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Vaishya R, Gupta BM, Mamdapur GMN, Vaish A. Multiligamentous Knee Injury: A Scientometric Assessment of Global Publications During 2008-2023. Indian J Orthop 2024; 58:1213-1223. [PMID: 39170657 PMCID: PMC11333647 DOI: 10.1007/s43465-024-01149-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/08/2024] [Indexed: 08/23/2024]
Abstract
Background Research and clinical studies on multiligamentous knee injuries (MLKI) have recently gained interest with several clinical studies reported recently. This study aims to identify, visualize, and characterize the MLKI research, to analyze the knowledge structure of MLKI during 2008-2023 and to identify the emerging research trends from a bibliometric perspective. Methods All articles reporting MLKI from 2008 to 2023 were curated from the Scopus database, on 1st January 2024. VOS viewer and Microsoft Excel were used to analyze the publications including the participating countries, authors, organizations, journals and research focus. These data were used to generate visual knowledge maps of the outputs. Results 406 papers on MLKI were published in 115 journals by 483 authors. There has been a slow publication growth in the past 16 years. The United States had more than 50% share in global publications. Knee Surgery Sports Traumatology Arthroscopy, Orthopaedic Journal of Sports Medicine and American Journal of Sports Medicine published the most papers. The three USA institutions, namely Mayo Clinic, Hospital for Special Surgery-New York and Twin Cities Orthopedics contributed the largest number of publications. B.A. Levy (Mayo Clinic, USA) (n = 66) and M.J. Stuart (Mayo Clinic, USA) (n = 63) have registered the highest collaborative links with other authors. Conclusions This study is the first comprehensive bibliometric study to analyze MLKI. The findings shed light on the growth trajectory of publications, the extent of international collaborations, the influence of highly cited articles, and the key countries, institutions, journals, and authors contributing to the field. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s43465-024-01149-9.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi,, 110076 India
| | | | - Ghouse Modin N. Mamdapur
- Department of Library and Information Science, Yenepoya (Deemed to Be University), Deralakatte, Mangalore, Karnataka, 575018 India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi,, 110076 India
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Figueroa D, Figueroa ML, Cañas M, Feuereisen A, Figueroa F. Meniscal Lesions in Multi-Ligament Knee Injuries. Indian J Orthop 2024; 58:1224-1231. [PMID: 39170649 PMCID: PMC11333639 DOI: 10.1007/s43465-024-01217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/24/2024] [Indexed: 08/23/2024]
Abstract
Introduction Multi-ligament knee injuries (MLKIs) are rare and complex knee lesions and are potentially associated with intra-articular injuries, especially meniscal tears. Understanding the meniscal tear patterns involved in MLKI can help the orthopedic surgeon treat these complex injuries. Objective The purpose of this study was to describe the incidence, classification, and treatment of meniscal injuries in a cohort of patients with MLKIs and carry out an updated review of the evidence available. Materials and methods Descriptive retrospective study. Patients with a history of reconstructive surgery for MLKI performed between 2013 and 2023 were included. Informed consent was obtained from all patients included in the study. Patient demographics, magnetic resonance imaging (MRI) study, and operative reports were reviewed. Groups were then formed based on ligament injury patterns. Meniscal tears were identified by MRI and through diagnostic arthroscopy for each patient. The association between meniscal lesions and injury patterns was calculated through Fisher's exact test. Agreement between the presence of meniscal tear on MRI and in diagnostic arthroscopy was measured using the kappa test. The sensitivity and specificity of MRI were calculated. We inferred the presence of a meniscal tear by injury pattern using the Agresti-Coull confidence interval. For the statistical analysis, a significance of 5% and a confidence interval of 95% were considered. Results Seventy patients with MLKIs were included, with a mean age of 30.69 years (SD 10.65). Forty-seven patients had meniscal lesions (67.1%). Of them, 6 had only medial meniscus tears, 31 had only lateral meniscus tears, and 10 had lesions of both menisci, comprising 57 meniscal lesions in total. An anterior cruciate ligament (ACL) + medial collateral ligament/posteromedial corner (MCL/PMC) was the most common injury pattern (52.86% of all patients). Of these 37 patients, 78.38% had meniscal injuries, and most of them (68.97%) were only lateral meniscus injuries. The odds ratio (OR) of having a meniscal tear when having an ACL + medial-side injury was 4.83 (95% CI; 0.89-26.17). Patients with ACL + lateral-side injury pattern had meniscal tears in 42.86%. The lateral meniscus was involved in 100% of these patients. 62.5% of medial meniscus injuries were treated by meniscal repair, and 37.5% by partial meniscectomy. 58.54% of lateral meniscus injuries were treated by meniscal repair, and 39.02% by partial meniscectomy. Agreement calculated using the kappa test between MRI and diagnostic arthroscopy for medial meniscal lesions was 78.57%, and for lateral meniscal lesions was 84.29%. Conclusion The ligament injury pattern and the side of the injured collateral ligament influenced the incidence and laterality of meniscal damage. ACL + medial-side injuries were shown to have significantly greater meniscal damage compared to other injury patterns. It is crucial to have a high index of suspicion, obtain a high-quality MRI, and arthroscopically evaluate any possible meniscal lesions in MLKIs.
