scholarly journals Surgical Results of Chronic Distal Biceps Ruptures: A Systematic Review

2022 ◽  
Vol 10 (1) ◽  
pp. 232596712110657
Author(s):  
Arpun Bajwa ◽  
Maciej J.K. Simon ◽  
Jordan M. Leith ◽  
Farhad O. Moola ◽  
Thomas J. Goetz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Functional Outcomes ◽  
Biceps Tendon ◽  
Surgical Techniques ◽  
Elbow Flexion ◽  
Level Of Evidence ◽  
Arm Pain ◽  
Distal Biceps ◽  
Cochrane Database

Background: Distal biceps tendon tears can cause weakness and fatigue with activities requiring elbow flexion and supination. Surgical management of chronic tears (>21 days) is not well described in the literature. Purpose: To determine the clinical outcomes of chronic distal biceps repairs and reconstructions. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of Medline (PubMed and Ovid), EMBASE, CINAHL physical therapy, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, and PubMed Central from inception until September 29, 2020, to identify articles on chronic distal biceps ruptures. The inclusion criteria were studies with at least 1 outcome measure and 10 patients with chronic distal biceps ruptures treated surgically. The quality of the included studies was assessed with the methodological index for nonrandomized studies (MINORS) score. Functional outcomes and complications were reviewed. Results: A total of 12 studies were included after systematic database screenings. The MINORS scores ranged from 5 to 19. There were a total of 1704 distal biceps ruptures, of which 1270 were acute and 434 were chronic. Average follow-up time was 12 months to 5.1 years. Single-incision (n = 3), 2-incision (n = 2), or both (n = 6) surgical techniques were used in these studies. Four studies described the use of autografts, and 4 articles used allografts in the chronic repair. Range of motion, function, and strength outcomes were similar when compared with the contralateral arm. Pain was reduced to minimal levels. Main postoperative complications were of paresthesia (specifically to the lateral antebrachial cutaneous nerve), which were temporary in 69.1% of cases. Conclusion: The results of this review indicate that surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability. Although there may be a slightly higher immediate complication rate, the functional outcomes remain comparable with those seen in the patient population with acute distal biceps.

Differences in risk factors exist for the occurrence of bilateral versus unilateral distal biceps tendon ruptures: a systematic review

2020 ◽  
pp. jisakos-2020-000570
Author(s):  
Christina Barrett Hawkins ◽  
Rebecca Abromitis ◽  
Carola van Eck
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Biceps Tendon ◽  
Meta Analysis ◽  
Distal Biceps Tendon ◽  
Level Of Evidence ◽  
Distal Biceps ◽  
Biceps Rupture ◽  
Tendon Ruptures ◽  
Distal Biceps Rupture

ImportanceDistal biceps rupture is a debilitating injury that is increasing in incidence. A subset of patient experiences this injury on both sides, simultaneously or at separated times. Previous studies have evaluated the incidence and risk factors of unilateral distal biceps rupture. However, little is known about the risk factors for bilateral distal biceps rupture.AimsThis aims of this study were to determine risk factors for bilateral distal biceps rupture and to compare these to the known risk factors for unilateral rupture.Evidence reviewA systematic review of literature was conducted using five databases, producing a total of 1183 papers. After the review process, 31 papers with data bilateral distal biceps tendon ruptures were included.FindingsThe 31 papers included a total of 2234 patients with 2366 ruptures. Patients with a bilateral rupture were younger than patients with unilateral ruptures (45.8 vs 48.8 years old). Women made up a larger percentage of patients with bilateral ruptures (6.8% vs 4.0%). Bilateral injuries occurred most commonly during heavy lifting or falls, whereas forced extension of the arm was the most frequently reported injury mechanism reported with unilateral ruptures. Tobacco used was more common in patients with bilateral ruptures (24.4% vs 6.8%). Labour-intensive occupations and anabolic steroid use did not appear to increase the risk of a bilateral rupture. Pooling of the data was not possible due to heterogeneity of the included studies.ConclusionsWhile differences in risk factors between patients with unilateral and bilateral ruptures were observed, there was too great of a degree of heterogeneity among the studies to perform a meta-analysis of the data.Level of evidenceSystematic review; level III evidence.

