| 1. |
- Tabiri, S, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 2. |
- Bravo, L, et al.
(författare)
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- 2021
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swepub:Mat__t
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| 3. |
- Khatri, C, et al.
(författare)
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11, s. e050830-
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Tidskriftsartikel (refereegranskat)abstract
- Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644
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| 4. |
- Ayeni, O. R., et al.
(författare)
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Clinical and Radiographic Criteria Define "Acceptable" Surgical Correction of Hip Femoroacetabular Impingement Syndrome as Well as Postoperative Complications: An International Modified Delphi Study
- 2023
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Ingår i: Arthroscopy-the Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 39:5, s. 1198-1210
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To develop recommendations for clinical and radiographic criteria to help define the "acceptable" surgical correction of femoroacetabular impingement syndrome (FAIS) and identify/define complications postoperatively. Methods: A 3-phase modified Delphi study was conducted involving a case-based survey; a Likert/multiple choice-based survey concerning radiographic and physical examination characteristics to help define FAIS correction, as well as the prevalence and definition of potential postoperative complications; and 2 consensus meetings. Results: Of the 75 experts invited, 54 completed the Phase I survey, 50 completed the Phase II survey (72% and 67% response rate), and 50 participated in the Phase III consensus meetings. For both typical and atypical (complex) cases, there was consensus that fluoroscopy with multiple views and dynamic hip assessment should be used intraoperatively (96% and 100%, respectively). For typical FAIS cases, the Expert Panel agreed that Dunn lateral and anteroposterior radiographs were the most important radiographs to evaluate the hip postoperatively (88%, consensus). When asked about evaluating the correction of cam impingement postoperatively, 87% voted that they use subjective evaluation of the "sphericity" of the femoral head. In the case of focal and global pincer-type FAIS, there was consensus that the reduction or elimination of the crossover sign (84%) and lateral center-edge angle (91%) were important to inform the extent of the FAIS correction. There was consensus for recommending further investigation at 6 months postoperatively if hip pain had increased/plateaued (92% agreed); that additional investigation and treatment should occur between 6 and 12 months (90% agreed); and that a reoperation may be recommended at 12 months or later following this investigation period (89% agreed). Conclusions: This consensus project identified the importance of using fluoroscopy and dynamic hip assessment intraoperatively; Dunn lateral and anteroposterior view radiographs postoperatively; evaluating the "sphericity" of the femoral head for cam-type correction and the use of dynamic hip assessment; reducing/eliminating the crossover sign for focal pincertype FAIS; evaluating the lateral center-edge angle for global pincer-type FAIS; and avoiding overcorrection of pincer-type FAIS. In cases in which postoperative hip pain increased/plateaued, further investigation and treatment is warranted between 6 and 12 months, and a reoperation may be recommended at a minimum of 12 months depending on the cause of the hip pain. Clinical Relevance: Hip arthroscopy surgeons have yet to reach a firm agreement on what constitutes an "acceptable" or "good" surgery radiographically and how they can achieve desired clinical outcomes. Although this was a comprehensive effort, more study is needed to determine therapeutic thresholds that can be universally applied.
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| 5. |
- Prill, R., et al.
(författare)
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Author guidelines for conducting systematic reviews and meta-analyses
- 2021
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29, s. 2739-2744
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Tidskriftsartikel (refereegranskat)abstract
- This article is a guidance how to write systematic reviews (SR's) and meta-analyses (MA) in orthopaedics and which aspects to focus on for transparency, systematicity and readability. Both SR and MA summarise and synthesise the best evidence available on a specific topic. This requires a systematic, structured and transparent process of analysis. The title should be concise, indicate type of review and ideally report the most important finding. Next, the structured abstract (no more than 350 words) should also raise key points and report the overall level of evidence. A relevant clinical question must be defined before the literature search is started. Methodological details such as databases searched, the exact search strategy (including time frame), inclusion/exclusion criteria, method of literature appraisal and statistical analysis must be described briefly. The primary and secondary outcomes should be mentioned. SR's be pre-registered before data extraction, to ensure transparency and the reduction of risk of bias. If registered, registration number should be stated in the abstract and the funding sources. A clear summary of the findings is important including the number of identified studies (depicted in a flowchart) and for meta-analyses a forest plot. The results of the literature appraisal and statistical analyses should be reported precisely. Subsequently, a general interpretation of findings and their significance and relevance to clinical practice should be provided. Clinical implications from the analysis should be drawn carefully and further research questions should be addressed. Finally, a conclusion, based solely on the results of the study is a necessity. Up to ten keywords are requested representing the main content of the article. Most applicable keywords should facilitate finding the manuscript in the databases and therefor considered carefully.
