- Comparison of Adverse Events and Postoperative Mobilization Following Knee Extensor Mechanism Rupture Repair: A Systematic Review and Network Meta-Analysis
Link: https://www.sciencedirect.com/science/article/pii/S0020138317306976
Rupture of the extensor tendons of the knee is a rare but potentially debilitating injury that often occurs due to trauma. While a wide variety of surgical treatments have been reported, there is currently no consensus on the most successful treatment method. Moreover, the timing of post-operative joint mobilization that is critical for successful recovery after rupture repair is not collectively established. Despite the traditional method of complete immobilization for 6 weeks, there is an increasing trend towards early post-operative knee mobilization. We employed a state-of-art type of meta-analysis (network meta-analysis) to compare adverse event rates and function outcomes between repair methods and between post-operative mobilization protocols.
- Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials
Link: https://journals.sagepub.com/doi/abs/10.1177/0363546518801914
Tennis elbow is a relatively common condition without a well-accepted treatment. While some physicians recommend rest and waiting some others tend to recommend medical treatment earlier. In this multiple-treatment meta-analysis we evaluated effectiveness of several medical treatments, presented the finding using NNT and NNH and reported outcome of study participants with tennis elbow who did not receive effective medical treatment. We found that majority of patients experienced pain relief while only received placebo or sham treatment.
- Risk factors and pooled rate of prolonged opioid use following trauma or surgery: a systematic review and meta-(regression) analysis
Link: https://journals.lww.com/jbjsjournal/FullText/2018/08010/Risk_Factors_and_Pooled_Rate_of_Prolonged_Opioid.9.aspx
In light of recent opioid addiction crisis, we performed a sophisticated variant of meta-analysis, meta-regression, to evaluate the rate of prolonged opioid use in near 2 million patients who received opioid painkillers because of undergoing a surgery or afflicted by an injury. We identified the factors that make some patients more susceptible to opioid misuse and we able to detect temporal trend of increased opioid misuses over time inside and outside of the United States.
- Meta-analysis and Systematic Review of Skin Graft Donor-site dressings with future guidelines
Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191241/
Skin graft is a common treatment for patients who have a burn injury. Many types of dressings are available for split-thickness skin graft (STSG) donor-site with little consensus from the literature on the optimal dressing type. We performed this systematic review and meta-analysis to identify outcomes of moist and non-moist dressings for STSG donor sites. In spite of vide variation in the quality of studies and methods of outcome assessment, we provided insight of the most effective method of dressing and recommendations for standardized research protocols to design better comparison studies and assess true efficacy.
- Diagnostic modalities for acute compartment syndrome of the extremities: a systematic review
Link: https://jamanetwork.com/journals/jamasurgery/fullarticle/2732432
Acute compartment syndrome (ACS) can cause catastrophic tissue damage leading to permanent muscle and nerve loss. Despite devastating consequences of late diagnosis of ACS, there are no reliable diagnostic methods. and the clinical evaluation is impossible to standardize. Additionally, the guidelines for diagnosis can result in overtreatment or delayed diagnosis. In this study, we provide a systematic and comprehensive review of current diagnostic modalities, both those that are approved to use on human and those that are still in investigational phase to provide most comprehensive and critically apprised information for physicians and patients as well as to build a solid background for future research.
- Comparison of surgical and non-surgical treatments for 3-and 4-part proximal humerus fractures: A network meta-analysis
Link: https://journals.sagepub.com/doi/abs/10.1177/1758573219831506
There is a wide variation of treatment strategies for proximal humerus fractures from non-surgical treatment to reverse total shoulder arthroplasty. There is currently no consensus regarding the superiority of any one surgical strategy. We used a complex method of meta-analysis, network meta-analysis, to determine the most successful treatment for proximal humerus fractures. We demonstrated non-surgical treatment results in fewer complications and additional surgeries compared to open reduction internal fixation. We also observed that the preliminary data supports reverse total shoulder arthroplasty over hemiarthroplasty, but more evidence is needed to strengthen this conclusion.