Treatment of Sagittal Band Injuries and Extensor Tendon Subluxation: A Systematic Review

Hand ◽  
2020 ◽  
pp. 155894471989562
Author(s):  
Kitty Wu ◽  
Geoffrey Masschelein ◽  
Nina Suh
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Surgical Management ◽  
Nonoperative Management ◽  
Case Reports ◽  
Surgical Techniques ◽  
Case Series ◽  
Extensor Tendon ◽  
Retrospective Case ◽  
Level Of Evidence

Background: This systematic review assesses the current literature and reviews the clinical outcomes of treatment for sagittal band injuries and extensor tendon instability. Materials: A systematic search of MEDLINE, EMBASE, and the Cochrane databases was performed for English-language articles on the treatment of nonrheumatoid adult sagittal band injuries between 1969 and 2019. Two independent reviewers were involved in screening, data extraction, and critical appraisal. The level of evidence was assigned using the Sackett scale, and the methodological quality of the studies was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Outcome measures were persistent pain, extensor lag, and recurrent tendon subluxation. Results: In all, 1653 abstracts were identified, with 43 articles reviewed in full text and 17 articles (429 treated digits) included in the final systematic review. There were 10 studies on surgical management, 3 on nonoperative management, and 4 on both. There were 4 retrospective case series and 13 retrospective case reports (Sackett level 4) with an average SEQES score of 15 (low quality). Studies on nonoperative management had on average more digits per study and higher SEQES scores (n = 27.7, SEQES = 19) compared with studies on surgical management (n = 11.8, SEQES = 13.8). Variability in reported outcome measures precluded meta-analysis. Conclusion: Qualitative synthesis of available literature suggests that acute sagittal band injuries can be successfully treated by splinting the injured digit in neutral or hyperextension. Patients with chronic injuries or those failing nonoperative management may benefit from surgical exploration. A lack of consistent outcome measures precluded comparison of surgical techniques.

scholarly journals Correction of Thumb Duplication: A Systematic Review of Surgical Techniques

2019 ◽  
Vol 12 (02) ◽  
pp. 074-084
Author(s):  
Robert Miller ◽  
Alexandre Kaempfen ◽  
Jamil Moledina ◽  
Bran Sivakumar ◽  
Gill Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Spare Parts ◽  
Risk Of Bias ◽  
Future Research ◽  
Level Of Evidence ◽  
Thumb Duplication ◽  
Patient Reported

AbstractSurgical intervention for thumb duplication can be divided into three categories: simple excision of the accessory thumb, excision of the accessory thumb with reconstruction from available “spare parts,” and combining the two thumbs into one, as described by Bilhaut. This prospectively PROSPERO registered systematic review evaluates the overall, aesthetic and functional outcomes for the latter two options (reconstruction from spare parts vs. combining two thumbs into one), aiming to facilitate evidence-based decision making when addressing thumb duplication and direct future research. The review was performed in accordance with the Cochrane Handbook of Systematic Reviews and PRISMA statement. Embase, PubMed, Medline, and Cochrane databases were systematically searched. Studies offering comparisons of techniques were included. Risk of bias was assessed using the Risk of Bias In Non-randomized Studies—of Intervention tool. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Ten retrospective observational studies were included. Data did not consistently allow analysis by procedure type. Four studies reported similar overall outcomes between techniques, while two specifically reported poor overall outcomes for the Bilhaut procedure. Two studies reported comparatively worse aesthetic outcomes for the Bilhaut procedure with four studies reporting comparatively improved functional outcomes for this procedure. Overall, interpretation of outcomes was challenging with no patient-reported outcome measures used. The quality of the evidence was universally “very low” due to all studies being at risk of methodological bias. Based on the available evidence, surgical techniques for thumb duplication correction appear comparable regarding overall outcome. There is limited evidence suggesting reconstruction with spare parts offers superior aesthetic outcomes at the expense of stability. The level of evidence is III.

