Jatupon Kongtharvonskul

Clinical outcomes of double- vs single-bundle anterior cruciate ligament reconstruction: A systematic review of randomized control trials

Clinical outcomes of anterior cruciate ligament (ACL) reconstruction with double‐bundle and single‐bundle techniques are still controversial. We therefore performed a systematic review to compare postoperative outcomes between the two techniques. Randomized control trials comparing the outcomes between the two techniques were identified from Medline and EMBASE since inception to April 27, 2011. Data were independently extracted by two reviewers. Thirteen of 318 studies were eligible; 9, 11, 7, and 8 studies were pooled for rotation, translation, function, and complication outcomes, respectively. The double‐bundle technique was approximately four times (95% CI: 2.65, 11.99) and two times (95% CI: 1.16, 5.21) more likely to show a normal pivot shift and normal International Knee Documentation Committee (IKDC) grading compared with the single‐bundle technique. However, there were nonsignificant differences in KT grading (OR = 1.66, 95% CI: 0.77, 3.82), IKDC score (0.29, 95% CI: −1.17, 1.75), Lysholm knee score (−0.87, 95% CI: −2.66, 0.93), Tegner activity score (0.37, 95% CI: −0.05, 0.79), and complications (OR = 1.11, 95% CI: 0.48, 2.57). Heterogeneity was present in some outcomes but there was no evidence of publication bias for any outcome. The double‐bundle may be better than the single‐bundle ACL reconstruction technique in rotational stability but not for function, translation, and complications.

Efficacy and safety of glucosamine, diacerein, and NSAIDs in osteoarthritis knee: a systematic review and network meta-analysis

BackgroundTo conduct a systematic review and network meta-analysis of randomized controlled trials (RCTs) with the aims of comparing relevant clinical outcomes (that is, visual analog scores (VAS), total and sub-Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores, Lequesne algofunctional index, joint space width change, and adverse events) between diacerein, glucosamine, and placebo.MethodsMedline and Scopus databases were searched from inception to 29 August 2014, using PubMed and Scopus search engines and included RCTs or quasi-experimental designs comparing clinical outcomes between treatments. Data were extracted from original studies. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes.ResultsThirty-one of 505 identified studies were eligible. Compared to placebo, glucosamine showed a significant improvement with unstandardized mean differences (UMD) in total WOMAC, pain WOMAC, function WOMAC, and Lequesne score of −2.49 (95% confidence interval (CI) −4.14, −0.83), −0.75 (95% CI: −1.18, −0.32), −4.78 (95% CI: −5.96, −3.59), and −1.03 (95% CI: −1.34, −0.72), respectively. Diacerein clinically improves visual analog scores, function WOMAC, and stiffness WOMAC with UMD values of −2.23 (95% CI: −2.82, −1.64), −6.64 (95% CI: −10.50, −2.78), and −0.68 (95% CI: −1.20, −0.16) when compared to placebo.ConclusionsThe network meta-analysis suggests that diacerein and glucosamine are equally efficacious for symptom relief in knee OA, but that the former has more side effects.

Extracorporeal shock wave therapy, ultrasound-guided percutaneous lavage, corticosteroid injection and combined treatment for the treatment of rotator cuff calcific tendinopathy: a network meta-analysis of RCTs.

AbstractsTreatment of calcific tendinitis using extracorporeal shock wave therapy (ESWT), ultrasound-guided percutaneous lavage (UGPL or barbotage), subacromial corticosteroid injection (SAI) and combined treatment is still controversial. This systematic review and meta-regression aimed to compare clinical outcomes between treatments. Relevant RCTs were identified using PubMed and Scopus search engines to date of September 23, 2015. Seven of 920 studies identified were eligible. Compared to the other treatments, the results of this study indicate that ESWT significantly improved CMS and VAS when compared to placebo. Barbotage plus ESWT significantly improved CMS, VAS and decreased size of calcium deposit when compared to ESWT, while barbotage plus SAI significantly improved CMS and decreased size of calcium deposit when compared to SAI. There have no different adverse effects of all treatment groups. Multiple active treatment comparisons indicated that barbotage plus SAI significantly improved VAS and size of calcium deposit when compared to other groups, while barbotage plus SAI improved CMS when compared to other groups. But there was no significant difference. The network meta-analysis suggested that combined US-guided needling and subacromial corticosteroid injection significantly decreased shoulder pain VAS, improved CMS score and decreased the size of calcium deposits, while also lowering risks of adverse event when compared to barbotage plus ESWT, ESWT and subacromial corticosteroid injection; therefore, the evidence points to UGPL as being the treatment of choice for nonsurgical options of treatment in calcific tendinitis of the shoulder. Level of evidence I.