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Affiliation(s)
- David Figueroa
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago Chile
| | - María Loreto Figueroa
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago Chile
| | - Martin Cañas
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago Chile
| | - Alexandra Feuereisen
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago Chile
| | - Francisco Figueroa
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Av Vitacura 5951, Vitacura, Santiago Chile
- Hospital Sótero Del Rio, Santiago, Chile
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Pizza N, Di Paolo S, Grassi A, Pagano A, Viotto M, Dal Fabbro G, Agostinone P, Lucidi GA, Monllau JC, Zaffagnini S. Good long-term patients reported outcomes, return-to-work and return-to-sport rate and survivorship after posterior cruciate ligament (PCL)-based multiligament knee injuries (MLKI) with posteromedial corner tears as significant risk factor for failure. Knee Surg Sports Traumatol Arthrosc 2023; 31:5018-5024. [PMID: 37668614 PMCID: PMC10598146 DOI: 10.1007/s00167-023-07547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To assess the survival rate and associated risk factors of a wide cohort of patient's underwent surgical treatment for posterior cruciate ligament (PCL)-based multiligament knee injury (MLKI) at long-term follow-up and to investigate the long-term patient's reported outcomes (PROMS) and functional activity. METHODS All cases of PCL-based MLKI performed at one single sport-medicine institution were extracted and patient's with a minimum 2 years of follow-up included. VAS, Lysholm, KOOS, Tegner Activity level scores, the incidence and time of return to sport (RTS) and return to work (RTW) were collected before, after surgery and at final follow-up. A multivariate logistic regression was performed to investigate the outcomes associated with the patient's acceptable symptoms state (PASS) for each sub-score of the KOOS. The Kaplan-Meier method with surgical failure (re-operation to one of the reconstructed ligaments) as endpoint was used to perform the survivorship analysis for the entire cohort. RESULTS Forty-two patients were included and evaluated at an average of 10 years. All PROMS significantly improved from pre- to post-surgery (range ηp2 0.21-0.43, p < 0.05) except for the Tegner score which significantly improved from pre-surgery and to final follow-up (ηp2 = 0.67, p < 0.001). RTW was achieved in the 95.2% after 2.4 ± 1.9 months. RTS was achieved in 78.6% after 6.7 ± 5.0 months. The higher number of surgeries were the significant negative predictors of PASS for the KOOS sub-scales Sport (p = 0.040) and Quality of Life (p = 0.046), while the presence of meniscal lesions was a significant negative predictor of PASS only for the KOOS sub-scale of Sport (p = 0.003). Six patients (14.3%) underwent reoperation and were considered as surgical failures. The global survivorship was 95.2%, 92.6%, 87.1%, and 74.7% at 2, 5, 12, and 15 years, respectively. The survivorship in patient undergoing PMC reconstruction surgery was significantly lower (p = 0.004; HR 7.1) compared to patients without a PMC lesion. CONCLUSION Good-to-excellent PROMS could be obtained and maintained at long-term follow-up after surgery, with the higher number of surgeries and meniscal lesions as significant negative predictors of the PASS. Moreover, the presence of a PMC lesion significantly increases the risk of the PCL reconstruction failure. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nicola Pizza
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
| | - Anna Pagano
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marianna Viotto
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Juan Carlos Monllau
- Knee and Arthroscopy Unit, ICATME, Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, DIBINEM, Università di Bologna, Bologna, Italy
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Makaram NS, Murray IR, Geeslin AG, Chahla J, Moatshe G, LaPrade RF. Diagnosis and treatment strategies of the multiligament injured knee: a scoping review. Br J Sports Med 2023; 57:543-550. [PMID: 36822842 DOI: 10.1136/bjsports-2022-106425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To map the current literature evaluating the diagnosis and treatment of multiligament knee injuries (MLKIs). DESIGN Scoping review. DATA SOURCES Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O'Malley frameworks were followed. A three-step search strategy identified relevant published literature comprising studies reporting on at least one aspect