scholarly journals Surgical Management of Patella Alta in Patellofemoral Instability: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199964
Author(s):  
Si Heng Sharon Tan ◽  
Erica Hian Kim Ngiam ◽  
Jia Ying Lim ◽  
Andrew Kean Seng Lim ◽  
James Hoipo Hui
Keyword(s):  
Systematic Review ◽  
Surgical Management ◽  
Random Effects ◽  
Surgical Techniques ◽  
Patellofemoral Instability ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Level Of Evidence

Background: Proximal, distal, and combined proximal and distal procedures have been performed for patellofemoral instability in the presence of patella alta. No consensus exists regarding the accepted surgical management for this condition. Purpose: To pool the outcomes of surgical management for patellofemoral instability in the presence of patella alta and to determine whether the outcomes differ for different surgical techniques. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies that reported surgical outcomes for patellofemoral instability in the presence of patella alta were included. The random-effects model was used to analyze pooled estimates of preoperative and postoperative differences for outcomes that were reported in ≥3 studies. If heterogeneity existed among the studies, further analysis was performed using random-effects meta-regression analysis, which allowed for the identification of moderators. Results: A total of 11 studies with 546 knees were included. The pooled relative risk (RR) of having no patellofemoral dislocation and no patellofemoral apprehension or subjective instability postoperatively was 51.80 (95% CI, 20.75-129.31) and 48.70 (95% CI, 17.22-137.71), respectively. The pooled weighted mean improvement (WMI) for the Kujala and Lysholm scores postoperatively was 31.98 (95% CI, 28.66-35.30) and 35.93 (95% CI, 30.12-41.74), respectively. The pooled WMI for patellar tilt angles postoperatively was 10.94 (95% CI, 7.87-14.01). These outcomes were homogeneous across all studies. The pooled WMI for Insall-Salvati ratio, Caton-Deschamps index, and tibial tubercle–trochlear groove distance postoperatively was 0.31 (95% CI, 0.17-0.45), 0.24 (95% CI, 0.12-0.36), and 6.77 (95% CI, 1.96-11.58), respectively. These outcomes were heterogeneous across the studies, with the presence of distal procedures being a significant moderator. The presence of distal procedures had a significantly higher unweighted RR of 38.07 (95% CI, 2.37-613.09) for major complications compared with proximal procedures alone, although the incidence of minor complications was comparable (unweighted RR, 1.25; 95% CI, 0.35-4.48). Conclusion: Surgical management for patellofemoral instability in the presence of patella alta consistently led to improvement in clinical and functional outcomes, regardless of the type of procedure performed. Distal procedures were better able to correct the patellar height and tibial tubercle–trochlear groove distance, although these procedures also posed a higher RR of subsequent surgery compared with proximal procedures alone.

scholarly journals Return of an Intact Hook Test Result: Clinical Assessment of Biceps Tendon Integrity After Surgical Repair

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711982731 ◽  
Author(s):  
Graham D. Pallante ◽  
Shawn W. O’Driscoll
Keyword(s):  
Surgical Repair ◽  
Biceps Tendon ◽  
Distal Biceps Tendon ◽  
Level Of Evidence ◽  
Distal Biceps ◽  
Effective Manner ◽  
Distal Biceps Repair ◽  
Tendon Ruptures ◽  
Test Result

