Efort Open Reviews最新文献

{"title":"Treatments for rotator cuff calcific tendinitis: a systematic review and network meta-analysis of randomized-controlled trials.","authors":"Yuming Yao, Guang Yang, Shide Jiang, Bingzhou Ji, Hongfu Jin, Peiyuan Tang, Hengzhen Li, Bangbao Lu, Yusheng Li","doi":"10.1530/EOR-2024-0078","DOIUrl":"10.1530/EOR-2024-0078","url":null,"abstract":"<p><strong>Purpose: </strong>Various conservative and surgical treatments was clinically applied in rotator cuff calcific tendinitis (RCCT), the evaluation of distinction among all available intervention is still lacking. This study aims to systematically compare the efficacy and safety of these interventions and provide guidance for RCCT treatment.</p><p><strong>Methods: </strong>The study utilized four electronic databases for literature retrieval and is registered in PROSPERO. Network meta-analyses (NMA) were conducted for continuous outcomes such as functional improvement and pain relief. For the outcome of calcification deposit resolution, due to discrepancies in statistical methods and insufficient data for pooling, a systematic review was conducted. The Cochrane Risk of Bias 2 tool was used to assess the risk of bias.</p><p><strong>Results: </strong>A total of 33 randomized-controlled trials (RCTs) covering 26 treatment methods were included. In nonsurgical treatments, comprehensive physical therapy (PT) methods (ranked 1st in Surface Under the Cumulative Ranking (SUCRA)) showed the best performance in terms of functional improvement, followed by high-energy extracorporeal shock wave therapy (ESWT-H) + PT, which ranked 2nd. For pain relief, radial shock wave therapy (RSWT) + PT (ranked 1st) was most effective. In surgical treatments, arthroscopic bursectomy debridement of rotator cuff (ABD) + arthroscopic subacromial decompression (ASD) showed similar effects to ABD alone for functional improvement (SMD: -0.01, 95% CI: -0.54 to 0.57) and pain relief (SMD: -0.02, 95% CI: -0.51 to 0.43), with no significant differences observed. For calcification resolution, ultrasound-guided needling (UGN) + subacromial corticosteroid injection (SAI) demonstrated promising therapeutic potential.</p><p><strong>Conclusion: </strong>Comprehensive PT demonstrates superior efficacy in improving functional outcomes, while RSWT + PT significantly alleviates pain. In terms of surgical interventions, ABD alone demonstrated similar clinical effects to ABD + ASD in both functional improvement and pain relief. However, there is currently no direct data to compare the effectiveness of operative versus nonoperative treatments for RCCT.</p><p><strong>Trial registration: </strong>PROSPERO CRD42023476423.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"520-533"},"PeriodicalIF":4.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periprosthetic humeral fractures after shoulder arthroplasty.","authors":"Anna Behrens, Nick Moronga, Milad Farkhondeh Fal, Konrad Mader, Lukas Heilmann, Till Orla Klatte","doi":"10.1530/EOR-2024-0053","DOIUrl":"10.1530/EOR-2024-0053","url":null,"abstract":"<p><p>Occurring in 0.5-3% of cases, periprosthetic humerus fractures pose a challenge, necessitating effective management strategies. A comprehensive review was conducted using PubMed. Used terms included 'Periprosthetic humerus fractures; complications; periprosthetic fractures shoulder arthroplasty; periprosthetic humeral fracture treatment; nerve palsy humeral revision arthroplasty; infections after shoulder arthroplasty; postoperative complications AND open reduction AND humeral fractures; allograft AND long humeral stem'. Studies were excluded if they did not meet the actual topic, included more than primary shoulder arthroplasty and/or were in non-English or non-German language. Thirty-eight papers with evidence levels ranging from two to three were selected for this review. Various classification systems have been implemented; their validation though was based on studies with only a limited number of patients. Risk factors include osteopenia/osteoporosis, rheumatoid arthritis, age, age-related lifestyle and gender. Treatment options range from conservative approaches to plate osteosynthesis or revision to a longer stem. Nevertheless, there is a lack of biomechanic studies and randomized-controlled clinical studies; hence, the evidence is low. Complications in revision arthroplasty encompass infections, nonunions, and nerve palsies, highlighting the importance of individualized treatment planning. The management of periprosthetic humeral fractures requires careful consideration of risk factors and tailored treatment plans. Existing literature relies on small case series and expert opinions, highlighting the need for further research to establish optimal treatment strategies for these challenging fractures.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"534-542"},"PeriodicalIF":4.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate randomization, adherence to Ethics board approved trial protocol and transparent reporting of amendments and exclusions define RCT integrity.","authors":"David Eckerdal, Hendrik Pakosta, Muhanned Ali, Isam Atroshi","doi":"10.1530/EOR-2025-0029","DOIUrl":"10.1530/EOR-2025-0029","url":null,"abstract":"","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"572-573"},"PeriodicalIF":4.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5% benzoyl peroxide is the most efficient in reducing the cutibacterium flora of the shoulder skin: a network meta-analysis.","authors":"Viktor Weninger, Gergely Agócs, Luca Hergár, Szilárd Váncsa, Bence Hegedűs, Imre Szerb, Péter Hegyi, Gábor Skaliczki","doi":"10.1530/EOR-2024-0160","DOIUrl":"10.1530/EOR-2024-0160","url":null,"abstract":"<p><strong>Purpose: </strong>Our study aims to compare different perioperative treatments to reduce C. acnes, the most common causative agent of surgical site infections following shoulder surgery.