scholarly journals Articular Cartilage Repair of the Pediatric and Adolescent Knee with Regard to Minimal Clinically Important Difference: A Systematic Review

Cartilage ◽  
2018 ◽  
Vol 11 (1) ◽  
pp. 9-18 ◽  
Author(s):  
Rosa S. Valtanen ◽  
Armin Arshi ◽  
Benjamin V. Kelley ◽  
Peter D. Fabricant ◽  
Kristofer J. Jones
Keyword(s):  
Systematic Review ◽  
Articular Cartilage ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Minimal Clinically Important Difference ◽  
Cochrane Library ◽  
Clinically Important Difference ◽  
Outcome Score ◽  
The Mean

Objective To perform a systematic review of clinical outcomes following microfracture (MFX), autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and osteochondral autograft transplantation system (OATS) to treat articular cartilage lesions in pediatric and adolescent patients. We sought to compare postoperative improvements for each cartilage repair method to minimal clinically important difference (MCID) thresholds. Design MEDLINE, Web of Science, Scopus, and Cochrane Library databases were searched for studies reporting MCID-validated outcome scores in a minimum of 5 patients ≤19 years treated for symptomatic knee chondral lesions with minimum 1-year follow-up. One-sample t tests were used to compare mean outcome score improvements to established MCID thresholds. Results Twelve studies reporting clinical outcomes on a total of 330 patients following cartilage repair were identified. The mean age of patients ranged from 13.7 to 16.7 years and the mean follow-up was 2.2 to 9.6 years. Six studies reported on ACI, 4 studies reported on MFX, 2 studies reported on OATS, and 1 study reported on OCA. ACI ( P < 0.001, P = 0.008) and OCA ( P < 0.001) showed significant improvement for International Knee Documentation Committee (IKDC) scores with regard to MCID while MFX ( P = 0.66) and OATS ( P = 0.11) did not. ACI ( P < 0.001) and OATS ( P = 0.010) both showed significant improvement above MCID thresholds for Lysholm scores. MFX ( P = 0.002) showed visual analog scale (VAS) pain score improvement above MCID threshold while ACI ( P = 0.037, P = 0.070) was equivocal. Conclusions Outcomes data on cartilage repair in the pediatric and adolescent knee are limited. This review demonstrates that all available procedures provide postoperative improvement above published MCID thresholds for at least one reported clinical pain or functional outcome score.

scholarly journals Derotational Femoral Osteotomy for Treating Recurrent Patellar Dislocation in the Presence of Increased Femoral Anteversion: A Systematic Review

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110571
Author(s):  
ZhiJun Zhang ◽  
Yanwei Cao ◽  
Guanyang Song ◽  
Yue Li ◽  
Tong Zheng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Patellar Dislocation ◽  
Femoral Anteversion ◽  
Femoral Osteotomy ◽  
Cochrane Library ◽  
Recurrent Patellar Dislocation ◽  
Patient Reported ◽  
The Mean

Background: Studies on the clinical outcomes of derotational femoral osteotomy to treat recurrent patellar dislocation in the presence of increased femoral anteversion are limited. Purpose: To investigate the role of derotational femoral osteotomy in the treatment of recurrent patellar dislocation in the presence of increased femoral anteversion. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) by searching the Medline, Embase, Web of Science, and Cochrane Library databases through February 10, 2021. Included were studies of skeletally mature patients presenting with recurrent patellar dislocation and exhibiting increased femoral anteversion who subsequently underwent derotational femoral osteotomy. Methodological quality was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. The basic characteristics of each study were recorded and analyzed: characteristic information, radiological parameters, surgical techniques, patient-reported outcomes, and complications. Results: A total of 6 studies with 163 patients (170 knees) were included. Sample sizes ranged from 7 to 66 patients, and the patients were predominantly women (range, 79%-100%). The mean age and follow-up ranges were 18 to 28 years and 16 to 44 months, respectively. The mean femoral anteversion decreased significantly from 34° preoperatively to 12° postoperatively. In studies reporting pre- and postoperative outcomes, significant improvements were found in the Lysholm score (from 24.8 to 44.1), Kujala score (from 15.8 to 41.9), International Knee Documentation Committee score (from 11.0 to 28.0), and visual analog scale for pain (from 2.0 to 3.7). All studies reported postoperative complications, giving an overall reported complication rate of 4.7%, but no redislocations occurred during the follow-up period. Conclusion: For recurrent patellar dislocation in the presence of increased femoral anteversion, combination treatment with derotational femoral osteotomy led to favorable clinical outcomes with a low redislocation rate. However, there was no consensus among researchers on the indications for derotational femoral osteotomy in the treatment of recurrent patellar dislocation.

