Effects of surgical management on multidirectional instability of the shoulder : a meta-analysis

Purpose: The purpose of this study was to assess the effectiveness of arthroscopic and open surgical techniques on the treatment of shoulder multidirectional instability. Methods: Literature searches were conducted using the databases MEDLINE, Embase, ClinicalTrials.gov, the Cochrane Library, and the Cochrane Central Register of Controlled Trials. Original articles on the surgical management of multidirectional instability were retrieved against selection criteria. Data were extracted and divided into three groups by surgical technique. Proportion and mean meta-analyses were performed for comparison. Results: The available evidence was from 35 level IV and 1 level II studies. The recurrent instability rate was 9.9 % (95 % CI 7.3–12.9 %) in open capsular shift (OCS) group and 6.0 % (95 % CI 3.7–8.9 %) in arthroscopic capsular plication (ACP) group, between which no difference was observed. However, thermal capsular shrinkage (TCS) group resulted in a recurrent instability rate of 23.9 % (95 % CI 16.6–32.2 %), significantly higher than the above two groups. OCS and ACP groups revealed low reoperation rates of approximately 5.2 % (95 % CI 2.7–8.5 %) and 4.8 % (95 % CI 2.3–8.0 %), respectively, which are lower than that in TCS group of 16.9 % (95 % CI 12.4–21.8 %). OCS caused more loss of external rotation than ACP, losing 7.0 (95 % CI 3.3–10.6) degrees versus 2 (95 % CI 0.9–2.4) degrees, respectively. Conclusions: ACP and OCS techniques have similar primary outcomes, but the former causes less post-operative stiffness. It is suggestible to avoid TCS in the treatment of MDI. Level of evidence: Level IV

Clinical outcomes associated with robotic and computer-navigated total knee arthroplasty: a machine learning-augmented systematic review

Background Robotic (RTKA) and computer-navigated total knee arthroplasty (CNTKA) are increasingly replacing manual techniques in orthopaedic surgery. This systematic review compared clinical outcomes associated with RTKA and CNTKA and investigated the utility of natural language processing (NLP) for the literature synthesis. Methods A comprehensive search strategy was implemented. Results of included studies were combined and analysed. A transfer learning approach was applied to train deep NLP classifiers (BERT, RoBERTa and XLNet), with cross-validation, to partially automate the systematic review process. Results 52 studies were included, comprising 5,067 RTKA and 2,108 CNTKA. Complication rates were 0–22% and 0–16% and surgical time was 70–116 and 77–102 min for RTKA and CNTKA, respectively. Technical failures were more commonly associated with RTKA (8%) than CNTKA (2–4%). Patient satisfaction was equivalent (94%). RTKA was associated with a higher likelihood of achieving target alignment, less femoral notching, shorter operative time and shorter length of stay. NLP models demonstrated moderate performance (AUC = 0.65–0.68). Conclusions RTKA and CNTKA appear to be associated with similarly positive clinical outcomes. Further work is required to determine whether the two techniques differ significantly with regard to specific outcome measures. NLP shows promise for facilitating the systematic review process