scholarly journals Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: a systematic review

2020 ◽  
pp. 1-7
Author(s):  
Cornelia M. Donders ◽  
Anne J. Spaans ◽  
Johannes H. J. M. Bessems ◽  
Christiaan J. A. van Bergen
Keyword(s):  
Systematic Review ◽  
Septic Arthritis ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Needle Aspiration ◽  
Scientific Quality ◽  
Knee Arthritis ◽  
Level Of Evidence ◽  
Septic Knee Arthritis

Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO). Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. Level of evidence IV

A systematic review of the optimal drainage technique for septic hip arthritis in children

2021 ◽  
pp. 112070002198966
Author(s):  
Cornelia Maria Donders ◽  
Anne J Spaans ◽  
Johannes H J M Bessems ◽  
Christiaan J A van Bergen
Keyword(s):  
Systematic Review ◽  
Septic Arthritis ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Paediatric Population ◽  
Scientific Quality ◽  
Comprehensive Overview ◽  
Hip Arthritis ◽  
Drainage Technique

Introduction: The hip is one of the most commonly affected joints in paediatric septic arthritis. Drainage can be performed using arthrocentesis (articular needle aspiration), arthroscopy or arthrotomy. The objective of this systematic review was to identify the most effective drainage technique for septic hip arthritis in the paediatric population. Materials and methods: The electronic MEDLINE, EMBASE and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the paediatric hip. Outcome parameters were additional drainage procedures, clinical outcomes and radiological sequelae. The quality of each of the included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) score. Results: Out of 2428 articles, 19 studies with a total of 406 hip joints were included in the systematic review. Additional arthroscopy or arthrotomy was performed in 15% of the hips treated with arthrocentesis, in 14% after arthroscopy and in 3% after arthrotomy. Inferior clinical outcomes and more radiological sequelae were seen in patients treated with an arthrotomy. A meta-analysis could not be performed due to the diversity and low quality of the studies (MINORS median 4 [range 2–15]). Conclusions: This systematic review gives a comprehensive overview of the available literature on treatment for septic hip arthritis in children. Arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy. However, arthrotomy might be associated with inferior outcomes in the longer term. The included studies are diverse and the scientific quality is generally low.

scholarly journals Safety and Efficacy of Therapeutic Taping in Primary Dysmenorrhea: a Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Bandara EMIA ◽  
Kularathne WNI ◽  
K Brain ◽  
Weerasekara I
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Adult Women ◽  
Primary Dysmenorrhea ◽  
Level Of Evidence ◽  
Effective Measure ◽  
Safety And Efficacy ◽  
Pain Anxiety

Abstract Primary dysmenorrhea (PD) is a common gynecological complaint among adolescents and adult women. Various pharmacological and alternative therapies such as therapeutic taping have been used as a treatment of PD. Although several studies have been conducted to evaluate the safety and efficacy of therapeutic taping in PD, these studies have not provided adequate level of evidence related to the safety and efficacy of therapeutic taping in PD. Hence, a systematic review and meta-analysis was performed to evaluate the safety and efficacy of therapeutic taping in PD. The following databases; Medline, Cochrane Library, Embase, PEDro, CINAHL and any other gray literature sources were searched for randomized controlled trials (RCTs) that used therapeutic taping to treat PD from inception to June 2021 with the language restricted to English. Independently screened articles by two reviewers were extracted according to the study objectives. A total of nine studies were included in the systematic review, involving 577 participants. Three studies were eligible for meta-analysis to find the pooled effect of taping on pain intensity. The review indicates that therapeutic taping is an effective measure in improving pain, anxiety and quality of life of women with PD. Meta-analysis conducted to compare the effect of elastic therapeutic taping (ETT) to sham taping showed that the ETT is an effective measure in improving pain among women with PD (MD = -3.12 (95% CI -5.64, -0.60); p=0.02; I2=95 %). The quality of the studies was assessed using the PEDro scale and the included RCTs indicated a fair to good level of quality. Our systematic review and meta-analysis demonstrated that therapeutic taping is an effective intervention for PD. However, RCTs with higher quality and larger sample sizes are necessary to verify the current results of the review.

