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Synopsis: 9 studies (7 randomized control trials, 2 non-randomized control trials) comparing a home-based, supervised exercise program (HET) to either a hospital-based, supervised exercise program (SET) or to simple, unsupervised "go home and walk" advice (GHWA) to treat intermittent claudication were included in this systematic review.The purpose of the review was to determine if a home-based exercise program benefited patient walking capacity and quality of life more than the comparative treatments.Qualitative analysis found HET to provide generally better results compared to GHWA.When compared to SET, HET showed somewhat worse results for pain-free walking capacity and health-related quality of life, but better daily life walking capacity. Outcomes were inconsistent... Read More »
Level 2 Meta Analysis
5%
Synopsis: 9 randomized controlled trials were included in this meta-analysis, comparing arthroscopic surgery to conservative management for the treatment of degenerative meniscal tears in patients over the age of 40 years.Outcomes of interest included knee pain and knee function. The results from... Read More »
Level 1 Meta Analysis
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Synopsis: Five randomized controlled trials (368 patients) were identified to analyze the effectiveness of steroid injection in the treatment of lumbar radicular pain.The results of this meta-analysis and systematic review indicated improvement in pain but not disability in the steroid treatment compared to the control; however, these differences were not significant. This meta-analysis demonstrated... Read More »
Level 2 Meta Analysis
2%
Synopsis: Six ACE Reports (5 randomized controlled trials and 1 systematic review/meta-analysis) were identified from the OrthoEvidence database which evaluated the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis.All included studies were randomized controlled trials, and reported clinical and functional assessment at various time points between 1 and 6 months following treatment.Pooled analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Total scores suggested a possible beneficial effect with PRP injection in comparison to saline and a lower effect versus hyaluronic acid.Beneficial effects were also noted for individual subscales of the WOMAC assessment (pain, stiffness, and physical function).However, pooling of OMERACT-OARSI responders and a review of the literature indicated that there was no significant difference between PRP and comparison groups in other functional outcome measures, such as the International Knee Documentation Committee (IKDC) assessment and Knee Injury and Osteoarthritis Outcome Score (KOOS).Furthermore, contrasting results were obtained between two studies reporting function on the Lequesne Index. The discrepancy in... Read More »
ACE Review
2%
Synopsis: 8 ACE Reports (7 randomized controlled trials and 1 systematic review and meta-analysis, n=694) from the OrthoEvidence database assessing the effectiveness of corticosteroid injections in comparison to control injections (either saline or local anesthesia) for the treatment of lateral epicondylitis were included in this review.The purpose of this review was to determine the impact of corticosteroid injections on pain and physical function in comparison to these control treatments.As such, information and data on platelet-rich plasma (PRP) injection efficacy as a treatment was not included from reports.Statistical pooling of VAS pain scores and Quick DASH scores exhibited that corticosteroid injections provided significant pain relief, compared to control injections only in the short-term (6-12 weeks), while having no functional benefits over control injections at any time point within a 6 month period. Similar results were... Read More »
ACE Review
2%
Synopsis: Six ACE Reports were identified from the OrthoEvidence database which compared intra-articular injection(s) of hyaluronic acid to corticosteroid in the treatment of osteoarthritis of the knee.All of the included studies were randomized controlled trials which reported pain and/or functional outcomes within 6 months of intervention.Pooled analysis of pain on a visual analog scale indicated that pain relief was significantly better with hyaluronic acid injections at both 3 and 6 months follow-up; however, this finding was strongly influenced by two studies of lower methodological quality. No significant differences between hyaluronic acid and corticosteroid injections were observed in any functional outcome measurement.Due to incomplete or lack of reporting adverse events, an assessment of safety could not be performed along with this review. Furthermore, these findings... Read More »
ACE Review
2%
Synopsis: Data from 22 articles (10 RCTs) spanning 3,583 patients was systematically reviewed to determine whether delayed anterior cruciate ligament (ACL) reconstruction produced more meniscal and chondral pathologies, contributing to an increased risk of osteoarthritis, when compared to early reconstruction.The analysis of the appropriate literature revealed that substantial variability existed between included studies in terms of study design, methodology, surgical technique involved, and outcome measurements.In particular, the definition of delayed and early intervention was not similar between studies. Eight articles supported... Read More »
Author verified Level 2 Meta Analysis
2%
Synopsis: 100 patients were randomized to total knee arthroplasty with either patient-specific instrumentation or conventional instrumentation.The purpose was to determine if patient-specific guides offered improved postoperative alignment over conventional methods. The results from... Read More »
Author verified Level 2 RCT
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Synopsis: Sixty patients with hip fractures were randomized to undergo surgical treatment using either an accelerated or the standard treatment protocol, in order to assess the feasibility of a true randomized controlled trial comparing these two approaches.Overall, feasibility targets were attained, with 60 patients recruited in less than 18 months, over 70% of eligible patients undergoing randomization, and 100% rate of 30-day follow-up.Major perioperative complications occurred in 9 and 14 patients in the accelerated and standard groups, respectively. The results justified... Read More »
Author verified Level 2 RCT
2%
Synopsis: 164 patients who had sustained a traumatic ACL injury causing instability and who were previously healthy in the contralateral knee were randomly assigned into 1 of 2 groups to determine the effect of ACL reconstruction on the development of OA in the operated knee.Patients were treated with either a semitendinosus tendon graft or a bone-patellar tendon-bone graft.The results of the study indicated that ACL reconstructed knees demonstrated a significant increase in the development of OA (14 years after surgical intervention) compared to contralateral knees.Osteoarthritis of the medial compartment was the most common form of OA following ACL reconstruction, and was also the most common form of OA in the contralateral knee.No difference was apparent between graft types in terms of occurrence of OA.Meniscus resection and BMI were found to be major risk factors for OA of the medial compartment. Further research is... Read More »
Author verified Level 2 RCT