Do Patient Positioning and Portal Placement for Arthroscopic Subtalar Arthrodesis Matter?

Background: Arthroscopic subtalar arthrodesis was first described over 2 decades ago and originally performed in the lateral decubitus or supine position using anterolateral and posterolateral portals situated about the fibula. More recently, several authors have advocated for prone positioning utilizing posteromedial and posterolateral portals with an optional accessory lateral portal. To date, a comparison of these techniques has been limited. Purpose: To determine the effect of patient positioning and portal placement on complication rates after arthroscopic subtalar arthrodesis. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Patients were placed into 1 of 3 groups: the lateral group if they were positioned lateral or supine with lateral-based portals; the 2-portal prone group if they were positioned prone with posteromedial and posterolateral portals; or the 3-portal prone group if posteromedial, posterolateral, and accessory lateral portals were utilized in the prone position. Inverse variance–weighted fixed-effects models were used to evaluate pooled estimates. Results: A total of 20 studies examining 484 feet in 468 patients with a mean follow-up of 36.1 months were included for analysis. Overall, 8 studies examined patients in the prone position with 2 posterior portals (n = 111; 22.9%), 7 articles evaluated lateral portals (n = 182; 37.6%), and 5 studies examined patients in the prone position with 3 portals (n = 191; 39.5%). The total complication rate was similar ( P = .620) between the 2-portal prone (18.9%), 3-portal prone (17.8%), and lateral (17.6%) groups. There was no difference observed in the rate of complications secondary to portal placement ( P ≥ .334), rate of painful hardware ( P ≥ .497), and rate of repeat surgery ( P ≥ .304). The 2-portal prone group had a significantly higher rate of nonunion than the lateral group (8.1% vs 1.1%, respectively; P = .020) but not the 3-portal prone group (5.8%; P = .198). Conclusion: The current study demonstrated a higher rate of nonunion following arthroscopic subtalar arthrodesis with prone patient positioning using posteromedial and posterolateral portals without an accessory lateral portal.

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Does Patient Positioning and Portal Placement for Arthroscopic Subtalar Arthrodesis Matter?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00435 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0043

Author(s):

Alan Shamrock ◽

Natalie Glass ◽

Keith Shamrock ◽

Chris Cychosz ◽

Kyle Duchman

Keyword(s):

Prone Position ◽

Subtalar Joint ◽

Patient Positioning ◽

Comfort Level ◽

Complication Rates ◽

Arthroscopic Procedure ◽

Subtalar Arthrodesis ◽

Lateral Group ◽

Surgeon Experience ◽

Portal Placement

Category: Arthroscopy Introduction/Purpose: Arthroscopic subtalar joint arthrodesis was first described over two decades ago. The procedure was originally performed with the patient in the lateral decubitus or supine position using anterolateral and posterolateral portals based on the fibula. More recently, several authors have advocated for prone positioning utilizing posteromedial and posterolateral portals. Proponents of the prone position cite improved intra-articular visualization with limited need for traction and more thorough preparation of the posterior facet. Multiple studies have compared arthroscopic to open subtalar arthrodesis and demonstrated similar fusion rates, lower morbidity, and a high level of patient satisfaction with the arthroscopic procedure. To our knowledge, this is the first study investigating how patient positioning and portal placement affects outcomes and morbidity for the arthroscopic procedure. Methods: A systematic review was performed according to PRISMA guidelines utilizing PubMed and Embase. All original studies with reported complication rates for arthroscopic subtalar arthrodesis were included. Two independent reviewers collected patient demographic data, operative positioning, complications, and outcomes including time to fusion and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Patients were placed into the prone group if they were positioned prone with posterior portals or the lateral group if they underwent lateral portal placement. The rate of complications related to portal placement, nonunion rate, rate of painful hardware, and rate of revision were also recorded. The proportions of patients with specific complications in each group were determined and transformed using the Freeman-Tukey double-arcsine method to stabilize variances. Heterogeneity across studies was present as determined using the Q and I2 statistics or likelihood ratio test. Inverse-variance weighted random-effects models were used to evaluate the pooled estimates using R software. Results: A total of 484 feet in 468 patients with a mean follow-up of 36.1 months were included for analysis. Thirteen studies examined patients in the prone position (n=302) and seven articles looked at lateral portals (n=182). Mean AOFAS scores improved from 46.3 to 81.6 following surgery. Fusion was seen in 95.8% of feet at a mean of 10.9 weeks. The total complication rate was similar (p=0.620) between the prone (18.2%) and lateral (17.6%) groups. There was no difference observed in the rate of complications secondary to portal placement (p=0.919), rate of painful hardware (p=0.534), and revision rate (p=0.400) between the two groups. The prone group sustained 20 nonunions (6.6%) which was significantly more than the 2 nonunions (1.1%) found in the lateral group (p=0.039). Conclusion: Arthroscopic subtalar arthrodesis is an effective treatment option for subtalar joint pathology. We found a higher rate of nonunion when the patient is positioned prone and the arthroscopic portals are placed posteriorly. There was no difference in the rate of nerve/tendon injury, painful hardware, and revision surgery. AOFAS scores were improved regardless of portal placement. Limitations of our study include the variability in fusion hardware and use of bone graft for fusion augmentation between studies. We also were unable to account for surgeon experience, operative volume, and comfort level with the procedure. Further large scale prospective studies are warranted.