Background: The hook test is a sensitive and specific tool that has been previously described for diagnosing distal biceps tendon ruptures in an efficient, cost-effective manner. However, its application in postoperative evaluations after surgical repair of distal biceps tendon ruptures is not documented. Hypothesis/Purpose: We hypothesized that the hook test result returns to normal at some point postoperatively after distal biceps repair. This information could be used in decision making during follow-up examinations with both normal and abnormal findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively reviewed records of distal biceps repair. Between July 1, 2003, and July 1, 2016, a total of 56 patients underwent distal biceps repair and also had clear documentation of the results of the hook test during the postoperative period. Hook test results consisted of “intact,” “abnormal,” or “absent.” The timing of the return to a normal hook test result was recorded. Results: Overall, 51 of 57 (89%) repairs were documented to have the hook test result return to “intact.” The test result returned to intact by a mean of 10 weeks after surgery (range, 2 weeks to 15 months). The biceps tendon was intact according to the hook test at the 4-month follow-up in 45 of the 51 patients (88%) in whom it ultimately returned. The hook test result was abnormal in 5 repairs in 5 patients with only a short-term follow-up, ranging from 2 to 7 weeks postoperatively. One patient with an abnormal hook test result at 2 weeks postoperatively underwent revision and was confirmed to have a partial tear of the biceps insertion. His hook test result returned to intact 3 months after revision repair. Conclusion: The hook test result returns to normal in patients who undergo distal biceps repair in the primary and revision settings with adequate follow-up. The vast majority of patients have a normal hook test result by 4 months postoperatively. An abnormal hook test result at 4 months postoperatively may indicate a failed repair and should prompt further investigation.

scholarly journals Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy

2018 ◽  
Vol 24 ◽  
pp. 782-790 ◽  
Author(s):  
Paweł Reichert ◽  
Aleksandra Królikowska ◽  
Jarosław Witkowski ◽  
Łukasz Szuba ◽  
Andrzej Czamara
Keyword(s):  
Surgical Management ◽  
Nerve Palsy ◽  
Biceps Tendon ◽  
Posterior Interosseous Nerve ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Posterior Interosseous Nerve Palsy

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

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

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

Anatomically Contoured Anterior Plating for Isolated Tibiotalar Arthrodesis: A Systematic Review

2017 ◽  
Vol 10 (4) ◽  
pp. 352-358 ◽  
Author(s):  
Nicholas Kusnezov ◽  
John C. Dunn ◽  
Logan R. Koehler ◽  
Justin D. Orr
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Wound Complications ◽  
Posttraumatic Arthritis ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Tibiotalar Arthrodesis ◽  
Anterior Plating

Introduction. We performed a systematic review of the published literature to characterize patient demographic, surgical techniques, and functional outcomes to elucidate the complication and revision rates following isolated tibiotalar arthrodesis with anatomically contoured anterior plating. Methods. A comprehensive literature search was performed. Inclusion criteria were peer-reviewed studies in English, after 1990, at least 10 patients, and reporting clinical outcomes following contoured anterior plating and with follow-up of at least 80% and 1 year. Primary outcomes were fusion rate, time to fusion, return to activities, satisfaction, and functional outcome scores. Complication rates, reoperation, and revision were also extracted. Results. Eight primary studies with 164 patients met the inclusion criteria. The average sample size was 21 ± 10.0 patients and average age was 49.2 years with 61.6% male. Posttraumatic arthritis (49.4%) was the most common operative indication, followed by primary osteoarthrosis (18.9%). The average follow-up was 21.1 months. At this time, 97.6% of patients went on to uneventful union at a weighted average time of 18.7 weeks postoperatively. AOFAS scores improved significantly ( P < .05). 25% complication rate was reported with wound complication (7.9%) and hardware irritation (6.7%) most common. Overall, 21.3% of patients underwent reoperation; 4 for revision arthrodesis following nonunion. Conclusion. Isolated tibiotalar arthrodesis utilizing anatomically contoured anterior plating demonstrates excellent clinical and functional outcomes at short-term follow-up. Overall, 97.6% of patients went on to fusion and functional outcomes consistently improved following surgery. Furthermore, while one-quarter of patients experienced complications, wound complications were relatively uncommon and less than one-quarter of these required surgical intervention. Levels of Evidence: Level IV: Systematic Review

Sign in / Sign up

Export Citation Format

Share Document