ABSTRACT
Background: Anterior Cruciate Ligament [ACL] reconstruction is a well-known surgical knee procedure performed by orthopaedic surgeons. There is a general consensus for the effectiveness of a postoperative ACL reconstruction rehabilitation program, however there is little consensus regarding the optimal components of a program
Objective of the Study: to assess the merits and demerits of current ACL reconstruction rehabilitation programs and interventions based on the evidence supported by previously conducted systematic reviews
Methods: a Systematic search in the scientific database [Medline, Scopus, EMBASE , and Google Scholer] between 1970 and 2017 was conducted for all relevant Systematic reviews discussing the primary endpoint [ ACL reconstruction rehabilitation ] studies were analyzed and included based on the preset inclusion and exclusion criteria. Study screening and quality was assessed against PRISMA guidelines and a best evidence synthesis was performed
Results: the search results yielded five studies which evaluated eight rehabilitation components [bracing, Continuous passive motion [CPM], neuromuscular electrical stimulation [NMES], open kinetic chain [OKC] versus closed kinetic chain [CKC] exercise, progressive eccentric exercise, home versus supervised rehabilitation, accelerated rehabilitation and water based rehabilitation]. A strong evidence suggested no added benefit of short term bracing [0-6 weeks post-surgery] compared to standard treatment. Whilst a moderate evidence reinforced no added advantage of continuous passive motion to standard treatment for boosting motion range. Furthermore, a moderate evidence of equal effectiveness of closed versus open kinetic chain exercise and home versus clinic based rehabilitation, on a range of short term outcomes. There was inconsistent or limited evidence for some interventions including: the use of NMES and exercise, accelerated and non-accelerated rehabilitation, early and delayed rehabilitation, and eccentric resistance programs after ACL reconstruction
Conclusion: short term post-operative bracing and continuous passive motion [CPM] introduce no benefit over standard treatment and thus not recommended. A moderate evidence suggested equal efficiency for 1] CKC and OKC are equally effective for knee laxity, pain and function, at least in the short term [6-14 weeks] after ACL reconstruction and 2] home based and clinic based rehabilitation. Nevertheless, the degree of physiotherapy input remains unclear
ABSTRACT
Background: Stone size is a key factor in the determination of the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery
Aim of the Study: to assess and compare the efficacy of retrograde intrarenal surgery [RIRS] in the treatment of kidney stones greater than 2 cm versus percutaneous nephrolithotomy [PCNL]
Patients and methods: A retrospective analysis was carried out for a total of 118 patients, of which 46 patients underwent RIRS while 72 patients underwent PCNL between May 2013 and May 2017
Results: The mean duration of operation was 96.39 +/- 41.11 min in the RIRS group and 69.51 +/- 19.3 min in the PCNL group [p<0.001]. Hospital stay was significantly shorter in the RIRS group [1.32 +/- 0.6 vs. 4.19 +/- 1.9 days] in the RIRS and PCNL groups respectively [p<0.001]. Stone-free rates after one session were 67.4% and 90.3% of the RIRS and PCNL groups, respectively. Blood transfusions were required in two patients in the PCNL group. Complication rates were generally higher in the PCNL group
Conclusion: The present study concluded that RIRS can be a successful substitute to PCNL in the treatment of kidney stones with a diameter of 2-4 cm particularly in patients with comorbidities