in the diagnosis or treatment of MLKI in adults. Data were synthesised to form a descriptive analysis and thematic summary. RESULTS Overall, 417 studies were included. There was a substantial chronological increase in the number of studies published per year, with 70% published in the last 12 years. Of included studies, 128 (31%) were narrative reviews, editorials or technical notes with no original data. The majority of studies (n=239, 57%) originated from the USA; only 4 studies (1%) were of level I evidence. Consistent themes of contention included clinical assessment, imaging, operative strategy, timing of surgery and rehabilitation. There was a lack of gender and ethnic diversity reported within patient groups. CONCLUSIONS There remains insufficient high-level evidence to support definitive management strategies for MLKI. There is considerable heterogeneity in outcome reporting in current MLKI literature, precluding robust comparison, interpretation and pooling of data. Further research priorities include the development of expert consensus relating to the investigation, surgical management and rehabilitation of MLKI. There is a need for minimum reporting standards for clinical studies evaluating MLKI.
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Affiliation(s)
- Navnit S Makaram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
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Kunze KN, Haddad A, White AE, Cohn MR, LaPrade RF, Chahla J. The Top 50 Most Cited Publications in Meniscus Research. J Knee Surg 2023; 36:329-334. [PMID: 34359092 DOI: 10.1055/s-0041-1733881] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Injuries to the menisci of the knee are common in orthopedic sports medicine. Bibliometric studies can identify the core literature on a topic and help further our collective knowledge for both clinical and educational purposes. The purpose of the current study was to (1) identify and describe the 50 most cited articles in meniscus research over an 80-year time period to capture a wide range of influential articles and (2) identify the "citation classics" and milestone articles related to the meniscus of the knee. The Science Citation Index Expanded subsection of the Web of Science Core Collection was systematically searched for the 50 most cited meniscus articles. Data pertaining to bibliometric and publication characteristics were extracted and reported using descriptive statistics. The top 50 articles were published between the years 1941 and 2014 and collectively cited 13,152 times. The median (interquartile [IQR]) number of total citations per article was 203.5 (167.0-261.8), while the median citation rate was 9.6 (7.4-13.9) citations per year. The most cited article was "Knee joint changes after meniscectomy," published in 1948. The article with the highest citation rate of 78.4 citations per year was "The long-term consequence of anterior cruciate ligaments and meniscus injuries - osteoarthritis," published in 2007. The majority of articles were clinical outcome studies (n = 28, 56%). The top 50 most cited meniscus articles represent a compilation of highly influential articles which may augment reading curriculums and provide a strong knowledge base for orthopaedic surgery residents and fellows. The decade with the most articles was the 2000s, representing a recent acceleration in meniscus-based research. This is a level IV, cross-sectional study.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Aidan Haddad
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Alexander E White
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Matthew R Cohn
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Robert F LaPrade
- Department of Orthopaedic Surgery, Twin Cities Orthopedics, Minneapolis, Minnesota
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Labarre C, Kim SH, Pujol N. Incidence and type of meniscal tears in multilligament injured knees. Knee Surg Sports Traumatol Arthrosc 2023; 31:465-474. [PMID: 35854134 DOI: 10.1007/s00167-022-07064-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Meniscal injuries occurring during multi-ligament knee injuries (MLKI) are underreported. The purpose of this study was to compare the incidence and type of meniscal tears seen at the time of multi-ligament reconstruction surgery compared to those occurring during isolated anterior cruciate ligament (ACL) surgery. METHODS Patients undergoing surgical treatment for MLKI and ACL-only injuries between 2010 and 2020 were reviewed. Two-hundred and thirty-five patients were included in the MLKI group. There were 131 