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| 6. |
- Öhlin, Axel, 1990, et al.
(författare)
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The evolution of femoroacetabular impingement surgical management as a model for introducing new surgical techniques
- 2020
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28, s. 1333-1340
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Tidskriftsartikel (refereegranskat)abstract
- Introducing new surgical techniques and concepts can be difficult. There are many hurdles to overcome initially, such as the learning curve, equipment and technique development, before a standard of care can be established. In the past, new surgical techniques have been developed, and even widely accepted, before any scientific evaluation has been made. At that stage, it may be too late properly to evaluate the effectiveness of treatments, as the objectiveness and/or randomisation process may be obstructed. Since the introduction of evidence-based medicine (EBM), there have been high standards of scientific rigour to prove the efficacy of treatments. Based on the nature of evidence-based acceptance, innovations cannot be subjected to this final process before their evolution process is complete and, as a result, there is a need for the staged scientific development of new surgical techniques that should be adopted. This paper presents a model for this kind of stepwise introduction based on the actual evolution of FAI syndrome surgery. By following a scientific algorithmic methodology, new surgical techniques and concepts can be introduced in a stepwise manner to ensure the evidence-based progression of knowledge. © 2019, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
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| 7. |
- Figueroa, D., et al.
(författare)
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus
- 2022
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Ingår i: Journal of ISAKOS. - : Elsevier BV. - 2059-7754. ; 7:6, s. 150-161
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Many factors can affect the return to pivoting sports, after an Anterior Cruciate Ligament Reconstruction. Prehabilitation, rehabilitation, surgical and psychological aspects play an essential role in the decision to return to sports. The purpose of this study is to reach an international consensus about the best conditions for returning to sports in soccer—one of the most demanding level I pivoting sports after anterior cruciate ligament (ACL) reconstruction. Methods: 34 International experts in the management of ACL injuries, representing all the Continents were convened and participated in a process based on the Delphi method to achieve a consensus. 37 statements related to ACL reconstruction were reviewed by the experts in three rounds of surveys in complete anonymity. The statements were prepared by the working group based on previous literature or systematic reviews. Rating agreement through a Likert Scale: strongly agree, agree, neither agree or disagree, disagree and strongly disagree was used. To define consensus, it was established that the assertions should achieve a 75% of agreement or disagreement. Results: Of the 37 statements, 10 achieved unanimous consensus, 18 non-unanimous consensus and 9 did not achieve consensus. In the preoperative, the correction of the range of motion deficit, the previous high level of participation in sports and a better knowledge of the injury by the patient and compliance to participate in Rehabilitation were the statements that reached unanimous consensus. During the surgery, the treatment of associated injuries, as well as the use of autografts, and the addition of a lateral extra-articular tenodesis in some particular cases (active young athletes, <25 years old, hyperlaxity, high rotatory laxity and revision cases) obtained also 100% consensus. In the postoperative period, psychological readiness and its validation with scales, adequate physical preparation, as well as not basing the RTSS purely on the time of evolution after surgery, were the factors that reached unanimous Consensus. Conclusions: The consensus statements derived from this international ISAKOS leaders, may assist clinicians in deciding when to return to sports soccer in patients after an ACL reconstruction. Those statements that reached 100% consensus have to be strongly considered in the final decision to RTS soccer. © 2022 The Authors
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| 8. |
- Judy, R. P., et al.