scholarly journals Sesamoidectomy for the Hallux Sesamoid Disorders

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0044
Author(s):  
Yoshiharu Shimozono ◽  
Eoghan Hurley ◽  
John Kennedy
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Complication Rate ◽  
Current Evidence ◽  
Cochrane Library ◽  
Short Term ◽  
Current Systematic Review ◽  
Previous Level ◽  
The Mean

Category: Midfoot/Forefoot Introduction/Purpose: Studies have shown that sesamoidectomy provides good clinical outcomes and quick return to sporting activities, however, there is concern regarding the complications following resection of one or both sesamoid bones. The purpose of the current systematic review was to evaluate the current evidence on sesamoidectomy for the treatment of the hallux sesamoid disorders. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases was performed based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Results: Ten studies with total 196 feet were included. The weighted mean age was 36.6 ± 11.0 with a mean follow-up of 45.1 ± 19.3 months. The mean Visual Analogue Scale score improved from a mean score of 6.5 ± 0.3 to 1.2 ± 0.5. The mean postoperative AOFAS score was 92.7 ± 2.7. Six studies demonstrated that 94.4% of patients returned to sport, with 90.0% returning to previous level, at a mean of 11.8 ± 1.8 weeks. The mean hallux valgus angle increased from 13.1 ± 2.1 preoperatively to 14.8 ± 3.7 postoperatively (p=0.470), and the mean intermetatarsal angle increased from 8.7 ± 0.8 to 9.7 ± 0.8 (p=0.180) following medial sesamoidectomy. The overall complication rate was 22.5%, and further surgeries were required in 3.0%(Table). Conclusion: The current systematic review demonstrated that sesamoidectomy for the hallux sesamoids disorders yields good clinical outcomes and a high rate of return to sports activity in the short-term. It is important to note however the high complications rate after sesamoidectomy, with a 22.5% complication rate in the short-term follow-up.

scholarly journals Natural history and treatment options of radiation-induced brain cavernomas: a systematic review

2021 ◽  
Author(s):  
Gildas Patet ◽  
Andrea Bartoli ◽  
Torstein R. Meling
Keyword(s):  
Systematic Review ◽  
Natural History ◽  
Radiation Treatment ◽  
Neurological Deficits ◽  
Cochrane Library ◽  
Average Dose ◽  
Cavernous Malformations ◽  
Radiation Induced ◽  
The Mean

AbstractRadiation-induced cavernous malformations (RICMs) are delayed complications of brain irradiation during childhood. Its natural history is largely unknown and its incidence may be underestimated as RCIMS tend to develop several years following radiation. No clear consensus exists regarding the long-term follow-up or treatment. A systematic review of Embase, Cochrane Library, PubMed, Google Scholar, and Web of Science databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Based on our inclusion/exclusion criteria, 12 articles were included, totaling 113 children with RICMs, 86 were treated conservatively, and 27 with microsurgery. We were unable to precisely define the incidence and natural history from this data. The mean age at radiation treatment was 7.3 years, with a slight male predominance (54%) and an average dose of 50.0 Gy. The mean time to detection of RICM was 9.2 years after radiation. RICM often developed at distance from the primary lesion, more specifically frontal (35%) and temporal lobe (34%). On average, 2.6 RICMs were discovered per child. Sixty-seven percent were asymptomatic. Twenty-one percent presented signs of hemorrhage. Clinical outcome was favorable in all children except in 2. Follow-up data were lacking in most of the studies. RICM is most often asymptomatic but probably an underestimated complication of cerebral irradiation in the pediatric population. Based on the radiological development of RICMs, many authors suggest a follow-up of at least 15 years. Studies suggest observation for asymptomatic lesions, while surgery is reserved for symptomatic growth, hemorrhage, or focal neurological deficits.

scholarly journals Outcomes of Arthroscopic Capsular Release in the Beach-Chair Versus Lateral Decubitus Position: A Systematic Review

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988817 ◽  
Author(s):  
Darby A. Houck ◽  
John W. Belk ◽  
Armando F. Vidal ◽  
Eric C. McCarty ◽  
Jonathan T. Bravman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Cochrane Library ◽  
Recurrence Rates ◽  
Capsular Release ◽  
Arthroscopic Capsular Release ◽  
Patient Reported ◽  
Lateral Decubitus ◽  
Beach Chair

