Conservative Treatment of Chronic Achilles Tendinopathy: A Systematic Review

Achilles tendinopathy is a common musculoskeletal disorder. Athletes, runners and jumpers, and the sedentary are frequently affected. Numerous are the therapeutic choices to manage these kinds of disorders. The aim of this review is to analyze the available literature to document the up-to-date evidence on conservative management of Achilles tendinopathy. A systematic review of two medical electronic databases was performed by three independent authors, using the following inclusion criteria: conservative treatment consisted of pharmacologic, physical therapy without operative treatment, with more of 6 months symptoms and a minimum average of 6-months follow-up. Studies of any level of evidence, reporting clinical results, and dealing with Achilles tendinopathy and conservative treatment were searched for. A total of n = 1228 articles were found. At the end of the first screening, following the previously described selection criteria, we selected n = 94 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 29 articles. Achilles tendinopathy is a frequent musculoskeletal disorder and several conservative treatments have been proposed, but no therapy is universally accepted, except for eccentric exercise training, which is the gold standard and a commonly used protocol.

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Extracorporeal Shockwave Therapy Treatment in Upper Limb Diseases: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm9020453 ◽

2020 ◽

Vol 9 (2) ◽

pp. 453 ◽

Cited By ~ 4

Author(s):

Gianluca Testa ◽

Andrea Vescio ◽

Stefano Perez ◽

Alberto Consoli ◽

Luciano Costarella ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Upper Limb ◽

Full Text ◽

High Energy ◽

Reference List ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Text Reading

Background: Rotator cuff tendinopathy (RCT), subacromial impingement (SAIS), and medial (MEP) and lateral (LEP) epicondylitis are the most common causes of upper limb pain caused by microtrauma and degeneration. There are several therapeutic choices to manage these disorders: extracorporeal shockwave therapy (ESWT) has become a valuable option. Methods: A systematic review of two electronic medical databases was performed by two independent authors, using the following inclusion criteria: RCT, SAIS, MEP, and LEP, ESWT therapy without surgical treatment, with symptoms duration more than 2 months, and at least 6 months of follow-up. Studies of any level of evidence, reporting clinical results, and dealing with ESWT therapy and RCT, SAIS, MEP, and LEP were included. Results: A total of 822 articles were found. At the end of the first screening, following the previously described selection criteria, we selected 186 articles eligible for full-text reading. Ultimately, after full-text reading, and reference list check, we selected 26 articles following previously written criteria. Conclusions: ESWT is a safe and effective treatment of soft tissue diseases of the upper limbs. Even in the minority cases when unsatisfied results were recorded, high energy shockwaves were nevertheless suggested in prevision of surgical treatment.

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Diagnosis, Treatment and Prevention of Sarcopenia in Hip Fractured Patients: Where We Are and Where We Are Going: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm9092997 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2997

Author(s):

Gianluca Testa ◽

Andrea Vescio ◽

Danilo Zuccalà ◽

Vincenzo Petrantoni ◽

Mirko Amico ◽

...

Keyword(s):

Systematic Review ◽

Hip Fracture ◽

Hip Fractures ◽

Full Text ◽

Treatment Strategies ◽

Reference List ◽

Welfare Policies ◽

Treatment And Prevention ◽

Care Models ◽

Text Reading

Background: Sarcopenia is defined as a progressive loss of muscle mass and muscle strength associated to increased adverse events, such as falls and hip fractures. The aim of this systematic review is to analyse diagnosis methods of sarcopenia in patients with hip fracture and evaluate prevention and treatment strategies described in literature. Methods: Three independent authors performed a systematic review of two electronic medical databases using the following inclusion criteria: Sarcopenia, hip fractures, diagnosis, treatment, and prevention with a minimum average of 6-months follow-up. Any evidence-level studies reporting clinical data and dealing with sarcopenia diagnosis, or the treatment and prevention in hip fracture-affected patients, were considered. Results: A total of 32 articles were found. After the first screening, we selected 19 articles eligible for full-text reading. Ultimately, following full-text reading, and checking of the reference list, seven articles were included. Conclusions: Sarcopenia diagnosis is challenging, as no standardized diagnostic and therapeutic protocols are present. The development of medical management programs is mandatory for good prevention. To ensure adequate resource provision, care models should be reviewed, and new welfare policies should be adopted in the future.

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Treatment of Complex Regional Pain Syndrome in Children and Adolescents: A Systematic Review

10.21203/rs.3.rs-28127/v1 ◽

2020 ◽

Author(s):

Andrea Vescio ◽

Gianluca Testa ◽

Annalisa Culmone ◽

Marco Sapienza ◽

Fabiana Valenti ◽

...

