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Introduction: The literature on the early reconstruction of severe acute lateral ligament injuries in professional athletes suggests earlier rehabilitation and reduced incidence of recurrent instability. Predicted time to return to training and sports is important to both the athlete and the club and has not previously been reported. Aims and Objectives: The primary aim was to establish the best treatment options available for lateral ligament injury in professional athletes and assess the average time to return to physical training and return to play (RTP). Secondary aims were to find out the rate of return to the pre-injury level of competitive sports and the reasons for delayed recovery. Materials and Methods: We performed a systematic review according to PRISMA guidelines to evaluate the demographics, clinical profile, management, and treatment outcomes. Electronic searches of the MEDLINE, EMBASE, and Cochrane databases were performed. Studies conducted between Jan 2000 and Dec 2020 with articles reporting the ankle lateral ligament reconstruction in professional athletes were included. Main Results: After initial screening, 982 articles were identified, of which, 10 articles evaluating 343 athletes met the criteria and were included for final review. The combined mean age was 23 years with an average follow-up of 58.4 months. After surgery 308 (89%) returned to their pre-injury level of sports, 7 (2%) patients returned to a lower-level sport while the remaining 28 (9%) never returned to play. Conclusion: Our results provide a guide to predict the expected time to return to play (RTP) after surgical repair of lateral ligament injuries along with associated injuries leading to delayed rehabilitation. Lateral ligament reconstruction is a safe and effective treatment for severe ruptures providing a stable ankle with a mean time of 16 weeks to return to sports. The available studies vary considerably in their metrics used for measuring patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Background: Meniscal injury is currently a well-recognized source of knee dysfunction. While it would be ideal to repair all meniscus tears, the failure rate is significantly high, although it may be reduced by careful selection of the patients. Our objective was to assess the outcome of meniscal repair surgery and the role of simultaneous reconstruction of the anterior cruciate ligament (ACL). Materials and methods: Retrospectively, all consecutive patients between January 2008 and 2011 who underwent meniscal repair were included. Patients were identified using the hospital database with diagnosis and procedure codes. Patient notes were reviewed, including details of the type of tear, chronicity, location, and surgery. We used symptomatic resolution as the outcome measure. Results: 136 Meniscal repairs were performed in 122 patients with a mean age of 26.8 years. Mean follow-up duration was 9 months. 63 % of the patients underwent medial and 37 % underwent lateral meniscal repair, with failure rates of 19 % for medial and 12 % for lateral menisci. Ligament injuries were found in 61 % of the patients ( n = 83). Failure of meniscal repair occurred in 14.5 % ( n = 12) of the patients who had early ACL reconstruction and in 27 % ( n = 22) of the patients who had delayed ACL reconstruction ( p = 0.0006). The failure rate was found to be 13 % in patients who were younger than 25 years (61 %) and 15 % in patients who were older than 25 years (39 %). Conclusion: The success rate of meniscal repair was found to be significantly better when ACL reconstruction was performed simultaneously with meniscal repair. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

This study is to estimate the diagnostic accuracy of Tokuhashi and Tomita scores that assures 6-month predicting survival regarded as a standard of surgical treatment. We searched PubMed, EMBASE, European PubMed central, and the Cochrane library for papers about the sensitivities and specificities of the Tokuhashi and/or Tomita scores to estimate predicting survival. Studies with cut-off values of ≥9 for Tokuhashi and ≤7 for Tomita scores based on prior studies were enrolled. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), and the best cut-off value were calculated via meta-analysis and individual participant data analysis. Finally, 22 studies were enrolled in the meta-analysis, and 1095 patients from 8 studies were included in the individual data analysis. In the meta-analysis, the pooled sensitivity/specificity/DOR for 6-month survival were 57.7 %/76.6 %/4.70 for the Tokuhashi score and 81.8 %/47.8 %/4.93 for Tomita score. The AUC of summary receiver operating characteristic plots was 0.748 for the Tokuhashi score and 0.714 for the Tomita score. Although Tokuhashi score was more accurate than Tomita score slightly, both showed low accuracy to predict 6 months residual survival. Moreover, the best cut-off values of Tokuhashi and Tomita scores were 8 and 6, not 9 and 7, for predicting 6-month survival, respectively. Estimation of 6-month predicting survival to decide surgery in patients with spinal metastasis is quite limited by using Tokuhashi and Tomita scores alone. Tokuhashi and Tomita scores could be incorporated as part of a multidisciplinary approach or perhaps interpreted in the context of a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Managing minimally displaced scaphoid fractures in young individuals doing physically demanding work remains an issue of debate due to duration of immobilisation and time required off work. Therefore, early diagnosis and appropriate treatment are important to avoid short- and long-term consequences. The literature lacks the exact definition of minimally displaced scaphoid waist fractures. The objective of this review article was to discuss nonoperative and minimally invasive treatment (percutaneous screw fixation) for minimally displaced scaphoid waist fractures and to systematically review the literature, focussing on young workers with physically demanding employment. Materials and methods: We searched for articles through the most commonly used portals using appropriate terminologies to identify the most relevant articles in the English language comparing nonoperative and percutaneous fixation methods for these fractures in patients between 16 and 40 years of age. Strict inclusion and exclusion criteria were observed. Results: Sixty relevant published articles were found. Twenty-one of these were considered valid for inclusion and comprised five randomised controlled trials, three prospective studies, four systematic reviews, three meta-analyses, and six retrospective studies. These studies provided a reasonable account of information on the managing undisplaced and minimally displaced scaphoid waist fractures, with satisfactory clinical and statistical analysis. However, it was difficult to assess the outcomes of minimally displaced fractures in isolation. Furthermore, few of these studies relied on plain radiographs for assessing union and did not report on patients' work status. Conclusion: Cast treatment has the disadvantages of longer immobilisation time, joint stiffness, reduced grip strength, and longer time to return to manual work. Percutaneous fixation is aimed at reducing damage to the blood supply and soft tissues, allowing early mobilisation of the wrist and early return to manual work. The best available evidence for percutaneous screw fixation versus cast treatment suggests that percutaneous fixation allows a faster time to union by 5 weeks and an earlier return to manual work by 7 weeks, with similar union rates. This systematic review indicates a potential requirement for a prospective randomised controlled trial to compare these two treatment modalities for minimally displaced scaphoid waist fractures in workers with physically demanding jobs in order to objectively assess functional outcomes, time to union and time to return to work. Level of evidence: Level 3. [ABSTRACT FROM AUTHOR]