- Shoulder biomechanics of RC repair and Instability: A systematic review of cadaveric methodology
Link: https://www.sciencedirect.com/science/article/pii/S0021929018308364
Identifying the most robust method for investigating shoulder biomechanics is crucial for any reliable research understanding the complicated anatomy and biomechanics of the shoulder in normal and disease conditions. While these investigations include a mix of in-vivo clinical reports, ex-vivo cadaveric studies, and computer-based simulations, each has its own strengths and limitations. In this systematic review, we presented various existing research methodologies evaluating shoulder biomechanics to emphasize the best research methodologies available to simulate physiologically and clinically relevant shoulder motion.
- Rehabilitation following meniscal repair: a systematic review
Link: https://bmjopensem.bmj.com/content/4/1/e000212?itm_campaign=bmjosem&itm_content=consumer&itm_medium=cpc&itm_source=trendmd&itm_term=0-A
While meniscal repairs are becoming a more appealing treatment for meniscal injuries, there is no consensus regarding the optimal postoperative protocol following meniscal repair. We have provided a comprehensive systematic review of current literature to identify most appropriate rehabilitation protocols for different types of repairs based on different patient characteristics. We also provided recommendations for new studies to better clarify the interplay between tear types, repair method and optimal rehabilitation protocol.
Ongoing Studies:
- Risk factors for hip fracture
Hip fractures are one the most devastating type of osteoporotic fractures. The prevention of these fractures appears to be the most effective method to alleviate the grave burden of this injury. Preventive methods require an accurate risk prediction to provide most effective treatments to those who are at risk, while limiting unnecessary treatments that are associated with inevitable side effects. The current method of risk prediction is not flawless. In a series of systematic reviews and meta-analyses, we aim to refine the current risk prediction algorithm by providing the updated and most accurate effect size for each risk factor for hip fracture that feed the fracture prediction algorithm. Currently, we have 4 studies underway in this area:
- Identify the role and effect size of each demographic risk factor for osteoporotic hip fractures
- Evaluate the role and effect size of various comorbidities as risk factors for osteoporotic hip fractures
- Evaluate the role and effect size of modifiable risk factors for osteoporotic hip fracture
- Evaluate the role and effect size of medications as a risk factor for osteoporotic hip fractures
- Factors associated with development of acute compartment syndrome: a systematic review and meta-analysis
Acute compartment syndrome remains a clinical diagnosis, thus identification of risk factors may help with earlier detection, and thereby improved outcomes. Our study identified the current significant risk factors for developing traumatic ACS and discussed the current gaps in the literature.
- Risk factors and pooled Nonunion Rate of Operative Treatment for Distal Femur Fractures
Distal femur fractures are severe injuries and the treatment technically challenging. With the rising geriatric populations, the incidence of these type of fractures will increase. This study reports on pooled rate of nonunion and infection in distal femur fractures. Furthermore, we report on the risk factors associated with nonunion that are currently available in the literature.
- Factors associated with development of non-traumatic acute compartment syndrome- a systematic review and meta-analysis
Non-traumatic ACS is a challenging diagnosis with a dreadful outcome if diagnosed late. We aim to search the literature to identify risk factors for developing non-traumatic ACS in order to help identify patients at risk and thereby facilitate an earlier detection.
- Factors associated with development of acute compartment syndrome in the pediatric population - a systematic review and meta-analysis
Delayed diagnosis of ACS in the pediatric population remains a concern due to the challenging communication and the variety of etiologies. We aim to report on the pooled risk factors currently available in the literature and identify potential gaps to be addressed in future studies.
- The role of supplements in sustaining a fragility hip fracture – a systematic review and meta-analysis
Supplements, hereunder Calcium and Vitamin D, is recommended in the geriatric population and especially in patients with osteoporosis in order to promote bone health and prevent fragility fractures. We aim to report on the role of supplements in sustaining a fragility hip fracture.