Keyword(s):

Systematic Review ◽

Complex Regional Pain Syndrome ◽

Full Text ◽

Behavioral Treatment ◽

Pain Syndrome ◽

Cognitive Behavioral ◽

Reference List ◽

Methodologic Quality ◽

Growing Age ◽

Text Reading

Abstract Background: Complex Regional Pain Syndrome (CRPS), as known as Reflex Sympathetic Dystrophy, is characterized by chronic, spontaneous and provoked pain of the distal extremities, whose severity is disproportionate to the triggering event. In growing age, CRPS affects most commonly women aged 5 to 17 years, with a maximum incidence peak around the 13th year of age. Among the orthopedics, diagnosis remains challenging, as well as, the treatment is still debated and multidisciplinary. The purpose of this systematic review is to analyze the available literature to provide an update on the latest evidence related to the treatment of CRPS in growing age. Methods: Three reviewers searched Pubmed and Web of Science databases from their date of inception to the 20th September 2019 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines.Data extraction was performed independently by 3 reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the the Newcastle-Ottawa Quality Assessment Scale Cohort Studies. Results:A total of n = 264 articles were found. At the end of the first screening, following the previously described selection criteria, we selected n = 103 articles eligible for full-text reading. Ultimately, after full-text reading and a reference list check, we selected n = 6. The articles focused on physical (PT), cognitive-behavioral (CBT) and pharmacological (PhT) treatments. The combination of PT+CBT is the most efficacy and suggested, but a commonly accepted protocol has been not developed. Despite the good patients outcome, several are the adverse events recorded in PT. Conclusions: Physical therapy in association with occupational, and cognitive behavioral treatment is the recommended option in the management of pediatric CPRS. Pharmacological therapy should be reserved for refractory and selected patients. The design and development of a standard protocol are strongly suggested.

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Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials

Clinical Rehabilitation ◽

10.1177/0269215520966694 ◽

2020 ◽

pp. 026921552096669 ◽

Cited By ~ 2

Author(s):

Robson Massi Bastos ◽

Jorge Geraldo de Carvalho Júnior ◽

Suellen Aline Martinez da Silva ◽

Shirley Ferreira Campos ◽

Matheus Vieira Rosa ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Conservative Treatment ◽

Femoroacetabular Impingement ◽

Methodological Quality ◽

Impingement Syndrome ◽

Level Of Evidence ◽

Femoroacetabular Impingement Syndrome ◽

Quality Evidence

Objective: To summarize the effects of surgical treatment compared to conservative treatment in femoroacetabular impingement syndrome in the short, medium, and long term. Study Design: Systematic review Methods: The following databases were searched on 14/09/2020: MEDLINE, EMBASE, CENTRAL, Web of Science, and PEDro. There were no date or language limits. The methodological quality assessment was performed using the PEDro scale and the quality of the evidence followed the GRADE recommendation. The outcomes pain, disability, and adverse effects were extracted. Results: Of 6264 initial studies, three met the full-text inclusion criteria. All studies were of good methodological quality. Follow up ranged from six months to two years, with 650 participants in total. The meta-analyses found no difference in disability between surgical versus conservative treatment, with a mean difference (MD) between groups of 3.91 points (95% CI –2.19 to 10.01) at six months, MD of 5.53 points (95% CI –3.11 to 14.16) at 12 months and 3.8 points (95% CI –6.0 to 13.6) at 24 months. The quality of the evidence (GRADE) varied from moderate to low across all comparisons. Conclusion: There is moderate-quality evidence that surgical treatment is not superior to conservative treatment for femoroacetabular impingement syndrome in the short term, and there is low-quality evidence that it is not superior in the medium term. Level of evidence: Therapy, level 1a. Registration number: PROSPERO CRD42019134118

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The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097347 ◽

2017 ◽

Vol 52 (6) ◽

pp. 387-407 ◽

Cited By ~ 33

Author(s):

Vasileios Korakakis ◽

Rodney Whiteley ◽

Alexander Tzavara ◽

Nikolaos Malliaropoulos

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Lower Limb ◽

Risk Of Bias ◽

Eccentric Training ◽

Level Of Evidence ◽

Extracorporeal Shockwave Therapy ◽

Low Level ◽

Shockwave Therapy

ObjectiveTo evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).DesignSystematic review.Eligibility criteriaRandomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.ResultsModerate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.ConclusionLow level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

