Hollywood, Fl July, 2013

Transcription

1 Treatment of Chronic Syndesmotic Injury: A Systematic Review and Meta-Analysis Hollywood, Fl July, 2013 Charles P. Hannon, BS Hospital for Special Surgery Parlamas G, Hannon CP, Murawski CD, Smyth NA, Ma Y, Kerkhoffs GM, van Dijk CN, Karlsson J, Kennedy JG

2 Institutional Affiliations Hospital for Special Surgery New York, NY George Paralamas Charles Hannon Christopher Murawski Niall A. Smyth John G. Kennedy, MD Academic Medical Center, University of Amsterdam Amsterdam, The Netherlands Prof. C Niek van Dijk Prof Gino M. Kerkhoffs Sahlgrenska University Hospital Mölndal, Sweden Prof. Jon Karlsson

3 Disclosure I have no financial disclosures D Dr. John Kennedy is a consultant to r. John Kennedy Arteriocyte, is a Inc. consultant to Arteriocyte, Inc. Professor C. Niek van Dijk is a consultant to Smith & Nephew The remaining co-authors declare no conflicts of interest The remaining co-authors declare no conflicts of interest

4 Syndesmostic Injuries Injuries to syndesmosis occur in up to 18% of all ankle sprains Difficult to diagnose Few reliable clinical tests Advanced imaging modalities such as MRI are often required Acute injuries often remain undiagnosed leading to long term disability Grass et al. FAI 2003 Han SH et al. FAI 2007; Sman AD et al. BJSM 2012; Takao M et al. JBJS Br. 2003

5 Treatment of Chronic Syndesmosis Injuries Symptomatic chronic injuries are not amenable to conservative treatment Main surgical options are: Arthroscopic debridement Screw fixation Anatomical ligamentous reconstruction Arthrodesis Surgical methods often combined to provide optimal bony and ligamentous stability Currently, no consensus regarding the optimal surgical treatment strategy Miyamoto W et al. WJO 2011 Olson et al. JBJS 2011

6 Purpose To systematically review and meta-analyze studies of the surgical treatment of chronic syndesmotic injuries to determine the most appropriate treatment strategy

7 Methods The electronic databases of PubMed/MEDLINE and EMBASE were systematically screened in August of 2012 independently and selected by two of the authors Studies that reported the outcomes of surgical treatment of chronic syndesmosis injury were included in our review Chronic injury of the syndesmosis was defined as injuries causing symptoms more than 6 months

8 Methods 15 articles included after full text-review Main treatment methods: Screw fixation Arthrodesis Arthroscopic debridement Meta-analysis was performed to pool the rates of success for different treatment methods

9 Results 1 Screw Fixation Arthrodesis Arthroscopic Debridement Number of Studies Total number Treatment of Strategy Pooled Rate 26 of Success Screw Patients Fixation (N=11) 87.9% Arthrodesis Mean Age (N=2) and SD 35±7 37± % 30±1 Arthroscopic (years) Debridement (N=2) 78.7% Average Percent Male (%) Average Follow Up 27± ±18 41±6 and SD (months) Mean Duration of 21±13 9± ±9 Symptoms and SD (months) Total Number of Functional Outcome Scores Used 7 2 2

10 Meta-regression Results Meta-regression was only performed for the screw fixation group Gender, age, average follow-up, mean duration of symptoms and method of diagnosis were all not significant in affecting rate of success after screw fixation

11 Discussion Surgical treatment of chronic syndesmosis results in favorable outcomes Lack of studies on arthroscopic debridement and arthrodesis limit the ability to draw definitive conclusions Current literature does not support one treatment modality over another for chronic syndesmotic injuries

12 Conclusions Goal of research on the treatment of chronic syndesmostic injuries should be to perform high level of evidence studies which are homogenous in the techniques utilized and variables reported Future studies are particularly warranted investigating the use of arthrodesis and arthroscopic debridement Randomized controlled, level I clinical trials are necessary to directly compare these treatment modalities and determine optimal treatment

13 Thank You!