Background: Arthroscopic capsular release (ACR) for the treatment of adhesive capsulitis of the shoulder can be performed in either the beach-chair (BC) or lateral decubitus (LD) position. Purpose: To determine the clinical outcomes and recurrence rates after ACR in the BC versus LD position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed by searching PubMed, Embase, and the Cochrane Library databases for studies reporting clinical outcomes of patients undergoing ACR in either the BC or LD position. All English-language literature from 1990 through 2017 reporting on clinical outcomes after ACR with a minimum 3-month follow-up were reviewed by 2 independent reviewers. Recurrence rates, range of motion (ROM) results, and patient-reported outcome (PRO) scores were collected. Study methodological quality was evaluated using the modified Coleman Methodology Score (MCMS). Results: A total of 30 studies (3 level 1 evidence, 2 level 2 evidence, 4 level 3 evidence, 21 level 4 evidence) including 665 shoulders undergoing ACR in the BC position (38.1% male; mean age, 52.0 ± 3.9 years; mean follow-up, 35.4 ± 18.4 months) and 603 shoulders in the LD position (41.8% male; mean age, 53.0 ± 2.3 years; mean follow-up, 37.2 ± 16.8 months) were included. There were no significant differences in overall mean recurrence rates between groups (BC, 2.5%; LD, 2.4%; P = .81) or in any PRO scores between groups ( P > .05). There were no significant differences in improvement in ROM between groups, including external rotation at the side (BC, 36.4°; LD, 42.8°; P = .91), forward flexion (BC, 64.4°; LD, 79.3°; P = .73), abduction (BC, 77.8°; LD, 81.5°; P = .82), or internal rotation in 90° of abduction (BC, 40.8°; LD, 45.5°; P = .70). Significantly more patients in the BC group (91.6%) underwent concomitant manipulation than in the LD group (63%) ( P < .0001). There were significantly more patients with diabetes in the LD group (22.4%) versus the BC group (9.6%) ( P < .0001). Conclusion: Low rates of recurrent shoulder stiffness and excellent improvements in ROM can be achieved after ACR in either the LD or BC position. Concomitant manipulation under anesthesia is performed more frequently in the BC position compared with the LD position.

Second-look arthroscopic cartilage status is related to intermediate-term outcomes after medial opening-wedge high tibial osteotomy

2021 ◽  
Vol 103-B (11) ◽  
pp. 1686-1694
Author(s):  
Hong-Yeol Yang ◽  
Woo-Kyoung Kwak ◽  
Sung Ju Kang ◽  
Eun-Kyoo Song ◽  
Jong-Keun Seon
Keyword(s):  
Clinical Outcomes ◽  
High Tibial Osteotomy ◽  
Cartilage Repair ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Status Group ◽  
Second Look ◽  
Wedge High Tibial Osteotomy ◽  
The Mean

Aims To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. Methods We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey. Results Significant improvements in all clinical outcome categories were found between the preoperative and second-look arthroscopic assessments in both groups (p < 0.001). At the latest follow-up, the mean IKDC and WOMAC scores in the good status group further improved compared with those at the time of second-look arthroscopic surgery (p < 0.001), which was not shown in the poor status group. The mean IKDC (good status, 72.8 (SD 12.5); poor status, 64.7 (SD 12.1); p = 0.002) and mean WOMAC scores (good status, 15.7 (SD 10.8); poor status, 21.8 (SD 13.6); p = 0.004) significantly differed between both groups at the latest follow-up. Moreover, significant correlations were observed between ICRS CRA grades and IKDC scores (negative correlation; p < 0.001) and WOMAC scores (positive correlation; p < 0.001) at the latest follow-up. Good cartilage status was found more frequently in knees with the desired range of 2° to 6° valgus correction than in those with corrections outside this range (p = 0.019). Conclusion Second-look arthroscopic cartilage status correlated with clinical outcomes after MOHTO at intermediate-term follow-up, despite the relatively small clinical differences between groups. Cite this article: Bone Joint J 2021;103-B(11):1686–1694.

scholarly journals Acute Versus Delayed Surgical Intervention in Multiligament Knee Injuries: A Systematic Review

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110278
Author(s):  
Ryan S. Marder ◽  
Husain Poonawala ◽  
Jorge I. Pincay ◽  
Frank Nguyen ◽  
Patrick F. Cleary ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Intervention Group ◽  
Knee Injuries ◽  
Cochrane Library ◽  
The Mean ◽  
Multiligament Knee Injuries ◽  
Level 2