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Timing of Arthrocentesis in the Management of Temporomandibular Disorders:A Systematic Review and Meta-analysis

10.20944/preprints202008.0155.v1 ◽

2020 ◽

Author(s):

Dion Tik Shun Li ◽

Natalie Sui Miu Wong ◽

Samantha Ka Yan Li ◽

Colman Patrick McGrath ◽

Yiu Yan Leung

Keyword(s):

Conservative Treatment ◽

Meta Analysis ◽

Mouth Opening ◽

Pain Reduction ◽

Clinical Results ◽

Computer Search ◽

Reference List ◽

Randomized Controlled ◽

Manual Search ◽

Meta Analyses

The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regards to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was done. Relevant articles were selected after 3 search rounds for final review based on 6 predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including 5 randomized controlled trials and 6 prospective clinical studies informed this review. The studies were divided into 3 groups based on the timing of arthrocentesis: 1). Arthrocentesis as the initial treatment, 2). Early arthrocentesis, and 3). Late arthrocentesis. Meta-analyses compared the efficacy of improvement in mouth opening and pain reduction in the 3 groups. The results were statistically significant and favoured early arthrocentesis, followed by late arthrocentesis in terms of both improvements in mouth opening and pain reduction. All 3 groups showed improvement in mouth opening and pain reduction. We conclude that early arthrocentesis may be able to produce the best clinical results, while arthrocentesis before attempting conservative treatment may produce less favourable outcomes.

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The Impact of Systematic Review Automation Tools on Methodological Quality and Time Taken to Complete Systematic Review Tasks: Case Study

JMIR Medical Education ◽

10.2196/24418 ◽

2021 ◽

Vol 7 (2) ◽

pp. e24418

Author(s):

Justin Clark ◽

Catherine McFarlane ◽

Gina Cleo ◽

Christiane Ishikawa Ramos ◽

Skye Marshall

Keyword(s):

Systematic Review ◽

Error Rate ◽

Full Text ◽

Methodological Quality ◽

Error Rates ◽

Level Of Evidence ◽

The Difference ◽

Time Required ◽

The Impact

Background Systematic reviews (SRs) are considered the highest level of evidence to answer research questions; however, they are time and resource intensive. Objective When comparing SR tasks done manually, using standard methods, versus those same SR tasks done using automated tools, (1) what is the difference in time to complete the SR task and (2) what is the impact on the error rate of the SR task? Methods A case study compared specific tasks done during the conduct of an SR on prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease. Two participants (manual team) conducted the SR using current methods, comprising a total of 16 tasks. Another two participants (automation team) conducted the tasks where a systematic review automation (SRA) tool was available, comprising of a total of six tasks. The time taken and error rate of the six tasks that were completed by both teams were compared. Results The approximate time for the manual team to produce a draft of the background, methods, and results sections of the SR was 126 hours. For the six tasks in which times were compared, the manual team spent 2493 minutes (42 hours) on the tasks, compared to 708 minutes (12 hours) spent by the automation team. The manual team had a higher error rate in two of the six tasks—regarding Task 5: Run the systematic search, the manual team made eight errors versus three errors made by the automation team; regarding Task 12: Assess the risk of bias, 25 assessments differed from a reference standard for the manual team compared to 20 differences for the automation team. The manual team had a lower error rate in one of the six tasks—regarding Task 6: Deduplicate search results, the manual team removed one unique study and missed zero duplicates versus the automation team who removed two unique studies and missed seven duplicates. Error rates were similar for the two remaining compared tasks—regarding Task 7: Screen the titles and abstracts and Task 9: Screen the full text, zero relevant studies were excluded by both teams. One task could not be compared between groups—Task 8: Find the full text. Conclusions For the majority of SR tasks where an SRA tool was used, the time required to complete that task was reduced for novice researchers while methodological quality was maintained.

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Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420968040 ◽

2020 ◽

Vol 46 (1) ◽

pp. 30-36

Author(s):

Michel E. H. Boeckstyns

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Internal Fixation ◽

Comparative Studies ◽

Closed Reduction ◽

Treatment Options ◽

Clinical Results ◽

Threshold Values ◽

Angulated Neck ◽

Angular Deformities

Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30° palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5° to 9° in three studies and 29° in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70° can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores <10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.

