Bone–Patellar Tendon–Bone Autografts Versus Hamstring Autografts Using the Same Suspensory Fixations in ACL Reconstruction: A Systematic Review and Meta-analysis

Background: Bone–patellar tendon–bone (BPB) autografts and hamstring tendon (HT) autografts are 2 popular choices for anterior cruciate ligament reconstruction (ACLR). Although existing meta-analyses have explored the clinical outcomes between BPB and HT autografts, none have based their analysis on studies with just femoral suspensory fixation methods. Purpose: To evaluate and compare clinical outcomes, particularly graft failure and knee stability, of ACLR with BPB or HT autografts with suspensory femoral fixation. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was conducted of studies reporting single-bundle ACLR with BPB autografts and HT autografts with suspensory fixation with a minimum 24-month follow-up. Graft failure rate, knee stability, and clinical outcomes were compared for BPB versus HT autografts. Knee stability was measured with the Lachman test, pivot-shift test, and KT-1000/2000 arthrometer side-to-side difference (SSD). Clinical outcomes were measured with Lysholm scores and the Tegner activity scale, as well as rate of return to preinjury sports. Donor site morbidity among included studies was reviewed. A random-effects model was used for calculations of summary estimates. Subgroup, sensitivity, and trial sequential analyses were conducted. Results: Five studies were included. Graft failure was seen more often in the HT group than the BPB group, and this was statistically significant ( P = .03). However, the trial sequential analysis outcome indicated that the included sample size was not large enough to support a solid positive finding. The analysis showed no significant difference in SSD, Lachman test, pivot-shift test, rate of return to sports, Lysholm score, or Tegner score between groups. Subgroup analyses found no significant difference between groups. Conclusion: This meta-analysis demonstrated no significant differences in knee stability and knee functional outcomes between BPB and HT autografts with suspensory fixation. More evidence is needed to prove the lower risk of failure with use of BTB autograft with suspensory fixation.

Download Full-text

Outcome Differences of Remnant- Preserving versus Non-Preserving Methods in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-analysis with Subgroup analysis

Knee Surgery and Related Research ◽

10.1186/s43019-019-0017-z ◽

2020 ◽

Vol 32 (1) ◽

Cited By ~ 2

Author(s):

Sung Hun Won ◽

Byung-Il Lee ◽

Su Yeon Park ◽

Kyung-Dae Min ◽

Jun-Bum Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Acl Reconstruction ◽

Subgroup Analysis ◽

Observational Studies ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Lachman Test ◽

Significant Difference ◽

Anterior Cruciate

Abstract Purpose To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. Methods International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A meta-analysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. Results Five RCTs and six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. Conclusions This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. Results of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.

Download Full-text

Outcomes of single bundle arthroscopic anterior cruciate ligament reconstruction in a limited resource setting

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2020-000500 ◽

2020 ◽

pp. jisakos-2020-000500

Author(s):

Binod Sherchan ◽

Saroj Rai ◽

Nira Tamang ◽

Siddhartha Dhungana ◽

Laxmi Kanta Sharma ◽

...

Keyword(s):

Graft Failure ◽

Ligament Reconstruction ◽

Pivot Shift ◽

Cruciate Ligament ◽

Pivot Shift Test ◽

Cruciate Ligament Reconstruction ◽

Lachman Test ◽

Urban Group ◽

Anterior Cruciate ◽

Rural Group

ObjectivesDespite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in low-income and middle-income countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) in the urban group and that of the rural group.MethodsWe evaluated a total of 194 patients, including 98 patients in the urban group and 96 patients in the rural group, undergoing arthroscopic ACLR between August 2015 and February 2018, and had completed a minimum of 2-year follow-up. Subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Laxity assessments were performed using the Lachman test and the Pivot-shift test. Functional evaluation included the range of motion, single-leg hop test and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis.ResultsThere was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of laxity and functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely abnormal in all parameters of functional outcomes was higher in the older female in the rural group. Graft failure occurred in 19 (17.6%) knees in the urban group and 17 (16.8%) knees in the rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections.ConclusionWe advised similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the urban group than the rural group. The rate of deep infection was higher in the rural group as compared with the urban group.Level of evidenceLevel III, retrospective comparative study.

