kai Hong ◽

Chao-Jui Chang ◽

Fa-Chuan Kuan ◽

Kai-Lan Hsu ◽

Yueh Chen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

English Language ◽

Arthroscopic Rotator Cuff Repair ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Retear of a repaired rotator cuff tendon is a major issue for shoulder surgeons. It is possible that diabetes mellitus (DM) is associated with a greater risk of tendon retear after arthroscopic rotator cuff repair. Purpose: To determine whether patients with DM have a higher tendon retear risk after arthroscopic rotator cuff repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Web of Science, PubMed, and Embase databases. Inclusion criteria were articles written in the English language that included patients undergoing arthroscopic rotator cuff repair surgeries, reported the numbers of patients with and those without DM, and reported the number of rotator cuff retears. Data relevant to this study were extracted and statistically analyzed. Random-effects models were used to generate pooled odds ratio estimates and CIs. Results: A total of 160 studies were identified from the initial search, and 5 of them met the inclusion criteria. A total of 1065 patients (207 patients with DM and 858 patients without DM) were included. The pooled results showed that the patients in the DM group had a significantly higher tendon retear risk than did those in the non-DM group (relative risk, 2.25; 95% CI, 1.14-4.45; P = .02). Conclusion: Patients with DM have a 2.25 times higher risk of tendon retear after arthroscopic rotator cuff repair compared with patients without DM.

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Bilateral total shoulder arthroplasty: A systematic review of clinical outcomes

Shoulder & Elbow ◽

10.1177/1758573220916822 ◽

2020 ◽

pp. 175857322091682

Author(s):

John-Rudolph H Smith ◽

Darby A Houck ◽

Jessica A Hart ◽

Jonathan T Bravman ◽

Rachel M Frank ◽

...

Keyword(s):

Patient Satisfaction ◽

Clinical Outcomes ◽

Shoulder Arthroplasty ◽

English Language ◽

External Rotation ◽

Total Shoulder Arthroplasty ◽

Cochrane Library ◽

Level Of Evidence ◽

Patient Reported

Background The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA ( n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA ( n = 26) and bilateral RTSA ( n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence IV.

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Real-Time Kinematic, Temporospatial, and Kinetic Biofeedback During Gait Retraining in Patients: A Systematic Review

Physical Therapy ◽

10.2522/ptj.20080281 ◽

2010 ◽

Vol 90 (8) ◽

pp. 1123-1134 ◽

Cited By ~ 59

Author(s):

Jeremiah J. Tate ◽

Clare E. Milner

Keyword(s):

Real Time ◽

English Language ◽

Treatment Effects ◽

Data Extraction ◽

Gait Training ◽

Effect Sizes ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Gait Retraining ◽

Real Time Kinematic

BackgroundBiofeedback has been used in rehabilitation settings for gait retraining.PurposeThe purpose of this review was to summarize and synthesize the findings of studies involving real-time kinematic, temporospatial, and kinetic biofeedback. The goal was to provide a general overview of the effectiveness of these forms of biofeedback in treating gait abnormalities.Data SourcesArticles were identified through searches of the following databases: MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central Register for Controlled Trials. All searches were limited to the English language and encompassed the period from 1965 to November 2007.Study SelectionTitles and abstracts were screened to identify studies that met the following requirements: the study included the use of kinematic, temporospatial, or kinetic biofeedback during gait training, and the population of interest showed abnormal movement patterns as a result of a pathology or injury.Data ExtractionAll articles that met the inclusion criteria were assessed by use of the Methodological Index for Nonrandomized Studies.Data SynthesisSeven articles met the inclusion criteria and were included in the review. Effect sizes were calculated for the primary outcome variables for all studies that provided enough data. Effect sizes generally suggested moderate to large treatment effects for all methods of biofeedback during practice.LimitationsSeveral of the studies lacked adequate randomization; therefore, readers should exercise caution when interpreting authors’ conclusions.ConclusionsEach biofeedback method appeared to result in moderate to large treatment effects immediately after treatment. However, it is unknown whether the effects were maintained. Future studies should ensure adequate randomization of participants and implementation of motor learning concepts and should include retention testing to assess the long-term success of biofeedback and outcome measures capable of demonstrating coordinative changes in gait and improvement in function.