scholarly journals Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098001
Author(s):  
Luke Geoghegan ◽  
Alexander Scarborough ◽  
Jeremy N. Rodrigues ◽  
Mike J. Hayton ◽  
Maxim D. Horwitz
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Return To Sport ◽  
Poor Quality ◽  
Accurate Estimation ◽  
Level Of Evidence ◽  
Metacarpal Fractures ◽  
Phalangeal Fractures

Background: Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes. Purpose: To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures. Study Design: Systematic review; Level of evidence, 4. Methods: A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to MEDLINE and In-Process, Embase, EMCARE, and CINAHL. Results: Overall, 3135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 vs 22.0 days). All studies were of fair or poor quality, and none were randomized. Conclusion: Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.

scholarly journals The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Eyal Ben-Arie ◽  
Pei-Yu Kao ◽  
Yu-Chen Lee ◽  
Wen-Chao Ho ◽  
Li-Wei Chou ◽  
...  
Keyword(s):  
Systematic Review ◽  
External Rotation ◽  
Meta Analysis ◽  
Frozen Shoulder ◽  
Pain Reduction ◽  
Shoulder Function ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Evidence Grade

Background. Frozen shoulder (FS) is associated with pain, reduced range of motion (ROM), and shoulder function. The condition occurs in 2–5% of the population, and it is especially common around the age of 50 years. FS symptoms will recover after 1–4 years. Many patients turn to acupuncture in order to alleviate the FS symptoms. Objective. In this review, we will investigate the efficiency of acupuncture as a FS treatment. Methods. A literature search of acupuncture and FS-related keywords was performed in the following databases: PubMed, Cochrane Library, Embase, and Web of Science. Thirteen publications were included for a systematic review, and a meta-analysis was done using the following measurements: visual analogue scale (VAS) for pain, Constant-Murley Shoulder Outcome Score (CMS) for shoulder function, and active shoulder ROM including flexion, abduction, and external rotation. The Cochrane Collaboration’s risk of bias tool and quality of evidence GRADE recommendations and STRICTA 2010 were used to grade the included publications. Results. A meta-analysis on VAS pain score showed significant pain reduction, restoring CMS shoulder function, and flexion ROM in favor of acupuncture versus the control. In external rotation and abduction ROM, a meta-analysis was not significant. The most used acupoints are Jian Yu (LI15) and Jian Liao (TB14). Conclusions. The results indicate that acupuncture could be safe and effective for pain reduction, restoring shoulder function, and restoring flexion ROM for FS patients in the short term and midterm. However, the level of evidence was very low. More high-quality and longer studies are needed in order to robust the evidence.

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

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

The Use of a Synthetic Cartilage Implant for Hallux Rigidus: A Systematic Review

2020 ◽  
pp. 193864002093716
Author(s):  
Niall A. Smyth ◽  
Christopher D. Murawski ◽  
Charles P. Hannon ◽  
Jonathan R. Kaplan ◽  
Amiethab A. Aiyer
Keyword(s):  
Systematic Review ◽  
Polyvinyl Alcohol ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Hallux Rigidus ◽  
Great Toe ◽  
Systematic Review Methodology ◽  
Level Of Evidence ◽  
High Level

Background. Hallux rigidus is a common pathology afflicting the foot, for which various joint salvage techniques have been described with a multitude of different implants. Recently, a synthetic cartilage implant composed of polyvinyl alcohol (PVA) received FDA premarket approval for the treatment of arthritis of the great toe. The purpose of this study was to (1) systematically review the clinical evidence supporting the use of a PVA implant in hallux rigidus and (2) determine the strength of the recommendation that can be made supporting the use of a PVA implant by evaluating the quality of evidence available. Methods. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Using the terms “cartiva OR polyvinyl alcohol OR synthetic cartilage OR hemiarthroplasty AND hallux rigidus OR great toe arthritis OR first toe arthritis” we searched the PubMed/Medline database. The quality of the included studies was evaluated using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Results. Seven studies met the inclusion criteria, 6 of these were derived from a single randomized controlled trial. A moderate recommendation can be given for the use of a PVA implant for hallux rigidus based on short-term outcomes. A limited recommendation can be given for the use of a PVA implant for hallux rigidus based on mid-term outcomes. Conclusion. There are limited studies available detailing the outcomes of a PVA implant for hallux rigidus; however, the results that are available demonstrate a high level of evidence. Levels of Evidence: Level I: Systematic review

scholarly journals The Impact of Calcitriol on Orthodontic Tooth Movement: A Cumulative Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 (19) ◽  
pp. 8882
Author(s):  
Ali Al-Attar ◽  
Mushriq Abid ◽  
Arkadiusz Dziedzic ◽  
Mustafa M. Al-Khatieeb ◽  
Maisa Seppala ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sample Size ◽  
Tooth Movement ◽  
Meta Analysis ◽  
Mean Difference ◽  
Level Of Evidence ◽  
Inadequate Sample Size ◽  
Significant Difference ◽  
The Impact

