Level of evidence in wrist ligament repair and reconstruction research: a systematic review

Abstract Background Wrist arthrolysis is a viable option in wrist stiffness and can be performed via open or arthroscopic techniques. Purpose The aim of the study is to describe and evaluate the available techniques of open and arthroscopic arthrolysis of the radiocarpal joint and the distal radio ulnar joint (DRUJ) in posttraumatic wrist stiffness. Methods A systematic literature search was performed in PubMed to identify studies reporting on open and arthroscopic wrist arthrolysis. Key words included “open wrist arthrolysis,” “arthroscopic wrist arthrolysis,” “post-traumatic wrist stiffness,” and “DRUJ arthrolysis.” Data were extracted independently by a pair of reviewers. Results Overall, 637 studies were identified; 13 additional articles were found through previous publications (total 650 articles). A total of 612 records resulted after duplicates was removed. Fourteen studies were selected and only eight respected the inclusions criteria. One study focused on volar open arthrolysis and four studies on arthroscopic arthrolysis of the radiocarpal joint; two studies reported on open arthrolysis and two studies on arthroscopic DRUJ arthrolysis. Range of motion following open and arthroscopic wrist arthrolysis improved in all studies. Conclusion Both arthroscopic and open arthrolysis can lead to similar and satisfactory results in radiocarpal joint and DRUJ stiffness.. Level of Evidence This is a level 3a study.

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Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence

BMC Surgery ◽

10.1186/s12893-021-01272-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stefano Granieri ◽

Francesco Sessa ◽

Alessandro Bonomi ◽

Sissi Paleino ◽

Federica Bruno ◽

...

Keyword(s):

Systematic Review ◽

Clinical Symptoms ◽

Rare Complication ◽

Meta Analysis ◽

Treatment Options ◽

Palliative Surgery ◽

Review Of The Literature ◽

Colovesical Fistula ◽

Level Of Evidence ◽

Meta Analyses

Abstract Background Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity. Results Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. Conclusions Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

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Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120982076 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098207

Author(s):

Sachin Allahabadi ◽

Favian Su ◽

Drew A. Lansdown

Keyword(s):

Systematic Review ◽

Lower Extremity ◽

Achilles Tendon ◽

Sports Medicine ◽

Direct Consequence ◽

National Basketball Association ◽

Return To Play ◽

Level Of Evidence ◽

Cartilage Injuries ◽

Women's National Basketball Association

Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.

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The relationship between physical fitness attributes and sports injury in female, team ball sport players: a systematic review

Sports Medicine - Open ◽

10.1186/s40798-020-00264-9 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Jessica B. Farley ◽

Lily M. Barrett ◽

Justin W. L. Keogh ◽

Carl T. Woods ◽

Nikki Milne

Keyword(s):

Systematic Review ◽

Body Composition ◽

Physical Fitness ◽

Sports Injury ◽

Quality Data ◽

Body Region ◽

Ankle Sprains ◽

Level Of Evidence ◽

Data Synthesis ◽

The Relationship

Abstract Background Understanding the relationships between physical fitness characteristics and sports injury may assist with the development of injury minimisation programs. The purpose of this systematic review was to investigate the association between physical fitness attributes and sports injury in female, team ball sport players. Methods Four scientific databases (MEDLINE, EMBASE, SPORTDiscus, Scopus) and reference lists of relevant research were searched for eligible studies up to September 2, 2019. Full-text articles examining the relationship between physical fitness and sports injury in female, team ball sport players were included. A modified Downs and Black checklist was used to assess methodological quality. Data synthesis determined summary conclusions based on the number of significant relationships divided by the total relationships investigated and reported as a percentage. Level of certainty was identified for summary conclusions based on level of evidence. Sub-analyses regarding competition level, age, and single injury types were also conducted. Results A total of 44 studies were included. Data synthesis revealed no associations (low to moderate certainty) between body composition (1/9; 11%), flexibility (18–20%), and balance (2/8; 25%) and ‘any injury’ classification. No associations (mostly of moderate certainty) were found between flexibility (0–27%), muscular strength (0–27%), and body composition (14–33%) and various body region injury classifications, whereas mixed summary conclusions were shown for balance (0-48%). Many associations between physical fitness and sports injury were deemed ‘unknown’ or with an insufficient level of certainty. Sub-analyses revealed no association between strength and noncontact ACL injuries (0/5; 0%) or ankle sprains (0/12; 0%), and between flexibility and ankle sprains (1/5; 20%); however, insufficient certainty of these results exists. Clear associations were concluded between balance and lower body injuries in female, non-elite (10/16; 63%) and junior (9/12; 75%) team ball sport players, with moderate and insufficient certainty of these results, respectively. Conclusion Limited evidence is available to demonstrate relationships between physical fitness and sports injury in female, team ball sport players. High-quality evidence investigating the multifactorial nature of sports injury, including the interactions physical fitness qualities have with other injury determinants, is needed to better understand the role of physical fitness in minimising sports injuries in female, team ball sport players. Trial Registration CRD42017077374 (PROSPERO on September 14, 2017).