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Fat Grafting to Improve Results of Facelift: Systematic Review of Safety and Effectiveness of Current Treatment Paradigms

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa002 ◽

2020 ◽

Vol 41 (1) ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Felipe Molina-Burbano ◽

J Michael Smith ◽

Michael J Ingargiola ◽

Saba Motakef ◽

Paymon Sanati ◽

...

Keyword(s):

Systematic Review ◽

Fat Grafting ◽

Treatment Modalities ◽

Fat Graft ◽

Cochrane Library ◽

Complication Rates ◽

Volume Loss ◽

Level Of Evidence ◽

Superficial Musculoaponeurotic System ◽

Age Related

Abstract Background Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, significant procedural variation exists between providers. Objectives The primary purpose of this systematic review was to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone. Methods A systematic review of the Cochrane Library and MEDLINE databases as completed was undertaken to identify all clinical reports of fat grafting combined with facelift surgery based on the following key terms: (“fat grafting” OR “lipotransfer” OR “lipofilling” OR “fat transfer”) AND (“facelift” OR “rhytidectomy” OR “SMASectomy” OR “facial rejuvenation”). Data on techniques, outcomes, complications, and patient satisfaction were collected. Results The systematic review was performed in April 2017. In total, 248 articles were identified for review. After application of exclusion criteria, 15 primary studies were included in this review. Various facelift techniques were reported, including deep-plane or sub–superficial musculoaponeurotic system (SMAS) facelift, SMAS facelift, modified minimal access cranial suspension lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy. The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvements in facial volume and aesthetic assessments. Conclusions Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss. Further research is required to validate and improve existing treatment modalities. Level of Evidence: 3

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Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis

Journal of Clinical Urology ◽

10.1177/20514158211017027 ◽

2021 ◽

pp. 205141582110170

Author(s):

David Eugenio Hinojosa-Gonzalez ◽

Mauricio Torres-Martinez ◽

Sergio Uriel Villegas-De Leon ◽

Cecilia Galindo-Garza ◽

Andres Roblesgil-Medrano ◽

...

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Operative Time ◽

Meta Analysis ◽

Treatment Strategies ◽

Percutaneous Nephrostomy ◽

Complication Rates ◽

Success Rates ◽

Level Of Evidence ◽

Cell Counts

Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV

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Return to Play After Revision Anterior Shoulder Stabilization: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120982059 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712098205

Author(s):

Brian C. Lau ◽

Lorena Bejarano Pineda ◽

Tyler R. Johnston ◽

Bonnie P. Gregory ◽

Mark Wu ◽

...

