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Meng J, Xie D, Meng F, Liu W, Xiao Y, Tang H, Gao S. Clinical outcomes in dynamic intraligamentary stabilization technique for anterior cruciate ligament tear: A meta-analysis. Medicine (Baltimore) 2023; 102:e33091. [PMID: 36897704 PMCID: PMC9997816 DOI: 10.1097/md.0000000000033091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/03/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND To compare the clinical outcome between dynamic intraligamentary stabilization (DIS) and anterior cruciate ligament (ACL) reconstruction in ACL tears. METHODS PubMed, the Cochrane Library, and Embase databases were searched to identify published articles on clinical studies comparing DIS versus ACL reconstruction. The results of the eligible studies were analyzed in terms of anteroposterior knee laxity translation (ΔATT) between the injured and contralateral knees, and subjective International Knee Documentation Committee (IKDC), Lysholm score, Tegner score, and ipsilateral ACL failure, implant removal, and ACL revision. RESULTS Five clinical studies including 429 patients with ACL tears met the inclusion criteria. DIS showed statistically comparable outcomes of ΔATT (P = .12), IKDC (P = .38), Tegner (P = .82), ACL failure (P = .50), ACL revision (P = .29) with ACL reconstruction. A significantly higher rate of implant removal (odds ratio for DIS vs ACL reconstruction, 7.73; 95% confidence interval [CI], 2.72-22.00; P = .0001) but statistically higher Lysholm score (mean difference between DIS and ACL reconstruction, 1.59; 95% CI, 0.24-2.93; P = .02) were found in DIS group. CONCLUSION Five clinical studies including 429 patients with ACL tears met the inclusion criteria. DIS showed statistically comparable outcomes of ΔATT (P = .12), IKDC (P = .38), Tegner (P = .82), ACL failure (P = .50), ACL revision (P = .29) with ACL reconstruction. A significantly higher rate of implant removal (odds ratio for DIS vs ACL reconstruction, 7.73; 95% CI, 2.72-22.00; P = .0001) but statistically higher Lysholm score (mean difference between DIS and ACL reconstruction, 1.59; 95% CI, 0.24-2.93; P = .02) were found in DIS group.
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Affiliation(s)
- Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fanqiang Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yifan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Browne IL, Zhang W, Sutton AJ. Exploring the approach to parameter uncertainty in early economic evaluations of surgical technology - a systematic review. Expert Rev Pharmacoecon Outcomes Res 2023; 23:29-41. [PMID: 36357336 DOI: 10.1080/14737167.2023.2145946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The role of early economic evaluation (EEE) in the development of medical technology has been increasingly recognized; however, data on the use of EEE in surgical technology are sparse. The objective of this review was to explore the use of EEE in the development of surgical technologies, with emphasis on how uncertainty has been addressed. AREAS COVERED A systematic review was conducted, and original articles employing any form of EEE of surgical technology were selected for review, with 10 studies included in the analysis. These studies demonstrated significant variation in the approach to managing parameter uncertainty, specifically regarding the type of analysis used and the inclusion of effectiveness parameters in sensitivity analysis. The conclusions drawn did not appear to factor in uncertainty in the models. EXPERT OPINION Approaches to handling parameter uncertainty in previous EEEs of surgical technology have been limited, with some studies failing to address parameter uncertainty. In addition, EEEs do not appear to follow established guidelines with respect to the use of sensitivity analyses. It is important that EEEs of surgical technology address parameter uncertainty in order to draw more robust conclusions from the analysis and allow investors to consider this uncertainty when making investment decisions.
