Months Of Nonsurgical Treatment Research Articles

Surgical Treatment of Proximal Hamstring Avulsion Injuries Compared With Nonsurgical Treatment: A Matched Comparative Study With a Mean Follow-up of >4 Years From the Proximal Hamstring Avulsion Surgery Cohort Study

Background: Surgical outcomes for proximal hamstring avulsion injury (PHAI) are well documented, yet comparative analyses with nonsurgical approaches remain scarce. Purpose: To compare the functional outcomes between surgical and nonsurgical interventions for PHAI. Study Design: Cohort study; Level of evidence, 3. Methods: This comparative study, conducted at a sports surgery center between January 2012 and July 2021, focused on patients with primary PHAI. The study was a retrospective analysis of prospectively collected data. Group selection involved utilizing propensity score matching to compare an arm of patients who were surgically treated (indications included patients with complete injury, patients with partial injury with >2 cm of retraction, and patients for whom 6 months of nonsurgical treatment failed) with another arm of patients who refused surgery. The primary outcome was evaluated using the Parisian Hamstring Avulsion Score (PHAS). The secondary outcomes included the Tegner Activity Scale (TAS) score; University of California, Los Angeles (UCLA) score; rate and quality of return to sport (RTS); and patient satisfaction. Results: The study included 32 patients (mean age, 55.8 years [SD, 8.4 years]) in the nonsurgical treatment arm and 95 patients in the surgical treatment arm (mean age, 53.4 years [SD, 7.7 years]) (P > .05). The interval from injury to treatment was 5.7 months (SD, 9.6 months) for the surgical group and 12.7 months (SD, 25.9 months) for the nonsurgical group (P > .05). At the final follow-up (nonsurgical group: mean, 56.5 months [SD, 28.2 months]; surgical group: mean, 50.7 months [SD, 33.1 months]), the PHAS was significantly higher in the surgical group (mean, 86.3 [SD, 13.7]) compared with the nonsurgical group (mean, 69.8 [SD, 15.1]) (P < .0001). Higher activity scores were also observed in the surgical group for the TAS and UCLA scores (P = .0224 and P = .0026, respectively). A higher percentage of the surgical group (68.4%) returned to sports compared with the nonsurgical group (46.9%) (P = .0354), with a greater proportion in the surgical group returning at the same or higher level (67.7% vs 26.7%) (P = .0069). Additionally, a higher satisfaction level was reported by patients in the surgical group (89.5%) in contrast to the nonsurgical group (25%) (P < .0001). Three patients in the surgical group experienced complications (2 reruptures and 1 hyperesthesia at the pudendal nerve territories). Odds ratios (ORs) indicated that patients in the surgical group were significantly more likely to achieve or exceed median scores for the PHAS (OR, 6.79; P < .001), TAS score (OR, 2.29; P = .045), and UCLA score (OR, 3.63; P = .003), as well as to RTS at any level (OR, 2.46; P = .031) or at the preinjury level or higher (OR, 6.04; P < .001). Conclusion: This study demonstrated that surgical treatment of PHAI significantly enhances long-term functional scores, including the PHAS, TAS score, UCLA score, satisfaction, and RTS, at a mean follow-up of >4 years compared with nonsurgical treatment. Registration: NCT02906865 (ClinicalTrials.gov identifier)

Non-surgical treatment of giant tumor-like lumbar disc herniation based on enhanced MRI: A case series.

