Minimally invasive versus open surgery for acute achilles tendon rupture: an umbrella review of systematic reviews and meta-analyses

BackgroundAchilles tendon rupture is a common injury requiring surgical intervention. The choice between Minimally Invasive Surgery (MIS) and Open Surgery (OS) has been widely debated. This umbrella review synthesized the results of systematic reviews and meta-analyses comparing outcomes of MIS and OS for acute Achilles tendon rupture.MethodsA comprehensive search was conducted using PubMed, Embase, Cochrane Library, Web of Science, and Scopus. The AMSTAR-2 checklist was employed to assess the quality of the included systematic reviews and meta-analyses. Data on complication rates, surgical times, functional outcomes, and other patient-centric metrics were extracted and analyzed.ResultsAn aggregate of 6,480 participants were drawn from 7 included studies (not de-duplicated across overlapping trials). The primary outcomes were re-rupture and validated functional recovery scores; key complications included infection and sural nerve injury; secondary endpoints included operative time and return-to-sport. Searches, selection, and extraction followed prespecified criteria. Because the unit of analysis was published evidence syntheses and the underlying randomized trials overlapped with heterogeneous outcome definitions, results were synthesized qualitatively rather than pooled quantitatively. Across reviews, minimally invasive and open repair showed broadly comparable clinical effectiveness, with differences contingent on technique, perioperative protocols, and follow-up windows.ConclusionMIS appears to offer significant advantages over OS for the repair of acute Achilles tendon ruptures, including reduced complication rates and faster recovery times, without compromising the effectiveness of the repair in preventing re-ruptures. However, the potential for nerve injury with MIS warrants careful consideration. Decisions regarding surgical techniques should be tailored to individual patient circumstances and the specific expertise of the surgical team

Effect of anteromedial portal location on femoral tunnel inclination, length, and location in hamstring autograft-based single-bundle anterior cruciate ligament reconstruction: a prospective study

Abstract Background Portal positioning in arthroscopic anterior cruciate ligament reconstruction is critical in facilitating the drilling of the femoral tunnel. However, the traditional approach has limitations. A modified inferior anteromedial portal was developed. Therefore, this study aims to compare the modified and conventional far anteromedial portals for femoral tunnel drilling, assessing factors such as tunnel length, inclination, iatrogenic chondral injury risk, and blowout. Material and methods Patients scheduled for hamstring autograft-based anatomical single-bundle arthroscopic anterior cruciate ligament reconstruction were divided into two groups: modified and far anteromedial groups. Primary outcomes include differences in femoral tunnel length intraoperatively, tunnel inclination on anteroposterior radiographs, and exit location on lateral radiographs. Secondary outcomes encompass tunnel-related complications and reconstruction failures. To identify potential risk factors for shorter tunnel lengths and posterior exits, regression analysis was conducted. Results Tunnel parameters of 234 patients were analyzed. In the modified portal group, femoral tunnel length and inclination were significantly higher, with tunnels exhibiting a more anterior exit position (p < 0.05). A higher body mass index exerted a negative influence on tunnel length and inclination. However, obese patients in the modified portal group had longer tunnels, increased inclination, and a lower risk of posterior exit. Only a few tunnel-related complications were observed in the far anteromedial group. Conclusion The modified portal allowed better control of tunnel length and inclination, ensuring a nonposterior femoral tunnel exit, making it beneficial for obese patients

The frequency of os acromiale in 751 shoulder MRI of Saudi population

Background: Os acromiale (OA) is an uncommon pathology with a variable prevalence rate among different populations. Objectives: The aim of this study was to report the frequency of OA utilizing shoulder MRI of patients with shoulder pathology. Methods: It was a retrospective study. After obtaining our IRB approval, we gathered all shoulder and upper arm MRIs from the radiology department and evaluated them. Results: The prevalence of OA was found to be 3.32%. The mean age of the affected patients was 50.87 years (25–81). Conclusion: The rate of OA in patients presenting with shoulder pain is 3.32% in Saudi Arabia, which correlates with what has been previously reported in the literature

