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Synopsis: 29 studies were included in this meta-analysis comparing operative and non-operative treatment for acute Achilles tendon ruptures.The primary outcome of interest was the rate of re-rupture.Secondary outcomes included the rate of complications, functional outcomes, time to return to sports and time to return to work.The results revealed a significantly lower rate of re-rupture, but a higher rate of complications, in the operative group compared to the non-operative group.Similar findings to the primary analyses were observed in the sensitivity analyses based on early and late weight bearing status, high quality studies and studies conducted after the year 2000.There were no significant differences in re-rupture rate in studies utilizing accelerated functional rehabilitation. There was no... Read More »
Level 1 Meta Analysis
2%
Synopsis: 110 patients scheduled for a primary unilateral total knee arthroplasty (TKA) were randomized to receive an immediate or delayed physiotherapy protocol following surgery.Outcomes of interest included the Knee Injury and Osteoarthritis Outcome Score (KOOS), VR-12 scores, visual analog scale (VAS) pain scores, range of motion, number of therapy visits, the Timed Up and Go (TUG) test, and rate of manipulation.Follow up was performed at 6 weeks and 6 months. Results from the... Read More »
Conference Report
2%
Synopsis: 13 ACE reports (4 reviews/ meta-analyses, 9 RCTs) were included from the OrthoEvidence database that compared operative versus nonoperative or operative versus operative treatments for displaced midshaft clavicle fractures.The findings of this review demonstrated that surgical procedures led to a lower rate of nonunion and malunion with better functional outcome when compared to nonoperative treatment. Comparisons of operative treatments indicated that an optimal surgical procedure - between plate fixation, nailing, and pin fixation - could not be determined based on union rates or functional outcome. The results of... Read More »
ACE Review
2%
Synopsis: 100 patients scheduled for total hip arthroplasty were randomized to either a direct anterior approach or a direct lateral approach.Patients were assessed for early and midterm outcomes with respect to pain, function performance, and patient-reported functional measures, as well as the incidence of complications.Results demonstrated significant advantages of the direct anterior approach relative to the direct lateral approach with respect to pain and narcotic consumption 2-3 days after surgery, functional performance at 3 days after surgery, and patient-reported function at 8 weeks after surgery. Nonetheless, midterm outcome... Read More »
Level 2 RCT
2%
Synopsis: 68 patients with a proximal humerus fracture were randomized to fixation with either an intramedullary nail (Locking Blade Nail; Marquard) or a locking plate (Proximal Humerus Interlocking Osteosynthesis [PHILOS] system; DePuy Synthes).Patients were assessed for outcome related to function and complications over 1-year follow-up.Results for the primary outcome measure of the Constant score, as well as secondary outcomes for pain and range of motion demonstrated no significant differences between groups at 3 months, 6 months or 1 year.The Disabilities of the Arm, Shoulder, and Hand score demonstrated a significant between-group difference in favour of the nail group at 1 year, but not at 3 or 6 months. Overall rate of... Read More »
Level 2 RCT
2%
Synopsis: 75 patients with a 3- or 4-part humerus fracture were randomized to fixation with either a locking intramedullary nail or locking compression plate.Patients were assessed over a minimum of 24 months after surgery for clinical scores, radiographic outcome, and incidence of complications and reoperation.Clinical scores, including visual analog pain scores, the Constant Score, and the American Shoulder and Elbow Surgeons (ASES) score, demonstrated no significant differences between the two groups.Rates of malunion/nonunion and avascular necrosis development were also similar between groups. A lower rate... Read More »
Conference Report
1%
Synopsis: 247 patients with a Weber type B1 malleolar fracture were randomized to immobilization for either 3 weeks in an orthosis, 3 weeks in a cast, or 6 weeks in a cast.The purpose of this study was to determine whether 3-week immobilization led to noninferior functional outcome over 52-week follow-up when compared to 6-week immobilization.Primary analysis suggested noninferiority of both 3-week immobilization protocols compared to the 6-week protocol with respect to Olerud-Molander Ankle Score after 52 weeks.In additional, all other secondary outcome measures of patient reported pain, function, and quality of life demonstrated no significant between group differences.The only significant difference noted between groups at 52 weeks was a higher range of plantar flexion in the 3-week orthosis group versus the 6-week cast group. Rate of nonunion... Read More »
Level 2 RCT
1%
Synopsis: 33 patients scheduled for bilateral total knee arthroplasty were randomized to receive a titanium alloy implant in one knee and a cobalt-chromium implant in the other knee.The purpose of this study was to examine and compare periprosthetic bone mineral density (BMD) over 2-year follow-up. When considering tibial periprosthetic BMD, scans taken in the anteroposterior (AP) plane demonstrated significantly greater BMD in the medial region in the TiN group compared to the CoCr, though both groups demonstrated a significant reduction from baseline.In addition, lateral scans demonstrated significantly greater BMD in the anterior region in the TiN group compared to the CoCR group.For the remaining tibial BMD measures, no significant differences between groups were noted in the lateral region on AP scans, or in the distal region on AP or lateral scans.When considering femoral periprosthetic BMD, no significant differences between groups were noted at any region, including anterior, central, posterior and distal regions on lateral scans. Reduction from baseline... Read More »
Conference Report
1%
Synopsis: 45 patients with acute lateral epicondylitis were randomized to treatment with either a counterforce brace or a placebo brace.The purpose of this study was to compare outcomes of pain and function between the two types of braces.The primary outcome was frequency of pain on activity.Important secondary outcomes included severity of pain on activity, frequency and severity of pain at rest, and overall impression of elbow function.Follow-up was scheduled for 2 weeks, 6 weeks, 12 weeks, and 26 weeks.Final follow-up continued to an average of 3 years.For pain during activity, no significant differences between groups were reported for either frequency or severity over follow-up, though improvement from baseline was significant in both groups after 26 weeks and 3 years. For pain at... Read More »
Conference Report
1%
Synopsis: Four randomized controlled trials were included in this meta-analysis which compared outcomes between suprapatellar intramedullary nailing and infrapatellar intramedullary nailing.Pooled analysis demonstrated a significant difference between approaches in favour of suprapatellar intramedullary nailing for pain scores, Lysholm scores, and fluoroscopy time. No significant differences... Read More »
Level 1 Meta Analysis