In recent clinical follow-up, it has been vertified that resorption in lumbar disc herniation (LDH) could be of great curative effect in non-surgical treatment for LDH. However, reports of resorption in giant tumor-like LDH are rarely mentioned due to its risk of irreversible neurological damage which could be caused by long-term non-surgical treatment. In our clinical observations, we have found that enhanced MRI helps to distinguish LDH from intradural tumours and to predict the probability of resorption in LDH. We analyzed 8 patients with giant tumor-like LDH who underwent non-surgical treatment, and these patients had resorption during follow-up. All patients were examined with enhanced MRI before treatment, and the type of "bull's eye" sign classification was determined by images. The MRI protrusion volume(VP), resorption rate(HR%) and JOA score of patients at the first visit and the last follow-up were recorded. 8 patients of Han ethnicity were admitted to the department of orthopedic complaining of low back pain for 1week to 12months. They were diagnosed with giant tumor-like LDH by enhanced MRI. These patients were diagnosed with giant tumor-like LDH. We adopted a non-surgical treatment plan for the patients, including taking oral non-steroidal anti-inflammatory agents and performing rehabilitation exercise. In consideration of the risk of irreversible neurological damage, patients were closely observed during treatment and follow-up. Once the following conditions occur, surgical treatment is required immediately: The symptoms are not signifcantly relieved after 3 to 6 months of non-surgical treatment; The symptoms are aggravated by non-surgica treatment; The clinical manifestations of cauda equina syndrome. After treated with oral non-steroidal anti-inflammatory agents and rehabilitation exercise, the resorption was accompanied by clinical symptom relief. No neurological damage occurred in all patients, and the clinical symptoms did not recur in the subsequent follow-up. Clinicians should fully consider the possibility of resorption prior to surgical treatment in patients with giant LDH. We can predict the probability of resorption in patients with giant LDH based on enhanced MRI. For patients with a high probability of resorption, we can choose non-surgical treatment in the absence of progressive neurological impairment and cauda equina syndrome.

Resection of Haglund’s deformity using the arthroscopic method with the three-portal technique

Introduction. Haglund?s deformity represents a reactive enlargement of the posterosuperior aspect of the calcaneus and often causes pain that can significantly disturb everyday activities. If the patient?s condition does not improve after six months of non-surgical treatment, surgical treatment could be taken into consideration. Although Haglund?s deformity is successfully treated by endoscopic calcaneoplasty with a two-portal technique, we decided to apply a slightly newer technique ? arthroscopic surgery with a three-portal technique. Case outline. A patient with clinically and radiographically confirmed Haglund?s deformity was operated on using arthroscopic calcaneoplasty with a three-portal technique. The postoperative recovery was uneventful and full weight-bearing was allowed after four weeks. A complete return to sports activities was allowed after four months. Conclusion. Arthroscopic calcaneoplasty with the three-portal technique proved to be a safe and costeffective surgical method in the treatment of Haglund?s deformity. There is still not enough data in the literature regarding this type of surgical treatment, but the good postoperative functional results are extremely encouraging since this surgical technique enables faster recovery and fewer postoperative complications.

Efficacy of vitrectomy combined with an intraoperative dexamethasone implant in refractory diabetic macular edema.

To evaluate the safety and efficacy of vitrectomy combined with an intraoperative dexamethasone (Ozurdex®) implant in refractory diabetic macular edema (DME). Patients who were diagnosed at our institution as having DME refractory to more than 6months of non-surgical treatment and underwent intravitreal dexamethasone implantation combined with vitrectomy. All patients were followed up for more than 12months. Best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT), and intraocular pressure at the initial visit and 1, 3, 4, 6, and 12months after treatment were recorded. Twenty-two eyes (22 patients) were included in this study. The mean preoperative BCVA was 0.68 and the mean CMT was 470.80µm. The total number of the previous injections was 5.1 ± 1.6. The mean BCVA was significantly improved at all visits, and the mean CMT was also significantly reduced (p < 0.05). Sixteen eyes (73%) did not need additional implantations during follow-up. Vitrectomy combined with an intraoperative dexamethasone (Ozurdex) implant was an effective and safe treatment option in patients with refractory DME.