Download Full-text

Healing Status of Meniscal Ramp Lesion Affects Anterior Knee Stability After ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120917674 ◽

2020 ◽

Vol 8 (5) ◽

pp. 232596712091767 ◽

Cited By ~ 2

Author(s):

Kazuhisa Hatayama ◽

Masanori Terauchi ◽

Kenichi Saito ◽

Ryota Takase ◽

Hiroshi Higuchi

Keyword(s):

Acl Reconstruction ◽

Pivot Shift ◽

Pivot Shift Test ◽

Knee Stability ◽

Ramp Lesion ◽

Significant Difference ◽

Mri Scans ◽

The Mean ◽

Postoperative Knee

Background: Although the biomechanical importance of the ramp lesion in the anterior cruciate ligament (ACL)–deficient knee has been demonstrated, there is no clear consensus on the appropriate treatment for ramp lesions during ACL reconstruction. Purpose: To compare the postoperative outcomes for ramp lesions between patients treated with all-inside repair through the posteromedial portal and those whose ramp lesions were left in situ without repair during ACL reconstruction. We also determined whether ramp lesion healing status affected postoperative knee stability. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 57 patients who underwent anatomic double-bundle ACL reconstruction between August 2011 and December 2017 had attendant ramp lesions. Of these, 25 ramp lesions that were considered stable were left in situ without repair (Nonrepaired group), and 25 ramp lesions, including 21 stable and 4 unstable lesions, were treated using all-inside repair through the posteromedial portal (Repaired group). We evaluated the side-to-side difference (SSD) in anterior tibial translation on stress radiographs and rotational stability by using the pivot-shift test 2 years after surgery, and healing status of the ramp lesions was evaluated on 3.0-T magnetic resonance imaging (MRI) scans 1 year after surgery. Results: The mean SSDs in anterior translation were 2.4 ± 1.6 mm for the Nonrepaired group and 1.9 ± 1.6 mm for the Repaired group, with no significant differences. The positive ratios on the pivot-shift test were not significantly different between groups. Healing rates of ramp lesions on MRI scans showed a significant difference between the Nonrepaired group (60%) and the Repaired group (100%) ( P = .001). The mean SSDs for knees in which the ramp lesion had healed as shown on MRI scans and those in which it had not healed were 1.9 ± 1.6 mm and 3.2 ± 1.1 mm, respectively, which was a significant difference ( P = .02). Conclusion: Healing rates of ramp lesions were significantly better in the Repaired group than in the Nonrepaired group, although postoperative knee stability was not significantly different between groups. Anterior laxity in the knees in which the ramp lesion was unhealed was significantly greater compared with the knees in which the ramp lesion healed. All-inside repair through the posteromedial portal was a reliable surgical procedure to heal ramp lesions.

Download Full-text

Suspensory Versus Aperture Fixation of a Quadrupled Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/0363546516680995 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2418-2427 ◽

Cited By ~ 24

Author(s):

William M. Browning ◽

Melissa A. Kluczynski ◽

Christian Curatolo ◽

John M. Marzo

Keyword(s):

