Flexor Synovectomy as an Adjunct to Carpal Tunnel Release in Primary Carpal Tunnel Syndrome: A Meta-Analysis.

Background: Carpal tunnel release (CTR) aims to achieve surgical decompression of the median nerve for the treatment of carpal tunnel syndrome (CTS). Flexor tenosynovectomy (FS) has been carried out as an adjunct to routine CTR, on the basis that chronic flexor tenosynovitis has been implicated as an etiological factor in idiopathic CTS. However, the benefits of this additional procedure remains unclear. As such, we aimed to compare functional outcomes, nerve function and complication rates from CTR with and without FS. Methods: A systematic review of published literature was performed for original data English language studies comparing outcomes of CTR with and without FS in the treatment of primary CTS. Mean weighted differences and their 95% confidence interval were used for analysis. Results: Three studies comprising 292 wrists were included. Meta-analysis showed no improvement in post-operative grip strength, symptom severity score, functional status score, median nerve motor latency or major complications with FS. Recurrence rate was not reported in the 3 selected articles. Conclusions: The available evidence suggests FS is an unnecessary adjunct which provides no benefit to CTR, and should not be used routinely to treat primary CTS. Larger studies are needed to validate our findings. FS may have a role in recurrent or secondary CTS.

Non-Operative Rehabilitation of Isolated Popliteus Tendon Rupture in a Rugby Player.

Isolated rupture of the popliteus tendon is uncommon; instead, it is often seen as part of multi-ligamentous posterolateral corner injuries. In this report, we present a case of a 22-year-old professional rugby player who sustained a lateral blow to his semi-flexed knee in a tackle during a competitive game. A complete popliteus tendon rupture at its musculo-tendinous junction was diagnosed on magnetic resonance imaging despite a relatively unremarkable physical examination. The aims of this report are to highlight the diagnostic challenges with this rare injury as physical signs are often subtle and non-specific. Furthermore, we demonstrate the viability of conservative management in the setting of a direct contact mechanism. Indeed, our patient was successfully treated with a specific rehabilitation protocol via isometric quadriceps contractions, gastrocnemius-soleus and hamstring strengthening exercises and graded activity with successful return to full contact activities at 4 weeks and regular season matches shortly after.

A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair.

BACKGROUND: The Bankart repair and Latarjet procedure are both viable surgical options for recurrent traumatic anterior instability of the shoulder joint. The anatomic repair is the more popular option, with 90% of surgeons internationally choosing the Bankart repair as the initial treatment. There has been no previous review directly comparing the 2 techniques. Hence, we aimed to systematically review studies to compare the outcomes of Bankart repairs vs. the Latarjet procedure for recurrent instability of the shoulder. METHODS: Six electronic databases were searched for original, English-language studies comparing the Bankart and Latarjet procedures. Studies were critically appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Data were extracted from the text, tables, and figures of the selected studies. RESULTS: Eight comparative studies were identified with 795 shoulders; 416 of them underwent open or arthroscopic Bankart repairs, and 379 were repaired by the open Latarjet procedure. Primary and revision procedures were studied. The Latarjet procedure conferred significantly lower risk of recurrence and redislocation. There was no significant difference in the rates of complication requiring reoperation between the two procedures. Rowe scores were higher and loss of external rotation lower in the Latarjet group compared with the Bankart repair group. CONCLUSIONS: Our studies demonstrate that the Latarjet procedure is a viable and possibly superior alternative to the Bankart repair, offering greater stability with no significant increase in complication rate. However, the studies identified were retrospective and of limited quality, and therefore randomized controlled trials with large populations of patients or prospective assessment of national orthopedic registries should be employed to confirm our findings.

Practical implications of the lumbar spine and its function on total hip arthroplasty.

Correct component placement is of significant importance to ensure optimal outcomes in total hip arthroplasty (THA). Traditionally, the Lewinnek plane has been referenced as an adequate "safe zone", formed between the anterior superior iliac spines and public tubercles to optimize acetabular orientation. However, recent evidence shows that the positioning of this plane may vary due to the biomechanical relationship between the lumbar spine and hip. Therefore, the plane acquired intraoperatively may not accurately recreate the actual functional plane and acetabular orientation encountered outside of the intraoperative environment. This review summarizes the hip-spine relationship and its implications on THA.

Hepatic resection for malignant liver tumours in the elderly: a systematic review and meta-analysis.

BACKGROUND: The number of elderly patients undergoing hepatic resection for surgical treatment of benign and malignant cancers is increasing. However, there is limited clinical data on the complications and long-term survival rates associated with liver surgery in the elderly patients (≥70 years) versus younger patients for malignant liver conditions. METHODS: Six electronic databases were searched for original published studies comparing elderly (≥70) versus younger (<70) cohorts for malignant liver tumours. Data were extracted and analysed according to predefined clinical endpoints. RESULTS: Twenty-seven comparative studies were identified, including 4769 elderly patients versus 15,855 younger patients (n = 20,624). There was significantly higher 30-day mortality in the elderly colorectal liver metastasis group (P < 0.00002) and significant difference between elderly and young in terms of overall survival (hazard ration (HR), 1.10; P = 0.02). However, there was no difference in disease-free survival (HR, 1.05; P = 0.27). Post-operative pneumonia, renal failure and infection were more frequent in the elderly group. CONCLUSIONS: Liver resection for malignant hepatic tumours in the elderly is associated with a greater 30-day mortality and overall mortality when compared with younger cohorts, but similar disease-free survival. Length of stay and transfusions were not significantly different while pneumonia, renal failure and infections were more frequent in the elderly group.