JBJS ReviewsPub Date : 2024-09-19eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00096
Anthony N Baumann, Robert J Trager, Omkar S Anaspure, Lorena Floccari, Ying Li, Keith D Baldwin
{"title":"The Schroth Method for Pediatric Scoliosis: A Systematic and Critical Analysis Review.","authors":"Anthony N Baumann, Robert J Trager, Omkar S Anaspure, Lorena Floccari, Ying Li, Keith D Baldwin","doi":"10.2106/JBJS.RVW.24.00096","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00096","url":null,"abstract":"<p><strong>Background: </strong>The Schroth method is the most commonly used patient scoliosis-specific exercise paradigm for treating pediatric scoliosis. The aim of this study is to systematically and critically examine the evidence for the Schroth method for pediatric scoliosis.</p><p><strong>Methods: </strong>PubMed, MEDLINE, CINAHL, and Web of Science were searched through April 5, 2024, for articles examining the Schroth method for pediatric scoliosis (<18 years old). Thirteen review questions were created spanning the study aim. Each included article was independently assessed for the level of evidence (I-IV). Research questions were given a grade of recommendation (A, B, C, and I [insufficient]).</p><p><strong>Results: </strong>A total of 29 articles (41.4% Level I, 31.0% Level II, 13.8% Level II, and 13.8% Level IV) met inclusion criteria out of 845 initially retrieved, describing 1,555 patients with scoliosis aged 4 to 18 years. There was grade A evidence that the Schroth method is most commonly used for adolescent idiopathic scoliosis (AIS), can improve the angle of trunk rotation, and is safe; grade B evidence for improvement in posture; and grade I evidence for improvement in Cobb angle, cosmetic deformity, quality of life, ideal treatment parameters, economic value, utility in delaying/preventing surgery, effectiveness in relation to patient characteristics (e.g., skeletal maturity or curve size), and comparative effectiveness to other conservative interventions.</p><p><strong>Conclusion: </strong>While there is good evidence that the Schroth method is commonly and safely used in AIS and can minimally improve the angle of trunk rotation and fair evidence of improvement in posture, there is insufficient evidence regarding multiple important clinical and economic outcomes, such as comparative effectiveness to other conservative interventions and improvement of Cobb angle. Although clinicians may consider the Schroth method as 1 option of several conservative strategies, clinical benefit may be limited, and further high-quality research is needed to evaluate its performance in areas of insufficient evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-19eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00099
James E Gardner, Hannah Jones, Eric R Wagner, Robert L Bowers
{"title":"Ultrasound Diagnosis of Upper Extremity Peripheral Entrapment Neuropathies: A Narrative Review.","authors":"James E Gardner, Hannah Jones, Eric R Wagner, Robert L Bowers","doi":"10.2106/JBJS.RVW.24.00099","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00099","url":null,"abstract":"<p><p>» Diagnostic ultrasound evaluation has become an important adjunct to electrodiagnostic studies in the diagnosis of upper extremity entrapment neuropathy. » For the common median and ulnar entrapment neuropathies, published normative values for nerve cross-sectional area at the wrist and elbow have demonstrated a high degree of diagnostic validity of diagnostic ultrasound. » Expert consensus on best practice for the clinical use of these reference is lacking and should be a logical next step in the deployment of ultrasound for upper extremity neuropathy evaluation.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-16eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00114
John F McKeon, Paul M Alvarez, Diego Martinez Castaneda, Uchechukwu Emili, James Kirven, Anthony D Belmonte, Varun Singh
