scholarly journals BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI)

2019 ◽  
Vol 27 (4) ◽  
pp. 230-236 ◽  
Author(s):  
Gustavo Constantino de Campos ◽  
Eduardo Branco de Sousa ◽  
Paulo César Hamdan ◽  
Cyro Scala de Almeida Júnior ◽  
Antonio Martins Tieppo ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Sports Medicine ◽  
Consensus Statement ◽  
Relevant Literature ◽  
Cost Effective ◽  
Academic Experience ◽  
Level Of Evidence ◽  
Key Aspects ◽  
Level Of Agreement ◽  
Reference Document

ABSTRACT Objective: The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods: A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. Conclusion: This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.

scholarly journals Orthobiologics and hyaluronic acid usage in the Netherlands: an electronic survey of 265 orthopaedic surgeons and sports physicians

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
J. J. de Graeff ◽  
M. P. J. van den Bekerom ◽  
B. L. van Meer ◽  
J. A. C. Zijl ◽  
Keyword(s):  
Hyaluronic Acid ◽  
The Netherlands ◽  
Sports Medicine ◽  
Online Survey ◽  
Platelet Rich Plasma ◽  
Scientific Evidence ◽  
Insurance Coverage ◽  
Lateral Epicondylitis ◽  
Level Of Evidence ◽  
Sport Physician

Abstract Purpose “Biologic therapies” in the field of orthopaedic surgery and sports medicine, so called orthobiologics, have been gaining significant interest from physicians and patients, with increasing usage over the recent years. The aim of this study is to (1) evaluate the usage of orthobiologics in the Netherlands, (2) to clarify the reasons for the use or non-use of orthobiologics, and (3) the most addressed disease for use of orthobiologics. Methods The authors created a 19-quenstion online survey comprised of both closed-ended and open-ended response questions in order to examine the use of and the indication for orthobiologics. The survey was sent to all the members of the Dutch Orthopaedic Association and Netherlands Association of Sports Medicine of which 15% responded. Results The majority of the 265 respondents (65%) did not treat patients with or refer patients for treatment with orthobiologics. The most important reasons for not using orthobiologics were the lack of scientific evidence, the lack of good experience, and the lack of insurance coverage. Of the physicians that used orthobiologics, the most used hyaluronic acid (76%) and platelet-rich plasma (27%). Orthobiologics were most used for knee osteoarthritis and medial or lateral epicondylitis. Conclusion Although some orthobiologic treatments might be effective and the research interest is growing, our study shows that the majority of orthopaedic and sport physician clinicians in the Netherlands still does not make use of orthobiologics as a treatment option, but almost a third of them is contemplating to start using orthobiologics. Level of evidence III.

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

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.

A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy

2021 ◽  
pp. 000348942110189
Author(s):  
Gani Atilla Şengör ◽  
Ahmet Mert Bilgili
Keyword(s):  
Salivary Gland ◽  
Success Rate ◽  
Cost Effective ◽  
Complete Removal ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Pneumatic Lithotripsy ◽  
Novel Approach ◽  
Surgical Methods ◽  
Salivary Gland Stones

Objective: The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. Materials and Methods: The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. Results: Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. Conclusions: We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients’ concerns. Level of Evidence: Level IV

scholarly journals Hyaluronic acid injections in post-enucleation or evisceration socket syndrome: a case series

2021 ◽  
Author(s):  
Renata Migliardi ◽  
Alessandra Modugno ◽  
Fabrizio Chirico ◽  
Nicola Zerbinati ◽  
Giovanni Francesco Nicoletti ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Case Series ◽  
Outpatient Setting ◽  
Level Of Evidence ◽  
Upper Eyelid ◽  
Filler Injection ◽  
Tear Trough Deformity ◽  
Vasovagal Response ◽  
Superior Sulcus ◽  
Therapeutic Study

Abstract Background One of the primary goals of enucleation and evisceration surgery is the restoration of an adequate orbital volume through the use of appropriately sized alloplastic or autogenous tissues. In patients inadequately treated, post-enucleation or evisceration socket syndrome occurs. Fillers are an ideal alternative for eyelid and eyebrow arcade volume enhancement since their injection is easily performed in an outpatient setting avoiding several complications. The aim of this study is to report the use of hyaluronic acid (HA) fillers to treat volume deficits of the upper and lower eyelids, projecting the brow arcade and reducing the asymmetry. Methods Thirteen patients (2 male, 11 female, mean age 32.7 years) were treated from June 2012 to May 2020. Non-surgical treatment by HA filler injection for aesthetic rehabilitation of deep superior sulcus, inferior tear trough deformity, and scleral show was performed. Results No complications as orbital-ache and/or vasovagal response were reported during the injections. Minor complications such as light swelling at the site of injection, self-resolved within 2 days, were recorded. Stable results were observed at follow-ups. In two cases, two successive treatments were required at 3 and 6 years from the first injection. Conclusions Hyaluronic acid fillers offer a versatile and safe method for replacing soft tissue lost from the upper eyelid/brow complex in cases of post-enucleation or evisceration socket syndrome. Level of evidence: Level IV, therapeutic study.

scholarly journals Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097434
Author(s):  
Daniel F. O’Brien ◽  
Lilah Fones ◽  
Victoria Stoj ◽  
Cory Edgar ◽  
Katherine Coyner ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Case Series ◽  
Graft Fixation ◽  
Level Of Evidence ◽  
Lateral Cortex ◽  
Suture Button ◽  
Suspensory Fixation

Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

scholarly journals Cost-of-illness for non-underweight binge-eating disorders

2021 ◽  
Author(s):  
Paul E. Jenkins
Keyword(s):  
Eating Disorders ◽  
Binge Eating ◽  
Economic Impact ◽  
Indirect Costs ◽  
Cost Effective ◽  
Level Of Evidence ◽  
Academic Impairment ◽  
The United Kingdom ◽  
Binge Eating Disorders ◽  
Low Weight

Abstract Purpose This study examined economic costs associated with untreated eating disorders (EDs) characterised by regular binge eating in the absence of low weight. Both direct and indirect costs were assessed, reporting a limited societal perspective of economic impact as some costs were not included. Methods One hundred and twenty six adults seeking treatment for recurrent binge eating were asked to report impairment associated with an ED. Costs were calculated using 2017 prices, including an examination of variables associated with costs. Results Estimated societal costs for the year preceding assessment were £3268.47 (€3758.54) per person. In multivariate analyses, no reliable baseline associates of cost were identified. Conclusion The economic burden of EDs characterised by regular binge eating is significant, and underscores the need for efficacious and cost-effective treatments. Individuals with binge-eating disorders report work impairment and healthcare use that may cost the United Kingdom economy upwards of £3.5 billion (€4bn) per annum. Further studies should consider academic impairment and the economic impact of EDs on families. Level of evidence III: evidence obtained from well-designed cohort or case–control analytic studies.

scholarly journals Contributions of PCSS, CISS, and VOMS for Identifying Vestibular/Ocular Motor Deficits in Pediatric Concussions

2021 ◽  
pp. 194173812199411
Author(s):  
Rishi D. Patel ◽  
Cynthia R. LaBella
Keyword(s):  
Sports Medicine ◽  
Tertiary Care ◽  
Motor Dysfunction ◽  
Motor Deficits ◽  
Ocular Motor ◽  
Symptom Scale ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Visual Problems ◽  
Clinical Tools

Background: Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS). Hypothesis: Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone. Study Design: Cross-sectional data from a prospective cohort study. Level of Evidence: Level 4. Methods: Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson’s correlations, and logistic regressions were used to describe relationships between clinical tools. Results: Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported “visual problems” on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported “visual problems” on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). “Visual problems” on PCSS did not predict abnormal CISS or VOMS. Conclusions: Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together. Clinical Relevance: These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.

An Artificial Intelligence Tool for Image Simulation in Rhinoplasty

2021 ◽  
Author(s):  
Hernan Chinsk ◽  
Ricardo Lerch ◽  
Damián Tournour ◽  
Luis Chinski ◽  
Diego Caruso
Keyword(s):  
Artificial Intelligence ◽  
Survey Study ◽  
P Value ◽  
Cross Sectional Survey ◽  
Simulated Image ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Partial Agreement ◽  
Aesthetic Rhinoplasty ◽  
Level Of Agreement

AbstractDuring rhinoplasty consultations, surgeons typically create a computer simulation of the expected result. An artificial intelligence model (AIM) can learn a surgeon's style and criteria and generate the simulation automatically. The objective of this study is to determine if an AIM is capable of imitating a surgeon's criteria to generate simulated images of an aesthetic rhinoplasty surgery. This is a cross-sectional survey study of resident and specialist doctors in otolaryngology conducted in the month of November 2019 during a rhinoplasty conference. Sequential images of rhinoplasty simulations created by a surgeon and by an AIM were shown at random. Participants used a seven-point Likert scale to evaluate their level of agreement with the simulation images they were shown, with 1 indicating total disagreement and 7 total agreement. Ninety-seven of 122 doctors agreed to participate in the survey. The median level of agreement between the participant and the surgeon was 6 (interquartile range or IQR 5–7); between the participant and the AIM it was 5 (IQR 4–6), p-value < 0.0001. The evaluators were in total or partial agreement with the results of the AIM's simulation 68.4% of the time (95% confidence interval or CI 64.9–71.7). They were in total or partial agreement with the surgeon's simulation 77.3% of the time (95% CI 74.2–80.3). An AIM can emulate a surgeon's aesthetic criteria to generate a computer-simulated image of rhinoplasty. This can allow patients to have a realistic approximation of the possible results of a rhinoplasty ahead of an in-person consultation. The level of evidence of the study is 4.

scholarly journals Systematic review of the factors affecting cat and dog owner compliance with pharmaceutical treatment recommendations

2018 ◽  
Vol 184 (5) ◽  
pp. 154-154 ◽  
Author(s):  
Kathryn Jennifer Wareham ◽  
Marnie Louise Brennan ◽  
Rachel S Dean
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Relevant Literature ◽  
Evidence Base ◽  
Treatment Recommendations ◽  
Social Risk ◽  
Dosing Regimen ◽  
Pharmaceutical Treatment ◽  
Level Of Evidence ◽  
Factors Affecting

The aim of this systematic review is to describe and assess the quality of the existing evidence base concerning factors that influence the compliance of cat and dog owners to pharmaceutical and specifically polypharmacy treatment recommendations. PubMed, CAB Abstracts and Google were searched to identify relevant literature and search results were filtered according to predetermined inclusion and exclusion criteria. Standardised data extraction and critical appraisal were carried out on each included study, and a Centre for Evidence-Based Medicine level of evidence grading was applied. Of the 8589 studies, eight studies were included in the review. Majority (five of eight) of the included studies were examining compliance with short-term antimicrobial therapies and none examined polypharmacy. Multiple definitions of compliance, methods of measurement and different factors potentially affecting compliance were used. Factors reported to have affected compliance in at least one study were dosing regimen, discussion of dosing regimen in light of owners’ circumstances, consultation time, disease, month of consultation/treatment, physical risk, social risk and method of administration. The evidence available regarding factors affecting client compliance with pharmaceutical treatment recommendations in cats and dogs is scarce and of poor quality.

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