(författare)
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Level of evidence and authorship trends of clinical studies in knee surgery, sports traumatology, arthroscopy, 1995-2015
- 2018
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Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:1, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- There is increasing emphasis on publication quality and internationalization of author groups in orthopaedic literature. The purpose of this review was to evaluate the type of studies and the level of evidence (LOE) published in knee surgery, sports traumatology, arthroscopy (KSSTA) from 1995 to 2015. The secondary aim was to analyze trends in authorship characteristics in KSSTA. Two reviewers reviewed the table of contents of KSSTA and identified original papers from 1995, 2000, 2005, 2010, and 2015. The reviewers graded LOE from Levels I to IV using guidelines from the University of Oxford's Centre for Evidence-Based Medicine. For each article, the total number of authors and country of author group were also analyzed. A total of 880 papers were analyzed. The proportions in LOE have stayed consistent throughout the study period (n.s.). There has been a significant increase in the number of published articles and the number of Level I and II studies (P < 0.01). Therapeutic articles were the most common type. The mean number of authors per KSSTA article significantly increased from 3.9 to 5.7 over the 20-year period (P < 0.01). The number of represented countries increased yearly and academic institutions from 40 different nationalities published articles in the Journal. Of the examined years, the percent of articles with international collaboration was 17.6%. The proportion of LOE I and II articles published in KSSTA remains consistently high. Therapeutic studies are the most frequently published articles. There is an increase in international groups publishing in KSSTA.
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| 9. |
- Svantesson, Eleonor, et al.
(författare)
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Future Perspectives of Anterior Cruciate Ligament Reconstruction
- 2017
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Ingår i: Operative Techniques in Orthopaedics. - : Elsevier BV. - 1048-6666. ; 27:1, s. 79-87
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Tidskriftsartikel (refereegranskat)abstract
- Reconstruction of the anterior cruciate ligament (ACL) is a common procedure of orthopaedic surgery. The challenges of recreating normal knee function after an injury to the ACL have led to excessive research and continuous innovation of the surgical techniques for ACL reconstruction. Recently, focus has been turned toward the anatomical ACL reconstruction that is one of the most intriguing approaches regarding the surgical technique. Furthermore, exploration of basic anatomy of the knee has led to further insight in concepts of tunnel placement, graft options, and treatment strategies. The possibility of quantitative measurement of knee laxity has evolved and is presented as one future approach to individualized surgery. The vast amount of literature available on ACL reconstruction illustrates that evidence regarding many aspects is advancing. However, it also illustrates that some studies are not generalizable, and that there is a need for further high-quality research. This article presents an overview of the development of ACL reconstruction and existing evidence. It reviews important aspects that influence current and future perspectives on ACL reconstruction.
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| 10. |
- Zhang, K. L., et al.
(författare)
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In-Office Needle Arthroscopy: A Systematic Review of Indications and Clinical Utility
- 2019
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Ingår i: Arthroscopy-the Journal of Arthroscopic and Related Surgery. - : Elsevier BV. - 0749-8063. ; 35:9, s. 2709-2721
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This review explores the current literature regarding both the clinical indications and utility of minimally invasive in-office needle arthroscopy (IONA) relative to conventional imaging modalities. Methods: In compliance with R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched in July 2018, in addition to the conference abstract databases of 5 prominent meetings between 2013 and 2018, for studies using IONA for diagnostic purposes. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: Among 932 conference abstracts and 369 studies identified, 11 publications involving 404 patients (395 knees and 9 shoulders) were included, with 9 clinical studies and 2 cost analyses. The median Methodological Index for Non-Randomized Studies (MINORS) score was 9 for noncomparative and 23 for comparative studies. Among the 9 clinical studies, IONA had a superior sensitivity, specificity, positive predictive value, and negative predictive value to magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis, anterior cruciate ligament insufficiency, and meniscal tears. IONA was comparable or inferior to MRI in the same parameters for the diagnosis of osteochondral defects and rotator cuff tears. In the 2 cost analyses, IONA had lower costs when used in place of MRI for treatment algorithms involving medial meniscal tears and rotator cuff tears but not lateral meniscal tears. Conclusions: IONA holds potential for cost savings and improved diagnostic accuracy relative to MRI, primarily for intra-articular meniscal, ligamentous, and chondral defects of the knee. However, its current indications for use in other joints are limited to rotator cuff tears in the shoulder, making its diagnostic value in other joints much more limited. The current quality and breadth of evidence are significantly lacking, with numerous practical shortcomings. To improve acceptance of IONA, priority should be placed on establishing defined protocols, indications, contraindications, and patient perspectives for the procedure.
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