Acl Reconstruction ◽

Pivot Shift ◽

Cruciate Ligament ◽

Meta Analysis ◽

Hamstring Tendon ◽

Significant Difference ◽

Fixation Techniques ◽

Suspensory Fixation ◽

Aperture Fixation ◽

Anterior Cruciate

Background: Hamstring grafts have become a popular choice for anterior cruciate ligament (ACL) reconstruction; however, the most effective means of fixation of these soft tissue grafts is unknown. Purpose: To determine whether suspensory or aperture fixation of hamstring tendon autografts provides better stability and clinical outcomes in ACL reconstruction. Study Design: Meta-analysis. Methods: A literature search of studies reporting single-bundle ACL reconstructions using 4-stranded hamstring tendon autografts with aperture or suspensory fixation with a minimum 24-month follow-up was conducted. Stability and clinical outcomes were compared for aperture versus suspensory fixation. Knee stability was measured with the Lachman or pivot-shift test or KT-1000 arthrometer side-to-side difference (SSD), and outcomes were determined with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores as well as graft failures. A random-effects model with a pooled estimate for the between-study variance was used to estimate proportions or means for each outcome and its corresponding 95% CI. Results: Forty-one studies were included, of which 20 utilized suspensory fixation techniques and 21 utilized aperture fixation techniques. A >3-mm SSD was seen more often in the aperture group than the suspensory group, which was statistically significant ( P < .0001), but there was no significant difference between groups for a >5-mm SSD ( P = .53). The aperture group demonstrated significantly more graft ruptures than did the suspensory group ( P = .03). There were no statistically significant differences in Lachman grade 0 ( P = .76), grade 1 ( P = .89), and grade 2 ( P = .55) or pivot-shift grade 0 ( P = .72), grade 1 ( P = .97), and grade 2 ( P = .28). There was no statistically significant difference in mean continuous IKDC ( P = .80), Tegner ( P = .34), or Lysholm ( P = .84) scores. Conclusion: This meta-analysis demonstrated improved overall arthrometric stability and fewer graft ruptures using suspensory fixation compared with aperture fixation of a quadrupled hamstring tendon autograft in ACL reconstruction. There were no differences in IKDC, Lysholm, Lachman, and pivot-shift outcomes between suspensory and aperture fixation.

Download Full-text

Comparison of Clinical Outcomes between Anteromedial and Transtibial Techniques of Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Journal of Sports Science and Medicine ◽

10.52082/jssm.2021.237 ◽

2021 ◽

pp. 237-249

Author(s):

Ran Li ◽

Tao Li ◽

Qiuping Zhang ◽

Weili Fu ◽

Jian Li

Keyword(s):

Clinical Outcomes ◽

Pivot Shift ◽

Cruciate Ligament ◽

Pivot Shift Test ◽

Controlled Trials ◽

Single Bundle ◽

Lachman Test ◽

Randomized Controlled ◽

Anterior Cruciate ◽

Tegner Activity Scale

This study compared clinical outcomes obtained after single-bundle anterior cruciate ligament (ACL) reconstruction using the anteromedial (AM) and transtibial (TT) techniques, which comprise the conventional transtibial (cTT) and modified transtibial (mTT) techniques. This study included clinical randomized controlled trials and prospective and retrospective controlled trials with AM and TT techniques from the PubMed and Embase databases and the Cochrane Library. All databases were searched from January 2010 to July 2020. Two independent evaluators verified the quality of the included studies using the Cochrane Collaboration’s risk of bias tool and the Newcastle-Ottawa Scale (NOS). Outcome measures analysed included the Lachman test, pivot-shift test, side-to-side difference (SSD), Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) grade and score. Ten randomized controlled trials (RCTs) and 16 prospective and retrospective controlled trials were included with a total of 2202 patients. There were 1180 patients and 1022 patients in the AM and TT groups, respectively. Compared to the cTT group, superior postoperative results were observed in the AM group based on the negative rate of the Lachman test and the pivot-shift test, IKDC grade and score, Lysholm score, Tegner activity scale and SSD (p < 0.05). However, there was no significant difference between the AM and mTT groups (p > 0.05). Compared to the conventional TT technique, the AM technique exhibited superior clinical outcomes. Nevertheless, the modified TT and AM techniques had comparable results. With neither of the techniques (mTT or AM) producing significantly superior outcomes, surgeons can choose either of them depending on their preferences.

Download Full-text

Outcomes of Single Bundle Arthroscopic Anterior Cruciate Ligament Reconstruction in a Limited Resource Setting.

10.21203/rs.3.rs-37653/v1 ◽

2020 ◽

Author(s):

Binod Sherchan ◽

Saroj Rai ◽

Siddhartha Dhungana ◽

Nira Tamang ◽

Laxmi Kanta Sharma ◽

...

Keyword(s):

Graft Failure ◽

Pivot Shift ◽

Pivot Shift Test ◽

Single Bundle ◽

Functional Evaluation ◽

Rehabilitation Protocol ◽

Lachman Test ◽

Urban Group ◽

Resource Setting ◽

Rural Group

Abstract Purpose: Despite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in developing countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic ACLR in the Urban group and that of the Rural group. Methods: We evaluated a total of 194 patients, including 98 patients in the Urban group and 96 patients in the Rural group, undergoing arthroscopic ACLR between August 2015 and February 2018. The subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) form. The laxity assessments were performed using the Lachman test and the Pivot-shift test. The functional evaluation included the ROM, single-leg hop test, and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis. Results: There was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of Laxity and Functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely-abnormal in all parameters of functional outcomes was higher in the older female in the Rural group. Graft failure occurred in 19(17.6%) knees in the Urban group and 17(16.8%) knees in the Rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the Rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections. Conclusion: We advised the similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the Urban group than the Rural group. The rate of deep infection was higher in the Rural group as compared to the Urban group.

