Rotator cuff tear (RCT) is a common shoulder condition frequently treated with arthroscopic rotator cuff repair (ARCR) after conservative interventions have failed. Postoperative shoulder stiffness (POSS) is a common complication after ARCR. The purpose of this study is to determine the incidence of POSS after ARCR in total and based on tear extent prior to ARCR. A systematic review was performed using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and ScienceDirect databases. The search terms were “rotator cuff repair” AND “arthrofibrosis” OR “postoperative shoulder stiffness.” Articles were selected based on ARCR and the presence of POSS documentation. Twenty-five articles out of 284 articles met the final selection criteria after reviewing for patients who received ARCR. Out of all patients (n=9,373), 597 had POSS (6.4%). Out of the 2,424 patients with a specified tear pattern, 96 out of 1,862 (5.2%) patients with full-thickness tears and 58 out of 562 (10.3%) patients with partial-thickness tears had POSS after ARCR. Partial-thickness tears are associated with higher rates of POSS after ARCR as compared to full-thickness tears (p<0.001). Overall, POSS is a common complication after ARCR with an incidence of 6.4%, regardless of tear type. POSS is more common in patients who receive ARCR for partial-thickness RCT (10.3%) as compared to patients who receive ARCR for full-thickness RCT (5.2%). More research is needed to determine other factors impacting the incidence of POSS after ARCR.

The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.

This study examined the efficacy of manual therapy for pain and disability measures in adults with sacroiliac joint pain syndrome (SIJPS). We searched six databases, including gray literature, on NaN Invalid Date NaN, for randomized controlled trials (RCTs) examining sacroiliac joint (SIJ) manual therapy outcomes via pain or disability in adults with SIJPS. We evaluated quality via the Physiotherapy Evidence Database scale and certainty via Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Standardized mean differences (SMDs) in post-treatment pain and disability scores were pooled using random-effects models in meta-regressions. We included 16 RCTs (421 adults; mean age = 37.7 years), with 11 RCTs being meta-analyzed. Compared to non-manual physiotherapy (i.e. exercise ± passive modalities; 10 RCTs) or sham (1 RCT) interventions, SIJ manual therapy did not significantly reduce pain (SMD: -0.88; 95%-CI: -1.84; 0.08, p = 0.0686) yet had a statistically significant moderate effect in reducing disability (SMD: -0.67; 95% CI: -1.32; -0.03, p = 0.0418). The superiority of individual manual therapies was unclear due to low sample size, wide confidence intervals for effect estimates, and inability to meta-analyze five RCTs with a unique head-to-head design. RCTs were of 'good' (56%) or 'fair' (44%) quality, and heterogeneity was high. Certainty was very low for pain and low for disability outcomes. SIJ manual therapy appears efficacious for improving disability in adults with SIJPS, while its efficacy for pain is uncertain. It is unclear which specific manual therapy techniques may be more efficacious. These findings should be interpreted cautiously until further high-quality RCTs are available examining manual therapy against control groups such as exercise. PROSPERO (CRD42023394326).

Neck pain is a common musculoskeletal condition frequently managed with numerous conservative interventions. The McKenzie method of mechanical diagnosis and therapy (MMDT) is a form of physical therapy evaluation and treatment that aims to improve pain and disability in patients with musculoskeletal pain, including neck pain. To date, no systematic review with meta-analysis has examined the use of the McKenzie MMDT for neck pain. This study aimed to examine the effectiveness of the McKenzie MMDT in adult patients with neck pain. A systematic review and meta-analysis were performed using PubMed, ScienceDirect, MEDLINE, CINAHL, Web of Science, and Google Scholar. Full search terms were “McKenzie method” OR “McKenzie approach” OR “McKenzie treatment” AND “neck pain.” Inclusion criteria were the use of the McKenzie MMDT, level I randomized control trials (RCTs), adults, and outcomes of pain (0-10 scale) and disability (neck disability index). A total of 11 RCTs met the final selection criteria from 1,955 articles on initial search with 289 patients receiving the McKenzie MMDT out of 677 total patients. For meta-analysis, there was a clinically insignificant but statistically significant improvement in pain (1.14/10 points) in patients receiving the McKenzie MMDT versus control interventions (p<0.02). There was no significant improvement in the neck disability index score between the McKenzie MMDT versus control interventions (p=0.19). For severity of pain, there was a clinically and statistically significant improvement in moderate or severe pain (2.06/10 points; p<0.01), but not in mild-to-moderate pain (p=0.84) when comparing the McKenzie MMDT to control interventions. Overall, the McKenzie MMDT provides very small but statistically significant improvements in neck pain of all severity compared to control interventions. However, the McKenzie MMDT does provide clinically and statistically significant pain improvement in moderate-to-severe neck pain. Use of the McKenzie MMDT did not provide any significant improvement in disability compared to control interventions. This study is the first systematic review with meta-analysis on the effectiveness of the McKenzie MMDT for adult patients with neck pain.