Influence of Subchondral Cysts on the Outcomes of Surgical Treatment for Osteochondral Lesions of the Talus: A Systematic Review and Meta-analysis.

Background: Limited literature is available regarding the effect of subchondral cysts on the surgical outcomes for treatment of osteochondral lesion of the talus (OLT). Purpose: To conduct a systematic review and meta-analysis of studies comparing surgical outcomes between OLTs with and without cysts. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant studies published up to January 7, 2023. The 4375 retrieved studies were screened, and 9 articles (level of evidence, 2-4) were included, which comprised 165 patients with OLT and subchondral cysts (cyst group) and 223 without cysts (noncyst group). After data extraction, mean differences in outcome scores (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle Hindfoot Scale, visual analog scale [VAS] score for pain) and adverse events were compared between the groups. Results: Functional scores improved after surgery in both groups, with the cyst group having a significantly higher AOFAS score than the noncyst group (P = .005; I2 = 0%); subgroup analysis revealed that this difference was attributable to the size of the osteochondral lesion and the type of surgical procedure. No significant difference was found between the cyst and noncyst groups in VAS pain scores (P = .77; I2 = 0%) or postoperative adverse events (P = .35; I2 = 0%). Conclusion: The results of this review indicated that patients with subchondral cysts improved with surgical treatment of OLT. A relatively low level of evidence was available to indicate that surgical treatment for small OLTs with subchondral cysts will result in better clinical outcomes compared with OLTs without cysts.

Application of "immersive contextualization based-learning teaching" mode in the orthopaedic musculoskeletal disorder module of clinical medicine education.

OBJECTIVE: To evaluate the effect and influence of the "immersive contextualization-based learning" teaching mode (ICBLT) in the orthopaedic musculoskeletal disorder module of clinical medicine education. METHODS: Undergraduate students in five consecutive semesters of clinical medicine in West China Hospital, Sichuan University were enrolled in this study. During the teaching process in each semester, a cross-over design was applied, and students were randomly divided into two classes (Class A and Class B) to receive the designated experimental courses with different routes. After they took the final exams, the scores of the selected chapters (sports injury chapter and osteoarthritis chapter) were extracted to conduct Tests of Between-Subjects Effects. Q-Q plot was drawn to test whether the distribution of the scores follows normal distribution. The part of the feedback questionnaires to assess these two teaching modes were also extracted for comparison. RESULTS: A total of 441 students were enrolled in this study, among which, Class A teaching route was implemented to 222 students and Class B to the rest 219. The results of Tests of Between-Subjects Effects showed that ICBLT mode could lead to better scores compared to the Lecturing-based learning teaching (LBLT) mode (p < 0.0001). In terms of mastery of practical skills, help to deepen the memory of knowledge and satisfaction with the teaching mode, the ICBLT mode showed better results (p < 0.0001). CONCLUSION: ICBLT mode had better potential in helping mastery of practical skills and deepening the memory of knowledge.

[Research progress on bioactive strategies for promoting tendon graft healing after anterior cruciate ligament reconstruction].

Objective: To review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR. Methods: The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized. Results: At present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient. Conclusion: With the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.

Effect of surgical approach on the treatment of Morton's neuroma: a systematic review and meta-analysis.

BACKGROUND: Surgical resection of Morton's neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this study was to conduct a systematic review and meta-analysis to compare the surgical results of dorsal and plantar approaches. METHODS: The literatures of PubMed, Cochrane library, Embase and Web of Science were searched on April 26th, 2023. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The data were extracted after screening the literature and evaluating the quality of the methodology included in the study. The RevMan5.4 software was used to analyze and calculate the OR value and 95% confidence interval. RESULTS: A total of 7 randomized controlled trials and comparative studies were published, of which only 5 were included. There were 158 feet via plantar approach (plantar group, PG) and 189 via dorsal approach (dorsal group, DG). There was no significant difference between PG and DG in overall adverse events, sensory problems, incision infection and deep vein thrombosis (p > 0.05). In terms of scar problems, PG showed more than DG (OR, 2.90[95%CI, 1.40 to 5.98]; p = 0.004). Other outcome indicators such as visual analogue scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were difficult to be included in the comparison. CONCLUSIONS: Based on the relatively low quality and small amount of available evidence, the meta-analysis conducted produces a hypothesis that the frequency of adverse events in surgical treatment of Morton's neuroma, dorsal approach and plantar approach may be the same, but the types are different. More high-level evidence is needed to further verify this hypothesis.