Download Full-text

A modified anterior drawer test for anterior cruciate ligament ruptures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02381-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Guang-lei Zhao ◽

Jin-yang Lyu ◽

Chang-quan Liu ◽

Jian-guo Wu ◽

Jun Xia ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Pivot Shift ◽

Cruciate Ligament ◽

Characteristic Curve ◽

Pivot Shift Test ◽

Anterior Drawer ◽

Lachman Test ◽

Anterior Drawer Test ◽

Significant Difference ◽

Anterior Cruciate

Abstract Objective This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests. Methods Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard. Results The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ2 = 1.682, p = 0.195). Conclusions The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings. Levels of evidence Level II/observational diagnostic studies Trial registration Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered

Download Full-text

Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Outcomes for Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring-Tendon Autografts

The American Journal of Sports Medicine ◽

10.1177/0363546518825340 ◽

2019 ◽

Vol 47 (14) ◽

pp. 3531-3540 ◽

Cited By ~ 28

Author(s):

Dany Mouarbes ◽

Jacques Menetrey ◽

Vincent Marot ◽

Louis Courtot ◽

Emilie Berard ◽

...

Keyword(s):

Acl Reconstruction ◽

Graft Failure ◽

Pivot Shift ◽

Cruciate Ligament ◽

Donor Site ◽

Lysholm Score ◽

Pivot Shift Test ◽

Lachman Test ◽

Donor Site Pain ◽

Site Pain

Background: Comprehensive studies evaluating quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction are lacking. The optimal choice of graft between bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and QT is still debatable. Hypothesis: The current literature supports the use of QT as a strong autograft with good outcomes when used in ACL reconstruction. Study Design: Meta-analysis; Level of evidence, 2. Methods: A systematic search of the literature was performed in PubMed, MEDLINE, Cochrane, and Ovid databases to identify published articles on clinical studies relevant to ACL reconstruction with QT autograft and studies comparing QT autograft versus BPTB and HT autografts. The results of the eligible studies were analyzed in terms of instrumented laxity measurements, Lachman test, pivot-shift test, Lysholm score, objective and subjective International Knee Documentation committee (IKDC) scores, donor-site pain, and graft failure. Results: Twenty-seven clinical studies including 2856 patients with ACL reconstruction met the inclusion criteria. Comparison of 581 QT versus 514 BPTB autografts showed no significant differences in terms of instrumented mean side-to-side difference ( P = .45), Lachman test ( P = .76), pivot-shift test grade 0 ( P = .23), pivot-shift test grade 0 or 1 ( P = .85), mean Lysholm score ( P = .1), mean subjective IKDC score ( P = .36), or graft failure ( P = .50). However, outcomes in favor of QT were found in terms of less donor-site pain (risk ratio for QT vs BPTB groups, 0.25; 95% CI, 0.18-0.36; P < .00001). Comparison of 181 QT versus 176 HT autografts showed no significant differences in terms of instrumented mean side-to-side difference ( P = .75), Lachman test ( P = .41), pivot-shift test grade 0 ( P = .53), Lysholm score less than 84 ( P = .53), mean subjective IKDC score ( P = .13), donor-site pain ( P = .40), or graft failure ( P = .46). However, outcomes in favor of QT were found in terms of mean Lysholm score (mean difference between QT and HT groups, 3.81; 95% CI, 0.45-7.17; P = .03). Conclusion: QT autograft had comparable clinical and functional outcomes and graft survival rate compared with BPTB and HT autografts. However, QT autograft showed significantly less harvest site pain compared with BPTB autograft and better functional outcome scores compared with HT autograft.

