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Krause F, Herrera M, Walcher M, Mahadevan D, Michels F. Quo vadis, foot & ankle research? A review. Foot Ankle Surg 2023; 29:502-505. [PMID: 37648639 DOI: 10.1016/j.fas.2023.08.003] [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: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
Over the last two decades, there has been a growing emphasis on the publication quality in Foot & Ankle research. A level-of-evidence rating system for clinical scientific papers has been proposed by the Centre for Evidence-based medicine in Oxford, United Kingdom. As opposed to other subspecialities, foot & ankle surgery deals with a wide variety of clinical problems and surgical solutions, which in turn leads to a generally low number of patients available for study groups. However, level III and IV studies still have a valuable place in orthopaedic research, given the challenges in running high-level studies.The measurement of outcomes in medicine from the patients' perspective (PROMS:(patient reported outcome measures) has grown almost exponentially in all surgical specialties including foot & ankle surgery. There are many PROMs available to foot & ankle surgeons, but there is little consensus on which assessment is most appropriate for a given procedure or diagnosis. Their use in research and clinical practice offers many advantages in clinical practice and research, however, besides the advantages there are also some downsides.
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Affiliation(s)
- Fabian Krause
- University of Bern, Orthopädie Sonnenhof, Salvisbergstrasse 4, 3006 Bern, Switzerland; Sportsclinic#1, Papiermühlestrasse 73, 3006 Bern, Switzerland; Department of Orthopaedic Surgery, Inselspital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - Mario Herrera
- Foot and ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, School of Medicine, Universidad de La Laguna, Tenerife, Spain
| | - Matthias Walcher
- Orthopädie Chirurgie Würzburg, Oeggstr. 3, 97070 Würzburg, Germany; Department of Orthopedics and Traumatology, Paracelsus Medial University, Breslauer Str. 201, 90471 Nuremberg, Germany
| | - Devendra Mahadevan
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading RG1 5AN, UK
| | - Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium.
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Alhadhoud MA, Alsiri NF, Daniels TR, Glazebrook MA. Surgical interventions of Freiberg's disease: A systematic review. Foot Ankle Surg 2021; 27:606-614. [PMID: 32917526 DOI: 10.1016/j.fas.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/21/2020] [Accepted: 08/11/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Freiberg's disease is an osteonecrosis of the metatarsal head bone. Numerous surgical interventions can be provided; however, the literature is limited in systematic reviews discussing the various options. The study aimed to systematically review the quantity and quality of literatures exploring the surgical interventions. METHODS Fifty articles were found to be relevant for assessing the efficacy of common surgical interventions. The articles were assigned a level of evidence (I-V) to assess their quality. Next, the studies were reviewed to provide a grade of recommendation (A-C, I). RESULTS Two studies were found at level III that explored osteotomy and autologous transplantation; the other studies were level IV-V. There is poor evidence (grade C) in supporting of joint sparing and joint sacrificing for Freiberg's disease. CONCLUSION Poor evidence exists to support the surgical interventions for Freiberg's disease, higher quality trials are needed to support the increasing application of these surgical techniques. LEVEL OF EVIDENCE Level IV, Systematic review.
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Affiliation(s)
- Meshal A Alhadhoud
- Al-Adan Hospital, Kuwait; Al-Razi Orthopedics and Rehabilitation Hospital, Kuwait; Dalhousie University, Orthopedic, 1796 Summer Street, Halifax, Canada.
| | - Najla F Alsiri
- Al-Razi Orthopedics and Rehabilitation Hospital, Kuwait.
| | - Timothy R Daniels
- University of Toronto, Surgery, 55 Queen Street, East Toronto, Canada.
| | - Mark A Glazebrook
- Dalhousie University, Orthopedic, 1796 Summer Street, Halifax, Canada.
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Bia A, Guerra-Pinto F, Pereira BS, Corte-Real N, Oliva XM. Percutaneous Osteotomies in Hallux Valgus: A Systematic Review. J Foot Ankle Surg 2018; 57:123-130. [PMID: 28870735 DOI: 10.1053/j.jfas.2017.06.027] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Indexed: 02/03/2023]
Abstract
Percutaneous and minimally invasive surgery is one of the greatest advances in the operating field of orthopedic since the late 1990s. The potential advantages include a shorter operative time, quicker recovery, and reduced hospital stay compared with traditional open surgery. However, scientific validation of the safety and efficacy of hallux valgus (HV) percutaneous surgery remains inconclusive. The objective of the present study was to systematically review the published data and clinical evidence for percutaneous HV surgery, evaluate the scientific method of the reports, and clarify the indications, safety, efficacy, and potential risks of these surgical techniques. Two reviewers independently identified the studies using a PubMed search, with the keywords "hallux valgus," "osteotomy," "minimally invasive," and "percutaneous." Quality assessment was performed using the Coleman methodology scale, and each study was assigned a level of evidence and grade of recommendation. Eighteen studies were included and reported a total of 1534 procedures for percutaneous HV surgery on 1397 patients. Of the 18 studies, 14 (77.8%) were level IV, 2 (11.1%) were level III, and 2 (11.1%) were level II. Overall, the average angle correction of the HV deformity improved postoperatively. Regarding the complications, although some investigators revealed no major complications, others described deformity recurrence in 7.8%, stiffness of the first metatarsophalangeal joint in 9.8%, malunion in 4% to 8.7%, and infection rates ranging from 1.9% to 14.3%. The main indication for percutaneous HV surgery is the correction of mild deformities. The complication rate was elevated even in experienced surgeons. In conclusion, future research in percutaneous techniques should include adequately sized randomized control trials, standardization of treatment protocols, and the use of validated tools for the measurement of clinical outcomes.
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Affiliation(s)
- Ana Bia
- Orthopedic Surgeon, Department of Orthopedic Surgery, Centro Hospitalar do Oeste-Unidade de Torres Vedras, Torres Vedras, Portugal.
| | - Francisco Guerra-Pinto
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hospital de Cascais Dr. José de Almeida, Alcabideche, Portugal; PhD Student, Faculdade de Ciencias Medicas da Universidade Nova de Lisboa, Lisboa, Portugal
| | - Bruno S Pereira
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hospital de Braga, Braga, Portugal; PhD Student, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Researcher, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; Orthopedic Surgeon and Researcher, Clinica do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Centre of Excellence, Minho University and University of Porto Research Center, Porto, Portugal
| | - Nuno Corte-Real
- Orthopedic Surgeon and Head of Department of Orthopedic Surgery, Hospital de Cascais Dr. José de Almeida, Alcabideche, Portugal
| | - Xavier Martin Oliva
- Orthopedic Surgeon, Department of Orthopedics, Clinica Del Remei, Barcelona, Spain; Professor, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Abstract
BACKGROUND The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. METHODS Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. RESULTS A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. CONCLUSION Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.
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