Purpose of Review To present an updated systematic review of the indications and outcomes of open and arthroscopic labral reconstruction. Due to the increasing popularity and recognition, the arthroscopic procedure has gained in recent years, the aim was to assess for changes in indications, graft selection, and improvement in outcomes within the last 5 years. Recent Findings A total of nine eligible studies (six case series, one cohort, and two retrospective comparative studies) with a total of 234 patients (265 hips), and an average 12/16 (non-comparative studies) and 20/24 (comparative studies) quality on the MINORS score were included in this review. All patients underwent labral reconstruction, whether as primary surgery or revision (76% vs 24% respectively). There were 244 hips assessed at final follow-up (92%) with a reported mean range of 12 and 61 months. There were more graft variabilities found in this study compared with the previous review (iliotibial band allograft, gracilis tendon autograft, indirect head of rectus femoris autograft, semitendinosus allograft, peroneus brevis allograft, labrum allograft, ligamentum capitus femoris). Surgical approaches differed (open 7.9% (previously 18.7%), arthroscopic 86% (previously 81. 3 %), arthroscopic assisted mini-open technique (AAMOT) (6%)). Overall, improvement was observed in the patientreported outcomes and functional scores, with variability in their statistical significance. The failure rate or conversion to total hip arthroplasty (THA) decreased compared with the previous review (20% vs 9.5% [conversion to THA was 5.7% and revision surgery rate was 3. 8%]). Indications for labrum reconstruction remained similar (i.e., young, active patients with no or minimal arthritis (Tonnis 0-1), irreparable or ossified labrum, and hypotrophic < 2 mm or dysfunctional hypertrophic labrum > 8 mm). Summary According to recent evidence, hip labrum reconstruction is a new technique that showed short-and mid-term improvement in patient-reported outcomes and functional scores postoperatively. The primary indication for reconstruction remained similar over time. The failure rates and/or conversion to THA appear to have decreased over time. Long-term follow-up with higher quality studies was not available in the literature based on this review. Level of evidence 2
Objective To assess the potential effectiveness of playing a simple, casual video game (Flower) in reducing stress relative to participating in a mindfulness-meditation session (body scan) among undergraduate students. Eighty undergraduate student participants (mean age = 19.46 years, SD = 1.43; gender: 48 females, 29 males, 3 preferred not to answer) were assigned to one of two groups in alternating order: one who played Flower and the comparison group who participated in a body scan, each lasting 20 min. Psychological and physiological stress measurements were made before and after each intervention. Self-perceived psychological stress was measured using a modified version of the nine-item Psychological Stress Measure (PSM-9), and physiological stress (heart rate, systolic and diastolic blood pressure) was measured using an electronic blood-pressure cuff. The results were analyzed with a 2 (measurement: pre, post) × 2 (intervention: video game, mindfulness-meditation) mixed model analysis of variance (ANOVA) for each of the four outcome measures. There was a statistically significant reduction (pre-to post-intervention) across all outcome measures. Notably, there was a significant measurement × intervention interaction (p < .001) for the psychological stress measure; participants in the mindfulness-meditation group reported greater stress reduction after the intervention than participants in the video game group. Although these results suggest mindfulness-meditation provides a slight advantage for stress reduction than casual video games, the similarity in reduction across all physiological measures between the two interventions nevertheless suggests casual video games may also be an effective medium. This finding is especially promising given casual video games' accessibility, ease of use, and popularity among students. These results may inform initiatives by colleges and universities to better support students during peak times of stress and especially during the current COVID-19 pandemic.
BackgroundThe primary objective of this systematic review is to examine the characteristics of pilot randomized controlled trials (RCTs) in the orthopaedic surgery literature, including the proportion framed as feasibility trials and those that lead to definitive RCTs. This review aim to answer the question of whether pilot RCTs lead to definitive RCTs, whilst investigating the quality, feasibility and overall publication trends of orthopaedic pilot trials.MethodsPilot RCTs in the orthopaedic literature were identified from three electronic databases (EMBASE, MEDLINE, and Pubmed) searched from database inception to January 2018. Search criteria included the evaluation of at least one orthopaedic surgical intervention, research on humans, and publication in English. Two reviewers independently screened the pool of pilot trials, and conducted a search for corresponding definitive trials. Screened pilot RCTs were assessed for feasibility outcomes related to efficiency, cost, and/or timeliness of a large-scale clinical trial involving a surgical intervention. The quality of the pilot and definitive trials were assessed using the Checklist to Evaluate a Report of a Non-Pharmacological Trial (CLEAR NPT).ResultsThe initial search for pilot RCTs yielded 3857 titles, of which 49 articles were relevant for this review. 73.5% (36/49) of the orthopaedic pilot RCTs were framed as feasibility trials. Of these, 5 corresponding definitive trials (10.2%) were found, of which four were published and one ongoing. Based on author responses, the lack of a definitive RCT following the pilot trial was attributed to a lack of funding, inadequacies in recruitment, and belief that the pilot RCT sufficiently answered the research question.ConclusionsBased on this systematic review, most pilot RCTs were characterized as feasibility trials. However, the majority of published pilot RCTs did not lead to definitive trials. This discrepancy was mainly attributed to poor feasibility (e.g. poor recruitment) and lack of funding for an orthopaedic surgical definitive trial. In recent years this discrepancy may be due to researchers saving on time and cost by rolling their pilot patients into the definitive RCT rather than publish a separate pilot trial.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2337-7) contains supplementary material, which is available to authorized users.
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