Background: The optimal timing of surgical intervention for multiligament knee injuries remains controversial. Purpose: To review the clinical and functional outcomes after acute and delayed surgical intervention for multiligament knee injuries. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to September 2020. Eligible studies reported on knee dislocations, multiligament knee injuries, or bicruciate ligament injuries in adult patients (age, ≥18 years). In addition to comparing outcomes between acute and delayed surgical intervention groups, we conducted 3 subgroup analyses for outcomes within isolated knee injuries, knee injuries with concomitant polytrauma/fractures, and high-level (level 2) studies. Results: Included in the analysis were 31 studies, designated as evidence level 2 (n = 3), level 3 (n = 8), and level 4 (n = 20). These studies reported on 2594 multiligament knee injuries sustained by 2585 patients (mean age, 25.1-65.3 years; mean follow-up, 12-157.2 months). At the latest follow-up timepoint, the mean Lysholm (n = 375), International Knee Documentation Committee (IKDC) (n = 286), and Tegner (n = 129) scores for the acute surgical intervention group were 73.60, 67.61, and 5.06, respectively. For the delayed surgical intervention group, the mean Lysholm (n = 196), IKDC (n = 172), and Tegner (n = 74) scores were 85.23, 72.32, and 4.85, respectively. The mean Lysholm (n = 323), IKDC (n = 236), and Tegner (n = 143) scores for our isolated subgroup were 83.7, 74.8, and 5.0, respectively. By comparison, the mean Lysholm (n = 270), IKDC (n = 236), and Tegner (n = 206) scores for the polytrauma/fractures subgroup were 83.3, 64.5, and 5.0, respectively. Conclusion: The results of our systematic review did not elucidate whether acute or delayed surgical intervention produced superior clinical and functional outcomes. Although previous evidence has supported acute surgical intervention, future prospective randomized controlled trials and matched cohort studies must be completed to confirm these findings.

scholarly journals Mid-Term Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Yoshiharu Shimozono ◽  
James Toale ◽  
Conor Mulvin ◽  
Jari Dahmen ◽  
Gino MMJ Kerkhoffs ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Reoperation Rate ◽  
Osteochondral Lesions ◽  
Long Term Outcomes ◽  
Weighted Mean ◽  
Bone Marrow Stimulation ◽  
The Mean

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) is the most common reparative surgical intervention in the treatment of small osteochondral lesions of the talus (OLT). BMS has shown favorable short term clinical outcomes but several recent studies have shown less satisfactory results in the mid- to long-term due to fibrocartilagenous repair tissue deterioration over time following BMS. However, conflicting results with good mid- to long-term outcomes following BMS have been reported. There is still a lack of evidence on the success rates of BMS at mid-term and longer-term follow-up. The purpose of this systematic review was to evaluate the clinical evidence of mid- to long-term outcomes following BMS for the treatment of OLT. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of evidence was decifered using the Modified Coleman methodology score (MCMS). Studies reporting outcomes of BMS for primary ostechndral lesions at a minimum 4-year follow-up were included. Clinical outcomes, radiological outcomes, and reported data were evaluated. Results: Fifteen studies containing 853 patients (858 ankles) were included at a weighted-mean follow-up time of 71.9 (48-141) months. The mean age was 35.3 (24.7-41.9) and the mean lesion size was 110.5mm2 (87-140). Nine studies (60%) used the AOFAS ankle hindfoot score with a weighted-mean postoperative score of 89.9 (78.4-91.8). Six studies showed both pre and post-operative AOFAS scores and showed a weighted-mean improvement of 24.5 (16-38.5). Four studies utilised the VAS score. The weighted-mean postoperative VAS scores were 2.4 (1.8-2.6). Three studies (20%) measured post-opeartive MRI at mid-term using the MOCART score and showed 48% complete filling, 74% complete integration, 76% surface damage, and 78% inhomogeneous repair tissue. Complication rate was 3.2% and reoperation rate was 6% following BMS at mid-term. Conclusion: This systematic review found good clinical outcomes following BMS for primary OLT at mid-term follow-up based on the AOFAS score. The complication rates were relatively low and the data showed a reoperation rate of 6% at mid-term. However, the radiological and MRI outcomes did not show similarly positive results, which may lead to recurrence and reoperation at long-term. Data were variable and numerous aspects largely under-reported in the literature relevant to the systematic review. Further high quality studies, a validated outcome scoring system and further MRI reports are required to accurately assess the success of BMS at mid-term.

Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review

2016 ◽  
Vol 45 (7) ◽  
pp. 1698-1705 ◽  
Author(s):  
Laura Ramponi ◽  
Youichi Yasui ◽  
Christopher D. Murawski ◽  
Richard D. Ferkel ◽  
Christopher W. DiGiovanni ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Lesion Size ◽  
Osteochondral Lesions ◽  
Lesion Area ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
Mean Diameter ◽  
The Mean

Background: The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. Purpose: To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. Study Design: Systematic review. Methods: A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. Results: Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. Conclusion: An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.

Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review

2021 ◽  
pp. jisakos-2021-000614
Author(s):  
Martin S Davey ◽  
Eoghan T Hurley ◽  
Mohamed Gaafar ◽  
John G Galbraith ◽  
Hannan Mullett ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Patient Reported ◽  
The Mean

ImportanceTears of the ulnar collateral ligament (UCL) of the elbow occur predominantly as an overuse injury, most commonly affecting throwing athletes, particularly baseball players. UCL reconstruction (UCLR) has been described as an effective treatment modality in the short term.ObjectiveThe purpose of this study was to systematically review the evidence in the literature to ascertain the clinical outcomes, complication and revision rates in baseball players following UCLR of the elbow at a minimum of 48 months of follow-up.Evidence reviewTwo independent reviewers performed a search of the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the EMBASE, PubMed and Scopus databases. Clinical studies were included if they reported outcomes of baseball players at a minimum of 48 months following UCLR.FindingsOur review included 8 studies including 1104 baseball players (1105 elbows) at mean 69.9 months (48–205) following UCLR. The majority of baseball players were pitchers (92.3%), with a mean age of 22.2 years (13–42). At final follow-up, the overall return to play (RTP) was 95.3%%, with 85.3% returning at pre-injury level. In addition, the mean reported Conway-Jobe score was 86.8%, the revision rate was 6.0% with postoperative neuropathy reported in 2.4% of patients. A total of 479 (43.4%) were professional baseball players, with an overall RTP rate of 97.5% and 82.3% managing to RTP at their pre-injury level. The mean number of career years following UCLR was 4.7 years (0–22).Conclusion and relevanceUCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. In addition, high rates of RTP at pre-injury level and career longevity were reported by baseball players following UCLR.Level of evidenceLevel IV; Systematic Review

Clinical Outcomes and Failure Rates of Osteochondral Allograft Transplantation in the Knee: A Systematic Review

2017 ◽  
Vol 46 (14) ◽  
pp. 3541-3549 ◽  
Author(s):  
Filippo Familiari ◽  
Mark E. Cinque ◽  
Jorge Chahla ◽  
Jonathan A. Godin ◽  
Morten Lykke Olesen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Survival Rate ◽  
Clinical Outcomes ◽  
Survival Rates ◽  
Osteochondral Allograft ◽  
Failure Rates ◽  
Weighted Mean ◽  
Chondral Defects ◽  
The Mean

Background: Cartilage lesions are a significant cause of morbidity and impaired knee function; however, cartilage repair procedures have failed to reproduce native cartilage to date. Thus, osteochondral allograft (OCA) transplantation represents a 1-step procedure to repair large chondral defects without the donor site morbidity of osteochondral autograft transplantation. Purpose: To perform a systematic review of clinical outcomes and failure rates after OCA transplantation in the knee at a minimum mean 2 years’ follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature regarding the existing evidence for clinical outcomes and failure rates of OCA transplantation in the knee joint was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE from studies published between 1980 and 2017. Inclusion criteria were as follows: clinical outcomes and failure rates of OCAs for the treatment of chondral defects in the knee joint, English language, mean follow-up of 2 years and minimum follow-up of 18 months, minimum study size of 20 patients, and human studies. The methodological quality of each study was assessed using a modified version of the Coleman methodology score. Results: The systematic search identified 19 studies with a total of 1036 patients. The mean 5-year survival rate across the studies included in this review was 86.7% (range, 64.1%-100.0%), while the mean 10-year survival rate was 78.7% (range, 39.0%-93.0%). The mean survival rate was 72.8% at 15 years (range, 55.8%-84.0%) and 67.5% at 20 years (range, 66.0%-69.0%). The weighted mean patient age was 31.5 years (range, 10-82 years), and the weighted mean follow-up was 8.7 years (range, 2-32 years). The following outcome measures showed significant improvement from preoperatively to postoperatively: d’Aubigné-Postel, International Knee Documentation Committee, Knee Society function, and Lysholm scores. The weighted mean reoperation rate was 30.2% (range, 0%-63%). The weighted mean failure rate was 18.2% (range, 0%-31%). Of note, revision cases, patellar lesions, and bipolar lesions demonstrated worse survival rates. Conclusion: Improved patient-reported outcomes can be expected after OCA transplantation, with a survival rate of 78.7% at 10 years. Revision cases, patellar lesions, and bipolar lesions were associated with worse survival rates; therefore, utilization of the most appropriate index cartilage restoration procedure and proper patient selection are key to improving results.

Sign in / Sign up

Export Citation Format

Share Document