Keyword(s):

Systematic Review ◽

Return To Play ◽

Rate Of Return ◽

Bone Block ◽

Complication Rates ◽

Weighted Mean ◽

Shoulder Stabilization ◽

Level Of Evidence ◽

Patient Goals ◽

Open Stabilization

Background: Revision shoulder stabilizations are becoming increasingly common. Returning to play after revision shoulder stabilizations is important to patients. Purpose: To evaluate the return-to-play rate after revision anterior shoulder stabilization using arthroscopic, open, coracoid transfer, or free bone block procedures. Study Design: Systematic review; Level of evidence, 4. Methods: All English-language studies published between 2000 and 2020 that reported on return to play after revision anterior shoulder stabilization were reviewed. Clinical outcomes that were evaluated included rate of overall return to play, level of return to play, and time to return to play. Study quality was evaluated using the Downs and Black quality assessment score. Results: Eighteen studies (1 level 2; 17 level 4; mean Downs and Black score, 10.1/31) on revision anterior shoulder stabilization reported on return to play and met inclusion criteria (7 arthroscopic, 5 open, 3 Latarjet, and 3 bony augmentation), with a total of 564 revision cases (mean age, 27.9 years; 84.1% male). The weighted mean length of follow-up was 52.5 months. The overall weighted rate of return to play was 80.1%. The weighted mean rate of return to play was 84.0% (n = 153) after arthroscopic revision, 91.5% (n = 153) after open revision, 88.1% (n = 149) after Latarjet, and 73.8% (n = 65) after bone augmentation. The weighted mean rate of return to same level of play was 69.7% for arthroscopic revision, 70.0% for open revision, 67.1% for Latarjet revision, and 61.8% after bone block revision. There were 5 studies that reported on time to return to play, with a weighted mean of 7.75 months (4 arthroscopic) and 5.2 months (1 Latarjet). The weighted mean rates of complication (for studies that provided it) were 3.3% after arthroscopic revision (n = 174), 3.5% after open revision (n = 110), 9.3% after Latarjet revision (n = 108), and 45.8% after bone block revision (n = 72). Conclusion: Revision using open stabilization demonstrated the highest return-to-play rate. Revision using Latarjet had the quickest time to return to play but had higher complication rates. When evaluated for return to same level of play, arthroscopic, open, and Latarjet had similar rates, and bone block had lower rates. The choice of an optimal revision shoulder stabilization technique, however, depends on patient goals. Higher-quality studies are needed to compare treatments regarding return to play after revision shoulder stabilization.

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A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation

Aesthetic Surgery Journal ◽

10.1093/asj/sjab117 ◽

2021 ◽

Author(s):

Seied Omid Keyhan ◽

Shaqayeq Ramezanzade ◽

Behnam Bohluli ◽

Hamid Reza Fallahi ◽

Madjid Shakiba ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Donor Site ◽

Reference List ◽

Complication Rates ◽

Nasal Dorsum ◽

Level Of Evidence ◽

Recipient Site ◽

Diced Cartilage

Abstract Background Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties. Objectives The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates. Methods We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews. Results The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%. Conclusions Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions. Level of Evidence: 4

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Factors Affecting Posterior Glottic Stenosis Surgery Outcomes: Systematic Review and Meta-analysis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489421997278 ◽

2021 ◽

pp. 000348942199727

Author(s):

Candice Kremer ◽

Roy Jiang ◽

Amrita Singh ◽

Jordan Sukys ◽

Alexandria Brackett ◽

...

Keyword(s):