Download Full-text

A meta-analysis indicating extra-short implants (≤ 6 mm) as an alternative to longer implants (≥ 8 mm) with bone augmentation

Scientific Reports ◽

10.1038/s41598-021-87507-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoran Yu ◽

Ruogu Xu ◽

Zhengchuan Zhang ◽

Yang Yang ◽

Feilong Deng

Keyword(s):

Survival Rate ◽

Clinical Outcomes ◽

Meta Analysis ◽

Risk Of Bias ◽

Bone Augmentation ◽

Moderate Quality ◽

Short Implants ◽

Significant Difference ◽

Complications Rate

AbstractExtra-short implants, of which clinical outcomes remain controversial, are becoming a potential option rather than long implants with bone augmentation in atrophic partially or totally edentulous jaws. The aim of this study was to compare the clinical outcomes and complications between extra-short implants (≤ 6 mm) and longer implants (≥ 8 mm), with and without bone augmentation procedures. Electronic (via PubMed, Web of Science, EMBASE, Cochrane Library) and manual searches were performed for articles published prior to November 2020. Only randomized controlled trials (RCTs) comparing extra-short implants and longer implants in the same study reporting survival rate with an observation period at least 1 year were selected. Data extraction and methodological quality (AMSTAR-2) was assessed by 2 authors independently. A quantitative meta-analysis was performed to compare the survival rate, marginal bone loss (MBL), biological and prosthesis complication rate. Risk of bias was assessed with the Cochrane risk of bias tool 2 and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. 21 RCTs were included, among which two were prior registered and 14 adhered to the CONSORT statement. No significant difference was found in the survival rate between extra-short and longer implant at 1- and 3-years follow-up (RR: 1.002, CI 0.981 to 1.024, P = 0.856 at 1 year; RR: 0.996, CI 0.968 to 1.025, P = 0.772 at 3 years, moderate quality), while longer implants had significantly higher survival rate than extra-short implants (RR: 0.970, CI 0.944 to 0.997, P < 0.05) at 5 years. Interestingly, no significant difference was observed when bone augmentations were performed at 5 years (RR: 0.977, CI 0.945 to 1.010, P = 0.171 for reconstructed bone; RR: 0.955, CI 0.912 to 0.999, P < 0.05 for native bone). Both the MBL (from implant placement) (WMD: − 0.22, CI − 0.277 to − 0.164, P < 0.01, low quality) and biological complications rate (RR: 0.321, CI 0.243 to 0.422, P < 0.01, moderate quality) preferred extra-short implants. However, there was no significant difference in terms of MBL (from prosthesis restoration) (WMD: 0.016, CI − 0.036 to 0.068, P = 0.555, moderate quality) or prosthesis complications rate (RR: 1.308, CI 0.893 to 1.915, P = 0.168, moderate quality). The placement of extra-short implants could be an acceptable alternative to longer implants in atrophic posterior arch. Further high-quality RCTs with a long follow-up period are required to corroborate the present outcomes.Registration number The review protocol was registered with PROSPERO (CRD42020155342).

Download Full-text

EXPRESS: Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion, a systematic review and meta-analysis

International Journal of Stroke ◽

10.1177/17474930211012545 ◽

2021 ◽

pp. 174749302110125

Author(s):

Mingming Zha ◽

Qingwen Yang ◽

Shuo Liu ◽

Min Wu ◽

Kangmo Huang ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Meta Analysis ◽

Working Hours ◽

Good Prognosis ◽

Large Vessel ◽

Cochrane Library ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Significant Difference

Background There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO). Aims This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours. Summary of review Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through February 23rd, 2021. The primary outcomes were onset to door, door to imaging, door to puncture, puncture to recanalization, procedural time, successful recanalization, symptomatic intracerebral hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale [mRS] score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture, onset to puncture, onset to recanalization, door to recanalization time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer onset to door (WMD [95%CI], 12.83 [1.84-23.82] min), door to puncture (WMD [95%CI], 11.45 [5.93-16.97] min), imaging to puncture (WMD [95%CI], 10.39 [4.61-16.17] min), onset to puncture (WMD [95%CI], 25.30 [13.11-37.50] min), onset to recanalization (WMD [95%CI], 25.16 [10.28-40.04] min), and door to recanalization (WMD [95%CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95%CI], 0.85 [0.76-0.95]; P=0.004; I2=0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend towards lower OR of good prognosis was witnessed in the off-hour group (OR [95%CI], 0.92 [0.84-1.01]; P=0.084; I2=0%). Conclusions Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend towards worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.

Download Full-text