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Ankle osteoarthritis symptoms can be severely debilitating, requiring surgical intervention in end-stage cases. Non-operative treatments to manage symptoms are essential to improve quality of life and prolong time to surgery. PRP is an injectable treatment which has been increasingly utilized in osteoarthritis cases (particularly knee osteoarthritis). Yet, evidence in ankle osteoarthritis cases is much more limited.
This multi-centered RCT randomized 100 patients with ankle osteoarthritis to receive 2 intra-articular injections of PRP (n=48) or placebo (n=52) into the talocrural joint. The primary outcome of interest was pain and function at 52 weeks follow-up.
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No significant differences were observed between the two groups at 52 weeks for patient reported pain and function (measure with the AOFAS scale) (p=0.31).
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No significant differences were found between the groups in any of the secondary outcomes, which included symptoms, quality of life, activity level, patient satisfaction, and goal attainment!
Bottom line. PRP injections did not provide any clinical advantage over a placebo injection for patients with ankle osteoarthritis, calling into question the efficacy of the intervention for this population!
Read the full ACE Report on this trial here. |
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With osteoarthritis cases rising around the world, mitigating risk factors is a hot topic. One factor which has been brought up is ACL injury – in particular, there have been concerns around the development of knee osteoarthritis in patients who undergo surgical reconstruction vs. conservative treatment. Assessing the existing literature could help determine whether there's a link between ACL reconstruction and knee osteoarthritis.
3 RCTs including a total of 343 ACL injuries were included in this meta-analysis assessing the effect of ACL reconstruction on osteoarthritis development. The findings were quite interesting:
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Patients who received an ACL reconstruction were at a significantly higher risk of developing knee osteoarthritis than those who received non-surgical treatment (RR 1.72 [95% CI 1.18, 2.53], p=0.005).
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The analysis including all study designs (RCTs, case-control, cohort) found similar results, with ACL reconstruction being associated with a significantly greater rate of osteoarthritis (p<0.001).
Bottom line. The current high-quality literature suggests that ACL reconstruction could be leading to an increased risk of knee osteoarthritis - but given the small number of studies, definitive conclusions can’t be made. Future studies are required to confirm the results – including an exploration of the effect of reconstruction technique.
Read the full ACE Report on this systematic review & meta-analysis here. |
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Pain after arthroscopic rotator cuff repair can impede recovery and require opioid prescription, putting patients at risk of opioid addiction. Non-opioid management strategies are therefore a major topic of discussion amongst orthopaedic professionals. Enter, cannabidiol (CBD).
CBD use as an analgesic has skyrocketed in popularity as countries continue to legalize treatment and its use in medical settings becomes more normalized. Despite its widespread use, however, evidence on its effectiveness in managing pain is relatively limited. Could it be useful for controlling pain after arthroscopic rotator cuff repair?
101 patients undergoing arthroscopic rotator cuff repairs were randomized to receive buccally absorbed CBD (either 25 or 50mg doses; n=54) or a placebo (n= 47) for 14 days, in addition to a pain management protocol. The primary outcome of interest was pain as measured with a Visual Analog Scale (VAS).
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Pain scores in the first post-operative day were significantly lower in the CBD group compared to the placebo group (p=0.04). No differences were observed between days 2-14.
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Patient satisfaction was significantly higher in the CBD group on days 1 and 2 post-operation compared to the placebo group (p<0.05 for both).
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Opioid consumption and nausea levels were similar in both groups (p>0.05 for all).
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Patients who received the higher CBD dose demonstrated the lowest levels of pain and satisfaction. However, the level of nausea was significantly higher with the 50mg dose compared to the 25mg dose.
Bottom line. CBD was able to reduce pain immediately post-operation for patients recovering from arthroscopic rotator cuff repair, particularly at higher doses. Future studies confirming safety and effectiveness and exploring optimal dosing regimens are of interest.
Read the full ACE Report on this trial here. |
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EDITOR’S PICKS |
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How to Become a Hyper-Performer – Whether it be in engineering, business, sports, or medicine, there are generally a select few who produce the majority of outcomes – who take the risk to try and to create, despite all odds and against the conventions of the day. In this OE Insight, we breakdown the defining characteristics of hyper performers, and how you can become one yourself! (Read) |
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Get to Know: Dr David Parker, President of ISAKOS – Our latest Surgeon Feature is on David Parker, current president of ISAKOS and founder of the Sydney Orthopaedic Research Institute. He details his career journey into orthopaedics, proudest moments, advice for young professionals, and favourite productivity tips! (Read) |
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