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Predictive Factors in Sacral Neuromodulation: A Systematic Review

Urologia Internationalis ◽

10.1159/000513937 ◽

2021 ◽

pp. 1-21

Author(s):

Ranjana Jairam ◽

Jamie Drossaerts ◽

Tom Marcelissen ◽

Gommert van Koeveringe ◽

Desiree Vrijens ◽

...

Keyword(s):

Systematic Review ◽

Predictive Factors ◽

Sacral Neuromodulation ◽

Level Of Evidence ◽

Specific Patient ◽

Detrusor Contractility ◽

Affective Symptoms ◽

Lower Success Rate ◽

Patient Groups ◽

Based Medicine

Introduction: Sacral neuromodulation (SNM) is an effective treatment in patients with overactive bladder syndrome or nonobstructive urinary retention when conservative treatment fails. Several factors that could impact outcome with SNM have been studied. This systematic review investigated these predictive factors and their relevance for clinical practice. Methods: Systematic review according to the PRISMA guidelines was conducted. This review is registered in the PROSPERO register (CRD42015016256). Results: Seventy-eight studies (of which 11 abstracts) were included. Females, younger patients, and a tined lead procedure tend to be predictive in successful SNM outcome. Factors that did not influence SNM outcome were prior back surgery, surgery for stress urinary incontinence, affective symptoms, and duration of complaints. Reduced detrusor contractility is associated with a lower success rate. The level of evidence of most studies (graded according to the Centre for Evidence-Based Medicine) was 3b. Conclusion: Even though this systematic review investigated predictive factors (gender, age, type of procedure, type of lead, and detrusor contractility), no general consensus on predictive factors could be made. Most studies are small, retrospective, and involve a heterogeneous population. Therefore, prospective research in larger specific patient groups remains necessary to find predictors of SNM outcome.

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Union rates and functional outcome of double plating of the femur: systematic review of the literature

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03767-6 ◽

2021 ◽

Author(s):

M. F. Lodde ◽

M. J. Raschke ◽

J. Stolberg-Stolberg ◽

J. Everding ◽

S. Rosslenbroich ◽

...

Keyword(s):

Systematic Review ◽

Fracture Healing ◽

Functional Outcome ◽

Femoral Fractures ◽

Periprosthetic Fractures ◽

Level Of Evidence ◽

Distal Femoral Fractures ◽

Femur Fractures ◽

Meta Analyses ◽

Double Plating

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

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Vitamin D in Basketball Players: Current Evidence and Future Directions

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211019343 ◽

2021 ◽

pp. 194173812110193

Author(s):