Laparoscopic Sleeve Gastrectomy Significantly Increases Serum Lipoprotein Lipase Level in Obese Patients

Objectives: Obesity is one of the causes of metabolic disorders. Laparoscopic sleeve gastrectomy (LSG) confers beneficial effects not only on body weight (BW) but also on metabolic disorders. The lipoprotein lipase (LPL) level in preheparin serum is associated with visceral adipose tissue and reflects insulin resistance. However, the change in serum preheparin LPL levels after LSG remains unclear. This study aimed to examine the effect of LSG on preheparin LPL level in obese patients compared with nonsurgical treatment. Methods: We retrospectively reviewed a total of 100 obese patients who were treated for obesity and had preheparin LPL levels measured before and 12 months after LSG or after 12 months of nonsurgical treatment. Fifty-six patients received LSG (LSG group), and 44 patients had no surgical treatment (nonsurgical group). We compared clinical parameters such as body mass index (BMI), hemoglobin A_1c (HbA_1c), and preheparin LPL level before and 12 months after treatment. Results: BMI and HbA_1c decreased significantly in both groups, but decreases in both parameters were greater in the LSG group than in the nonsurgical group. Estimated glomerular filtration was significantly improved only in the LSG group. Preheparin LPL level increased significantly only in the LSG group (from 45.8 ± 21.6 to 75.0 ± 34.9 ng/mL, p < 0.001). Multiple regression identified LSG and decreased BMI as independent predictors of preheparin LPL level increase. Conclusions: These results suggest that LSG independently increases pre­heparin LPL level beyond BW reduction in obese patients.

MAÏA Trapeziometacarpal Joint Arthroplasty: Clinical and Radiological Outcomes of 80 Patients With More than 6 Years of Follow-Up

Trapeziometacarpal (TMC) total joint replacement is increasingly being performed in Europe. MAÏA TMC total joint arthroplasty is a modular uncemented ball-and-socket hydroxyapatite-coated implant. This study assessed the midterm clinical and radiological results of the MAÏA TMC prosthesis. This single-center retrospective study involved 80 patients who underwent 96 MAÏA TMC prosthesis implantations from February 2006 to April 2009, and who had a minimum of 5 years' follow-up. Indications for the procedure were painful TMC joint osteoarthritis affecting activities of daily living and a failure of at least 6 months of nonsurgical treatment. Pre- and postoperative clinical and radiographic data were reviewed. The mean age at surgery was 68 years (range, 53-84 years) and the median follow-up was 76 months (range, 60-102 months). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 17.5 ± 16. The mobility of the thumb was restored to a range of motion comparable with that of the contralateral thumb. Opposition, defined by the Kapandji score, was almost normal (9.2 of 10; range, 6-10), as was the final mean key pinch and grip strength, which improved by 26% and 43%, respectively. Among the 96 implants, 4 (4.2%) were surgically revised for trapezium loosening. One dislocation was treated with closed reduction; 3 (3.1%) posttraumatic trapezium fractures were immobilized for 8 weeks. Among the 26 preoperative reducible z-deformities, only 5 (19.2%) were not totally corrected after surgery. The procedure success, by survival analysis over 6 years, was 93% (95% confidence interval, 87-98). MAÏA TMC total joint arthroplasty may be a reliable treatment option for TMC joint osteoarthritis, with very good results for pain relief, strength, mobility, and restoration of the thumb length, providing correction of most thumb z-deformities. Therapeutic IV.

Development of a Predictive Model for the Outcome of Nonsurgical Treatment of Insertional Achilles Tendinosis

