Andrea Tecame

Home-based vs supervised rehabilitation programs following knee surgery: a systematic review

INTRODUCTION Following knee surgery, rehabilitation can dramatically affect the postoperative course and the final outcomes of the procedure. We systematically reviewed the current literature comparing clinical outcomes of home-based and outpatient supervised rehabilitation protocols following knee surgery. SOURCES OF DATA We searched Medline, CINAHL, Embase, Google Scholar, The Cochrane Library and SPORTDiscus. The reference lists of the previously selected articles were then examined by hand. Only studies comparing clinical outcomes of patients who had undergone knee surgery followed by different rehabilitation programs were selected. Then the methodological quality of each article was evaluated using the Coleman methodology score (CMS), a 10-criterion scoring list assessing the methodological quality of the selected studies. AREAS OF AGREEMENT Eighteen studies were evaluated in the present review. Three were retrospective studies. The remaining 15 studies were prospective randomized clinical trials. The supervised and home-based protocols did not show an overall significant difference in the outcomes achieved within the studies reviewed. The mean CMS was 77.2. AREAS OF CONTROVERSY The heterogeneity of the rehabilitation protocols used in the studies reviewed makes it difficult to draw definite conclusion on the subject. GROWING POINTS Supervision and location does not seem to directly determine the final outcomes. Numerous variables, including comorbidities and motivation, could influence the results and deserve to be accounted for in future investigations. RESEARCH Better designed studies are needed to show a clear superiority of one rehabilitation approach over another and its applicability to the various surgical procedures involving the knee.

Small joints replacement for hand osteoarthritis: a systematic review.

INTRODUCTION Small joints replacement is a valid treatment for moderate to severe osteoarthritis of the hand. Several design and materials are now available for prostethic procedures with very different clinical and functional outcomes. SOURCES OF DATA An online search was carried out using Medline, Cochrane and Google scholar online databases, searching for studies on small joints replacement in hand surgery. AREAS OF AGREEMENT Good functional and clinical outcomes can be achieved with silicone and pyrolitic carbon implants, either for trapeziometacarpal and metacarpophalangeal joints. In particular, the silicone spacer seems to be very effective for trapeziometacarpal osteoarthrosis, while the pyrolitic carbon total joint prosthesis produces excellent outcomes if used for metacarpophalangeal replacement. Major complications, such as persistent pain and implant loosening, have still a variable rate of occurrence. AREAS OF CONTROVERSY Heterogeneity in the methodology of the assessments in the studies reviewed and the implants and techniques involved makes it difficult to carry out a complete and effective comparative analysis of the data collected. GROWING POINTS Larger cohorts treated with the same implant should be investigated in better designed trials, to draw more clinically relevant conclusions from the evidences presented. Better methodology is also a goal to achieve, since the average Coleman Methodology Score measured for the articles included was 54.9 out of 100. RESEARCH More and better designed studies are needed to produce clear guidelines to define the better implant in terms of clinical outcomes, function and complications for trapeziometacarpal and metacarpophalangeal joints.

Italian consensus statement for the use of allografts in ACL reconstructive surgery

PurposeGraft choice for primary anterior cruciate ligament reconstruction (ACL-R) is debated, with considerable controversy and variability among surgeons. Autograft tendons are actually the most used grafts for primary surgery; however, allografts have been used in greater frequency for both primary and revision ACL surgery over the past decade. Given the great debate on the use of allografts in ACL-R, the “Allografts for Anterior Cruciate Ligament Reconstruction” consensus statement was developed among orthopedic surgeons and members of SIGASCOT (Società Italiana del Ginocchio, Artroscopia, Sport, Cartilagine, Tecnologie Ortopediche), with extensive experience in ACL-R, to investigate their habits in the use of allograft in different clinical situations. The results of this consensus statement will serve as benchmark information for future research and will help surgeons to facilitate the clinical decision making.MethodsIn March 2017, a formal consensus process was developed using a modified Delphi technique method, involving a steering group (9 participants), a rating group (28 participants) and a peer-review group (31 participants). Nine statements were generated and then debated during a SIGASCOT consensus meeting. A manuscript has been then developed to report methodology and results of the consensus process and finally approved by all steering group members.ResultsA different level of consensus has been reached among the topics selected. Strong agreement has been reported in considering harvesting, treatment and conservation methods relevant for clinical results, and in considering biological integration longer in allograft compared to autograft. Relative agreement has been reported in using allograft as the first-line graft for revision ACL-R, in considering biological integration a crucial aspect for rehabilitation protocol set-up, and in recommending a delayed return to sport when using allograft. Relative disagreement has been reported in using allograft as the first-line graft for primary ACL-R in patients over 50, and in not considering clinical results of allograft superior to autograft. Strong disagreement has been reported in using allograft as the first-line graft for primary ACL-R and for skeletally immature patients.ConclusionsResults of this consensus do not represent a guideline for surgeons, but could be used as starting point for an international discussion on use of allografts in ACL-R.Level of evidenceIV, consensus of experts.