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Hip and Groin Injuries in Dancers: A Systematic Review

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117724159 ◽

2017 ◽

Vol 9 (5) ◽

pp. 422-427 ◽

Cited By ~ 4

Author(s):

Natasha Trentacosta ◽

Dai Sugimoto ◽

Lyle J. Micheli

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Descriptive Analysis ◽

Injury Rate ◽

Time Frame ◽

Musculoskeletal Injuries ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Skill Levels ◽

Professional Dancers

Context: Injury data on hip and groin injuries vary, and these injuries are often misrepresented or overlooked for more commonly seen injuries, such as those to the foot and ankle. Objective: To provide a systematic review of the injury rates of hip and groin pathology in dancers and look to establish a better understanding of the occurrence of hip and groin injuries in the dancer population. Data Sources: A literature search was performed using PubMed and CINAHL databases for articles published between 2000 and 2016. Study Selection: Inclusion criteria consisted of (1) documentation of the number of hip and/or groin injuries, (2) study population consisting of dancers whose training included some level of ballet, and (3) studies of levels 1 through 3 evidence. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: A single reviewer identified studies that met the inclusion criteria. The number of overall injuries, hip/groin injuries, study participants, injured participants, training hours per week, mean age of study group, injury definition, injury reporting method, and study time frame were extracted. Results: Thirteen unique studies were included in the descriptive analysis. Of the 2001 dancers included in this study, 3527 musculoskeletal injuries were seen in 1553 dancers. Of these, 345 injuries were localized to the hip and groin region (overall rate, 17.2%). An incidence rate of 0.09 hip and groin injuries per 1000 dance-hours was seen in the selected cohort studies. Of 462 professional dancers, 128 hip/groin injuries were recorded, for an injury rate of 27.7%. Of the 1539 student dancers, 217 hip/groin injuries were recorded, for an injury rate of 14.1% ( P < 0.01). Conclusion: Data on hip and groin injuries have many limitations. However, these injuries represent an important health issue for dancers of all skill levels, encompassing 17.2% of musculoskeletal injuries seen in dancers. An increasing rate of hip/groin injuries is seen in professional dancers compared with students.

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Key components of intravenous chemotherapy labeling: A systematic review and practice guideline

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155210385160 ◽

2010 ◽

Vol 17 (4) ◽

pp. 409-424 ◽

Cited By ~ 8

Author(s):

Maureen Trudeau ◽

Esther Green ◽

Roxanne Cosby ◽

Flay Charbonneau ◽

Tony Easty ◽

...

Keyword(s):

Systematic Reviews ◽

English Language ◽

Data Extraction ◽

Sources Of Information ◽

Inclusion Criteria ◽

Intravenous Chemotherapy ◽

Safe Delivery ◽

Environmental Scan ◽

Relevant Evidence ◽

Study Characteristics

Objective. To determine the necessary components and formatting of an intravenous chemotherapy label to maximize safe delivery and minimize errors. Date sources. The MEDLINE and EMBASE databases (up to April 2009) were searched for relevant evidence. Reference lists from retained studies were then searched for additional trials. An environmental scan was also conducted to locate other published and unpublished sources of information. Study selection. Relevant articles were selected and reviewed by one methodologist. Articles were selected for inclusion if they were published English language reports of Phases II or III randomized controlled trials, other comparative studies, single-arm studies, practice guidelines, or systematic reviews with or without meta-analyses, which related to the study question. MEDLINE and EMBASE searches yielded 685 potential studies of which 17 met the inclusion criteria. The environmental scan located one guideline. Three additional relevant studies were identified during the external review process. In total, 21 documents met the inclusion criteria. Data extraction. Data were extracted by one methodologist. Quality of systematic reviews was assessed using the AMSTAR tool. All other studies were evaluated based on study characteristics applicable to the particular study design. Data synthesis. The evidence collected and the consensus of expert opinion of Cancer Care Ontario’s Chemotherapy Labeling Panel form the basis of a series of recommendations for the generation of intravenous chemotherapy labels including formatting, required information, and order of information. These guidelines inform the efficient, effective, and safe administration of intravenous chemotherapy. Illustrative examples are provided.

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