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Arthroscopic partial meniscectomies (APMs) are one of the most widely performed procedures in orthopaedics. It aims to reduce the risk of osteoarthritis and improve symptoms – but recent evidence suggests it could be doing more harm than good. Published in the NEJM, Researchers out of Finland conducted a placebo-surgery trial to see whether APM has harmful long-term effects.
146 patients with symptoms consistent with a degenerative medial meniscus tear were randomized to receive an arthroscopic partial meniscectomy procedure (n=70) or placebo surgery (n=76). The primary outcome of interest was knee symptoms and function, up to 5 years follow-up.
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After 5 years, there were no significant differences between the two groups in knee pain, meniscus-specific quality of life scores, or knee function scores (p>0.05 for all).
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After 5 years, 72% of patients in the APM group and 60% in the placebo surgery group had at least a 1 grade progression in radiographic knee osteoarthritis.
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OARSI scores indicated significantly more radiographic progression in the APM group.
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Both groups displayed similar levels of satisfaction and reported improvement.
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The rate of mechanical symptoms was significantly higher in the APM group.
Bottom line. Arthroscopic partial meniscectomy did not provide any benefit in knee symptoms or functional outcomes after 5 years and led to an increased progression of osteoarthritis and a higher rate of mechanical symptoms!
Check out the comprehensive analysis of this paper in our ACE Report. |
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Decompression with fusion has long been the standard treatment for degenerative spondylolisthesis. But recent studies have called into question the necessity of adding fusion to decompression. With a rising prevalence and associated costs in the billions of dollars, a randomized trial was of interest.
This multicentre, open-label, non-inferiority trial randomized 267 patients with spinal stenosis and degenerative spondylolisthesis to receive either decompression only (n=124) or decompression with instrumented fusion (n=133). The primary outcome of interest was the number of patients with at least 30% reduction in disability scores, with a non-inferiority margin of -15 percentage points.
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Decompression without fusion demonstrated a non-inferior ability to reduce disability by at least 30% compared to decompression with fusion (71.4% vs. 72.9%).
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Similar disability, pain, quality of life, and symptom severity scores were observed at 2 years post-operation.
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The decompression with fusion group demonstrated a longer operative time, longer length of hospitalization, and an increased rate of dural tears.
Bottom line. Decompression only provided non-inferior levels of disability improvement and similar clinical outcomes compared to decompression with fusion. Moreover, decompression alone was quicker to perform and led to faster discharge and a lower rate of dural tears.
Check out the comprehensive analysis of this paper in our ACE Report. |
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With the majority of carpal fractures affecting the scaphoid, the optimal treatment strategy is a major topic for hand & wrist surgeons. Surgical fixation is often chosen over cast immobilization, but the evidence supporting its superiority is limited – published in the Lancet, the SWIFFT Trial aimed to compare the effectiveness of surgical fixation & cast immobilization.
This multicentre, open-label RCT conducted in England and Wales randomized 439 patients with scaphoid waist fractures to receive percutaneous or open surgical fixation (n=219) or cast immobilization (n=220). The primary outcome of interest was pain and disability (measured with the PRWE scale) after 1 year.
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No differences in pain and disability scores were observed between the two groups at 52 weeks (p=0.27). A statistically significant but clinically irrelevant difference pain and disability scores at 12 weeks was observed in favour of the surgery group (p=0.01).
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Functional sub-scale scores were significantly better in the surgery group at 6- and 12-weeks follow-up (p<0.01 for both).
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Physical quality of life scores were significantly better in the surgery group at 12- and 52-weeks follow-up (p<0.05 for both).
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Grip strength was significantly better in the surgery group at 6 weeks follow-up (p=0.001).
Bottom line. Casting provided similar levels of pain and function after 1 year for patients with scaphoid waist fractures. However, there is indication that early clinical outcomes may be in favour of the surgery group.
Check out the comprehensive analysis of this paper in our ACE Report. |
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EDITOR’S PICKS |
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OrthoJoe Podcast 75: Are Stress Tests Needed for Ankle Fracture? – In this podcast, Dr’s Mohit Bhandari and Marc Swiontkowski discuss a recent article by a Norwegian group on ankle fractures and the issue of gravity stress tests for the assessment of fracture stability. (Watch) |
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Improving Mobility After Lumbar Disc Surgery – Patients have a lot of fear and anxiety around movement after surgery, but the lack of mobility can reduce activity levels post-operation and led to increased kinesiophobia. This RCT assessed the effectiveness of a pre-operative training programme aimed at teaching patients to turn and mobilize in-bed after lumbar disc surgery. Mobility scores and anxiety levels were better in the mobilization group! (Read) |
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Building Effective Advisory Boards – Advisory boards can be one of the greatest superchargers for growth and success, but they can also be an inefficient, unfulfilling waste of time and resources for both its members and the organization. Building an elite, effective advisory board is no easy task. In this OE Insight, we dive into the key considerations of building an advisory board to maximize the value for your team and the board members!
(Read) |
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