Efficacy and Safety of Tranexamic Acid in Shoulder Arthroscopic Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND: Visual clarity during shoulder arthroscopy can ensure an efficient and effective performance of the procedure, and it is highly related to bleeding without a tourniquet. Tranexamic acid (TXA) is widely used in adult reconstruction procedures; however, its use in shoulder arthroscopic operations is a relatively novel topic. PURPOSE: To analyze the available literature on visual clarity, blood loss, pain control, functional outcomes, and complications after the administration of tranexamic acid in shoulder arthroscopic surgery. METHODS: A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of shoulder arthroscopic surgery. The literature search included the MEDLINE, Embase, Web of Science, and Cochrane Library databases. The primary outcomes included visual clarity, blood loss, and visual analog scale scores for pain. Secondary outcomes were operative time, irrigation amount used, postoperative shoulder swelling, the need for pressure increase, mean arterial pressure (MAP), functional outcomes, postoperative adverse effects such as deep venous thrombosis, and pulmonary embolism. The outcomes were pooled to perform a meta-analysis. RESULTS: Seven prospective randomized controlled trials met the inclusion criteria for analysis. All of the included studies performed arthroscopic rotator cuff repair. No significant difference in visual clarity was observed (SMD (standardized mean difference), 0.45 [95% CI(confidence interval), -0.68, 1.59]; p = 0.44) nor in pain score (MD (mean difference), -0.46 [95% CI, -0.97, 0.05]; p = 0.08) between the TXA group and the control group. Two studies found no significant difference in blood loss between the TXA group and the control group. The meta-analysis from five studies demonstrated no significant difference between the TXA and control groups in operative time (MD, -3.51 [95% CI, -15.82, 8.80]; p = 0.58) or irrigation amount used (MD, -2.53 [95% CI, -5.93, 0.87]; p = 0.14). Two trials reported different statistical results in postoperative shoulder swelling. No significant differences regarding the need for pressure increase and MAP were reported between groups. No wound complications or infections or cardiac, thrombotic, or thromboembolic complications were recorded in either group. CONCLUSION: The use of intravenous or local TXA in shoulder arthroscopic surgery did not increase complications or thromboembolic events, but TXA had no obviously effect of reducing bleeding to obtain a clear visual field or pain release in patients undergoing shoulder arthroscopic surgery.

Oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy.

OBJECTIVE: To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate (DAC) managed with radical prostatectomy (RP) or radiotherapy (RT) and optimize the proper treatment modality to DAC comprehensively. METHODS: The cohorts included a total of 528 patients from the Surveillance, Epidemiology and End Results (SEER) database, 354 receiving RP and 174 receiving RT. Cox proportional hazards regressions were performed to assess cancer specific mortality (CSM) and overall mortality (OM) between treatment groups. A competing risk analysis was further conducted. Subgroup analyses by age and level of prostate-specific antigen (PSA) were performed. Propensity score matching was implemented. RESULTS: Patients managed with RP had lower risks of CSM and OM compared with RT (before matching: Hazard ratio [HR]=0.24, 95% confidence interval [CI] 0.13-0.47 and HR=0.26, 95% CI 0.17-0.40, respectively; after matching: HR=0.18, 95% CI 0.04-0.82 and HR=0.28, 95% CI 0.11-0.70, accordingly). Subgroup analyses demonstrated that patients in the middle tertile of the age or with lower tertile PSA level managed with RP took lower risks of OM significantly (HR=0.18, 95% CI 0.06-0.57, p<0.01 and HR=0.17, 95% CI 0.06-0.54, p<0.01). CONCLUSION: Among patients with DAC, treatment with RP was associated with better survival outcomes in comparison with RT. Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.

[The killer turn in the posterior cruciate ligament reconstruction: mechanism and improvement].

OBJECTIVE: To summarize the research progress of killer turn in posterior cruciate ligament (PCL) reconstruction. METHODS: The literature related to the killer turn in PCL reconstruction in recent years was searched and summarized. RESULTS: The recent studies show that the killer turn is considered to be the most critical cause of graft relaxation after PCL reconstruction. In clinic, this effect can be reduced by changing the fixation mode of bone tunnel, changing the orientation of bone tunnel, squeezing screw fixation, retaining the remnant, and grinding the bone at the exit of bone tunnel. But there is still a lack of long-term follow-up. CONCLUSION: There are still a lot of controversies on the improved strategies of the killer turn. More detailed basic researches focusing on biomechanics to further explore the mechanism of the reconstructed graft abrasion are needed.

Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). METHODS: RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. RESULTS: 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and. CONCLUSION: PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.