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Synopsis: A non-inferiority trial including 356 patients presenting to a general practitioner with traumatic knee complaints were randomized to receive immediate referral for magnetic resonance imaging (MRI) or usual protocol directed by the guidelines provided by the Dutch college of general practitioners.The primary outcome of interest was the Lysholm knee score.Secondary outcomes of interest included the EQ-5D quality of life questionnaire, the Knee Injury and Osteoarthritis Outcome Scale (KOOS), pain on a numeric rating scale (NRS), as well as patient perceived recovery and satisfaction.Follow up was performed at 6 weeks, 3, 6, 9 and 12 months. Results found no... Read More »
Level 2 RCT
4%
Synopsis: The use of anticoagulants for lower limb outpatient procedures such as knee arthroscopy is varied, and questions remain.The authors performed a meta-analysis of nine randomized controlled trials. The interventions included low molecular weight heparin (LMWH), Rivaroxaban, and acetylsalicylic acid (ASA), and comparators included no treatment, placebo, and compression stockings.A total of 4290 patients were included.Overall, they found no significant difference between pharmacologic interventions and controls in terms of symptomatic venous thromboembolism (excluding distal deep vein thrombosis (DVT)).There were significantly fewer symptomatic distal DVTs in the treatment group. Overall, the authors... Read More »
Level 1 Meta Analysis
3%
Synopsis: 116 patients with a chronic anterior cruciate ligament (ACL) rupture and scheduled for an arthroscopic ACL reconstruction were randomized to receive preparation of the femoral tunnel via an anteromedial technique or a transtibial technique.Outcomes of interest included anatomical outcomes, bio-mechanical outcomes, the International Knee Documentation Committee (IKDC) subjective score, the Lysholm score, and incidence of graft failure.Follow up was performed up to 2 years post-operation.Results from this study found no significant differences between the anteromedial and transtibial groups in the IKDC subjective score and Lysholm score.Femoral tunnel length and graft angulation in the sagittal and coronal planes were significantly smaller in the anteromedial group compared to the transtibial groups.Absolute improvement in internal rotation was significantly greater in the anteromedial group compared to the transtibial group. The incidence of... Read More »
Level 2 RCT
3%
Synopsis: Paediatric flexible flatfoot is a very common condition which tends to improve over time in many children.During the period of its persistence, however, it can be quite painful and debilitating.The authors randomized patients to receive a customized arch support for 12 weeks or control (no insoles).Outcomes included radiographic outcomes, pain, function, stair ascent time, and overall mobility. Patients with customized... Read More »
Level 1 RCT
3%
Synopsis: 9 studies were included in this meta-analysis comparing computer-navigated and conventional TKA with regards to radiological, long-term function and survivorship outcomes.Outcomes of interest included the outlier rate of coronal and sagittal alignment of the femoral and tibial components, the outlier rate of lower extremity alignment, range of motion, the Knee Society Score (KSS), the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, revision rate and rate of aseptic loosening.Results found significantly lower outlier rates of sagittal alignment of the femoral component and coronal alignment of the tibial component in the computer-navigated TKA group compared to the conventional TKA group. No significant differences... Read More »
Level 1 Meta Analysis
2%
Synopsis: Previous studies have established the success of non-operative treatment following Achilles tendon rupture.37/60 patients were analyzed in this follow-up study comparing an early weight-bearing protocol to standard weight-bearing protocol during dynamic rehabilitative treatment of acute Achilles tendon ruptures.The primary outcome of interest was the Achilles Tendon Rupture Score (ATRS).Secondary outcomes of interest included heel raise height and work, as well as the return to level (heavy, light but active, sedentary) of work and sporting, and the incidence of re-rupture.Follow up was performed at 4.5 years post-operation.At 4.5 years, there were no significant differences between the early weight-bearing and usual care groups in ATRS score, heel raise height or heel raise work.All 37 patients had return to some level of work by the 4.5 year follow up, and 33/37 patients had returned to some level of sporting activity. Three cases of... Read More »
Level 2 RCT
2%
Synopsis: 53 polytraumatic patients were randomized to receive surgical rib fixation or conservative treatment for the treatment of flail chest.Outcomes of interest included length of stay outcomes, the incidence of adverse events, mechanical ventilation, and pain at rest, during coughing and during deep breathing. Study results revealed... Read More »
Level 2 RCT
1%
Synopsis: 54 patients with chronic midportion Achilles tendinopathy undergoing an eccentric exercise programme were randomized to receive either a platelet-rich plasma (PRP) injection or a saline injection (placebo), in order to determine whether PRP injections would result in enhanced tendon structure and neovascularisation that could be observed through ultrasonographic methods. Following evaluations over a 24 week period, the results indicated that no significant differences existed in neovascularisation scores between groups and that PRP injections did not contribute to improved tendon structure. Read More »
Author verified Level 1 RCT
1%
Synopsis: 48 single or double blinded, prospective, randomized control trails that used human subjects and compared the therapeutic effects of intra-articular hyaluronic acid with intra-articular injection of a placebo to treat osteoarthritis of the knee were analyzed to determine if the qualitative conclusions by authors about the therapeutic effects of hyaluronic acid was affected by industry sponsorship or financial conflicts of interest. Results of the systematic review indicated that industry funding may have an effect on the conclusions provided within the study and that clinicians should be aware of potential financial conflicts of interest in authors reporting on the topic of intra-articular injection of hyaluronic acid for treatment of knee OA. Read More »
Level 2 Meta Analysis
1%
Synopsis: 99 patients with a partial-thickness rotator cuff tear or rotator cuff tendinopathy were randomized to injection therapy with either a platelet rich plasma injection or corticosteroid injection.Patients were assessed for outcome on a visual analog scale for pain, the Western Ontario Rotator Cuff Index, the American Shoulder and Elbow Surgeons (ASES) score, and incidence of patients who progressed to operative treatment. Results demonstrated significantly... Read More »
Conference Report