A cumulative review with a systematic approach aimed to provide a comparison of studies’ investigating the possible impact of the active form of vitamin D3, calcitriol (CTL), on the tooth movement caused by orthodontic forces (OTM) by evaluating the quality of evidence, based on collating current data from animal model studies, in vivo cell culture studies, and human clinical trials. Methods: A strict systematic review protocol was applied following the application of the International Prospective Register of Systematic Reviews (PROSPERO). A structured search strategy, including main keywords, was defined during detailed search with the application of electronic database systems: Medline/Pubmed, EMBASE, Scopus, Web of Science, and PsycINFO. In addition, a search was carried out with the use of ClinicalTrials.gov search in order to include ongoing or recently completed trials. The Oxford Level of Evidence and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was utilized to critically evaluate the risk of bias and relative quality of studies included. Meta-analysis with the use of RevMan5 software, random effect, and inverted variable method allowed the quantification of cumulative results. Results: Twenty-seven studies were identified which fulfilled inclusion criteria, including two clinical studies. The assessed level of evidence was variable and inconsistent, predominantly being moderate or low due to a significant difference in study design, sample size, and study protocols. Data synthesis rendered from meta-analysis involving various CTL doses demonstrated slight discrepancies in tooth movement between control and experimental groups (mean difference = 0.27; 95% CI: 0.01–0.53, std mean difference = 0.49; 95% CI: 0.09–0.89), as well as relatively moderate heterogenicity. Conclusions: Although it has been suggested that CTL could accelerate OTM in animal studies and clinical context, these scarce data were supported by a low level of evidence and the studies were carried out using inadequate sample size. Well-powered RCT studies would help to overcome the lack of robustness of the research.

Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis of Complication Rates With Best- and Worst-Case Analyses for Rerupture Rates

2021 ◽  
pp. 036354652199828
Author(s):  
Dexter Seow ◽  
Youichi Yasui ◽  
James D.F. Calder ◽  
John G. Kennedy ◽  
Christopher J. Pearce
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Meta Analysis ◽  
Treatment Options ◽  
Nonsurgical Treatment ◽  
Case Scenario ◽  
Level Of Evidence ◽  
Worst Case

Background: An acute Achilles tendon rupture (AATR) is a common injury. The controversy that has surrounded the optimal treatment options for AATRs warrants an updated meta-analysis that is comprehensive, accounts for loss to follow-up, and utilizes the now greater number of available studies for data pooling. Purpose: To meta-analyze the rates of all complications after the treatment of AATRs with a “best-case scenario” and “worst-case scenario” analysis for rerupture rates that assumes that all patients lost to follow-up did not or did experience a rerupture, respectively. Study Design: Systematic review and meta-analysis; Level of evidence, 1. Methods: Two authors performed a systematic review of the PubMed and Embase databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on February 17, 2020. The included studies were assessed in terms of the level of evidence, quality of evidence, and quality of the literature. A meta-analysis by fixed-effects models was performed if heterogeneity was low ( I2 < 25%) and by random-effects models if heterogeneity was moderate to high ( I2≥ 25%). Results: Surgical treatment was significantly favored over nonsurgical treatment for reruptures. Nonsurgical treatment was significantly favored over surgical treatment for complications other than reruptures, notably infections. Minimally invasive surgery was significantly favored over open repair for complications other than reruptures (no difference for reruptures), in particular for minor complications. Conclusion: This meta-analysis demonstrated that surgical treatment was superior to nonsurgical treatment in terms of reruptures. However, the number needed to treat analysis produced nonmeaningful values for all treatment options, except for surgical versus nonsurgical treatment and minimally invasive surgery versus open repair. No single treatment option was revealed to be profoundly favorable with respect to every complication. The results of this meta-analysis can guide clinicians and patients in their treatment decisions that should be made jointly and on a case-by-case basis.

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