chronic injuries and 104 acute injuries. Two-hundred and twenty-two ACL-only chronic injuries were used as a control group for comparison with the chronic MLKI group. Demographic data, type of meniscal tears, ligament injury patterns (Schenck classification) and time from injury to surgery were recorded. A delayed procedure was defined by a 4-week interval after the knee injury. RESULTS A meniscus was torn in 69 knees (29.4%): 36 knees (15.3%) with an isolated medial meniscus tear, 33 knees (17.9%) with an isolated lateral meniscus tear,.Nine knees (3.8%) had both menisci torn. MLKI with medial or lateral-sided bicruciate ligament injuries (KDIIIM-KDIIIL) were significantly associated with a lower rate of meniscal tears than knee injuries involving the ACL-only and medial/lateral-sided ligament injuries (KDI) (medial-sided injuries p = 0.025; lateral-sided injuries p = 0.049). Lateral-sided injuries had significantly less meniscal damage than medial-sided injuries: 22/124 (17.7%) vs. 41/100 (41%); (p < 0.001). No significant differences were found for frequency, type and distribution of meniscal tears between acute and chronic MLKI surgery. ACL-only chronic injuries were associated with a higher rate of meniscal tears: 123/222 knees (55.4%) vs. 35/131 (26.9%) chronic MLKI; (p < 0.001), mainly involving the medial meniscus: 102/222 (46%) vs. 18/131 (13.7%); (p < 0.001). CONCLUSIONS Meniscal tears were less common in the MLKI group than in the isolated ACL injury group. The degree of ligament injury patterns and the side of the injured collateral ligament influenced the type and incidence of meniscal damage. Contrary to isolated ACL injuries, a delayed procedure was not associated with a higher rate of meniscal lesions but did influence the type of treatment. Understanding of meniscal tears patterns in MLKI helps to improve the treatment management of these complex injuries.
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Affiliation(s)
- Chloé Labarre
- Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles ,André Mignot Hospital, Île-de-France Ouest University, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Jinjeop-eup, Namyangju-si, Gyunggi-do, Republic of Korea
| | - Nicolas Pujol
- Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles ,André Mignot Hospital, Île-de-France Ouest University, 177 Rue de Versailles, 78150, Le Chesnay, France.
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Li C, Liu Y, Zheng R, Sun J, Peng W, Deng X, Huang X. One-Stage Arthroscopic Multiple Ligament Reconstruction for Schenck IV Knee Dislocation. Orthop Surg 2022; 15:502-509. [PMID: 36513497 PMCID: PMC9891907 DOI: 10.1111/os.13611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/09/2022] [Accepted: 11/06/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Schenck IV knee dislocation patients have dissatisfactory knee function and return-to-sport rate with the existing treatment methods. The purpose of this study was to illustrate a one-stage arthroscopic multiple ligament reconstruction method for treating Schenck IV knee dislocations. METHODS A retrospective case series study was performed. All patients with a history of Schenck IV knee dislocation who underwent one-stage arthroscopic multi-ligament reconstruction from 2010 to 2018 were followed for 24 months. The outcomes, including general patient data, Lysholm scores, International Knee Documentation Committee (IKDC) scores, visual analog scale (VAS) pain scores, knee active range of motion, and complications, were reviewed. The data was analyzed with paired-samples t-test. RESULTS A total of 12 patients, comprising nine males and three females, were followed up and reviewed. The mean age at the time of the surgical procedure was 40.3 ± 9.0 (22-57) years. The mean body mass index (BMI) was 24.6 ± 4.9 (15.2-32.5) kg/m2 . The mean IKDC score and Lysholm score before surgery were 30.4 ± 6.1 (21-42) and 28.2 ± 6.2 (22-39), respectively. The average operation time was 121.8 minutes. The mean IKDC score and Lysholm score at the 24-month follow-up were 80.6 ± 6.5 (68-92) and 82.0 ± 7.5 (72-95), respectively. There were significant differences in the IKDC and Lysholm scores between the preoperative and 24-month postoperative time points (p < 0.01). The mean knee range of motion was 124.6° ± 6.6° (115°-135°) at the 24-month follow-up. No major complications occurred. CONCLUSIONS The results of this retrospective study suggest that the new arthroscopic one-stage multi-ligament reconstruction technique is an effective way to treat Schenck IV knee dislocation with satisfactory postoperative knee function.