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Affiliation(s)
- Ikennah L Browne
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wei Zhang
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Häberli J, Bieri KS, Aghayev E, Eggli S, Henle P. Dynamic intraligamentary stabilization of anterior cruciate ligament repair: hardware removal has no effect on knee laxity at 2-year follow-up. Arch Orthop Trauma Surg 2019; 139:639-644. [PMID: 30649589 DOI: 10.1007/s00402-019-03113-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Dynamic intraligamentary stabilization (DIS) stabilizes the knee joint during anterior cruciate ligament (ACL) healing. After 6 months, tibial hardware removal is offered to the patients if local discomfort at the implant site is present. AIM This study compared knee laxity and functional scores 2 years after DIS between patients with and without hardware removal. It is hypothesized that it does not affect ACL healing. MATERIALS AND METHODS The study retrospectively analyzed prospectively collected data from 173 patients with either hardware removal (n = 47) or no additional intervention (n = 126). Inverse probability of treatment weighting using the propensity score was applied to balance the groups for baseline characteristics. The primary outcome was the side-to-side difference in knee laxity measured with the rolimeter at manual maximum force (Δ-Lachman). Secondary outcomes were the pivot-shift test and subjective scores. RESULTS Mean age was 34 years in both groups, and female gender was 47% (hardware removal group) and 50% (control group), respectively. No significant differences were found for Δ-Lachman (p = 0.09), pivot-shift test (p = 0.41), and subjective scores (p > 0.10) two years after DIS. CONCLUSION Knee laxity 2 years after DIS in patients with tibial hardware removal and patients without hardware removal was not significantly different. The groups were also similar regarding all the assessed functional scores. This study confirms the hypothesis that the healing ACL resumes its stabilizing role, and the hardware can be removed beginning 6 months after surgery without adverse consequences for joint stability. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Janosch Häberli
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Kathrin Susan Bieri
- Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
| | - Emin Aghayev
- Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Spine Center, Schulthess Klinik, Lennghalde 2, 8008, Zurich, Switzerland
| | - Stefan Eggli
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
| | - Philipp Henle
- Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland
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Osti M, El Attal R, Doskar W, Höck P, Smekal V. High complication rate following dynamic intraligamentary stabilization for primary repair of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2019; 27:29-36. [PMID: 30032314 DOI: 10.1007/s00167-018-5067-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/13/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE New strategies for dynamic intraligamentary stabilization (DIS) in the primary repair of anterior cruciate ligament (ACL) ruptures are currently under debate. It has been proposed that these might serve as alternative techniques to conventional ACL reconstruction procedures using tendon autografts. The aims of the present investigation were to evaluate the functional results and critically assess the complication rate following primary ACL repair with DIS and to review existing reports of favourable clinical results with the method in relation to knee joint stability and patient satisfaction. METHODS Fifty-nine patients received dynamic intraligamentary stabilization a mean of 14 days after ACL rupture. Fifty-seven patients (96.6%, male:female = 37:20; mean age 27.6 years) were available for follow-up examinations including the Tegner activity level, anteroposterior stability in comparison with the uninjured knee, subjective satisfaction, and range of knee motion. Complications after 3 and 12 months were also analyzed. Associated lesions requiring surgical measures were found in 30 patients. RESULTS A statistically significant decrease in Tegner activity levels was detected between the preoperative status (median 7) and the 12-month follow-up (median 5). The overall complication rate was 57.9%, including rerupture or non-healing (n = 10, 17.5%), repeat arthroscopy (n = 13, 22.8%) as a result of meniscus tears (n = 2, 15.4%), cyclops syndrome (n = 4, 30.8%) or restricted range of motion (n = 7, 53.8%), arthrofibrosis (n = 3, 5.3%), and implant interference (n = 7, 12.3%). Anteroposterior KT-1000 stability of 3 mm or below was achieved in 29 (50.9%) patients. CONCLUSIONS The DIS procedure does not appear to be appropriate for providing predictable results in a young and active cohort of patients following ACL rupture, as it has an unacceptably high complication rate and leads to residual anteroposterior knee joint laxity of 3 mm or more in 28 (49.1%) of cases. LEVEL OF EVIDENCE IV (prospective case series).
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Affiliation(s)
- Michael Osti
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Rene El Attal
- Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Wolfgang Doskar
- AUVA Trauma Centre Klagenfurt, Waidmannsdorfer Straße 35, 9020, Klagenfurt am Wörthersee, Austria
| | - Paul Höck
- AUVA Trauma Centre Klagenfurt, Waidmannsdorfer Straße 35, 9020, Klagenfurt am Wörthersee, Austria
| | - Vinzenz Smekal
- AUVA Trauma Centre Klagenfurt, Waidmannsdorfer Straße 35, 9020, Klagenfurt am Wörthersee, Austria
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Afzali T, Fangel MV, Vestergaard AS, Rathleff MS, Ehlers LH, Jensen MB. Cost-effectiveness of treatments for non-osteoarthritic knee pain conditions: A systematic review. PLoS One 2018; 13:e0209240. [PMID: 30566527 PMCID: PMC6300294 DOI: 10.1371/journal.pone.0209240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/03/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Knee pain is common in adolescents and adults and is associated with an increased risk of developing knee osteoarthritis. The aim of this systematic review was to gather and appraise the cost-effectiveness of treatment approaches for non-osteoarthritic knee pain conditions. METHOD A systematic review was conducted according to the PRISMA guidelines and registered on PROSPERO (CRD42016050683). The literature search was done in MEDLINE via PubMed, EMBASE, The Cochrane Library, and the National Health Service Economic Evaluation Database. Study selection was carried out by two independent reviewers and data were extracted using a customized extraction form. Study quality was assessed using the Consensus on Health Economic Criteria list. RESULTS Fifteen studies were included. The majority regarded the treatment of anterior cruciate ligament (ACL) injuries, but we also identified studies evaluating other knee pain conditions such as meniscus injuries, cartilage defects, and patellofemoral pain syndrome. Study interventions were categorized as surgical or non-surgical interventions. The surgical interventions included ACL reconstruction, chondrocyte implantation, meniscus scaffold procedure, meniscal allograft transplantation, partial meniscectomy, microfracture, and different types of autografts and allografts. The non-surgical management consisted of physical therapy, rehabilitation, exercise, counselling, bracing, and advice. In general, for ACL injuries surgical management alone or in combination with rehabilitation appeared to be cost-effective. The quality of the economic evaluations was of moderate to high quality. CONCLUSION There was insufficient evidence to give a firm overview of cost-effective interventions for non-osteoarthritic knee pain, but surgical treatment of acute ACL injury appeared cost-effective. There is very little data regarding the cost-effectiveness of non-surgical interventions for non-traumatic knee conditions.