</p><p><strong>Methods: </strong>A systematic search was performed in MEDLINE (PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and the Web of Science for studies published up to October 20, 2022. We included randomized-controlled trails investigating the efficacy of different dermal preparation in reducing the C. acnes colonising the skin surface. The studies examined positive bacterial cultures before and after skin treatment. The included trials were able to compare seven different skin treatment methods. We performed a frequentist network meta-analysis and calculated pooled risk ratios (RRs) with 95% confidence interval (CI).</p><p><strong>Results: </strong>Our study could include comparisons of 946 different patients. The use of 5% benzoyl peroxide (BPO) and its combination with the antibiotic clindamycin was found to be the most effective in reducing C. acnes colonization on the skin (BPO 5% RR = 0.25, CI: 0.08-0.72, BPO with clindamycin RR = 0.25, CI: 0.04-1.50). Based on the rank plot, 5% BPO (P score: 0.808) was the most effective treatment, followed by BPO 5% with clindamycin (P score: 0.749). We could not perform a network meta-analysis regarding the efficacy of different dermal preparation in reducing C. acnes colonization on the dermis and in the joint.</p><p><strong>Conclusion: </strong>Cutibacterium colonization of the skin flora can be effectively reduced on the skin surface by the use of 5% BPO.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"543-550"},"PeriodicalIF":4.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding 'Bias in published randomized trials that compare collagenase injection with percutaneous needle fasciotomy in the treatment of Dupuytren disease: a systematic review' by Eckerdal et al.","authors":"Joakim Strömberg","doi":"10.1530/EOR-2024-0140","DOIUrl":"10.1530/EOR-2024-0140","url":null,"abstract":"","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"570-571"},"PeriodicalIF":4.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of hindfoot and ankle in Charcot arthropathy.","authors":"Nicolas Cellier","doi":"10.1530/EOR-2025-0057","DOIUrl":"10.1530/EOR-2025-0057","url":null,"abstract":"<p><p>Charcot neuroarthropathy is the most severe complication of the diabetic foot. Its diagnosis is difficult and often overlooked, delaying management, with sometimes disastrous consequences. Its incidence is increasing due to the rapid global rise in the number of people with diabetes. Its pathophysiology remains unclear, although the activation of the RANK/RANK-L system appears to be involved, triggered either by neurotraumatic or neurovascular mechanisms, leading to the differentiation of monocytes into osteoclasts. Diagnosis relies on clinical and radiological arguments, particularly MRI. There are different types of Charcot foot depending on the evolution, according to Eichenholtz's classification and based on location according to Sanders and Brodsky's classifications. Treatment involves a multidisciplinary approach with diabetes management and addressing other general complications. Medical treatment is indicated as the first line, with offloading and immobilisation using a 'total contact cast'. In case of failure of this method, or if there is immediate deformity, surgical intervention is indicated, and techniques are evolving rapidly. Depending on the deformity, minimally invasive or arthroscopic procedures may be performed. In cases of significant deformity, foot reconstruction may be proposed, using the so-called 'super construct' technique if necessary. Infection will be treated concurrently or initially, depending on severity. Many complications are reported, but increasingly early and aggressive surgery improves patients' quality of life and reduces amputation rates.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 6","pages":"327-335"},"PeriodicalIF":4.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shoulder replacement in the under 55's is anatomical or reverse the best solution?","authors":"Partha Sarangi","doi":"10.1530/EOR-2025-0052","DOIUrl":"10.1530/EOR-2025-0052","url":null,"abstract":"<p><p>Shoulder arthroplasty is increasingly utilised among patients under 55 years of age due to rising incidences of traumatic injuries, inflammatory arthritis, avascular necrosis, degenerative joint diseases and heightened participation in demanding sports and occupational activities. Anatomic shoulder arthroplasty (ASA) remains the preferred surgical option for younger patients with intact rotator cuffs and minimal glenoid deformities, preserving natural biomechanics, strength and range of motion, and demonstrating high long-term implant survival rates at 10-15 years. Despite favourable outcomes, ASA carries potential long-term risks including implant wear, prosthetic loosening, glenoid erosion and progressive rotator cuff degeneration, particularly relevant for physically active younger patients. Reverse shoulder arthroplasty (RSA) offers a valuable alternative in complex clinical scenarios characterised by irreparable rotator cuff tears, extensive glenoid bone loss, severe anatomical disruption or previous surgical failures. RSA can be used as an alternative to ASR for primary osteoarthritis and an intact rotator cuff, with excellent clinical outcomes and survivorship in patients over 60. RSA is also being used successfully in patients under the age of 55 with excellent short-term results. There remain concerns regarding the longevity and reliability of RSA in younger, highly active individuals. ASA can be revised to RSA with good clinical outcomes, while failure of RSA is extremely challenging to address. If we accept that ASA will fail with time, then the primary ASA should allow for ease of revision to an RSA. Recent advances in modular prosthetic designs facilitate simpler revisions from ASA to RSA.