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PURPOSE: To provide an updated comparison between modern arthroscopic and mini-open repairs for treating rotator cuff tears. METHODS: Multiple online databases were searched from 2010 to October 1st, 2020. A meta-analysis was conducted for patient-reported outcomes and complications. RESULTS: Eleven studies were included. Majority of patients underwent mini-open repair (MOR) compared to arthroscopic repair (AR) (57.4% vs 42.6%). A meta-analysis found statistically significant differences (p

The opioid epidemic is one of the biggest public health crises of our time, and overprescribing of opioids after surgery has the potential to lead to long-term use. The purpose of this review was to identify and summarize the available evidence on interventions aimed at reducing opioid use after orthopedic surgery.We searched CENTRAL, Embase and Medline from inception until August 2019 for studies comparing interventions aimed at reducing opioid use after orthopedic surgery to a control group. We recorded demographic data and data on intervention success, and recorded or calculated percent opioid reduction compared to control.We included 141 studies (20 963 patients) in the review, of which 113 (80.1%) were randomized controlled trials (RCTs), 6 (4.3%) were prospective cohort studies, 16 (11.4%) were retrospective cohort studies, 5 (3.6%) were case reports, and 1 (0.7%) was a case series. The majority of studies (95 [67.4%]) had a follow-up duration of 2 days or less. Interventions included the use of local anesthetics and/or nerve blocks (42 studies [29.8%]), nonsteroidal anti-inflammatory drugs (31 [22.0%]), neuropathic pain medications (9 [6.4%]) and multimodal analgesic combinations (25 [17.7%]. In 127 studies (90.1%), a significant decrease in postoperative opioid consumption compared to the control intervention was reported; the median opioid reduction in these studies was 39.7% (range 5%-100%). Despite these reductions in opioid use, the effect on pain scores and on incidence of adverse effects was inconsistent.There is a large body of evidence from randomized trials showing the promise of a variety of interventions for reducing opioid use after orthopedic surgery. Rigorously designed RCTs are needed to determine the ideal interventions or combination of interventions for reducing opioid use, for the good of patients, medicine and society.

Purpose To consolidate the existing literature evaluating anterior capsular release and circumferential capsular release in the treatment of adhesive capsulitis (AC) of the shoulder. Methods The electronic databases PUBMED, EMBASE, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 8, 2020. Data are presented descriptively where appropriate. A meta-analysis was conducted for patient-reported outcomes. Results Overall, there were forty-six articles included. The majority of patients underwent circumferential release compared to anterior release (80.1% vs. 19.9%). Concomitant Manipulation Under Anesthesia (MUA) was employed in 25 studies, with a higher occurrence in the anterior compared to the circumferential release group (70% vs 60%). Both groups experienced significant improvements postoperatively in range of motion (ROM) and patient-reported outcomes. Complication rates were low for both anterior release (0.67%) and 360° release (0.44%). Conclusion Both anterior and circumferential release are effective techniques for treating AC with low complication rates. Future studies should improve documentation of patient demographics, surgical techniques and outcomes to determine an individualized treatment protocol for patients. Level of evidence Level IV, Systematic Review of Level I–IV studies.

Context: Energy drinks are the fastest growing product in the beverage industry. However, there is concern regarding potential for adverse effects with use. Objective: To evaluate the reported adverse effects of energy drink consumption. Data Sources: The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies from inception to November 2019, and pertinent data were abstracted. Study Selection: Only clinical studies reporting adverse events after energy drink consumption were included. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Data regarding sample size characteristics, energy drink characteristics, comparators, and all adverse events were extracted in duplicate and recorded. Results: A total of 32 studies and 96,549 individuals were included. Frequently reported adverse events in the pediatric population were insomnia (35.4%), stress (35.4%), and depressive mood (23.1%). Frequently reported adverse events in the adult population were insomnia (24.7%), jitteriness/restlessness/shaking hands (29.8%), and gastrointestinal upset (21.6%). Alcohol mixed with energy drinks significantly reduced the likelihood of sedation effects but increased the likelihood of stimulatory effects. Energy drink consumption significantly increased the odds of insomnia (OR, 5.02; 95% CI, 1.72-14.63) and jitteriness/activeness (OR, 3.52; 95% CI, 1.28-9.67) compared with the control group. Conclusion: The authors recommend that individuals avoid frequent energy drink consumption (5-7 energy drinks/week) and avoid co-consumption with alcohol; increased regulatory standards should be placed in the sale of energy drinks, particularly with regard to the pediatric population.

Background. Faced with the current opioid epidemic, alternative methods to managing postoperative pain are being investigated that could eliminate or substantially reduce opioid prescription and use. Prescribing opioids peri- and post-operatively has been shown to trigger chronic abuse independent of previous drug use and increase the risk of long-term use. The postoperative pain experienced in orthopedic surgery is substantial and it is not surprising that the highest incidence of long-term opioid use occurs after total knee and total hip arthroplasty. Despite the numbers of abuse continuing to rise, there remains a need for high quality and reproducible evidence to support protocols that reduce or eliminate opioid prescription. The goal of this scoping review is to identify the current literature and on opioid reduction after orthopedic surgery, 2) describe the interventions used 3) describe the author’s conclusion on opioid use and postoperative outcomes and 4) synthesize the results of included studies to highlight patterns seen with different interventions.Methods. This is a protocol for a scoping review of opioid sparing analgesic strategies that eliminate or significantly reduce opioid prescription after orthopedic surgery. We will include studies of all designs, excluding expert opinions. We will search Cochrane Library, Embase and Medline. Literature will be managed using Rayyan QCRI software. Two reviewers will independently screen the studies for inclusion, and extract information surrounding the effectiveness of alternative strategies and reduction in opioid prescription. Our analysis will be descriptive in nature. We will group studies based on type of orthopedic procedure and nature of intervention used to report study outcomes.Discussion. Our study will consolidate the current literature on opioid-sparing analgesia after orthopedic surgery and describe the effectiveness of current alternative options. It will look to reveal gaps in our knowledge surrounding our current treatment alternatives to establish areas of interest for future research. Registration. This review was registered prospectively on PROSPERO (registration number CRD42020153418).

Supplemental material, sj-docx-1-sph-10.1177_1941738120949181 for Energy Drinks and Their Adverse Health Effects: A Systematic Review and Meta-analysis by Ibrahim M. Nadeem, Ajaykumar Shanmugaraj, Seaher Sakha,, Nolan S. Horner, Olufemi R. Ayeni and Moin Khan in Sports Health: A Multidisciplinary Approach

Supplemental material, sj-docx-1-sph-10.1177_1941738120949181 for Energy Drinks and Their Adverse Health Effects: A Systematic Review and Meta-analysis by Ibrahim M. Nadeem, Ajaykumar Shanmugaraj, Seaher Sakha,, Nolan S. Horner, Olufemi R. Ayeni and Moin Khan in Sports Health: A Multidisciplinary Approach