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Affiliation(s)
- Chao Li
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina
| | - Yubo Liu
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina,School of MedicineNankai UniversityTianjinChina
| | - Runlong Zheng
- Department of Orthopaedic SurgeryPLA Strategic Support Force Characteristic Medical CenterBeijingChina
| | - Jitong Sun
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina
| | - Wei Peng
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina
| | - Xiang‐Hua Deng
- Sports Medicine and Shoulder ServiceHospital for Special SurgeryNew YorkUSA,Orthopaedic Soft Tissue Research ProgramHospital for Special SurgeryNew YorkUSA
| | - Xunwu Huang
- Senior Department of OrthopaedicsThe Fourth Medical Center of PLA General HospitalBeijingChina,National Clinical Research Center for OrthopaedicsSports Medicine & RehabilitationBeijingChina
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Bugarin A, Schroeder G, Shi BY, Jones KJ, Kremen TJ. Assessment of Characteristics and Methodological Quality of the Top 50 Most Cited Articles on Platelet-Rich Plasma in Musculoskeletal Medicine. Orthop J Sports Med 2022; 10:23259671221093074. [PMID: 35656192 PMCID: PMC9152206 DOI: 10.1177/23259671221093074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/21/2022] [Indexed: 12/18/2022] Open
Abstract
Background: The wide range of clinical applications and controversial scientific evidence associated with platelet-rich plasma (PRP) therapy in musculoskeletal medicine requires an examination of the most commonly cited studies within this field. Purpose: To identify the 50 most cited articles on PRP, assess their study design, and determine any correlations between the number of citations and level of evidence (LoE) or methodological quality. Study Design: Cross-sectional study. Methods: The Web of Science database was queried to identify the top 50 most cited articles on PRP in orthopaedic surgery. Bibliometric characteristics, number of citations, and LoE were recorded. Methodological quality was evaluated using the Modified Coleman Methodology Score (MCMS), Methodological Index for Non-randomized Studies (MINORS), and Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO). The Pearson correlation coefficient and Spearman correlation coefficient (rS) were used to determine the degree of correlation between the number of citations or citation density and LoE, MCMS, MINORS score, and MIBO score. Student t tests were performed for 2-group comparisons. Results: The top 50 articles were published between 2005 and 2016 in 21 journals. The mean number of citations and citation density were 241 ± 94 (range, 151-625) and 23 ± 8, respectively, and the mean LoE was 2.44 ± 1.67, with 15 studies classified as LoE 1. The mean MCMS, MINORS score, and MIBO score were 66.9 ± 12.6, 16 ± 4.7, and 12.4 ± 3.7, respectively. No correlation was observed between the number of citations or citation density and LoE, MCMS, MINORS score, and MIBO score. A significant difference (P = .02) was noted in LoE in articles from the United States (3.56 ± 1.7) versus outside the United States (2 ± 1.5). Seven of the 8 in vivo studies were published between 2005 and 2010, whereas 19 of the 25 clinical outcome investigations were published between 2011 and 2016. Studies that were published more recently were found to significantly correlate with number of citations (rS = –0.38; P = .01), citation density (rS = 0.36; P = .01), and higher LoE (rS = 0.47; P = .01). Conclusion: The top 50 most cited articles on PRP consisted of high LoE and fair methodological quality. There was a temporal shift in research from in vivo animal studies toward investigations focused on clinical outcomes.