{"title":"Cervical Collar Use Following Cervical Spine Surgery: A Systematic Review.","authors":"John F McKeon, Paul M Alvarez, Diego Martinez Castaneda, Uchechukwu Emili, James Kirven, Anthony D Belmonte, Varun Singh","doi":"10.2106/JBJS.RVW.24.00114","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00114","url":null,"abstract":"<p><strong>Background: </strong>The utility and risks associated with the use of cervical collars in the postoperative period after cervical spine surgery have been of debate. The purpose of this study was to systematically review the currently available evidence on the use of cervical collars after cervical spine surgery to assess their impact on outcomes.</p><p><strong>Methods: </strong>A literature search of the PubMed database was performed using keywords \"cervical collar,\" \"anterior cervical discectomy and fusion (ACDF),\" \"posterior cervical decompression and fusion,\" \"laminoplasty,\" \"post-operative orthotic bracing,\" \"cervical decompression,\" and \"cervical orthosis\" in all possible combinations. All English studies with the level of evidence of I to IV that were published from May 1, 1986, to December 3, 2023, were considered for inclusion.</p><p><strong>Results: </strong>A total of 25 articles meeting the inclusion criteria were identified and reviewed. Regarding anterior and posterior fusion procedures, cervical collar use demonstrated improved short-term patient-reported outcomes and pain control. While surgeon motivation for collar use was to increase fusion rates, this is not well drawn out in the literature with the majority of studies demonstrated no significant difference in fusion rates between patients who wore a cervical collar and those who did not. Regarding motion-preserving procedures such as cervical laminoplasty, patients with prolonged postoperative cervical collar use demonstrated increased rates of axial neck pain and decreased final range of motion (ROM).</p><p><strong>Conclusion: </strong>Surgeon motivation for postoperative cervical collar immobilization after completion of fusion procedures is to increase fusion rates and improve postoperative pain and disability despite this not being fully drawn out in the literature. After completion of motion-sparing procedures, the benefits of collar immobilization diminish with their prolonged use which could lead to increased rates of axial neck pain and decreased ROM. Cervical collar immobilization in the postoperative period should be considered its own intervention, with its own associated risk-benefit profile.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-16eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00115
Charles Gusho, Wayne Hoskins, Elie Ghanem
{"title":"A Comparison of Incisional Dressings and Negative-Pressure Wound Therapy for the Prevention of Infection and Wound Complications After Primary Total Hip and Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials.","authors":"Charles Gusho, Wayne Hoskins, Elie Ghanem","doi":"10.2106/JBJS.RVW.24.00115","DOIUrl":"10.2106/JBJS.RVW.24.00115","url":null,"abstract":"<p><strong>Background: </strong>Incisional dressings may decrease wound complications and joint infection after total hip and knee arthroplasties (THA; TKA). However, there is no consensus on the superiority of a particular product. This study compared infection and wound complications among randomized controlled trials (RCTs) across various dressing types after primary THA and TKA.</p><p><strong>Methods: </strong>Scopus, Ovid/MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were queried in May 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared minor and major wound complications and dressing changes using P-scores.</p><p><strong>Results: </strong>Of 3,067 compiled studies, 12 RCTs of 1,939 patients with median (interquartile range) follow-up of 42 (382) days undergoing primary THA (n = 880, 45.4%) or TKA (n = 1,059, 54.6%) with alginate (n = 208; 10.7%), absorbent (n = 236; 12.2%), gauze (n = 474; 24.4%), or hydrofiber (n = 683; 35.2%) dressings or negative-pressure wound therapy (NPWT; n = 338; 17.4%) were included for meta-analysis. Compared with gauze, alginate and hydrofiber dressings were associated with fewer postoperative changes (mean difference [MD], -12.1; 95% confidence interval [CI], -15.08 to -9.09, p < 0.001; MD, -3.5; 95% CI, -6.30 to -0.74, p = 0.013, respectively). In a subanalysis, silver-ion hydrofiber also was associated with fewer changes (MD, -5.0; 95% CI, -5.70 to -4.39; p < 0.001). Overall, there was no statistically significant risk of increased minor nor major wound complications including superficial and deep infections among all dressing types and NPWT compared with gauze.</p><p><strong>Conclusion: </strong>Despite no association between wound complications nor infection risk among various incisional dressings and NPWT vs. gauze, the alginate, hydrofiber, and silver hydrofiber dressings had statistically fewer mean postoperative changes. Future studies are required to assess whether these dressings confer reduced infection risk.</p><p><strong>Level of evidence: </strong>Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-16eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00090