Systematic Review ◽

Fixed Effects ◽

Meta Analysis ◽

Surgical Approaches ◽

Patient Counseling ◽

Repeat Surgery ◽

Surgical Interventions ◽

Factors Affecting ◽

Specific Variation ◽

Poor Outcomes

Objectives: To investigate surgical adjuncts (stents) and previous surgeries on outcomes from posterior glottic stenosis (PGS). Methods: PubMED/Medline, CINAHL, EMBASE, and Web of Science were searched for publications on adult patients undergoing surgery for PGS. Decannulation and need for additional surgeries were evaluated as outcomes. Linear mixed-effects (with random effects and fixed effects) models were used for multivariate testing. Results: In total, 516 abstracts were reviewed and 26 articles were considered for systematic review. Of these, 19 articles with 140 pooled patient cases were extracted for meta-analysis. On multivariate meta-analysis analysis accounting for study-specific variation and use of open procedures, prior surgeries were associated with additional surgeries (RR = 3.76 [1.39-3.86], P = .038) and the use of a stent was associated with a lower likelihood of decannulation (RR = 0.42 [0.09-0.98], P = .044). Conclusion: Minimizing repeat surgery is a predictor for avoiding additional future surgeries and use of a stent was correlated with poor outcomes. These 2 findings may assist providers in patient counseling regarding the need for further surgical interventions. Further, this study is the first to compare the efficacy of surgical approaches for the resolution of PGS, and highlights the importance of avoiding repeat procedures and stents for the management of PGS.

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The Use of High Strength Sutures and Anchors in Olecranon Fractures: A Systematic Review

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321996626 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199662

Author(s):

Omid Nazifi ◽

Rajitha Gunaratne ◽

Harry D’Souza ◽

Aaron Tay

Keyword(s):

Systematic Review ◽

High Strength ◽

The Elderly ◽

Tension Band ◽

Current Evidence ◽

Complication Rates ◽

Level Of Evidence ◽

Suture Tension ◽

Reoperation Rates ◽

Olecranon Fractures

Purpose/Background: Olecranon fractures are common, particularly in the elderly osteoporotic population. Although various techniques of fixation are available, the gold standard—tension band wiring (TBW)—has high complication and reoperation rates. We sought to identify current evidence for the use of high-strength suture tension banding methods to determine whether they reduce complications and reoperation rates while maintaining fixation. Methods: A systematic review of several databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases included Cochrane, PubMed, MEDLINE and Embase. We searched for evidence of at least Level I to IV (according to NHMRC) of the use of tension band suturing or anchors in the surgical treatment of displaced olecranon fractures. We also analyzed the cost of fixation in our institute. Results: Four hundred and forty articles were identified. Of these, 9 met the inclusion criteria. One hundred thirty-one subjects had an average age of 66 years. All the studies showed that high-strength suture tension banding/anchoring maintained fixation with displaced olecranon fractures, reducing the complication rates and showed minimal reoperation rates. There was also a significant cost advantage of the suture tape construct mainly due to avoiding subsequent removal of metal. Conclusion: Tension band suturing or anchoring displaced olecranon fractures may be an alternative cost effective method to TBW in maintaining fixation, reducing metalware complications and reducing re-operation rates. Level of Evidence: IV.

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Nonsurgical Tear Trough Volumization: A Systematic Review of Patient Satisfaction

Aesthetic Surgery Journal ◽

10.1093/asj/sjab116 ◽

2021 ◽

Author(s):

Enrique Gorbea ◽

Sarah Kidwai ◽

Joshua Rosenberg

Keyword(s):

Systematic Review ◽

Patient Satisfaction ◽

Facial Rejuvenation ◽

Filler Material ◽

Filler Materials ◽

Complication Rates ◽

Level Of Evidence ◽

Filler Injection ◽

Tear Trough ◽

Tear Trough Deformity

Abstract Background Nonsurgical rejuvenation of the tear trough area via the use of injectable filler material has become a popular procedure in facial rejuvenation. This procedure offers immediate, albeit temporary, results with minimal recovery time. Objectives The aim of this systematic review was to report on patient satisfaction and complication rates to further guide practitioners. Methods PubMed, Cochrane, and Scopus libraries were queried for articles containing relevant terms. Articles with more than 5 patients who reported on satisfaction and/or complications from the procedure were included for review. In addition to these variables, we noted other aspects of injection, including filler material, technique, and needle or cannula delivery. Studies that did not otherwise fulfill inclusion criteria for statistical analysis but reported on intravascular injection–related complications were cited. Results Initial query resulted in 1655 studies which were assessed for duplicates and inclusion/exclusion criteria. After screening, 28 articles were included for analysis. In total, 1956 patients were captured who had been injected with 1 of 4 materials: hyaluronic acid (1535), calcium hydroxyapatite (376), autologous fibroblast/keratin gel (35), and collagen-based filler (10). Short- and long-term satisfaction rates were 84.4% and 76.7%, respectively. Minor complications were common (44%). Secondarily, we found the use of cannula for filler injection of this region to be associated with a lower rate of ecchymosis (7% vs 17%, P < 0.05). Conclusions Filler injection volumization of tear trough deformity is an effective technique for facial rejuvenation associated with high patient satisfaction. Multiple filler materials offer acceptable satisfaction and complication profiles. Level of Evidence: 4

