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Synopsis: Six comparative studies (5RCT, 1 cohort) were included in this meta-analysis comparing osteochondral autograft transfer (OAT) and microfracture (MFx) in the treatment of cartilage lesions of the knee.Activity level, patient-reported outcome scores, and the incidence of failure were pooled.Results demonstrated a significant difference in Tegner score in favour of OAT groups compared to MFx groups, though subgroup analysis suggested the difference may be associated with greater lesion size.The patient reported outcome scores also favoured the OAT groups compared to MFx within a 3-year follow-up, though no significant difference was observed when pooled at 5-10 years. The incidence of... Read More »
Author verified Level 2 Meta Analysis
3%
Synopsis: 220 patients scheduled for total hip arthroplasty were randomized to undergo the procedure on either an outpatient or inpatient basis.Outpatients were to be discharged within 12 hours of surgery, while inpatients were allocated to at least a one-night stay in hospital.Patients were assessed for pain on the day of surgery (POD0), postoperative day 1 (POD1), and at 4 weeks.Results demonstrated no significant differences between groups in pain on POD0 or at 4 weeks, but significantly higher pain among outpatients on POD1. There were no... Read More »
RCT
3%
Synopsis: 160 patients with a Robinson type 2B1-2 displaced midshaft clavicle fracture were included in this multicenter randomized controlled trial to compare outcomes between operative and nonoperative treatment methods.Patients were evaluated for nonunion, constant shoulder score, disabilities of the arm, shoulder, and hand (DASH) score, pain, secondary operations, and cosmetic result.At one year the rate of nonunion was significantly higher in the nonoperative group as was the rate of secondary plate fixation to manage nonunion.However, there was no difference in the total number of secondary procedures between groups.Additionally, there were no differences in constant and DASH scores between the groups. Read More »
Level 2 RCT
3%
Synopsis: 11 randomized controlled trials were included in this meta-analysis comparing outcomes between intramedullary fixation and extramedullary fixation of unstable intertrochanteric fractures.Outcomes which demonstrated significant differences between fixation options included blood loss and postoperative mobility scores, both favour intramedullary implants. Otherwise, operative time,... Read More »
Level 1 Meta Analysis
2%
Synopsis: 1543 patients undergoing knee arthroscopy (POT-KAST trial) and 1519 patients undergoing casting of the lower leg (POT-CAST trial) were randomized to receive or not anticoagulant therapy.The aim of these studies was to examine the efficacy of thromboprophylaxis in these groups of patients.The result of these trials indicated that the use of low-molecular-weight heparin did not reduce the rate of symptomatic venous thromboembolism in either patient population compared to no anticoagulant treatment. Read More »
Level 2 RCT
2%
Synopsis: 14 randomized controlled trials were included in this systematic review and meta-analysis to evaluate the use of corticosteroid injections in the management of rotator cuff tendinosis in comparison to a placebo.The primary outcome of interest for this meta-analysis was pain assessed at 3 months (12 weeks).A subgroup analysis was also performed to compare the efficacy of single vs multiple injections.The results of this study indicated that corticosteroid injections provided greater reductions in pain at 4 and 8 weeks compared to placebo, however, these differences were small and not clinically relevant.There were no differences observed between groups at 12 weeks.Additionally, there were no differences observed between single and multiple injections of a corticosteroid. Read More »
Author verified Meta Analysis
2%
Synopsis: Twelve studies were included in this meta-analysis and systematic review to determine the effects of exercise therapy in the management of meniscal lesions as a non-operative treatment and as a modality for rehabilitation following meniscectomy compared to other treatments.This summary focused on the results from the meta-analyses conducted in this publication.When exercise therapy alone was compared to isolated meniscectomy/meniscal repair, exercise therapy demonstrated significantly greater strength in extension at 3 months, and no significant differences in short- and long-term pain and function.When exercise therapy was assessed as a rehabilitative treatment following meniscectomy/meniscal repair, standard exercise therapy demonstrated no significant differences in short-term pain and short- and long-term function when compared to alternative exercise therapies (early range of motion, isokinetic exercise, etc). There was limited... Read More »
Level 1 Meta Analysis
2%
Synopsis: 151 patients undergoing total knee arthroplasty were included in this randomized trial to evaluate the efficacy of different intravenous tranexamic acid administration protocols for reducing hidden blood loss.Patients were randomized into 3 groups: Group A (control) received intravenous (IV) TXA pre-op and IV placebo at 3 and 6 hours.Group B (3h TXA) received IV TXA pre-op and at 3 hours, and IV placebo at 6 hours.Group C (3h+6h TXA) received IV TXA pre-op, at 3 and at 6 hours, all patients received 1-g of topical TXA intraoperatively.The results of this trial indicated that the group that received additional TXA doses at 3 and 6 hours had a significant reduction in hidden blood loss, total blood loss, postoperative hemoglobin drop, and a shorter length of hospital stay when compared to the other two groups, without an increase in thromboembolic adverse events. Read More »
Level 1 RCT
2%
Synopsis: 18 randomized controlled trials were included in this meta-analysis evaluating the efficacy and safety of newer anticoagulants compared to enoxaparin in total knee and total hip arthroplasty.Anticoagulants evaluated included apixaban, dabigatran, fondaparinux, rivaroxaban, and edoxaban.The only newer anticoagulant which failed to demonstrate a significant reduction in VTE incidence relative to enoxaparin was dabigatran at both 150mg and 220mg once daily doses. Of the remaining... Read More »
Level 1 Meta Analysis
2%
Synopsis: 84 patients scheduled for revision total hip arthroplasty were randomized to administration of either combined intravenous and topical tranexamic, or intravenous tranexamic acid administration alone during the procedure.The purpose of this study was to compare transfusion rate, blood loss parameters, and the incidence of venous thromboembolic complications between groups.Results demonstrated significantly lower transfusion rate, smaller maximum hemoglobin drop, and lower postoperative and total blood loss volume in the combined TXA group compared to the IV TXA group.The incidence of deep vein thrombosis was low, with only one case documented in the combined group. No patient in... Read More »
Level 2 RCT