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Affiliation(s)
- Amador Bugarin
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Grant Schroeder
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Brendan Y. Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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Polyethylene liner cementation into a well-fixed metal acetabular shell for the management of periacetabular osteolysis: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1459-1468. [PMID: 34605989 DOI: 10.1007/s00590-021-03130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Although various papers have reported on the clinical performance of cup retention with cementation of a new liner and bone grafting in the management of well-fixed cups with polyethylene wear and periacetabular osteolysis after total hip arthroplasty (THA), no systematic review of this topic has been published to date. METHODS Medline, EMBASE and Cochrane Library were searched for articles published from January 1999 to January 2019 using "osteolysis" AND "well-fixed", "osteolysis" AND "retro-acetabular", "bone graft" AND ("retention" OR "retained" OR "stable") AND "cup", and "cemented liner" AND "well-fixed". RESULTS Nine articles were selected for review (186 cases, 76.1 months mean follow-up). The overall revision rate was 11.3% (21 hips) most commonly due to aseptic loosening (9/186 hips), dislocation (8/186 hips), and liner wear progression (2/186 cases). The reported square size of osteolytic lesions ranged from a mean of 465.84 mm2 to a max of 4,770 mm2. Almost all reported lesions treated with bone grafts resolved or did not progress 97% (72/74). All studies indicated improved pain and functional scores at follow-up. CONCLUSION Cementation of a new liner with periacetabular bone grafting provides an alternative option to isolated liner exchange and cup revision for the management of periacetabular osteolysis in well-fixed cups with a disrupted locking mechanism or unavailable exchange liner. Further higher quality studies are required in order to examine if the use of highly cross-linked polyethylene, highly porous-coated cups, hydroxyapatite-coated cups, and small-diameter cups influence the clinical outcome of liner cementation in well-fixed cups with periacetabular osteolysis.
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10
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Clinical studies of single-stage combined ACL and PCL reconstruction variably report graft tensioning, fixation sequence, and knee flexion angle at time of fixation. Knee Surg Sports Traumatol Arthrosc 2021; 29:1238-1250. [PMID: 32705296 DOI: 10.1007/s00167-020-06171-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE In single-stage ACL-PCL reconstruction, there is uncertainty regarding the order of graft tensioning and fixation, as well as the optimal knee flexion angle(s) for graft fixation. A systematic review of clinical studies of single-stage combined ACL-PCL reconstruction was performed to determine whether a particular fixation sequence and/or knee flexion angle is associated with superior outcomes. METHODS A systematic review was performed according to PRISMA guidelines. All levels of evidence were included. All outcome measures were extracted, including physical examination values, radiographic measurements, and objective and subjective outcomes. RESULTS Of the 19 included studies, 17 tensioned and fixed the PCL before the ACL. Only four studies reported the methods/forces used for graft tensioning. Across studies, the ACL was fixed at variable knee flexion angles, from full extension to 70°. Conversely, 3 studies fixed the PCL at a knee flexion angle < 45°, while the remaining 16 studies fixed the PCL at a flexion angle > 70°. Patient-reported outcomes were qualitatively similar between groups. CONCLUSIONS This systematic review found considerable variability in graft tension, fixation sequence, and knee flexion angle at the time of fixation, with insufficient evidence to support specific surgical practices. Most commonly, the PCL is fixed before the ACL graft, with fixation occurring at a knee flexion angle between 70° and 90° and near full extension, respectively. The methodology for quantifying the forces applied for graft tensioning is rarely described. Given this clinical equipoise, future studies should consistently report these surgical details. Furthermore, prospective, randomized studies on the treatment of multiligament knee injuries are needed to improve outcomes in patients. LEVEL OF EVIDENCE IV.
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Held M, Schenck RC, Khanduja V, Campos TVDO, Tapasvi S, Williams A, Yau WP, Harner C. Prioritised challenges in the management of acute knee dislocations are stiffness, obesity, treatment delays and associated limb-threatening injuries: a global consensus study. J ISAKOS 2021; 6:193-198. [PMID: 34272294 DOI: 10.1136/jisakos-2020-000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Heterogeneous patient factors and injury mechanisms result in a great variety of injury patterns encountered in knee dislocations (KD). Attempts to improve outcome can focus on a wide range of challenges. The aim of this study was to establish and prioritise a list of challenges encountered when treating patients with acute KD. METHODS A modified Delphi consensus study was conducted with international knee specialists who generated a prioritised list of challenges. Selected priorities were limited to half of the possible items. Agreement of more than 70% was defined as consensus on each of these items a priori. RESULTS Ninety-one international surgeons participated in the first round. The