Purpose To systematize the surgical outcomes of anatomic and non-anatomic reconstruction in patients with chronic acromio-clavicular joint (ACJ) instability and determine which technique is superior. Methods This review was conducted according to the PRISMA guidelines. PubMed and Cochrane Library databases were searched up to April 30th, 2018 for original articles that assessed the outcomes of one or more surgical techniques of anatomic and non-anatomic reconstruction in patients with chronic ACJ instability. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Pre-to-post meta-analysis was performed for both anatomic and nonanatomic reconstructions. Results Twenty-eight studies were included comprising 799 patients (mean age of 36.6 years old and 84% males) with a mean follow-up of 34.6 months (range 13 to 74). Surgical techniques included anatomic (tendinous or synthetic grafts/constructs) and non-anatomic reconstruction (Weaver-Dunn or Modiied Weaver-Dunn, conjoined tendon transfer, or temporary hook plate). There were signiicant pre-to-post improvements on the constant score with an average improvement ranging from 11.1 to 50.7 (p < 0.01). Average failure rate was 7.6% (7.5% for anatomic and 8.5% for non-anatomic reconstruction). Noncomparative studies had a mean MINORS score of 9 points (out of 16) and comparative studies 17 (out of 24) with excellent interrater agreement (k = 0.910). Conclusion Both anatomic and non-anatomic ACJ reconstructions provide signiicant post-operative improvements, but deinitive conclusions on optimal technique remain elusive. Notwithstanding, comparative studies support the use of anatomic ACJ reconstruction which should be preferably used. However, until superiority is demonstrated by robust studies, surgeons should supplement their decision-making with experience and patient preference. Level of evidence IV.
Background:
The coronavirus disease-2019 pandemic has forced health systems to undergo dynamic changes. This study aims to evaluate the impact of the pre-lockdown and of the lockdown period on the surgical activity of a Portuguese Orthopaedic and Traumatology Department and to compare it with the homologous period of 2019.
Methods:
The surgical activity between March 2 and May 2, 2020 and that of the homologous period of 2019 were analyzed and compared. Additionally, the impact of national and institutional measures was analyzed.
Results:
There was a decrease in elective surgeries, from 587 to 100. In 2020, 59.3% of all surgeries were urgent and 48.4% were trauma whereas in 2019 there were 25.5% urgent and 23.0% trauma surgeries (P < .001 and P < .001, respectively). There was no difference in the mean of proximal hip fractures operated per week (P = .310), even when analyzing only the lockdown period (P = .102). However, proximal hip fractures corresponded to significantly higher proportion of surgeries in 2020 (P = .04). Hand and tendon injuries significantly reduced in 2020, as were sports-related trauma surgeries. Mean number of days until surgery was significantly lower in 2020 (2020:1.6 ± 2.1, 2019: 2.2 ± 2.5, P = .012).
Conclusion:
Governmental and institutional measures had high impact on the production and on the epidemiology of trauma. While resumption of elective surgery is needed, lessons from these measures may help in the response to a possible second wave.
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