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 6","pages":"396-402"},"PeriodicalIF":4.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based guidelines on orthobiologics.","authors":"Tobias Winkler, Stephan Oehme, Alexander Hildebrandt, Azzurra Paolucci, Lorenz Pichler","doi":"10.1530/EOR-2025-0069","DOIUrl":"10.1530/EOR-2025-0069","url":null,"abstract":"<p><p>Orthobiologics (OBs) have seen a constant increase in the number of available therapies and their clinical applications. Existing therapies can be categorized into blood-based (e.g., platelet-rich plasma (PRP)) and tissue/cell-based (e.g. mesenchymal stromal cells) approaches. While the popularity of OBs continues to grow, their diverse natures create unique challenges for the establishment of evidence-based guidelines. PRP has been reported by meta-analyses to increase patient-reported outcomes for conditions such as knee osteoarthritis (KOA), lateral epicondylitis and plantar fasciitis. However, the randomized controlled trials (RCTs) included often exhibit a high risk of bias due to the heterogeneity in the PRP preparation protocols and accompanying measures as well as inconsistent trial quality. The development pipeline of cell/tissue-based therapies is typically longer and more cost-intensive than that of blood-based therapies. Nevertheless, several products have demonstrated clinical safety. While some RCTs and meta-analyses on the outcome of cell/tissue-based therapies exist, their number is considerably lower than that of blood-based therapies and they focus mainly on KOA, with limited evidence on other orthopedic indications. Orthopedic societies such as ESSKA and AAOS have taken on the challenge of developing guidelines for OBs by combining high-level synthesized evidence with expert consensus. Patient stratification strategies represent a promising key to unlocking the full potential of OBs and are currently being investigated in ongoing studies. Further efforts to establish guidelines for the use of OBs should focus on developing frameworks for clinical trials and their reporting, alongside standardized protocols for the preparation, application and accompanying measures of OB therapies.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 6","pages":"345-351"},"PeriodicalIF":4.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterolateral tibia plateau fractures: pros and cons of different surgical approaches.","authors":"Mattia Alessio-Mazzola, Giacomo Placella, Marco Conca, Vincenzo Salini","doi":"10.1530/EOR-2025-0037","DOIUrl":"10.1530/EOR-2025-0037","url":null,"abstract":"<p><p>Posterolateral tibial plateau fractures are complex injuries requiring a thorough understanding of the anatomical structures involved, including the popliteus tendon, lateral collateral ligament and posterior horn of the lateral meniscus. Standard anterolateral or midline approaches provide limited access to the posterolateral corner, often necessitating specific surgical techniques to achieve optimal fracture reduction and joint stability. This review explores the main surgical approaches used for these fractures outlining their indications, advantages and limitations. Each section provides a step-by-step guide for an effective surgical technique, based on experience from a high-volume trauma center, to optimize exposure, reduction and fixation. Understanding the biomechanical and anatomical aspects of these fractures is crucial for selecting the most appropriate surgical strategy, minimizing complications and improving patient outcomes.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 6","pages":"416-423"},"PeriodicalIF":4.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellar instability: current approach.","authors":"David H Dejour, David Mazy, Tomas Pineda, Nicolas Cance, Michael J Dan, Edoardo Giovannetti de Sanctis","doi":"10.1530/EOR-2025-0051","DOIUrl":"10.1530/EOR-2025-0051","url":null,"abstract":"<p><p>Patellar dislocations present predominantly during adolescence, with a higher incidence observed among female patients. Patellofemoral joint stability depends critically on both osseous anatomy and soft tissue structures. Patellofemoral pathology can be classified into three major groups: objective patellar instability OPI, potential patellar instability and painful patellar syndrome. Three primary risk factors predispose individuals to patellar dislocation: trochlear dysplasia, patella alta and increased tibial tuberosity-trochlear groove (TT-TG) distance. Three secondary risk factors should be considered: femoral and tibial rotational abnormalities and valgus deformity. MRI has become the imaging modality of choice, enabling precise quantification of OPI risk factors in a single imaging examination. The 'menu à la carte' approach guides the treatment of OPI by addressing the most relevant anatomical risk factors for each patient using statistical thresholds.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 6","pages":"378-387"},"PeriodicalIF":4.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12139600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}