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Effectiveness of Telementoring in Surgery Compared With On-site Mentoring: A Systematic Review

Surgical Innovation ◽

10.1177/1553350617708725 ◽

2017 ◽

Vol 24 (4) ◽

pp. 379-385 ◽

Cited By ~ 17

Author(s):

Elif Bilgic ◽

Sena Turkdogan ◽

Yusuke Watanabe ◽

Amin Madani ◽

Tara Landry ◽

...

Keyword(s):

Systematic Review ◽

Distance Learning ◽

Educational Intervention ◽

Clinical Encounter ◽

Complication Rates ◽

Level Of Evidence ◽

Training Tool ◽

Levels Of Evidence ◽

Technical Issues

Background. Mentorship is important but may not be feasible for distance learning. To bridge this gap, telementoring has emerged. The purpose of this systematic review was to evaluate the effectiveness of telementoring compared with on-site mentoring. Methods. A search was done up to March 2015. Studies were included if they used telementoring between surgeons during a clinical encounter and if they compared on-site mentoring and telementoring. Results. A total of 11 studies were included. All reported no difference in complication rates, and 9 (82%) reported similar operative times; 4 (36%) reported technical issues, which was 3% of the total number of cases in the 11 studies. No study reported on higher levels of evidence for effectiveness of telementoring as an educational intervention. Conclusion. Studies reported that telementoring is associated with similar complication rates and operative times compared with on-site mentoring. However, the level of evidence to support the effectiveness of telementoring as a training tool is limited. There is a need for studies that provide evidence for the equivalence of the effectiveness of telementoring as an educational intervention in comparison with on-site mentoring.

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All-arthroscopic reconstruction of the anterior talofibular ligament is comparable to open reconstruction: a systematic review

EFORT Open Reviews ◽

10.1530/eor-21-0075 ◽

2022 ◽

Vol 7 (1) ◽

pp. 3-12

Author(s):

Ulrike Wittig ◽

Gloria Hohenberger ◽

Martin Ornig ◽

Reinhard Schuh ◽

Andreas Leithner ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Ankle Instability ◽

Search Algorithm ◽

Case Reports ◽

Anterior Talofibular Ligament ◽

List Type ◽

Complication Rates ◽

Level Of Evidence ◽

Return To Activity

The aim of this study was to determine whether all-arthroscopic repair would lead to improved clinical outcomes, lower complication rates, shorter postoperative immobilization and earlier return to activity compared to open Broström repair in the surgical treatment of chronic lateral ankle instability (CLAI). A systematic literature search was conducted using Pubmed and Embase to identify studies dealing with a comparison of outcomes between all-arthroscopic and open Broström repair for CLAI. The search algorithm was ‘ankle instability’ AND ‘Brostrom’ AND ‘arthroscopic’ AND ‘open’. The study had to be written in English language, include a direct comparison of all-arthroscopic and open Broström repair to treat CLAI and have full text available. Exclusion criteria were former systematic reviews, biomechanical studies and case reports. Overall, eight studies met the inclusion criteria and were included in the analysis. Clinical outcomes did not differ substantially between patients treated with either arthroscopic or open Broström repair. Studies that reported on return to activity and sports following surgery suggested that patients that had all-arthroscopic Broström repair returned at a quicker rate. Overall complication rate tended to be lower after arthroscopic Broström repair. Similar to open repair, all-arthroscopic ligament repair for CLAI is a safe treatment option that yields excellent clinical outcomes. Level of Evidence: Level III evidence (systematic review of level I, II and III studies).

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