Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-analyses Covering Treatments for Achilles Tendon Ruptures.

BACKGROUND: Approximately 18 in every 100 000 people have experienced a ruptured Achilles tendon. Despite the prevalence of this condition, treatment options remain contested. HYPOTHESIS/PURPOSE: The objective of this study was to evaluate the use of spin-reporting practices that may exaggerate benefit or minimize harm-in abstracts of systematic reviews related to Achilles tendon repair. We also evaluated whether particular study characteristics were associated with spin. STUDY DESIGN: Cross-sectional. METHODS: We developed a search strategy for Ovid MEDLINE and Ovid Embase for systematic reviews focused on Achilles tendon treatment. Following title and abstract screening of these search returns, these reviews were evaluated for spin (according to a previously developed classification scheme) and received AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2) appraisals by 2 investigators in a masked, duplicate manner. Study characteristics for each review were also extracted in duplicate. RESULTS: Our systematic search returned 251 articles of which 43 systematic reviews and meta-analyses were eligible for data extraction. We found that 65.1% of included studies contained spin (28/43). Spin type 3 was the most common type, occurring in 53.5% (23/43) of abstracts. Spin types 5, 6, 1, and 4 occurred in 16.3% (7/43), 9.3% (4/43), 7% (3/43), and 5.3% (1/43), respectively. Spin types 2, 7, 8, and 9 did not occur. AMSTAR-2 appraised 32.6% (14/43) of the studies as "moderate" quality, 32.6% (14/43) as "low" quality, and 34.9% (15/43) as "critically low" quality. No systematic reviews were rated as "high" quality. There was no significant association between the presence of spin and the following study characteristics: intervention type, article discussing Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) adherence, journal recommending PRISMA adherence, funding sources, journal 5-year impact factor, year the review was received for publication, or AMSTAR-2 critical appraisals. CONCLUSION: Spin was present in abstracts of systematic reviews and meta-analyses-covering Achilles tendon tear treatment. Steps should be taken to improve the reporting quality of abstracts on Achilles tendon treatment as well as other common orthopedic conditions. CLINICAL RELEVANCE: In order to avoid negative patient outcomes, articles should be free of spin within the abstract.

Role of the triradiate cartilage in predicting curve progression in adolescent idiopathic scoliosis.

Braces are commonly used to treat progressive adolescent idiopathic scoliosis. Several previous studies have reported a correlation between the success of brace treatment and skeletal maturity markers. These studies have not focused on the status of the triradiate cartilage (TRC) as it relates to successful brace treatment for adolescent idiopathic scoliosis. The authors retrospectively evaluated all patients at their institution from 1990 to 1997 with a diagnosis of adolescent idiopathic scoliosis who were treated in a Boston brace. Sixty-two patients met inclusion criteria. At presentation, the average age was 12.87 years, the average Risser sign was 0.56, and 45% of patients had an open TRC. The average follow-up was 2.92 years. Greater than 5 degrees of progression at discontinuation of bracing was considered a failure. Curves with a closed TRC failed bracing 21% of the time, whereas those with an open TRC failed 54% of the time (P = 0.0069). Those curves with a closed TRC progressed 3.12 degrees on average, whereas curves with an open TRC progressed 6.86 degrees. Curves associated with a closed TRC at initiation of bracing progressed less frequently and to a lesser degree than those associated with an open TRC (P = 0.027). Although the TRC is not an independent predictor of curve stability, it is an additional indicator of skeletal maturity and may prove most useful in patients with otherwise borderline indications for brace treatment.

Functional outcome after modified Blair tibiotalar arthrodesis for talar osteonecrosis.

BACKGROUND: Osteonecrosis of the talar body is a challenging problem for both patient and surgeon. One reconstruction option is an arthrodesis of the tibia to the talar neck, as described by Blair, which has the theoretical advantages of salvaging some hindfoot height and motion of the subtalar joint. A few case series have been published describing outcome after modified Blair fusions, none with validated functional outcomes. The purpose of this article is to describe a modification of Blair's original technique, and report the functional outcomes in a series of patients undergoing this procedure. METHOD: A retrospective review of seven patients with talar osteonecrosis undergoing modified Blair tibiotalar arthrodesis was performed. The median patient age was 51 (range, 39-78). Median follow-up was 20 months (range, 12-112). Two patients required a repeat procedure for delayed/nonunion, with subsequent uneventful union. In all patients the procedure included compression screw fixation of the talar head to the anterior distal tibia, with the two repeat procedures and the most recent patient having an additional anterior compression plate and bone graft. Functional outcome measures using both the AOFAS ankle-hindfoot score and the SF-36 global health outcome measure were obtained at latest follow-up. In addition, radiographic assessment of bone union and time to union was determined. RESULTS: Median SF-36 physical and mental component scores were 46 and 61, respectively. The median AOFAS ankle-hindfoot score was 67 out of 100. Median visual analog scales for postoperative pain and function were 7.1 and 6.0 respectively, out of a best possible score of 10. CONCLUSION: Functional outcome scores after modified Blair arthrodesis are lower than similar scores after conventional tibiotalar fusion, and much lower than "normal" values; however, the procedure has similar, if not lower, complication rates to alternative complex hindfoot reconstructions, and this procedure is a valuable alternative in the management of talar osteonecrosis with arthrosis.