Category: Hindfoot Introduction/Purpose: Insertional Achilles tendinosis (IAT) is less responsive to nonsurgical treatment than midstubstance disease. The purpose of this study was to develop a predictive model for the treatment outcomes of patients with IAT. Objectives were to discriminate between predictive and non-predictive presenting parameters with respect to the outcome of nonsurgical treatment, to develop a predictive model using these parameters which assigns individual patients a likelihood of failing nonsurgical treatment based on their respective risk profiles, and to validate this model. Methods: Following IRB-approval, patients with Achilles tendinosis were identified using ICD-9 code 726.71. The authors reviewed medical records and included all 664 patients with IAT who underwent at least 3 months of nonsurgical treatment. Exclusion criteria included midstubstance or bilateral disease, skeletal immaturity, or previous hindfoot surgery. Parameters collected included presenting age, gender, body mass index, presence of diabetes mellitus or rheumatoid arthritis, tobacco use, workman’s compensation status, previous corticosteroid injection, ankle range of motion, visual analogue pain score, Foot and Ankle Ability Measure score, presenting SF-12 score, presence of Haglund’s exostosis, insertional enthesophyte or intrasubstance calcification. Univariate analysis was used to describe the study population. A multivariate logistic regression was developed and pruned using Akaike information criterion. The final model was used to predict an individual’s likelihood of undergoing surgery for IAT and the model was validated using bootstrapping analysis. Results: The study sample was 53% female, had a mean age of 53.7 years (SD 14.7 years), and 80% were overweight or obese. Duration of symptoms at presentation averaged 10.4 months (range, 0 to 348 months, SD 28 months). 1 in 12 patients failed nonsurgical treatment. Final predictors of outcome were presenting visual analog scale &gt;4 (OR 1.13, 95% CI 1.01 -1.26, p=0.02), limited ankle range of motion (OR 0.33, 95% CI 0.19-0.58, p &lt; 0.01), previous corticosteroid injection (OR 2.33, 95% CI 1.06-5.10, p=0.04), and Achilles insertion enthesophyte (OR 2.21, 95% CI 1.38-3.54, p &lt; 0.01). The model assigned a risk of failure ranging from 5% for one predictor to 55% for 4 predictors. For this model, the area underneath the curve was 0.7. Conclusion: These data indicate that patients with IAT can be risk-stratified according to presenting data. A validated model for risk stratifying patients with IAT did not exist prior to this study. Such a model has potential utility in clinical care and when planning and interpreting the outcomes of clinical trials. Strengths of this study were its breadth of included parameters and its large sample size. Weaknesses were its retrospective nature and lack of a defined nonoperative treatment protocol. While encouraging, these findings require prospective validation prior to clinical or investigational use.

Ultrasound assessment of early clubfoot treatment: a comparison of the Ponseti method and a modified Copenhagen method

The purpose of this study was to sonographically compare the early anatomical outcome of a group of clubfeet treated with the Ponseti method (group A, nine clubfeet) with a group treated with an adjustable plexidur splint, the Copenhagen method (group B, 19 feet). The clinical severity was assessed using the Diméglio-Bensahel classification. The need for complementary surgery was clinically assessed at the age of about 2 months. Ultrasound investigation was made in the neonatal period, after 2-3 months of non-surgical treatment and 1-2 months post-surgically. After 2 months of non-surgical treatment the correction obtained at the talo-navicular joint, expressed as the distance between the medial malleolus and the navicular (MM-N distance), was significantly greater in group A. After surgery, tenotomy of the Achilles tendon for all group A feet, and posterior or posteriomedial release for 13 feet in group B, the correction at the talo-navicular and calcaneo-cuboid joints was similar for the two groups. Anatomical correction of the displacement in these joints can be achieved without extensive interventional procedures. Ultrasound may be a valuable tool to assess the effects of different treatment protocols quantitatively.

V-Y slide of the common extensor origin for lateral elbow tendonopathy.