majority worked in public hospitals and treated patients from low-income and middle-income households. Their propositions were prioritised by 27 knee surgeons from Europe, Africa, Asia, as well as North and South America, with a mean of 15.3 years of experience in knee surgery (SD 17.8). Consensus was reached for postoperative stiffness, obesity, delay to presentation and associated common peroneal nerve injuries. Challenges such as vascular injuries, ipsilateral fractures, open injuries as well as residual laxity were also rated high. Most of these topics with high priority are key during the initial management of a patient with KD, at presentation. Topics with lower priority were postsurgical challenges, such as patient insight, expectations and compliance, rehabilitation programme, and pain management. CONCLUSION This consensus study has a wide geographical footprint of experts around the world practising in various settings. These participants prioritised stiffness, obesity, treatment delays and associated limb-threatening injuries as the most important challenges when managing a patient with acute KD. This list calls for applicable and feasible solutions for these challenges in a global setting. It should be used to prioritise research efforts and discuss treatment guidelines. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Michael Held
- Orthopaedic Surgery, University of Cape Town, Rondebosch, South Africa
| | - Robert C Schenck
- Orthopaedic Surgery, University of New Mexico - Albuquerque, Albuquerque, New Mexico, USA
| | - Vikas Khanduja
- Orthopaedic Department, Addenbrooke's Hospital, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Sachin Tapasvi
- Orthopaedics, The Orthopaedic Speciality Clinic, Pune, Maharashtra, India
| | | | - Wai Pan Yau
- Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, Hong Kong
| | - Christopher Harner
- University of Texas McGovern Medical School, Pittsburgh, Pennsylvania, USA
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Malahias MA, Manolopoulos PP, Mancino F, Jang SJ, Gu A, Giotis D, Denti M, Nikolaou VS, Sculco PK. Safety and outcome of simultaneous bilateral unicompartmental knee arthroplasty: A systematic review. J Orthop 2021; 24:58-64. [PMID: 33679029 DOI: 10.1016/j.jor.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/14/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes. Methods The US National Library of Medicine (PubMed/MEDLINE), Google Scholar, and the Cochrane Database of Systematic Reviews were queried for publications. Results Ten articles were included with 765 simultaneous BUKA. Overall complication rate was 7.0%, survivorship was 97.6% at mean 17 months follow-up. No differences were reported between simultaneous and staged BUKA. Conclusion Simultaneous BUKA is as safe as staged BUKA, it is associated with decreased length of stay and operative time, although it has an increased rate of blood transfusion.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Philip P Manolopoulos
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- School of Medicine, European University of Cyprus, Diogenis Str 6 Nicosia CY, 2404, Cyprus
| | - Fabio Mancino
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Division of Orthopaedics and Traumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Seong J Jang
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Dimitrios Giotis
- Department of Orthopaedic Surgery, General Hospital of Grevena, Grevena, Greece
| | - Matteo Denti
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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Agarwalla A, Yao K, Darden C, Gowd AK, Sherman SL, Farr J, Shubin Stein BE, Amin NH, Liu JN. Assessment and Trends of the Methodological Quality of the Top 50 Most Cited Articles on Patellar Instability. Orthop J Sports Med 2021; 9:2325967120972016. [PMID: 33614793 PMCID: PMC7869164 DOI: 10.1177/2325967120972016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
Background Studies with a low level of evidence (LOE) have dominated the top cited research in many areas of orthopaedics. The wide range of treatment options for patellar instability necessitates an investigation to determine the types of studies that drive clinical practice. Purpose To determine (1) the top 50 most cited articles on patellar instability and (2) the correlation between the number of citations and LOE or methodological quality. Study Design Cross-sectional study. Methods The Scopus and Web of Science databases were assessed to determine the top 50 most cited articles on patellar instability between 1985 and 2019. Bibliographic information, number of citations, and LOE were collected. Methodological quality was calculated using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS). Mean citations and mean citation density (citations per year) were correlated with LOE, MCMS, and MINORS scores. Results Most studies were cadaveric (n = 10; 20.0%), published in the American Journal of Sports Medicine (n = 13; 26.0%), published between 2000 and 2009 (n = 41; 82.0%), and conducted in the United States (n = 17; 34.0%). The mean number of citations and the citation density were 158.61 ± 59.53 (range, 95.5-400.5) and 12.74 ± 5.12, respectively. The mean MCMS and MINORS scores were 59.62 ± 12.58 and 16.24 ± 3.72, respectively. No correlation was seen between mean number of citations or citation density versus LOE. A significant difference was found in the mean LOE of articles published between 1990 and 1999 (5.0 ± 0) versus those published between 2000 and 2009 (3.12 ± 1.38; P = .03) and between 2010 and 2019 (3.00 ± 1.10; P = .01). Conclusion There was a shift in research from anatomy toward outcomes in patellar instability; however, these articles demonstrated low LOE and methodological quality. Higher quality studies are necessary to establish informed standards of management of patellar instability.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Kaisen Yao
