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Synopsis: 20 patients with a clinical diagnosis of mid-substance Achilles tendinopathy were randomized to compare the efficacy of two nonoperative interventions: platelet-rich plasma (PRP) injections and an eccentric loading programme.Patients were evaluated over 6 months with the VISA-A questionnaire and the EuroQol 5-Dimension questionnaire (EQ-5D).The evidence presented in this study indicated that VISA-A score was better in the platelet-rich plasma (PRP) injection group compared to eccentric loading programme group, but this difference was not significant.Furthermore, no significant differences between groups were observed for the EQ-5D between groups, and no complications were associated with either treatment. This evidence demonstrates... Read More »
Level 2 RCT
3%
Synopsis: 7 studies were included in this meta-analysis comparing exercise-based rehabilitation plus usual care to usual care alone for the prevention of re-injury following acute ankle sprain.EMBASE, the Cochrane Library, and MEDLINE were searched from inception to January 2017. Results revealed no... Read More »
Level 2 Meta Analysis
3%
Synopsis: 8 ACE Reports (all randomized controlled trials) from the OrthoEvidence database were included in this review/meta-analysis examining the effect of arthroscopic surgery and physical therapy in the treatment of degenerative tears of the meniscus and knee osteoarthritis.The purpose of this review was to determine if any differences in outcome were demonstrated between arthroscopy followed by physical therapy versus physical therapy alone, regarding pain, function, satisfaction, adverse events, or osteoarthritis progression.Pain results were pooled at 3 different time point: 2-3 months, 6 months, and 12-24 months postintervention.At short-term (2-3 months) and long-term (12-24 months) follow-up, pain was similar between groups, with no significant difference observed.There tended to be less pain experienced at 6 months following arthroscopy, however this only reached significance in the KOOS pain outcome and the clinical importance of this observation is unknown.Assessments of functional outcome, either pooled or qualitative, suggested no significant difference between groups as well. The rate of... Read More »
ACE Review
3%
Synopsis: 70 patients with plantar fasciopathy were randomized to receive a self-dosed or pre-determined heavy-slow resistance exercise treatment program.The primary outcome of interest was the Foot Health Status Questionnaire (FHSQ) pain score.Secondary outcomes of interest included FHSQ function, footwear, and general health scores, the Global Rating of Change, plantar fascia thickness, exercise compliance, the Pain Self-Efficacy Questionnaire, the Patient Acceptable Symptom State, and the International Physical Activity Questionnaire (IPAQ, short version).Follow up was performed at 4 and 12 weeks post-operation. Results revealed no... Read More »
Level 2 RCT
2%
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
2%
Synopsis: 14 randomized controlled trials were included in this meta-analysis which sought to investigate the impact of autologous bone marrow-derived mesenchymal stem cell (MSC) administration alongside core decompression on outcomes in treatment of patients with osteonecrosis of the femoral head. Pooled analyses of pain scores from 6 months to 2 years, function from 1 to 2 years, and incidence of eventual total hip arthroplasty, ranging from 1 to 5 years in the same analysis, all significantly favoured MSC groups compared to control groups. Read More »
Level 1 Meta Analysis
1%
Synopsis: 50 patients with acute compartment syndrome stemming from leg fracture and/or blunt injury undergoing leg fasciotomy were randomized to wound closure through either vacuum-assisted closure (VAC) or the shoelace technique.This study aimed to compare wound outcome, time to closure, and complications between these treatments.Results indicated significantly shorter time to wound closure, and significantly lower daily costs with the shoelace technique compared to VAC. Fasciotomy wound length... Read More »
Level 2 RCT
1%
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
1%
Synopsis: 53 patients scheduled for a unilateral total knee replacement under spinal anesthesia were randomized to receive local infiltration analgesia with levobupivacaine and adrenaline, or intrathecal preservative-free morphine in conjunction with the spinal anesthesia.The primary outcomes of interest were pain scores at 24 hours at rest and on passive flexion to 30deg, measured on a Visual Analog Scale (VAS).Secondary outcomes of interest included VAS pain scores at rest and during motion, morphine consumption, maximum active flexion, maximum active straight leg raise, the incidence of opioid-related adverse events, and patient satisfaction with analgesia and the overall experience.Follow up was performed up to 48 hours post-operation.Results revealed significantly favourable VAS pain at rest and during passive flexion in the LIA group compared to the morphine group at 24 hours post-operation.Additionally, pain scores during movement were significantly in favour of the LIA group at both 24 and 48 hours.There were no significant differences in maximum active flexion or maximum active straight leg raise, morphine consumption, or patient satisfaction with analgesia.The incidence of nausea and pruritus were significantly lower in the LIA group. Patient satisfaction with... Read More »
Level 2 RCT
1%
Synopsis: 147 patients scheduled for a primary total knee arthroplasty for arthritis were randomized to receive the same cruciate-retaining implant with either cemented fixation or cementless, biological fixation.The primary outcome of interest was the Oxford Knee Score (OKS).Secondary outcomes of interest included the Knee Society Score (KSS), the Forgotten Joint Score (FJS), the percentage of normal knee function, overall health rating, satisfaction with overall function, radiographic outcomes, the incidence of of failure or component subsidence, and the incidence of revision.Follow up was performed at 4-6 weeks, 1 year and 2 years post-operation.Results revealed no significant differences in OKS, KSS, FJS, or the percentage of normal knee function between the two groups at all time points.There were no significant differences in overall health rating or the satisfaction with overall function at 2 years.No cases of failure or component subsidence were reported.1 case of revision was reported in the cemented group. The mean thicknesses... Read More »
Level 2 RCT