The Effect of HbA1c level on Post-Operative Complications Following Rotator Cuff Tear Repair Surgery: A Meta-Analysis Study
Introduction: Rotator cuff repair is a widely performed orthopedic surgical procedure to ease pain and restore shoulder movement in individuals with tears in the rotator cuff. This meta-analysis examined the relationship between preoperative HbA1c levels and susceptibility to postoperative complications following rotator cuff tear repair surgery.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Relevant studies published until July 2023 were identified across multiple databases.
Results: The meta-analysis included 14 articles (3 prospective, 11 retrospective) with 113,286 diabetic and 342,895 non-diabetic patients. Diabetic patients were slightly older on average. There were more males and smokers in the non-diabetic group, while the diabetic group had more hypertensive patients. Diabetic patients had worse outcomes, including higher rates of rotator cuff retears (RR 1.62;95%1.27, 2.06; P<0.001). Non-diabetic patients generally achieved better healing (OR;2.68;95%CI;1.45,4.95;P=0.002), pain, and range of motion improvements. Diabetes did not significantly impact infection risk or hospital utilization.
Conclusions: The findings suggest that optimizing glycemic control in diabetic patients may be important for improving outcomes following rotator cuff repair. This opens new avenues for research to understand the mechanisms driving the differences in outcomes between diabetic and non-diabetic patients. Developing strategies to minimize the negative impact of diabetes on rotator cuff injuries and repair procedures could be beneficial.
DOI: 10.29245/2767-5130/2025/1.1214 View / Download PdfState of the art for Bone substitutes
Background: Bone substitutes are increasing in orthopaedic surgery. The ideal bone substitute should be biocompatible and not evoke any adverse inflammatory response.
Material and Methods: In this mini review we have considered the bone substitutes that are most used in orthopedic surgery, observing their advantages and disadvantages, trying to define the characteristics of the ideal bone substitute.
Results - State of the art: Literature related to orthopaedic surgery reports about the use of autologous bone, allograft, Xenograft based HA ceramics, Synthetic bone substitutes, Growth factor-based substitutes and Polymethyl methacrylate.
Conclusion: The integration of a defect filler into a new bone and its influence on bone healing depend on the osteoconductive, osteoinductive or osteogenic properties of the material. Ideally, bone void filler materials should combine all of these properties.
DOI: 10.29245/2767-5130/2025/1.1215 View / Download PdfC-arm Oblique View Assisted Percutaneous Kyphoplasty (PKP) for Treating Osteoporotic Vertebral Compression Fractures
Objective: To assess the efficacy of C-arm oblique radiography-assisted percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF) and its impact on radiation exposure for both surgeons and patients.
Methods: In total, 192 patients with single-segment OVCF were included. Traditional anteroposterior (AP) and lateral fluoroscopy were used for puncture positioning in 86 cases (AP-lateral group), whereas C-arm oblique fluoroscopy was used in 106 cases (oblique group). the surgical time and the number of fluoroscopies were recorded. DR radiography was used to measure vertebral height, differences in vertebral compression and Cobb angle before and after surgery were compared. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were recorded to assess surgical efficacy.
Results: The oblique group had fewer intraoperative fluoroscopies (18.02±5.86) compared to the AP-lateral group (29.09±7.67); and shorter surgery time (29.67±11.32 min vs. 36.35±9.32 min), with both differences being statistically significant (P<0.05). Three months post-surgery, the VAS pain scores in the AP-lateral group were 2.19±1.30 and 2.26±1.30 in the oblique group, both significantly lower than pre-surgery scores, with statistical significance (P<0.05). However, there were no significant differences between the groups (P>0.05).
Conclusion: C-arm oblique view assisted PKP can reduce surgery time, improve puncture accuracy, and decrease ionizing radiation exposure, effectively treating OVCF.
DOI: 10.29245/2767-5130/2025/1.1216 View / Download PdfVertebral Body Tethering (VBT): Non-Fusion Surgical Treatment for Scoliosis. Our First 60 Patients
Present: Present our experience with the vertebral body tethering (VBT) technique in surgical treatment for scoliosis. Analyze its advantages, disadvantages, and complications.
Methods: A prospective case series, submitted to the VBT technique by our surgical team from September 2020 to March 2022 with a minimum follow-up of six months. Patients with flexible curves between 35º and 65º were operated on. The main thoracic and thoracolumbar/lumbar curves were evaluated with the Cobb method preoperatively, postoperatively, and at the last follow-up.
Results: In our series of 60 patients, 90% were female, with a mean age of 15.1 ± 2.9 years, and follow-up was 10.1 ± 4.7 months. The VBT technique was used to treat 53 (88%) patients with adolescent idiopathic scoliosis, 6 (10%) syndromic scoliosis, and 1 (2%) neuromuscular scoliosis. The mean preoperative main thoracic curve was 48.2º ± 9.4º and thoracolumbar/lumbar 47.8º ± 9.7º. The mean Cobb in the immediate postoperative was 19.2º ± 9.0º for the main thoracic curve and 9.4º ± 8.9º for the thoracolumbar/lumbar curve. The mean Cobb in the last follow-up was 22.8º ± 11.0º for the main thoracic curve and 12.7º ± 11.1º thoracolumbar/lumbar. Giving a final correction of 54% (p < 0.0001) in main thoracic curves and 71% (p < 0.0001) in thoracolumbar/lumbar curves. A 10% of complications (6) were reported, and hemothorax (4) was the most common.
Conclusion: We propose VBT as a safe and effective option, with good results, for treating scoliosis. To our knowledge, our study is the largest case series in Latin America and is the first published study using this surgical technique.
Level of Evidence: IV, Therapeutic Studies, Case Series
DOI: 10.29245/2767-5130/2025/1.1218 View / Download Pdf