Clinical outcomes after minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion for treatment of degenerative lumbar disease: a systematic review and meta-analysis

The surgical procedures used for arthrodesis in the lumbar spine for degenerative lumbar diseases remain controversial. This systematic review aims to assess and compare clinical outcomes along with the complications and fusion of each technique (minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or minimally invasive lateral lumbar interbody fusion (MIS LLIF)) for treatment of degenerative lumbar diseases. Relevant studies were identified from Medline and Scopus from inception to July 19, 2016 that reported Oswestry Disability Index (ODI), back and leg pain visual analog score (VAS), postoperative complications, and fusion of either technique. Fifty-eight studies were included for the analysis of MIS-TLIF; 40 studies were included for analysis of LLIF, and 1 randomized controlled trial (RCT) study was included for comparison of MIS-TLIF to LLIF. Overall, there were 9506 patients (5728 in the MIS-TLIF group and 3778 in the LLIF group). Indirect meta-analysis, MIS-TLIF provided better postoperative back and leg pain (VAS), disabilities (ODI), and risk of having complications when compared to LLIF technique, but the fusion rate was not significantly different between the two techniques. However, direct meta-analysis between RCT study and pooled indirect meta-analysis of MIS-TLIF have better pain, disabilities, and complication but no statistically significant difference when compared to LLIF. In LLIF, the pooled mean ODI and VAS back pain were 2.91 (95% CI 2.49, 3.33) and 23.24 (95% CI 18.96, 27.51) in MIS approach whereas 3.14 (95% CI 2.29, 4.04) and 28.29 (95% CI 21.92, 34.67) in traditional approach. In terms of complications and fusion rate, there was no difference in both groups. In lumbar interbody fusion, MIS-TLIF had better ODI, VAS pain, and complication rate when compared to LLIF with direct and indirect meta-analysis methods. However, in terms of fusion rates, there were no differences between the two techniques.

The short and midterm outcomes of lumbar transforaminal epidural injection with preganglionic and postganglionic approach in lumbosacral radiculopathy: a systematic review and meta-analysis

The purpose of this study was to compare clinical outcomes after preganglionic versus ganglionic epidural steroid injection (ESI) using a systematic review and network meta-analysis. A systematic review and meta-regression was performed to compare postoperative outcomes between the two difference injection techniques. Relevant randomized controlled trials were identified from Medline and Scopus up to September 24, 2016. Sixteen out of 598 studies were eligible; 3, 2, and 3 studies were included in the pooling of outcomes including effectiveness, visual analog score (VAS), and complications (nerve root, injury, dural puncture, and intraneural injection). Preganglionic ESI has a 2.38 (95% CI 1.12, 5.04) times statistically significantly higher chance of effectiveness when compared to ganglionic ESI. There were differences in pain VAS and complications in lumbar radiculopathy, but these displayed no statistical significance. This meta-analysis indicated that preganglionic ESI has a statistically significantly higher chance of effectiveness when compared to ganglionic ESI. In terms of pain score and complications, there were no statistically significant differences between the two groups. These results were generally homogeneous and with little publication bias, thus should be generalizable.