Alvaro Ibaseta, Ahmed Emara, Ignacio Pasqualini, Benjamin Jevnikar, Ceylan Colak, Oguz Turan, Shujaa T Khan, Matthew E Deren, Nicolas S Piuzzi
{"title":"Nuclear Imaging in Orthopaedic Practice: A Critical Analysis Review.","authors":"Alvaro Ibaseta, Ahmed Emara, Ignacio Pasqualini, Benjamin Jevnikar, Ceylan Colak, Oguz Turan, Shujaa T Khan, Matthew E Deren, Nicolas S Piuzzi","doi":"10.2106/JBJS.RVW.24.00090","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00090","url":null,"abstract":"<p><p>» Nuclear imaging techniques, including bone scintigraphy, labeled leukocyte scintigraphy, positron emission tomography (PET), and single-photon emission computed tomography (SPECT) combined with computed tomography (CT), have wide applications in orthopaedics for evaluating trauma, painful total joint arthroplasty, musculoskeletal infection, and orthopaedic oncology.» Three-phase bone scintigraphy is a first-line, highly sensitive nuclear medicine study for evaluating orthopaedic pathology when initial studies are inconclusive. However, its specificity is limited, and findings may be falsely positive for up to 2 years after total joint arthroplasty because of physiologic bone remodeling.» Labeled leukocyte scintigraphy or gallium scintigraphy can improve diagnostic accuracy in patients with a positive bone scan and suspected musculoskeletal or periprosthetic joint infection.» 18-Fluorodeoxyglucose PET/CT demonstrates high sensitivity and specificity for diagnosing bone neoplasms, infections, and metabolic disorders. Emerging PET/magnetic resonance imaging technology offers reduced radiation exposure and greater soft-tissue detail but presents technical and cost challenges.» SPECT/CT provides valuable functional and anatomic detail for characterizing the extent and location of bone pathology, serving as an important adjunct to other imaging modalities.» Ultimately, the choice of nuclear imaging modality should consider the specific clinical context, diagnostic accuracy, impact on management, and cost-effectiveness on a case-by-case basis.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-16eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00107
Ryan C Palmer, Ian A Jones, Peter K Sculco, Charles P Hannon, Yale A Fillingham, Nathanael D Heckmann
{"title":"Perioperative Systemic Corticosteroids in Modern Total Hip and Knee Arthroplasty: A Primer for Clinical Practice.","authors":"Ryan C Palmer, Ian A Jones, Peter K Sculco, Charles P Hannon, Yale A Fillingham, Nathanael D Heckmann","doi":"10.2106/JBJS.RVW.24.00107","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00107","url":null,"abstract":"<p><p>» Perioperative corticosteroids are strongly recommended for reducing the incidence and severity of postoperative nausea and vomiting following elective total hip or total knee arthroplasty.» Corticosteroids may reduce postoperative pain and opioid requirements. Similarly, corticosteroids appear to have a neutral-to-positive effect on length of stay, venous thromboembolism, mobility, delirium, acute kidney injury, and bone cement implantation syndrome (i.e., decreased length of stay).» Perioperative corticosteroids may induce hyperglycemia among both diabetic and nondiabetic patients; however, there is no strong evidence indicating that these transient corticosteroid-induced glycemic derangements may increase the risk of postoperative infectious complications.» The dosage and frequency of perioperative corticosteroid administration play a critical role in optimizing postoperative outcomes, with higher doses showing promise in reducing opioid consumption, postoperative pain, and length of stay.» The optimal dosage and frequency of corticosteroids remain unclear; however, the perioperative administration of 8 to 16 mg dexamethasone, or equivalent steroid, appears reasonable and safe in most cases.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-05eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00106
Chloe R Wong, Alice Zhu, Heather L Baltzer
