Greg Neal-Smith

🦶Chronic Ankle Instability: A Meta-Analysis of Randomized Controlled Trials An OE Original Roughly 20% of ankle sprains become chronic. When surgery is needed, lateral ligament augmentation is the go-to. The modified Brostrom-Gould procedure (MBG) is the most common approach but is associated with reduced ligament strength. Could the use of suture tapes as an internal brace provide a superior alternative? 🏗️METHODS We searched the MEDLINE, EMBASE, Cochrane CENTRAL, and OE MIND databases for randomized controlled trials (RCTs) on chronic ankle instability comparing: 1⃣ Modified Brostrom-Gould Procedure 2⃣ Suture Tape Augmentation Outcomes of interest included - Pain - Foot function & quality of life (on the Foot and Ankle Outcome Score) - Complications We also assessed the quality of the evidence using the Cochrane Risk of Bias tool & the GRADE approach. 🔎RESULTS Our search resulted in 5 RCTs, including a total of 328 patients. The majority of included trials didn't provide info on blinding of outcome assessors or selective reporting. Pain We found no difference in pain scores between the two surgical procedures at 6-12 months and 24-36 months follow-up! Foot Function & Quality of Life No differences in pooled Foot and Ankle Outcome Scores were observed between the two groups at 6-12 months and 24-36 months follow-up! Complications The risk of instability and wound infection was similar in both groups. ✅INTERPRETATION The results of this study suggest that suture tape augmentation provides similar outcomes to the modified Brostrom-Gould procedure for chronic ankle instability! However, the quality of the evidence was low as per GRADE, and more rigorously designed trials are needed!

Surgical vs. Non-Surgical Treatment for ACL Tears An OE Original Pain. Lost training time. Risk of Osteoarthritis. ACL tears are one of the most common and troublesome injuries in sports. Surgical treatment -- the ACL Reconstruction -- is a popular intervention for many patients and physicians. But is it better than non-surgical treatment? We ran a series of analyses using our OE MIND platform to find out! 🏗️METHODS We searched through the OE MIND database, which has close to 4,000 studies and over 1.7 million patients! We included RCTs comparing ACL reconstruction vs. rehabilitation for the treatment of ACL tears. We performed meta-analyses of clinical outcomes, pain, activity scores, stability, return to pre-injury activity levels, re-injury, and revision surgery. We also performed a sequential meta-analysis, an assessment of ongoing trials, and an academic market analysis! 🔎RESULTS We included 6 RCTs, with a total of 1,373 patients, comparing surgical and non-surgical treatment (rehabilitation) for the treatment of ACL tears. Composite Clinical Outcomes We found no difference in composite clinical outcomes between ACL reconstruction & rehabilitation Pain Similarly, we found no difference in pain scores between ACL reconstruction and rehabilitation! Tegner At >2 years follow-up, Tegner scores were significantly better in the reconstruction group! Stability Patients who received reconstruction had a significantly lower risk of giving way and rotational instability (pivot shift test) than rehabilitation patients! Return to Pre-injury, Re-injury & Revision Surgery The risk of revision surgery and re-injury was significantly lower in the reconstruction group! However, no difference in return to pre-injury levels was observed between the two groups. 🏁INTERPRETATION ACL reconstruction was associated with a small positive effect in Tegner activity score, superior stability outcomes & lower risk of re-injury and revision surgery compared to rehabilitation!