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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(05): e681-e688
DOI: 10.1055/s-0043-1776133
Revisão Sistemática e Metanálise
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Early or Delay? The Most Suitable Rehabilitation Protocol for “No Man's Land” Injury: Meta-Analysis with Trial Sequential Analysis – 20 Years Trends

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Celleen Rei Setiawan 
1   Residente do Departamento de Ortopedia e Traumatologia, Hospital Geral Sanglah, Faculdade de Medicina, Universidade Udayana, Denpasar, Bali, Indonésia
,
Made Bramantya Karna
2   Equipe do Departamento de Ortopedia e Traumatologia, Hospital Geral Sanglah, Faculdade de Medicina, Universidade Udayana, Denpasar, Bali, Indonésia
› Institutsangaben

Financial Support The authors declare that they have not received any no financial support from public, commercial, or non-profit sources to conduct the present study.
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Abstract

Objective The aim of this study is to analyze various rehabilitation protocol and determine which methods will yield a better outcome.

Methods The database reports were searched within 1990 until 2020, using PubMed, Cochrane library database, Ovid, Medline, and the other several published trials. A statistical analysis was made from Review Manager and Trial Sequential Analysis (TSA).

Result The mean of re-rupture rate is 3.3% (n = 8) in the combination protocol until 8% (n = 48) in CAM protocol. Meta-analyses found no significant difference between Kleinert vs CAM in re-rupture rate. Also no significant difference in Duran vs CAM in rerupture rate. In Trial Sequential Analysis (TSA), the z-curve does not cross both of the trial sequential boundaries, a further trial with larger sample will be required. The TSA of flexion contracture CAM vs Kleinert was indicated that CAM protocol may be superior than Kleinert to reduce the incidence of flexion contracture. For the range of mean flexion contracture 6.6% (n = 18) in CAM to 23.6% (n = 76) in Kleinert protocol.

Conclusion Current meta-analysis proposed that the combination technique will result less re-rupture incidence and better functional outcome in flexor zone II injuries than other techniques. The CAM method also results less flexion contracture than others. However, a further meta-analyses with larger sample trials will be required to confirm this review's conclusion.

Keywords

tendon injuries - postoperative care - surgical procedures, operative

Work developed in the Orthopaedics and Traumatology Department, Sanglah General Hospital, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia




Publikationsverlauf

Eingereicht: 16. Mai 2022

Angenommen: 05. Mai 2023

Artikel online veröffentlicht:
30. Oktober 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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