Diagnosis and treatment strategies of meniscus root tears: A scoping review

Background: Meniscus root tears comprise 10% to 21% of all meniscal tears. These tears alter knee biomechanics, elevating contact pressure, akin to a meniscectomy. Consequently, they are linked to advanced joint degeneration and cartilage damage in the affected compartment. Purpose: To systematically evaluate and relate the current literature describing the diagnosis and treatment strategies for meniscus root tears. Study Design: Scoping review; Level of evidence, 4. Methods: This review was conducted following the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Inclusion criteria encompassed English-language clinical and preclinical research, technical notes, and narrative reviews on meniscus root tears. Exclusion criteria were studies on patellar tendon rupture, studies on medial patellofemoral ligament rupture with additional knee joint ligament injuries, studies of patients <16 years old, and studies involving open fractures. The data were summarized using a descriptive analysis and a thematic analysis. Results: After 1425 articles were identified, 461 studies were included; 17% (n = 78) were case reports or case series, 15% (n = 71) were technical notes, 9% (n = 41) addressed aspects of diagnosis, 7% (n = 32 ) were narrative reviews, and 5% (n = 21) were systematic reviews or meta-analyses. Studies presenting original data comprised 57% (n = 262) of all included studies, and 97% of the studies were of evidence levels 3 to 5. Contributions were mainly from the United States (n = 123; 27%), Republic of Korea (n = 102; 22%), and Japan (n = 99; 21%). Many studies (n = 216; 47%) focused on the treatment and outcomes of meniscus root tears. A significant chronological surge in the quantity of studies addressing the diagnosis and treatment of meniscus root tears was evident, particularly over the past 3 years. Consensus was found regarding the definition of meniscus root tears, the advantages of early repair, and postoperative rehabilitation protocols. The variations in surgical techniques and operative strategies created the greatest amount of contention, along with clinical assessment and imaging modalities. Conclusion: High-level evidence studies for diagnosing and managing meniscus root tears were scarce. A consensus has yet to be reached regarding the role of concomitant osteotomy, comparison of repair techniques, the use of a centralization stitch, patient factors affecting outcomes, and long-term outcomes of nonoperative management.publishedVersio

Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability

Purpose: Acromioclavicular joint reconstruction is a well-established and frequently performed procedure. Recent scientific and commercial interest has led to a drive to develop and perform surgical techniques that more reliably restore horizontal stability in order to improve patient outcomes. The aim of this systematic review was to evaluate the biomechanical evidence for procedures directed at restoring horizontal stability and determine whether they are associated with superior clinical results when compared to well-established procedures. Methods: A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 23rd December 2017. Biomechanical and clinical studies reporting either static or dynamic horizontal displacement following acromioclavicular joint reconstruction (Coracoclavicular reconstruction or Weaver-Dunn) were included. In addition, biomechanical and clinical studies reporting outcomes after additional augmentation of the acromioclavicular joint were included. The studies were appraised using the Methodological index for non-randomised studies tool. Results: The search strategy identified 18 studies eligible for inclusion: six biomechanical and 12 clinical studies. Comparative biomechanical studies demonstrated that acromioclavicular augmentation provided significantly increased horizontal stability compared to the coracoclavicular reconstruction and Weaver–Dunn procedure. Comparative clinical studies demonstrated no significant differences between coracoclavicular reconstruction with and without acromioclavicular augmentation in terms of functional outcomes (American Shoulder and Elbow Surgeon and Constant score), complication or revision rates. However, one comparative study did demonstrate an improvement in Taft (p = 0.018) and Acromioclavicular Joint Instability scores (p = 0.0001) after acromioclavicular augmentation. Conclusion: In conclusion, coracoclavicular reconstruction with augmentation of the acromioclavicular joint has been shown to provide improved horizontal stability in both biomechanical and clinical studies compared to isolated coracoclavicular reconstruction. However, comparative studies have shown no clinical advantage with respect to American Shoulder and Elbow Surgeon or Constant scores and, therefore, the results of this systematic review do not support acromioclavicular augmentation in routine clinical practice. Level of evidence: IV

Multiligament knee injury (MLKI) : an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation

Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined ‘a priori’ if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.https://bjsm.bmj.com/hj2024Sports MedicineSDG-03:Good heatlh and well-bein

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Genotype Effect on Proximate and Mineral Analysis of Safflower as a Green Leafy Vegetable

Two field trials were carried out at the Botswana University of Agriculture and Natural Resources Content Farm (59o24&amp;prime;S, 95o25&amp;prime;E and 993 m above sea level) in Southern Region of Botswana, to evaluate the effects of genotypes on proximate and mineral composition of safflower leaves. Five safflower genotypes (Kiama composite (local), Sina-PI-537598, Gila-PI-537692, PI-537636 and PI-527710) were evaluated in a randomized complete block design (RCBD) with three replications. During the rosette stage safflower leaves (both petiole and blade) were harvested, dried, and ground for analysis. The results showed that safflower genotypes significantly varied in the leaf proximate content of crude protein (24-28%), crude fibre (8-14%), moisture content (86-87%) and dry matter content (13-14%) in both winter and summer growing seasons. The genotype &amp;lsquo;Sina&amp;rsquo; had the highest crude fibre content compared to other genotypes. The average leaf mineral content significantly (p &amp;lt; 0.05) varied from 2-3 mg g-1 phosphorus, 3-4 mg g-1 calcium, 5-6 mg g-1 sodium, 15-17 mg g-1 magnesium and 15-18 mg g-1 potassium. The Na:K and Ca:P ratios ranged between 0.18 and 3.41. All the safflower genotypes evaluated had sufficient nutritional content to be used as a green leafy vegetable for human consumption and food security. </jats:p

Proximate and Mineral Nutrition of Common Bean Genotypes as Influenced by Harvesting Time

Common bean is the most consumed legume by humans and hence significant for global food security and nutritive value mainly iron (Fe) and zinc (Zn). The objective of the study was to evaluate the effect of harvesting time and genotypes on proximate and mineral composition of common bean. Two field experiments were carried out in Sebele (24o33&amp;prime;S, 25o54&amp;prime;E, 994 m above sea level) horticultural fields during summer 2018/2019. Treatments included two common bean genotypes DAB 564 (white) or 520 (red) and three harvesting stages as the early, mid and late season harvest. In both seasons, genotype and harvesting time significantly (P &amp;lt; 0.05) influenced proximate, macro and micro mineral composition of common bean seeds. Generally genotypes studied had a sufficient amount of proximate and mineral content with crude protein, iron (Fe) and zinc (Zn) content as the most abundant minerals at a range between 20-22%, 33-101 mg g-1 and 41-45 mg g-1, respectively across harvesting times. Genotype DAB 564 (white coloured) significantly (P &amp;lt; 0.05) produced seeds with the highest concentration of proximate and mineral contents especially zinc (45 mg g-1) and iron (70 mg g-1) content irrespective of season. Harvesting common bean seed early or mid-stage produced high seed concentration of proximate, micro and macro mineral content across genotype or season. </jats:p