Arthroscopic Bone Grafting for Anteroinferior Glenoid Defect Using Template

Significant anteroinferior glenoid bone loss is widely accepted as a major pathology of recurrent anterior shoulder dislocation, particularly after failed arthroscopic Bankart repair. Numerous surgical techniques for glenoid bone grafting have been described and have been reported to yield successful outcomes. Both open and arthroscopic approaches have been used, with the coracoid and the iliac crest being commonly used for bone graft. When compared with open surgery, an arthroscopic approach has many advantages. These include a smaller incision, better visualization, the ability to correct any concomitant pathology, and most important, preservation of the subscapularis muscle function. However, technical challenges and the steep learning curve of this complex arthroscopic procedure can be huge obstacles for shoulder arthroscopists. We describe, step by step, a simplified arthroscopic bone graft technique for repair of an anteroinferior glenoid defect using a template as a helpful tool.

Comparative Outcomes of Perioperative Epidural Steroids After Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Randomized Placebo-Controlled Trial

OBJECTIVE To assess postoperative outcomes and complications after percutaneous endoscopic lumbar discectomy (PELD) with or without epidural steroids (ES) administration in lumbar disc herniation. METHODS In a double-blind randomized, placebo-controlled trial at Ramathibodi Hospital, Mahidol University, from May 2014 to May 2015, 30 patients were randomly allocated to receive ES or placebo (saline) after PELD. The primary outcome was 24-hour morphine consumption. Secondary outcomes were visual analog scale (VAS) scores for leg and back pain, Oswestry Disability Index score, Roland-Morris Disability Questionnaire score, and complications at 6-month follow-up. RESULTS Mean patient age was 60.0 years, and 0.57% of patients were male. Mean VAS back pain, VAS leg pain, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores at baseline were 4.7, 6.1, 24.9, 17.5 in the ES group and 5.1, 5.5, 24.7, 16.7 in the placebo group, respectively. Mean morphine requirements measured at 8, 16, and 24 hours were 3.47, 2.67, and <0.001 in the ES group and 3.13, 1.67, and 0.40 in the placebo group. The mean VAS scores measured at 4, 8, 12, 16, 20, and 24 hours were 2.99, 2.70, 2.56, 3.30, 3.05, and 2.05 the ES group and 3.13, 1.13, 1.26, 1.65, 1.22, and 1.08 in placebo group. The difference was not statistically significant (P > 0.05 for all). CONCLUSIONS Administration of ES with PELD for lumbar disc herniation does not improve postoperative pain, morphine requirements, or disability scores in the short-term and midterm periods.

Comparative Outcomes of Cast and Removable Support in Fracture Fifth Metatarsal Bone: Systematic Review and Meta-Analysis

Abstract Fractures of the metatarsals account for 35% of all foot fractures. Conservative management of fractures proximal to the metaphyseal–diaphyseal junction of the fifth metatarsal bone (pseudo‐Jones) is protected weightbearing. The methods of protected weightbearing include a short‐leg cast and splint (boot cast, Jones bandage, and elastic bandage). However, no consensus has yet been reached regarding which method is most suitable. We conducted a systematic review and meta‐analysis to compare the outcomes of a short‐leg cast and splint for pseudo‐Jones metatarsal fractures. We searched the PubMed and Scopus databases up to October 29, 2016. Five of 104 studies (3 comparative studies and 2 randomized controlled trials; n = 246 patients) were eligible. Of the studies, 3, 5, and 4 were included in pooling of early (within 1 month) and last follow‐up foot function scale scores and fracture nonunion, respectively. The unstandardized mean difference of early (within 1 month) and last follow‐up foot scores for the short leg cast were −14.58 (95% confidence interval [CI] −24.12 to −5.04) and −3.89 (95% CI −6.30 to −1.49), significantly lower than the scores for the splint (bandage or boot support) for pseudo‐Jones fracture of the fifth metatarsal bone. The risk of nonunion of the fifth metatarsal bone fracture of the patients who were treated with short leg cast method was insignificantly greater at 1.57 times (95% CI 0.29 to 8.49) that compared with the splint. The treatment of fracture of the pseudo‐Jones fifth metatarsal bone with a splint (boot or bandage) resulted in foot function scale scores better than those with short leg cast treatment and a lower nonunion rate. &NA; Level of Clinical Evidence: 2

Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis

Surgical management is recommended for unstable distal clavicle fractures. A variety of methods have been previously reported, but there is no current consensus regarding which method is most suitable. Therefore, we have conducted a systematic review and network meta-analysis to compare postoperative shoulder function and complications between different fixation methods to identify which class of fixation is best for unstable distal clavicle fractures. We searched the literature systematically using eligibility criteria of all comparative studies that compared postoperative outcomes of coracoclavicular fixation (tight rope, screw or endobutton), hook plating, plate and screws, tension band wiring and transacromial pinning fixation for unstable distal clavicle fractures from PubMed, EMBASE, and Scopus databases up to February 10, 2018. Two reviewers independently extracted data. A network meta-analysis was applied to combine direct and indirect evidence and to estimate the relative effects of the treatment options. The probability of being the best treatment was estimated using surface under the cumulative ranking curves (SUCRA). Ten comparative studies (n = 505 patients) with one RCT study (n = 42) met the inclusion criteria. Intervention included coracoclavicular fixation (n = 111 patients), hook plating (n = 300 patients), plate and screws (n = 41 patients), tension band wiring (n = 81 patients) and transacromial pinning (n = 14 patients). A network meta-analysis showed that CM scores of coracoclavicular fixation were significantly higher when compared to hook plate and tension band wiring, with pooled mean of 2.98 (95% CI 0.05–5.91) and 7.11 (95% CI 3.04–11.18). For UCLA, CC fixation and plate and screw fixation had significantly higher scores compared to hook plating fixation with a mean score 2.22 (95% CI 0.44–3.99) and 3.20 (95% CI 0.28–6.12), respectively. In terms of complications, plate and screw fixation had lower risk with RRs of 0.63 (95% CI 0.20–1.98), 0.37 (95% CI 0.19–0.72), 0.11 (95% CI 0.04–0.30) and 0.02 (95% CI 0.002–0.16) when compared to coracoclavicular fixation, hook plating, tension band wiring and transacromial pinning. The SUCRA probabilities of CC fixation were in the first rank with 96.8% for CMS, while plate and screw fixation were in the first rank with 67.7 and 93.8% for UCLA score and complications. We recommend using plate and screw and CC fixation as the first- and second-line treatment of unstable distal clavicle fractures. As the quality of studies for this meta-analysis was not high, larger and higher-quality randomized controlled trials are required to confirm these conclusions for informed clinical decision making.

A new method for measurement of occipitocervical angle by occiput-C3 angle

BackgroundThe description of the measurement technique of the posterior occiput—third cervical spine (OC3) angle—before performing occipitocervical fusion is still controversial. Setting an appropriate alignment in occipitocervical instrumentation is important for successful fixation surgery. Several methods were used for quantifying occipitocervical alignment on the lateral radiograph. This study was performed to describe a measurement technique of OC3 angle and comparing reliability and reproducibility in the measurement of occipitocervical angle with previous method. The purpose of this study was to determine the best technique for assessing this angle.Materials and methodsThree hundred and twenty-six lateral cervical spine radiographs from volunteers without spinal disorder were taken in neutral position and collected from June 2011 to December 2012. Analysis consisted of measurement of the OC3 angle and posterior occipitocervical angle. Inter- and intra-observer reliabilities were assessed using limit agreement test.ResultsThe mean OC3 angle measurements were approximately 107 (94–120) degrees. Intra- and inter-observer error assessed by 95% limit agreement was approximately ±5.5 and ±7.5, while the POCA measurements were approximately 108 (94–120) degrees. Intra- and inter-observer error assessed by 95% limit agreement was approximately ±13.3 and ±18.2.ConclusionThe OC3 angle measurement is a simple method, good inter- and intra-observer reliabilities to measure of the occipitocervical angle. That can be useful to setting the patient’s position and facilitate confirmation of the occipitocervical neutral position during occipitocervical fusion.