Emilija Stojanović ◽

Dragan Radovanović ◽

Tamara Hew-Butler ◽

Dušan Hamar ◽

Vladimir Jakovljević

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Body Composition ◽

Physical Performance ◽

Bone Health ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

Current Evidence ◽

Basketball Players ◽

Level Of Evidence

Context: Despite growing interest in quantifying and correcting vitamin D inadequacy in basketball players, a critical synthesis of these data is yet to be performed to overcome the low generalizability of findings from individual studies. Objective: To provide a comprehensive analysis of data in basketball pertaining to (1) the prevalence of vitamin D inadequacy; (2) the effects of vitamin D supplementation on 25-hydroxyvitamin D [25(OH)D] concentration (and its association with body composition), bone health, and performance; and (3) crucial aspects that warrant further investigation. Data Sources: PubMed, MEDLINE, ERIC, Google Scholar, SCIndex, and ScienceDirect databases were searched. Study Selection: After screening, 15 studies were included in the systematic review and meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: The prevalence of vitamin D inadequacy, serum 25(OH)D, body composition, stress fractures, and physical performance were extracted. Results: The pooled prevalence of vitamin D inadequacy for 527 basketball players in 14 studies was 77% ( P < 0.001; 95% CI, 0.70-0.84). Supplementation with 4000 IU/d and 4000 IU/wk (absolute mean difference [AMD]: 25.39 nmol/L; P < 0.001; 95% CI, 13.44-37.33), as well as 10,000 IU/d (AMD: 100.01; P < 0.001; 95% CI, 70.39-129.63) vitamin D restored 25(OH)D to normal concentrations. Body composition data revealed inverse correlations between changes in serum 25(OH)D (from pre- to postsupplementation) and body fat ( r = −0.80; very large). Data concerning positive impacts of vitamin D supplementation on bone health and physical performance remain sparse. Conclusion: The high proportion of vitamin D inadequacy underscores the need to screen for serum 25(OH)D in basketball players. Although supplementation restored vitamin D sufficiency, the beneficial effects on bone health and physical performance remain sparse. Adiposity can modulate 25(OH)D response to supplementation.

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Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

Archives of Dermatological Research ◽

10.1007/s00403-021-02264-5 ◽

2021 ◽

Author(s):

Joanna Nowaczyk ◽

Michał Zawistowski ◽

Piotr Fiedor

Keyword(s):

Systematic Review ◽

Complete Remission ◽

Minimally Invasive ◽

Subcutaneous Tissue ◽

Sodium Thiosulfate ◽

Common Adverse Event ◽

Chronic Infections ◽

Level Of Evidence ◽

Calcinosis Cutis ◽

Extracorporeal Shock Wave

AbstractCalcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient’s adherence (mean treatment duration, 4.9 months; range 2–24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0–9 and 1; range 0–5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO2 laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.

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Failed Latarjet procedure: a systematic review of surgery revision options

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00587-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Matteo Buda ◽

Riccardo D’Ambrosi ◽

Enrico Bellato ◽

Davide Blonna ◽

Alessandro Cappellari ◽

...

Keyword(s):

Systematic Review ◽

Case Series ◽

Review Of The Literature ◽

Inclusion Criteria ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Level Of Evidence ◽

Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

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Current status of wet lab and cadaveric simulation in urological training: A systematic review

Canadian Urological Association Journal ◽

10.5489/cuaj.6520 ◽

2020 ◽

Vol 14 (11) ◽

Author(s):

Ahmed Al-Jabir ◽

Abdullatif Aydin ◽

Hussain Al-Jabir ◽

M. Shamim Khan ◽

Prokar Dasgupta ◽

...

Keyword(s):

Systematic Review ◽

English Language ◽

In Vivo Studies ◽

Current Status ◽

Level Of Evidence ◽

Cadaveric Simulation ◽

Randomized Controlled Studies ◽

Wet Lab ◽

Urological Training

Introduction: We undertook a systematic review of the use of wet lab (animal and cadaveric) simulation models in urological training, with an aim to establishing a level of evidence (LoE) for studies and level of recommendation (LoR) for models, as well as evaluating types of validation. Methods: Medline, EMBASE, and Cochrane databases were searched for English-language studies using search terms including a combination of surgery, surgical training, and medical education. These results were combined with wet lab, animal model, cadaveric, and in-vivo. Studies were then assigned a LoE and LoR if appropriate as per the education-modified Oxford Centre for Evidence-Based Medicine classification. Results: A total of 43 articles met the inclusion criteria. There was a mean of 23.1 (±19.2) participants per study with a median of 20. Overall, the studies were largely of low quality, with 90.7% of studies being lower than 2a LoE (n=26 for LoE 2b and n=13 for LoE 3). The majority (72.1%, n=31) of studies were in animal models and 27.9% (n=12) were in cadaveric models. Conclusions: Simulation in urological education is becoming more prevalent in the literature, however, there is a focus on animal rather than cadaveric simulation, possibly due to cost and ethical considerations. Studies are also predominately of a low LoE; more higher LoEs, especially randomized controlled studies, are needed.

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