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Synopsis: 29 studies were included in this meta-analysis comparing operative and non-operative treatment for acute Achilles tendon ruptures.The primary outcome of interest was the rate of re-rupture.Secondary outcomes included the rate of complications, functional outcomes, time to return to sports and time to return to work.The results revealed a significantly lower rate of re-rupture, but a higher rate of complications, in the operative group compared to the non-operative group.Similar findings to the primary analyses were observed in the sensitivity analyses based on early and late weight bearing status, high quality studies and studies conducted after the year 2000.There were no significant differences in re-rupture rate in studies utilizing accelerated functional rehabilitation. There was no... Read More »
Level 1 Meta Analysis
5%
Synopsis: 7 studies containing 395 patients with knee osteoarthritis were included in this systematic review and meta-analysis comparing laser acupuncture treatment to sham laser acupuncture for the relief of pain and improvement of function and quality of life.Outcomes of interest included pain on a Visual Analog Scale (VAS), the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis pain, function and stiffness scores, and quality of life questionnaire scores.Outcomes were analyzed at short-term (2 months post-treatment) and long-term (1 year post-treatment) follow ups.Results revealed significantly favourable VAS pain scores at short-term follow up in the laser acupuncture group compared to the sham group. All remaining pooled... Read More »
Level 2 Meta Analysis
4%
Synopsis: Five randomized controlled trials were included in this meta-analysis which sought to investigate the efficacy of mesenchymal stem cell injections in patients with knee osteoarthritis.Included studies featured various control groups, including placebo injection, hyaluronic acid injection, and no injection, as well as various concomitant treatments, including high tibial osteotomy, microfracture, platelet rich plasma injection and hyaluronic acid injection.Accordingly, clinical heterogeneity was assumed.Data was pooled from 12-24 month time points. Analyses on visual... Read More »
Level 2 Meta Analysis
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Synopsis: 72 patients with knee osteoarthritis were randomized to intraarticular injection with either 40mg methylprednisolone or 30m ketorolac.Patients were assessed for improvement over 6-week follow-up in numeric rating scale (NRS) pain scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Oxford Knee Score (OKS).Results demonstrated significant significant within-group improvement in both groups for NRS pain score and WOMAC scores. However, for OKS... Read More »
Conference Report
4%
Synopsis: Femoral neck fractures, a type of hip fracture, are a common and disabling injury, particularly given an ageing population in many countries.Throughout the past half-century, multiple different treatments have evolved for the treatment of these fractures, and these include sliding hip screws, cannulated screws, hemiarthroplasty (HA), and total hip arthroplasty (THA).Given that femoral neck fractures have the potential to compromise blood flow to the femoral head, arthroplasty options have gained prominence in recent years.However, it remains unclear which of the two options (THA or HA) is optimal in this population.Thus, in this definitive, landmark randomized controlled trial, which is by far the largest of its kind to date, the investigators randomized 1495 patients 50 years of age older with a displaced femoral neck fracture to undergo HA or THA.The trial was conducted across 80 centres in 10 different countries.Primary outcome was a secondary hip procedure within 24 months.Secondary endpoints included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health.There was no significant difference between the two groups in terms of revision rate, mortality, serious adverse events, revision procedures, EQ-5D, timed up and go test, or Short-Form 12 scores.There was a trend toward higher dislocation rates in THA, though this was not statistically significant.There was a significant difference in favour of THA on the WOMAC total and sub-scores, though this difference fell below the minimal clinically important threshold.Overall, in the absence of a convincing indication for THA, HA is a comparable treatment for femoral neck fracture which does not result in a significant difference in revision rate.There may be a slightly higher rate of serious adverse events with THA, and slightly better function with THA, though these differences may not reach clinical significance. Read More »
Level 1 RCT
4%
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
3%
Synopsis: 103 patients with fibular fractures proximal to an associated syndesmosis injury were randomized to receive internal reduction and fixation with either a knotless TightRope device or screw fixation.Outcomes of interest included radiographic outcomes, the Foot and Ankle Disability Index (FADI), the EQ-5D quality of life questionnaire, the Olerud-Molander (OM) Ankle score, the rate of unplanned re-operation, the rate of malreduction, and the Work Productivity and Impairment (WPAI) score.Follow up was performed at 3 months post-operation for radiographic outcomes, and up to 12 months for clinical outcomes.Results revealed significantly lower rates of unplanned re-operation and lower rates of malreduction in the TightRope group compared to the screw fixation group.Additionally, patients in the TightRope group had a significantly favourable WPAI daily activity rating at 6 weeks compared to the screw fixation group, although total scores were not significantly different. No significant differences... Read More »
Level 2 RCT
3%
Synopsis: 39 patients with distal radius fractures undergoing open reduction and internal fixation (ORIF) with a volar locking plate were randomized to receive 2 weeks of post-operative immobilization with a plaster splint or no immobilization.The primary outcome of interest was pain as measured on a Visual Analog Scale.Secondary outcomes included tramadol (opioid) use, DASH score, range of motion (wrist flexion-extension; forearm rotation), patient satisfaction, wrist edema and incidence of complications.Follow up was performed up to 6 months. The results from... Read More »
Level 2 RCT
3%
Synopsis: 220 patients with isolated pertrochanteric femoral fractures were randomized to receive surgical intervention with a short or long cephalomedullary nail.Primary outcomes of interest included the Short Form 36 (SF-36) questionnaire and the Harris Hip Score.Secondary outcomes of interest included implant failure, peri-implant failure, mortality, operative time, estimated blood loss and the incidence of re-operation.Outcomes were assessed up to 12 months post-operation.Results revealed significantly favourable 3 month Harris Hip scores, lower operative time and lower estimated blood loss in the short nail group compared to the long nail group. No significant differences... Read More »
Level 2 RCT
2%
Synopsis: 329 patients with an operative extremity fracture, or pelvic and/or acetabular fracture and required thromboprophylaxis were randomized to either low molecular weight heparin 30mg twice daily or aspirin 81mg twice daily for 90 days.Patients were followed up for bleeding events and venous thromboembolic complications.Results demonstrated no significant differences between groups in rates of either bleeding events, pulmonary embolism, or deep vein thrombosis. However, in subgroup... Read More »
Conference Report