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18. Perioperative Pain and Addiction Interdisciplinary Network (PAIN): consensus recommendations for perioperative management of cannabis and cannabinoid-based medicine users by a modified Delphi process

Author

Ladha, Karim S., McLaren-Blades, Alexander, Goel, Akash, Buys, Michael J., Farquhar-Smith, Paul, Haroutounian, Simon, Kotteeswaran, Yuvaraj, Kwofie, Kwesi, Le Foll, Bernard, Lightfoot, Nicholas J., Loiselle, Joel, Mace, Hamish, Nicholls, Judith, Regev, Aviva, Rosseland, Leiv Arne, Shanthanna, Harsha, Sinha, Avinash, Sutherland, Ainsley, Tanguay, Rob, Yafai, Sherry, Glenny, Martha, Choi, Paul, Ladak, Salima S.J., Leroux, Timothy Sean, Kawpeng, Ian, Samman, Bana, Singh, Rajbir, and Clarke, Hance

Published
2021
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19. The Continuous Fragility Index of Statistically Significant Findings in Randomized Controlled Trials That Compare Interventions for Anterior Shoulder Instability.

Author

Al-Asadi, Mohammed, Sherren, Michelle, Abdel Khalik, Hassaan, Leroux, Timothy, Ayeni, Olufemi R., Madden, Kim, and Khan, Moin

Subjects
SHOULDER joint surgery, MEDICAL information storage & retrieval systems, CONTINUING education units, DATA analysis, T-test (Statistics), SHOULDER joint, DECISION making in clinical medicine, RANDOMIZED controlled trials, DESCRIPTIVE statistics, META-analysis, MANN Whitney U Test, MEDLINE, SYSTEMATIC reviews, MEDICAL research, STATISTICS, CONFIDENCE intervals, COMPARATIVE studies, JOINT instability, REGRESSION analysis
Abstract

Background: Evidence-based care relies on robust research. The fragility index (FI) is used to assess the robustness of statistically significant findings in randomized controlled trials (RCTs). While the traditional FI is limited to dichotomous outcomes, a novel tool, the continuous fragility index (CFI), allows for the assessment of the robustness of continuous outcomes. Purpose: To calculate the CFI of statistically significant continuous outcomes in RCTs evaluating interventions for managing anterior shoulder instability (ASI). Study Design: Meta-analysis; Level of evidence, 2. Methods: A search was conducted across the MEDLINE, Embase, and CENTRAL databases for RCTs assessing management strategies for ASI from inception to October 6, 2022. Studies that reported a statistically significant difference between study groups in ≥1 continuous outcome were included. The CFI was calculated and applied to all available RCTs reporting interventions for ASI. Multivariable linear regression was performed between the CFI and various study characteristics as predictors. Results: There were 27 RCTs, with a total of 1846 shoulders, included. The median sample size was 61 shoulders (IQR, 43). The median CFI across 27 RCTs was 8.2 (IQR, 17.2; 95% CI, 3.6-15.4). The median CFI was 7.9 (IQR, 21; 95% CI, 1-22) for 11 studies comparing surgical methods, 22.6 (IQR, 16; 95% CI, 8.2-30.4) for 6 studies comparing nonsurgical reduction interventions, 2.8 for 3 studies comparing immobilization methods, and 2.4 for 3 studies comparing surgical versus nonsurgical interventions. Significantly, 22 of 57 included outcomes (38.6%) from studies with completed follow-up data had a loss to follow-up exceeding their CFI. Multivariable regression demonstrated that there was a statistically significant positive correlation between a trial's sample size and the CFI of its outcomes (r = 0.23 [95% CI, 0.13-0.33]; P <.001). Conclusion: More than a third of continuous outcomes in ASI trials had a CFI less than the reported loss to follow-up. This carries the significant risk of reversing trial findings and should be considered when evaluating available RCT data. We recommend including the FI, CFI, and loss to follow-up in the abstracts of future RCTs. [ABSTRACT FROM AUTHOR]

Published
2024
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48. Surgical treatment options for articular cartilage defects of the glenohumeral joint: A systematic review.

Author

Dagher, Danielle, Selznick, Asher, Prada, Carlos, Al Shehab, Yasser, Leroux, Timothy, and Khan, Moin

Subjects
GLENOHUMERAL joint, ARTICULAR cartilage, TOTAL shoulder replacement, PATIENT reported outcome measures, CARTILAGE, OPERATIVE surgery, SHOULDER disorders
Abstract

Background: Many joint-preserving surgical interventions for cartilage defects of the knee have been adapted for use in the shoulder; however, there still exists no clear consensus for treatment. Thus, the purpose of this systematic review was to evaluate the outcomes of different interventions in patients with focal chondral lesions of the glenohumeral joint. Methods: A literature search was conducted using PubMed, Embase, and Medline. Patients who underwent a joint-preserving surgical procedure to treat a focal chondral defect of the glenoid, humeral head or both were included. Patients treated for diffuse cartilage defects or with shoulder arthroplasty were excluded. Results: Ten studies were included, with follow-up data available for 194 shoulders. Eight joint-preserving procedures were evaluated, with microfracture being the most common. One study evaluating microfracture reported significant improvements in patient-reported outcomes at short-term and long-term follow-up compared to preoperative scores. Across all studies, 32 patients underwent subsequent shoulder surgery, with 22 being arthroplasties. Conclusions: We found improvements in patient-reported and functional outcomes across all studies. Although joint-preserving procedures have shown reasonable outcomes for focal chondral defects of the glenohumeral joint, long-term outcomes remain unknown, and the progression of osteoarthritis remains a concern. Higher quality evidence is required to make definitive recommendations. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

Published
2023
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