The Level of Public Awareness About Clubfoot in The Al-Qassim Region and Importance of Early Childhood Intervention: A Cross-Sectional Study

Background: Clubfoot is a childhood congenital abnormality that can lead to disabilities, which can last a lifetime if untreated. There are several types of interventions to treat this condition. However, these interventions depend on the age of presentation and result in good outcomes if started early. This study aimed to investigate the level of public awareness about clubfoot in the Al-Qassim region in Saudi Arabia. Method: This observational cross-sectional study was conducted on a population living in the Al-Qassim region in 2020. The study was conducted using a structured, validated questionnaire that was available online. The chi-square test and t-test were used to analyze the data. All the analyses were conducted using SPSS (version 21). Results: This study included 7085 individuals from the Al-Qassim region. The level of public awareness was as follows 15.6% had poor knowledge, 43.8% had fair knowledge, and 40.6% had high knowledge. The most common sources of knowledge were relatives and friends (42.55%) and websites (29.83%). A multivariate analysis showed that several factors affected the levels of knowledge, including gender (P˂0.0001), having an affected child (P˂0.0003), certain sources of information, affected persons (P˂0.005), relatives and friends (P˂0.0001), websites (P˂0.0001), and printed media (P˂0.0001). Conclusion: A moderate level of knowledge was found among the population in the Al-Qassim region. Their knowledge level was affected by several factors, such as the source of information. Therefore, educational interventions, such as campaigns, are needed to improve the awareness level, leading to better outcomes. Keywords: Clubfoot, Awareness, General population, Al-Qassim, Serial casting, misconception, Early Interventions</jats:p

Determination of Bone Age and its Correlation to the Chronological Age Based on the Greulich and Pyle Method in Saudi Arabia

Introduction: Many clinical indications need the measurement of bone age, including growth and development abnormalities, the timing of corrective procedures in pediatric patients, and the assessment and treatment of specific endocrine conditions. These evaluations are also useful in forensic science.&#x0D; Aim: This study aims to compare the bone age of children aged 4 to 18 years old with their chronological age in order to determine whether the Greulich-Pyle (GP) method is trustworthy for Saudi youngsters.&#x0D; Materials &amp; Methods: Multiple approaches for determining bone age have been published, but Greulich and Pyle's methodology is the most extensively utilized. This method is based on an inspectional evaluation that compares the radiograph to the pattern described in a 1950 atlas using a sample of North American children aged birth to 18 years for the female sex and up to 19 years for the male sex. It is one of the most commonly utilized procedures for assessing the skeletal age of children and adolescents since it is rapid and quick to perform. It is based on the fact that ossification centers in the hand and wrist bones emerge in a predetermined order. For male and female youngsters, the degree of ossification in various hand and wrist bones is compared to the nearest matching plate on the Greulich &amp; Pyle Atlas. This cross-sectional study was performed during April 2021 to September 2021.&#x0D; Results: Total 216 patients were included or selected in this study among age group 4-18 years, the sex distribution among them were 148 (68.5%) and 68 (31.5%) were male and female respectively. Chronological age and bone age assessment by GP methodamong doctors when chronological age was 135.2 ± 45.0 (range, 45-216 months). Chronological age in male and female were 143.5 ± 44.0 and 116.9 ± 41.8 respectively with p value &lt;0.001 which was statistically significant. The bone age were observed in two reading, first reading and second reading after 15 days by two doctors separately and all the finding were recorded almost similar and significant with p value &lt;0.001. Correlation between Chronological age and Bone age by GP method in both sex observed significant p value &lt;0.001. Linear regression analysis showed that the bone ageand its correlation to the chronological age assessment in first reading in male(r=0.761 and p&lt;0.001) and female(r=0.889 and p&lt;0.001), in reading after 15 days in male(r=0.760 and p&lt;0.001) and female(r=0.868 and p&lt;0.001).&#x0D; Conclusion: In order to evaluate whether the Greulich-Pyle (GP) technique is accurate for Saudi children, the bone age of children aged 4 to 18 years old should be evaluated to their chronological age, according to this research.</jats:p