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, New York, USA
| | - Christon Darden
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Anirudh K Gowd
- Department of Orthopedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Jack Farr
- Cartilage Restoration Center, OrthoIndy, Greenwood, Indiana, USA
| | | | - Nirav H Amin
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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14
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Xiao R, Matijakovich D, Mikhail C, Colvin A. The Top 50 Most-Cited Papers in the Diagnosis and Management of SLAP Tears. Arthrosc Sports Med Rehabil 2021; 3:e127-e134. [PMID: 33615257 PMCID: PMC7879167 DOI: 10.1016/j.asmr.2020.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/26/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To identify and characterize the top 50 most-cited articles regarding SLAP tears. Methods Referencing the methodology of previous citation analyses, varying Boolean searches were performed using the Web of Science database and the search terms yielding the greatest number of results was used. The top 50 most-cited articles were identified and the following data points were gathered from each article: author, institution, country of origin, year of publication, publishing journal, level of evidence, and citation density. Results The total number of citations was 7834, with a median of 106 citations. The top 50 list was largely composed of diagnostic level I, II, and III studies (5, 7, and 8 total publications, respectively) and therapeutic level III (6 publications) or level IV (10 publications). Most articles originated from the United States (40). In total, 19 of the top 50 most-cited articles were published in the American Journal of Sports Medicine, followed by Arthroscopy (15) and the Journal of Bone and Joint Surgery (5). Conclusions Our analysis demonstrated a correlation with earlier publications being cited more frequently than recent studies. Importantly, the current study found that therapeutic studies in the most cited list were largely level III or level IV evidence. This makes the management of SLAP tears seem anecdotal, with little in the way of high-impact level I or level II therapeutic studies. We must reconsider our current understanding of SLAP tears and their management with more studies that demonstrate a clearer treatment algorithm for these common injuries of the shoulder. Clinical Relevance Given the complexity of SLAP tears, this list of the most-cited articles can provide a reference point to better guide practice, resident education, and future areas of orthopaedic research.
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Affiliation(s)
- Ryan Xiao
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Douglas Matijakovich
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Christopher Mikhail
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
| | - Alexis Colvin
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, U.S.A
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Mosquera MF, Jaramillo A, Gil R, Gonzalez Y. Controversies in acute multiligamentary knee injuries (MLKI). J Exp Orthop 2020; 7:56. [PMID: 32715370 PMCID: PMC7383048 DOI: 10.1186/s40634-020-00260-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/08/2020] [Indexed: 01/12/2023] Open
Abstract
Multiligament injuries of the knee (MLKI), remain an infrequent pathology especially in developed countries compared to mono-ligament lesions. In Colombia, MLKI is frequent due to the high accident rate on motorcycles. In the city of Bogota alone, about 160 motorcycle accidents have been estimated daily, being one of the cities that proportionately use this means of transport less compared to small cities. The term MLKI, include all ruptures of two or more major ligaments and therefore it has a broad spectrum of clinical presentation which creates a great challenge for the orthopedists and the surgeons envolved in this topic. The literature is rich in studies level IV but very poor in level I and level II, which generates controversies and little consensus in the diagnosis and treatment of this pathology. However there has been a gradual and better understanding of all factors involved in the treatment of MLKI that has improved the functional results of these knees in our patients, in fact we currently are more precise to achieve accurate diagnosis, evolved from not surgical approach to operate most, applying new anatomical and biomechanical concepts, with specialized and skill surgical techniques with more stable and biocompatible fixation implants, which allow in most cases to initiate an early integral rehabilitation program. Nevertheless due to the complexity and severity of the lesions, in some patients the functional results are poor. The goal of this revision is to identify the most frequent controversies in the diagnosis and treatment of MLKI, defining which of them are agreed according to what is reported in the literature and share some concepts based from the experience of more than 25 years of the senior author (MM) in the management of these injuries. LEVEL OF EVIDENCE: V - Expert Opinion.
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Affiliation(s)
- Manuel F Mosquera
- Clinica Erasmo, Valledupar, Colombia. .,Clinica La Carolina, Carrera 14 # 127-11 Cons 307-308, Bogota, Colombia.
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