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Affiliation(s)
- Tamana Afzali
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - Mia Vicki Fangel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne Sig Vestergaard
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
| | | | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Aalborg, Denmark
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Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair - past, present and future. J Exp Orthop 2018; 5:20. [PMID: 29904897 PMCID: PMC6002325 DOI: 10.1186/s40634-018-0136-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing. Current standard The poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries. History of primary ACL repair The history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed. New primary repair techniques There has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur. In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair. Bio enhanced repair In addition, biological supplementation is being investigated as an adjunct and we will review the current literature with regards to bio-enhancement in the form platelet rich plasma, bio-scaffolds and stem cells. On the basis of current evidence, there appears to be a role for bio-enhancement, however, this is not yet translated into clinical practice. Conclusions Several promising avenues of further research now exist in the form of mechanical and biological augmentation techniques. Further work is clearly needed but there is renewed interest and focus for primary ACL repair that may yet prove the new frontier in ligament repair.
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Affiliation(s)
- Piyush Mahapatra
- Trauma and Orthopaedic Department, Croydon University Hospital, 530 London Road, London, CR7 7YE, UK.
| | - Saman Horriat
- Trauma and Orthopaedic Department, Croydon University Hospital, 530 London Road, London, CR7 7YE, UK
| | - Bobby S Anand
- Trauma and Orthopaedic Department, Croydon University Hospital, 530 London Road, London, CR7 7YE, UK
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Recovery of ACL function after dynamic intraligamentary stabilization is resultant to restoration of ACL integrity and scar tissue formation. Knee Surg Sports Traumatol Arthrosc 2018; 26:589-595. [PMID: 28741153 DOI: 10.1007/s00167-017-4656-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Dynamic intraligamentary stabilization (DIS) is recognized as a ligament preserving technique for the treatment of acute anterior cruciate ligament (ACL) injuries. The aim of this study was to assess the integrity and morphology of the recovered ACL after DIS repair. METHODS The cohort comprised 47 patients with an acute proximal ACL rupture undergoing DIS repair. All patients underwent diagnostic arthroscopy after a minimum postoperative interval of 6 months for semi-quantitative evaluation of ACL integrity, function and scar tissue formation. Tegner, Lysholm and International Knee Documentation Committee (IKDC) scores as well as objective anteroposterior (ap) translation were assessed at 6 weeks, 3-, 6- and 12 months postoperatively. RESULTS Full restoration of the ACL volume was affirmed in 30 (63.8%) patients and two-third restoration in 13 (27.7%). Hypertrophic scar formation was observed in 23 (48.9%) patients. Forty-four patients (93.6%) demonstrated sufficient ACL tensioning intraoperatively upon anterior stress. At final follow-up, the median Tegner activity level was 5.5 (3-10), Lysholm and IKDC scores were 100 (64-100) and 94 (55-100) points, respectively. The mean ap-translation differed from the normal knee by 2.1 ± 2.2 mm. Deficient ACL recovery was noted in four patients (8.5%), none of which required secondary reconstructive surgery. CONCLUSION The results demonstrate that clinical recovery of ACL function after DIS repair is resultant to both restoration of ACL volume and scar tissue formation. Factors influencing the degree of scar tissue formation need further investigation to enable future attempts of guiding a balanced biological healing response. LEVEL OF EVIDENCE IV.
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