{"title":"The Accuracy of Artificial Intelligence Models in Hand/Wrist Fracture and Dislocation Diagnosis: A Systematic Review and Meta-Analysis.","authors":"Chloe R Wong, Alice Zhu, Heather L Baltzer","doi":"10.2106/JBJS.RVW.24.00106","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00106","url":null,"abstract":"<p><strong>Background: </strong>Early and accurate diagnosis is critical to preserve function and reduce healthcare costs in patients with hand and wrist injury. As such, artificial intelligence (AI) models have been developed for the purpose of diagnosing fractures through imaging. The purpose of this systematic review and meta-analysis was to determine the accuracy of AI models in identifying hand and wrist fractures and dislocations.</p><p><strong>Methods: </strong>Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Diagnostic Test Accuracy guidelines, Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to October 10, 2023. Studies were included if they utilized an AI model (index test) for detecting hand and wrist fractures and dislocations in pediatric (<18 years) or adult (>18 years) patients through any radiologic imaging, with the reference standard established through image review by a medical expert. Results were synthesized through bivariate analysis. Risk of bias was assessed using the QUADAS-2 tool. This study was registered with PROSPERO (CRD42023486475). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Results: </strong>A systematic review identified 36 studies. Most studies assessed wrist fractures (27.90%) through radiograph imaging (94.44%), with radiologists serving as the reference standard (66.67%). AI models demonstrated area under the curve (0.946), positive likelihood ratio (7.690; 95% confidence interval, 6.400-9.190), and negative likelihood ratio (0.112; 0.0848-0.145) in diagnosing hand and wrist fractures and dislocations. Examining only studies characterized by a low risk of bias, sensitivity analysis did not reveal any difference from the overall results. Overall certainty of evidence was moderate.</p><p><strong>Conclusion: </strong>In demonstrating the accuracy of AI models in hand and wrist fracture and dislocation diagnosis, we have demonstrated that the potential use of AI in diagnosing hand and wrist fractures is promising.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-05eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00112
James T Layson, Kenneth Choy, Randy M Cohn, Giles R Scuderi
{"title":"A Comparison of Proximal Patellar Realignment vs. Medial Patellofemoral Ligament Reconstruction: A Review of the Literature.","authors":"James T Layson, Kenneth Choy, Randy M Cohn, Giles R Scuderi","doi":"10.2106/JBJS.RVW.24.00112","DOIUrl":"https://doi.org/10.2106/JBJS.RVW.24.00112","url":null,"abstract":"<p><p>» Patellar instability is challenging to address, and although there are many surgical options, proximal patellar realignment (PPR) and medial patellofemoral ligament (MPFL) reconstruction are both used-recently, the MPFL reconstruction has become more popularized.» Both procedures have demonstrated similar recurrent dislocation rates and rates of arthritic progression.» PPR is a cost-efficient procedure using just suture alone as compared with MPFL reconstruction, which uses different grafts and methods of fixation.» PPR has demonstrated durable results, with a lower overall complication rate, much of which is caused by the MPFL reconstruction having unique complications due to fixation methods.» The PPR is a beneficial procedure and should still be considered when dealing with patellar instability.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-05eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00080
Joseph P Costello, Levi M Travis, Jacob Jahn, Juan A Pretell-Mazzini
