Publications (56) View all
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Article: Treatment of chronic syndesmotic injury: a systematic review and meta-analysis.
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ABSTRACT: PURPOSE: The purpose of this study is to systematically review and meta-analyse the available literature on the treatment of chronic syndesmotic injuries of the ankle. METHODS: A systematic review of the PubMed/MEDLINE and EMBASE databases was conducted in August 2012 utilizing the keywords (treatment OR intervention) AND (injury OR sprain OR rupture) AND (syndesmosis OR syndesmotic OR "high ankle" OR "anterior inferior tibiofibular ligament" OR AITFL OR "posterior inferior tibiofibular ligament" OR PITFL OR tibiofibular diastasis). Studies that reported the outcomes of the surgical treatment of chronic syndesmotic injury were included in our review. Chronic was defined as symptoms longer than 6 months. Meta-analysis based on random-effects models was performed to pool the rates of success for different treatment methods. RESULTS: The search yielded 416 publications from PubMed/MEDLINE and 473 publications from EMBASE. After abstract and full-text review, 15 articles were included in this review. Treatment methods were placed into three broad surgical treatment categories: screw fixation, arthrodesis and arthroscopic debridement. The most common treatment strategy employed was screw fixation. The pooled rates of success for screw fixation, arthrodesis and arthroscopic debridement were 87.9, 79.4 and 78.7 %, respectively. CONCLUSION: The current evidence on the treatment of chronic syndesmosis injuries in the ankle is limited to prospective and retrospective case series. The pooled success rates for screw fixation, arthrodesis and arthroscopic debridement each exceeded 78 %. Future high-level studies are required to discern the most appropriate treatment strategy(ies) for chronic syndesmotic injuries of the ankle.Knee Surgery Sports Traumatology Arthroscopy 04/2013; · 2.21 Impact Factor -
Article: A Systematic Review on the Reporting of Outcome Data in Studies on Autologous Osteochondral Transplantation for the Treatment of Osteochondral Lesions of the Talus.
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ABSTRACT: Purpose. The purpose of this study was to systematically review studies on autologous osteochondral transplantation (AOT) for osteochondral lesions (OCLs) of the talus and descriptively analyze the outcome data reported to determine whether it is consistent from one study to another and able to be pooled for systematic review. Methods. A systematic electronic search was performed using the MEDLINE and EMBASE databases. Studies that were published between January 1966 and June 2011 were included in the review. Only studies that reported data specifically on AOT for treatment of OCLs of the talus and written in English were included in this review. A predefined data sheet with 36 variables was created, and it was determined whether or not each of those variables were reported or not reported. The 36 variables were then grouped into 6 categories, and the categorical means were reported. Results. A total of 20 studies were included in this systematic review. The categories of general demographics and study design were generally well reported (each more than 80% of studies). Patient-reported outcomes and clinical variables were reported less in 73% and 67% of studies, respectively. The least-reported categories were patient history (45%) and imaging data (49%). Conclusions. Inconsistencies and an underreporting of data were apparent between studies, such that pooling was deemed not possible. An effort must be made by investigators to ensure that there is adequate reporting of data in studies of AOT treatment for OCLs of the talus.Levels of Evidence: Therapeutic Level IV.Foot & Ankle Specialist 04/2013; -
Article: Surgical Treatment for Posterior Ankle Impingement.
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ABSTRACT: PURPOSE: This study aims to provide an overview of both the open and endoscopic procedures used to treat posterior ankle impingement, as well as an analysis, evaluation, and comparison of their outcomes. METHODS: A systematic literature search of the Medline, Embase (Classic), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases and the Cochrane Database of Clinical and Randomized Controlled Trials was performed. Quality of included studies was assessed by use of the Downs and Black scale. RESULTS: After we reviewed 783 studies, 16 trials met the inclusion criteria. Of these trials, 6 reported on open surgical techniques and 10 evaluated endoscopic techniques. The complication rate (15.9% v 7.2%) and time to return to full activity (16.0 weeks v 11.3 weeks) differed between the 2 groups, both favoring endoscopic surgery. CONCLUSIONS: Although the level of evidence of the included studies is relatively low, it can be concluded that the endoscopic technique is superior to the open procedure. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.Arthroscopy The Journal of Arthroscopic and Related Surgery 03/2013; · 3.02 Impact Factor -
Article: Platelet-Rich Plasma in Tendon Models: A Systematic Review of Basic Science Literature.
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ABSTRACT: PURPOSE: To perform a systematic review of the basic science literature on the use of platelet-rich plasma (PRP) in tendon models. METHODS: We searched the PubMed/Medline and Embase databases in June 2012 using the following parameters: ((tenocytes OR tendon OR tendinitis OR tendinosis OR tendinopathy) AND (platelet rich plasma OR PRP OR autologous conditioned plasma OR ACP)). The inclusion criteria for full-text review were in vivo and in vitro studies examining the effects of PRP on tendons and/or tenocytes. Clinical studies were excluded. Only studies published in peer-reviewed journals that compared PRP directly with a control were included. Data were extracted based on a predefined data sheet, which included information on PRP preparation, study methods, and results. Studies were analyzed for trends, comparing and contrasting the reported effects of PRP. RESULTS: The search yielded 31 articles for inclusion in our review. Of the studies, 22 (71%) reported platelet concentrations in the PRP; 6 (19%) reported cytology. Eight in vivo studies found decreased tendon repair time, increased fiber organization, or both with PRP treatment. Eight in vitro studies reported that PRP treatment increased cell proliferation; 7 reported an increase in growth factor expression. Three in vivo studies found increased vascularity, and 4 found increased tensile strength with PRP treatment. CONCLUSIONS: In the basic science studies evaluated, it appears that PRP confers several potential effects on tendon models compared with a control. However, the literature is inconsistent with regard to reporting the methods of preparation of PRP and in reporting platelet concentrations and cytology. CLINICAL RELEVANCE: Establishing proof of concept for PRP may lead to further high-quality clinical studies in which the appropriate indications can be defined.Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2013; · 3.02 Impact Factor -
Article: The biology of ewing sarcoma.
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ABSTRACT: Objective. The goal of this study was to review the current literature on the biology of Ewing's sarcoma, including current treatments and the means by which an understanding of biological mechanisms could impact future treatments. Methods. A search of PubMed and The Cochrane Collaboration was performed. Both preclinical and clinical evidence was considered, but specific case reports were not. Primary research articles and reviews were analyzed with an emphasis on recent publications. Results. Ewing sarcoma is associated with specific chromosomal translocations and the resulting transcripts/proteins. Knowledge of the biology of Ewing sarcoma has been growing but has yet to significantly impact or produce new treatments. Localized cases have seen improvements in survival rates, but the same cannot be said of metastatic and recurrent cases. Standard surgical, radiation, and chemotherapy treatments are reaching their efficacy limits. Conclusion. Improving prognosis likely lies in advancing biomarkers and early diagnosis, determining a cell(s) of origin, and developing effective molecular therapeutics and antiangiogenic agents. Preclinical evidence suggests the utility of molecular therapies for Ewing sarcoma. Early clinical results also reveal potential for novel treatments but require further development and evaluation before widespread use can be advocated.ISRN oncology. 01/2013; 2013:759725.