Twenty-two patients (23 limbs) with chronic lateral elbow tendonopathy were examined retrospectively after surgical management. Thirteen men and 9 women with an average age of 43 years (range, 32-54 years) had a mean follow-up time of 41.2 months (range, 9-97 months). All patients underwent at least 6 months of nonsurgical treatment without favorable response. V-Y slide of the common extensor origin was done for all patients. Sixteen patients (17 elbows) were examined after surgery and 6 were interviewed by telephone. None of the patients had major complications or permanent loss of elbow motion. A pain rating scale of 1 to 10 (10 being the worst) showed a difference from a rating of 9.0 (range, 7-10) before surgery to 1.4 (range, 0-4) after surgery. Grip strength increased from 57 lb (range, 5-125 lb) to 99 lb (range, 60-135 lb). Five patients (23%) reported some degree of cold intolerance. Twenty-one patients (95%) returned to their preoperative occupation with 1 patient not returning to work because of elbow pain caused by heavy and repetitive elbow stress especially from vibrating tools. Twenty-one patients (95%) reported no limitations in daily activities; 1 patient reported difficulty with opening jars. Seven people (32%) reported limitations in high-demand recreational activities. All patients were rated as poor before surgery and excellent or good after surgery by a grading scale. All patients were satisfied with the outcome of surgery. After surgical treatment for lateral elbow tendonopathy, pain relief and restoration of elbow function can be achieved. V-Y slide of the extensor origin has low morbidity, does not violate the joint space or lateral stabilizing ligaments of the elbow, allows adequate release, and has a high rate of satisfaction.

Arthroscopic surgery of the temporomandibular joint: comparison of two successful techniques

We have compared two techniques of arthroscopic surgery for advanced internal derangement of the temporomandibular joint (TMJ). Patients with stage III or above TMJ internal derangement, who had not responded to three months of non-surgical treatment, were prospectively and randomly assigned to one of two types of treatment. One group had arthroscopic lysis and lavage (ALL) and the other had ALL plus arthroscopic anterolateral capsular release (AALCR). All patients were assessed preoperatively, and at 1, 3, 6, and 12 months postoperatively. Thirty-five patients (41 joints) had ALL and 66 patients (73 joints) had AALCR. The only significant difference was at 1 month, when the ALL group could not open their mouths as far as the AALCR group (P< 0.01). Both groups had significantly less pain in the joint and better jaw opening one year postoperatively. The stage of disease did not affect the outcome. Both ALL and AALCR gave good results in the management of advanced internal derangement of the TMJ. Unless early wide mouth-opening is required, the less invasive procedure of lysis and lavage should be chosen.

The outcome of arthroscopic treatment of temporomandibular joint arthropathy.

Ninety patients underwent arthroscopic temporomandibular joint surgery to 124 joints for arthropathy which had failed to respond to at least six months of non-surgical treatment. They were surveyed at between 6 months and 5 years (mean 2.5 years) after surgery and 63 per cent responded to the survey. They reported an 82 per cent improvement for pain (50 to 100 per cent better), 80 per cent for clicking and 82 per cent for locking. There was no morbidity following the treatment. Arthroscopic surgery should be considered for advanced temporomandibular joint arthropathy which is refractory to non-surgical treatment.

Correlation between preoperative mouth opening and surgical outcome after arthroscopic lysis and lavage in patients with disc displacement without reduction

Purpose: This study was designed to evaluate the efficacy of arthroscopic lysis and lavage for patients with limited mouth opening. The relationship between preoperative mouth opening and the surgical outcome was determined. Method: Fourteen patients with 16 internally deranged joints were treated by arthroscopic lysis and lavage. All had received 10.4 (7 to 19) months of nonsurgical treatment before arthroscopy. The preoperative magnetic resonance images showed anterior disc displacement without reduction in all treated joints. Results: Twelve of the 14 patients (86%) showed good reduction in pain and improved range of jaw movement on average follow-up of 28.5 (13 to 66) months. Two patients showed no improvement after arthroscopy and required open surgical procedures. The preoperative mouth opening of the successful group averaged 29.4 (22 to 35) mm, whereas the two failed cases had 10- and 19-mm openings, respectively ( P < .05). Conclusion: Persistent limitation of mouth opening of more than 22 mm after nonsurgical treatment has a good prognosis when treated by arthroscopic lysis and lavage. However, those with greater limitation should probably have earlier surgical intervention.