{"title":"The Role of Bone Grafting vs. Bone Cement in the Treatment of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis on the Risk of Recurrence in 1,454 Patients.","authors":"Joseph P Costello, Levi M Travis, Jacob Jahn, Juan A Pretell-Mazzini","doi":"10.2106/JBJS.RVW.24.00080","DOIUrl":"10.2106/JBJS.RVW.24.00080","url":null,"abstract":"<p><strong>Background: </strong>Giant cell tumor of bone (GCTB) presents a challenge in management due to its invasive nature and propensity for local recurrence. While either bone grafting (BG) or bone cement (BC) can be utilized to fill defects after intralesional curettage, the optimal treatment remains contested. The purpose of this study was to examine the impact of defect filling with BC compared with BG on recurrence rates in patients with GCTB following intralesional curettage.</p><p><strong>Methods: </strong>A random-effects model binary outcome meta-analysis was performed utilizing recurrence rate for the BC and BG groups to evaluate the risk ratio (p < 0.05 considered significant). There were 1,454 patients included.</p><p><strong>Results: </strong>Intralesional curettage with BG had a recurrence risk ratio of 1.68 (95% confidence interval [CI], 1.22-2.31, p = 0.001) when compared with BC. The overall rate of recurrence for GCTB after intralesional curettage with BC was 20.05% vs. 29.74% with BG (95% CI, 0.17-0.23 vs. 0.26-0.33, p < 0.001).</p><p><strong>Conclusion: </strong>Intralesional curettage with BC for the treatment of GCTB demonstrated lower recurrence rates than intralesional curettage with BG. However, the rates of recurrence remain substantial for both groups, necessitating careful consideration of the benefits and potential pitfalls associated with BC vs. BG when considering salvage options after recurrences.</p><p><strong>Level of evidence: </strong>Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JBJS ReviewsPub Date : 2024-09-03eCollection Date: 2024-09-01DOI: 10.2106/JBJS.RVW.24.00085
Roderick J M Vossen, Daniel Verstift, Faridi S Van Etten-Jamaludin, Bryan J Hamans, Michel P J van den Bekerom, Lukas P E Verweij
{"title":"Choice of Acromioclavicular Dislocation Treatment Should Not Be Influenced by Risk of Development of Acromioclavicular Osteoarthritis: A Systematic Review With Meta-Analysis.","authors":"Roderick J M Vossen, Daniel Verstift, Faridi S Van Etten-Jamaludin, Bryan J Hamans, Michel P J van den Bekerom, Lukas P E Verweij","doi":"10.2106/JBJS.RVW.24.00085","DOIUrl":"10.2106/JBJS.RVW.24.00085","url":null,"abstract":"<p><strong>Background: </strong>It is currently unknown to what degree surgical or nonoperative treatment of acromioclavicular (AC) dislocation influences the development of osteoarthritis (OA). The aim of this study was to evaluate AC OA after surgical and nonoperative treatment for AC dislocations, compare OA prevalence between treatment options, and compare OA prevalence between the injured and contralateral shoulder.</p><p><strong>Methods: </strong>Articles reporting on the prevalence of OA after surgical or nonoperative treatment of an AC dislocation with a minimal 2-year follow-up were included. AC OA presence was extracted for the injured and contralateral shoulder. Treatment categories were defined based on anatomical variation in the reattachment of ligaments: AC fixation, coracoclavicular (CC) fixation, AC and CC fixation, Bosworth screw synthetic graft, tendon graft, and conservative. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.</p><p><strong>Results: </strong>Ninety-four articles were included for qualitative analysis, and 7 articles were included for meta-analysis (n = 3,812; follow-up = 2.0-24.2 years; mean age 37.6 ± 10.4 years). A total of 3,483 patients underwent surgical treatment, and 329 patients underwent conservative treatment. OA prevalence ranged from 6.7%-29.3% between 7 pooled treatment categories. Most included studies had a follow-up <10 years (94%) and OA prevalence increased with time, regardless of treatment option. There was no difference in OA prevalence between the injured and contralateral shoulder (p = 0.120). MINORS scores were varied, ranging from poor to very good.</p><p><strong>Conclusion: </strong>The pooled AC OA prevalence of the 7 treatment categories ranged from 6.7% for the CC fixation surgical group to 29.3% for the conservative treatment group. However, the included studies were predominantly of low quality and had varying follow-up periods, with most having relatively short follow-up durations. No difference in AC OA prevalence was found between the injured and contralateral shoulder. Based on the available evidence, treatment choice for AC dislocation should not be influenced by the potential development of AC AO.</p><p><strong>Level of evidence: </strong>Level IV. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":47098,"journal":{"name":"JBJS Reviews","volume":"12 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11365602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}