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The Value of Power Doppler Ultrasonography in Achilles Tendinopathy

The American Journal of Sports Medicine ◽

10.1177/0363546507303116 ◽

2007 ◽

Vol 35 (10) ◽

pp. 1696-1701 ◽

Cited By ~ 77

Author(s):

Robert-Jan de Vos ◽

Adam Weir ◽

Lodewijk P. J. Cobben ◽

Johannes L. Tol

Keyword(s):

Conservative Treatment ◽

Doppler Ultrasonography ◽

Power Doppler ◽

Achilles Tendinopathy ◽

Clinical Severity ◽

Power Doppler Ultrasonography ◽

Level Of Evidence ◽

Vas Score ◽

The Mean

Background Neovascularization, detected with power Doppler ultrasonography (PDU), is thought by some to play a central role in pathogenesis of Achilles tendinopathy. Hypothesis Power Doppler ultrasonography neovascularization score is correlated with clinical severity at baseline and after conservative treatment. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Seventy tendons from 58 patients with chronic midportion Achilles tendinopathy were included, and 63 symptomatic tendons were analyzed. All patients were prescribed a 12-week heavy-load eccentric training program and evaluated with PDU at baseline and 12 weeks. Patient satisfaction, Victorian Institute of Sports Assessment—Achilles (VISA-A) score, and mean visual analog scale (VAS) score were correlated with degree of neovascularization (5-grade scale). Results Of the 63 symptomatic tendons, baseline neovascularization scores were 23 grade 0 (37% no neovessels), 18 grade 1, 8 grade 2, 8 grade 3, and 6 grade 4 (63% neovascularization grades 1-4). At baseline, neovascularization was not significantly correlated with the mean VAS score (r = .19, P = .131) and VISA-A score (r = —.23, P = .074). At 12-week follow-up, the neovascularization score significantly correlated with the mean VAS score (r = .43, P < .001) and VISA-A score (r = —.46, P < .001). No significant differences were found in improvement of VISA-A score after treatment between patients with neovessels (grades 1-4) or without neovessels (grade 0) at baseline. Conclusion Sixty-three percent of the symptomatic tendons were found to have neovessels at baseline. There was no significant correlation between neovascularization score and clinical severity at baseline, but at follow-up, there was a significant correlation. Neovascularization at baseline did not predict clinical outcome after conservative treatment.

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Physeal Injuries of the Coracoid Process Are Closely Associated With Sports Activities: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120967914 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096791

Author(s):

Kiyohisa Ogawa ◽

Wataru Inokuchi ◽

Noboru Matsumura

Keyword(s):

Systematic Review ◽

Full Text ◽

Evaluation Method ◽

Patient Characteristics ◽

Coracoid Process ◽

Ossification Center ◽

Level Of Evidence ◽

Articular Fracture ◽

Physeal Injury ◽

Sports Activities

Background: Physeal injuries of the coracoid process are rare but may be increasing because of increased participation of youth in year-round sports. Purpose: To analyze reported physeal and apophyseal injuries of the coracoid process. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed and Scopus were searched using the terms scapula fracture and coracoid fracture. The inclusion criteria were English full-text articles describing coracoid fracture as well as articles that described patient characteristics and presented appropriate images. The exclusion criteria were descriptive cases without images as well as those lacking appropriate images. Citation tracking was conducted to find additional articles and full-text articles written in other languages. Articles were included if they reported physeal injury or judged to involve physeal injury based on the provided images. Results: Overall, 22 studies including 32 patients (29 males, 3 females) were identified. All but 2 patients were younger than 18 years of age, and 66% (21/32) had sustained injuries during or as a result of participation in sporting activities. The affected site was the physis at the base in 18 patients, an intra-articular fracture in the primary coracoid ossification center combined with the subcoracoid ossification center to form an intra-articular fracture in 5, the apophysis of the tip in 3, the apophysis of the angle in 5, and uncertain in 1. Eleven patients had concurrent acromioclavicular injuries. The injury was acute in 23 patients, chronic in 6, and traumatic nonunion in 3. Among 21 cases in which treatment methods and outcomes were described, 21% of the acute cases (4/19), and 2 of the 3 nonunions were surgically treated. Only 1 study used a widely accepted evaluation method. Follow-up periods ranged from 6 weeks to 2 years. Outcomes were generally excellent for nonoperative and operative treatment and without any serious complications. Conclusion: Coracoid physeal injuries occurred most commonly in patients aged 13 to 15 years of age (71%) and were usually sustained during or as a result of sports activities (66%). The most common injury site was the physis at its base. The cause of these injuries is probably severe or repeated traction of the attached muscles and ligaments. The majority of these injuries can be successfully treated nonoperatively.

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