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Synopsis: Five randomized controlled trials were included in this meta-analysis which sought to investigate the efficacy of mesenchymal stem cell injections in patients with knee osteoarthritis.Included studies featured various control groups, including placebo injection, hyaluronic acid injection, and no injection, as well as various concomitant treatments, including high tibial osteotomy, microfracture, platelet rich plasma injection and hyaluronic acid injection.Accordingly, clinical heterogeneity was assumed.Data was pooled from 12-24 month time points. Analyses on visual... Read More »
Level 2 Meta Analysis
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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
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Synopsis: Two hundred and seven studies with 32959 participants were analyzed in this network meta-analysis.The aim of this study was to compare outpatient treatments for managing acute pain from non-low back musculoskeletal injuries.Results revealed that the treatment with the greatest benefit was using topical nonsteroidal anti-inflammatory agents (NSAIDs).Afterwards, oral NSAIDs were beneficial which was followed by acetiminophen with or without diclofenac.The benefits included relieving pain 1-7 days, as well physical functioning , and symptom relief. Moreover, topical NSAIDs demonstrated increase in treatment satisfaction. Fentanyl and acetaminophen... Read More »
Meta Analysis
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Synopsis: 8 ACE Reports (all randomized controlled trials) from the OrthoEvidence database were included in this review/meta-analysis examining the effect of arthroscopic surgery and physical therapy in the treatment of degenerative tears of the meniscus and knee osteoarthritis.The purpose of this review was to determine if any differences in outcome were demonstrated between arthroscopy followed by physical therapy versus physical therapy alone, regarding pain, function, satisfaction, adverse events, or osteoarthritis progression.Pain results were pooled at 3 different time point: 2-3 months, 6 months, and 12-24 months postintervention.At short-term (2-3 months) and long-term (12-24 months) follow-up, pain was similar between groups, with no significant difference observed.There tended to be less pain experienced at 6 months following arthroscopy, however this only reached significance in the KOOS pain outcome and the clinical importance of this observation is unknown.Assessments of functional outcome, either pooled or qualitative, suggested no significant difference between groups as well. The rate of... Read More »
ACE Review
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Synopsis: 100 patients with chronic lateral epicondylitis were randomized to receive either leukocyte-enriched platelet-rich plasma (PRP) or a corticosteroid treatment, as a control.This was performed in order to determine the efficacy of PRP treatment in the recovery of postoperative function and pain relief.Patients were followed-up at two years to determine the effect on pain and function. Both pain and... Read More »
Author verified Level 1 RCT
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Synopsis: 381 patients with knee osteoarthritis (OA) were randomized to receive intra-articular injections with either Synovail (highly purified intra-articular hyaluronic acid) or Synvisc (hylan G-F20) once a week for three weeks.This double blinded randomized trial examined the efficacy and non-inferiority of Synovial treatment in patients with OA of the knee.The results from this study indicate that both treatments provide significant reductions in the WOMAC Index pain sub-scores at 6 months. Comparisons of mean... Read More »
Author verified Level 1 RCT
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Synopsis: 40 patients presenting with non-insertional Achilles tendinopathy were randomized to receive standard physical therapy with or without topical glyceryl trinitrate (GTN) treatment.Follow-up at 6 months indicated both groups made significant improvements; however, there were no differences between groups for ankle osteoarthritis scale (AOS) scores. There were also... Read More »
Level 2 RCT
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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
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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
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Synopsis: Seven randomized controlled trials were included in this study investigating the difference in outcome between arthroscopic surgery and nonoperative treatment in patients with degenerative meniscal tears and mild if any concurrent knee osteoarthritis.Patient-related outcome measures of function and pain were pooled at short-term (<6 months) and long-term (<24 months).Results of the analyses demonstrated no clinically relevant differences in functional improvement or pain relief in either the short or long term between arthroscopic meniscal debridement and nonoperative/sham treatment. Read More »
Author verified Level 1 Meta Analysis