Supplement Use in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review

Efficacy of Protein and Essential Amino Acid Supplementation in Lower Limb Surgeries: A Systematic Review and Meta-Analysis

This study aimed to examine the efficacy and safety of protein and/or essential amino acid (EAA) supplementation in all lower limb surgeries using systematic reviews and meta-analysis of randomized controlled trials (RCTs). We included RCTs that assessed the efficacy of protein and/or EAA supplementation in lower limb surgeries. On June 2, 2023, we searched EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. The primary outcomes were mobility, patient-reported outcomes (PRO), and acute kidney injury (AKI). The secondary outcomes were exercise capacity, muscle strength, muscle mass, and all adverse events. We performed meta-analyses using the random-effects model. We assessed the risk of bias using the Cochrane risk-of-bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We included 12 RCTs (622 patients). These studies included four on hip fracture surgery, three on total hip arthroplasty, and five on total knee arthroplasty. Protein and/or EAA supplementation may slightly improve PRO (standard mean difference 0.51, 95% confidence interval (CI): 0.22 to 0.80, low certainty of evidence). Nevertheless, it may not improve mobility (mean difference 0.07 m/s, 95% CI: -0.01 to 0.16, low certainty of evidence). No adverse events including AKI were reported. Muscle strength may have increased (standard mean difference 0.31, 95% CI: 0.02 to 0.61, very low certainty of evidence). However, exercise capacity (mean difference 5.43 m, 95% CI: -35.59 to 46.45, very low certainty of evidence) and muscle mass (standard mean difference -0.08, 95% CI: -0.49 to 0.33, very low certainty of evidence) were not improved. While protein and/or EAA supplementation in lower limb surgeries may improve PRO, it is unlikely to affect mobility. Despite this, the medical team and patients might still consider protein and/or EAA supplementation a useful option.

Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus

OBJECTIVE

Synthesise evidence for effectiveness of rehabilitation interventions following ACL and/or meniscal tear on symptomatic, functional, clinical, psychosocial, quality of life and reinjury outcomes.

DESIGN

Overview of systematic reviews with Grading of Recommendations Assessment, Development and Evaluation certainty of evidence.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library.

ELIGIBILITY CRITERIA

Systematic reviews of randomised controlled trials investigating rehabilitation interventions following ACL and/or meniscal tears in young adults.

RESULTS

We included 22 systematic reviews (142 trials of mostly men) evaluating ACL-injured individuals and none evaluating isolated meniscal injuries. We synthesised data from 16 reviews evaluating 12 different interventions. Moderate-certainty evidence was observed for: (1) neuromuscular electrical stimulation to improve quadriceps strength; (2) open versus closed kinetic chain exercises to be similarly effective for quadriceps strength and self-reported function; (3) structured home-based versus structured in-person rehabilitation to be similarly effective for quadriceps and hamstring strength and self-reported function; and (4) postoperative knee bracing being ineffective for physical function and laxity. There was low-certainty evidence that: (1) preoperative exercise therapy improves self-reported and physical function postoperatively; (2) cryotherapy reduces pain and analgesic use; (3) psychological interventions improve anxiety/fear; and (4) whole body vibration improves quadriceps strength. There was very low-certainty evidence that: (1) protein-based supplements improve quadriceps size; (2) blood flow restriction training improves quadriceps size; (3) neuromuscular control exercises improve quadriceps and hamstring strength and self-reported function; and (4) continuous passive motion has no effect on range of motion.

CONCLUSION

The general level of evidence for rehabilitation after ACL or meniscal tear was low. Moderate-certainty evidence indicates that several rehabilitation types can improve quadriceps strength, while brace use has no effect on knee function/laxity.

Arthroscopy Annual Awards: The "Old Normal"

With sincere thanks to the Arthroscopy Association of North America Education Foundation for their support, we are pleased to announce the Annual Awards for our best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2020, as well as the Most Downloaded and Most Cited papers published 5 years ago. We proudly introduce new members of our editorial team, and your editors update their disclosures of potential conflicts of interest.