scholarly journals Relationship of Timing of Anterior Cruciate Ligament (ACL) Reconstruction Surgery with Meniscal Tears, Chondral Injuries, Functional and Patient Reported Outcomes. A Systematic Review

2017 ◽  
Vol 47 ◽  
pp. S78
Author(s):  
A. Prodromidis ◽  
N. Zreik ◽  
G. Thivaios ◽  
A. Waqar ◽  
P. Dey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Meniscal Tears ◽  
Reconstruction Surgery ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Relationship Of

Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review

2018 ◽  
Vol 32 (03) ◽  
pp. 218-221 ◽  
Author(s):  
Lea Johnson ◽  
Robert Brophy ◽  
Ljiljana Bogunovic ◽  
Matthew Matava ◽  
Matthew Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Level Of Evidence ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Anterior Cruciate

AbstractRevision anterior cruciate ligament (ACL) reconstruction typically has worse outcomes than primary reconstructions. Minimal long-term data exist regarding 5-year results. We chose to perform a systematic review to evaluate midterm (5-year) revision ACL reconstruction outcomes (patient-reported outcomes, reoperation, stability, arthritis) in comparison to primary ACL reconstructions at similar time points. Embase, Cochrane, and PubMed databases were queried, and four studies met the inclusion criteria. Two authors reviewed and performed data extraction. All were level 4 studies. Review of the studies demonstrated that results at 5 years are consistently worse than those noted in primary reconstructions for objective and patient-reported outcomes. Revision ACL reconstruction outcomes remain worse than primary reconstructions at midterm 5-year follow-up. The level of evidence is 4.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

Timeline for Maximal Subjective Outcome Improvement After Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 47 (10) ◽  
pp. 2501-2509 ◽  
Author(s):  
Avinesh Agarwalla ◽  
Richard N. Puzzitiello ◽  
Joseph N. Liu ◽  
Gregory L. Cvetanovich ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Clinical Significance ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Pubmed Database ◽  
Patient Reported ◽  
Clinically Significant ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are one of the most common traumatic knee injuries experienced by athletes. Return to sport is considered the pinnacle endpoint among patients receiving ACL reconstruction. However, at the time of return to sport, patients may not be participating at their previous levels of function, as defined by clinical metrics. Purpose: To establish when patients perceive maximal subjective medical improvement according to patient-reported outcome measures (PROMs). Study Design: Systematic review. Methods: A systematic review of the PubMed database was conducted to identify studies that reported sequential PROMs up to a minimum of 2 years after ACL reconstruction. Pooled analysis was conducted for PROMs at follow-up points of 3 months, 6 months, 1 year, and 2 years. Clinically significant improvement was determined between pairs of intervals with the minimal clinically important difference. Results: This review contains 30 studies including 2253 patients who underwent ACL reconstruction. Clinically significant improvement in the KOOS (Knee injury and Osteoarthritis Outcome Score) was seen up to 1 year after ACL reconstruction, but no clinical significance was noted from 1 to 2 years. Clinically significant improvement in the IKDC (International Knee Documentation Committee) and Lysholm questionnaires was seen up to 6 months postoperatively, but no clinical significance was noted beyond that. Conclusion: After ACL reconstruction, maximal subjective medical improvement is established 1 year postoperatively, with no further perceived clinical improvement beyond this time point according to current PROMs. The KOOS may be a more responsive metric to subjective improvements in this patient cohort than other patient-reported outcomes, such as the IKDC and Lysholm. Clinical Relevance: After ACL reconstruction, patients perceive interval subjective improvements until 1 year postoperatively.

Timing of Anterior Cruciate Ligament Reconstruction and Relationship With Meniscal Tears: A Systematic Review and Meta-analysis

2020 ◽  
pp. 036354652096448
Author(s):  
Apostolos D. Prodromidis ◽  
Chrysoula Drosatou ◽  
Georgios C. Thivaios ◽  
Nasri Zreik ◽  
Charalambos P. Charalambous
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Acl Reconstruction ◽  
Retrospective Cohort ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Meniscal Tears ◽  
Reconstruction Surgery ◽  
Retrospective Cohort Studies ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) ruptures are common, but the ideal timing for ACL reconstruction after injury is unclear with regard to meniscal insult. Purpose: To determine whether there is a relationship between timing from ACL rupture to ACL reconstruction and development of meniscal tears within this period. Study Design: Systematic review and meta-analysis. Methods: A systematic literature search was undertaken independently by 2 reviewers using the Cochrane method for systematic reviews in 5 online databases. The reviewers performed independent data extraction and assessment of risk of bias and study quality. The search included any comparative study, including randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case-control studies of an adult population, that assessed the relationship between timing of ACL reconstruction surgery and rates of meniscal tears. Results: After screening, 12 studies (No. of participants = 3042) out of 3390 records were included for analysis: 3 RCTs (n = 272), 2 prospective cohort studies (n = 307), and 7 retrospective cohort studies (n = 2463). In analysis of these studies, rates of reported meniscal tears were compared for ACL procedures performed at 3 and 6 months after injury. Meta-analysis of 5 studies (n = 2012) showed that ACL reconstruction performed >3 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 3 months of injury (estimated OR, 2.235; 95% CI, 1.183-4.223; P = .013) but not with a higher rate of lateral meniscal tears. Similarly, meta-analysis of 4 studies (n = 990) showed that ACL reconstruction performed >6 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 6 months of injury (estimated OR, 2.487; 95% CI, 1.241-4.984; P = .01) but not with a higher rate of lateral meniscal tears. Conclusion: Our results suggest that delay of ACL reconstruction surgery >3 months after injury is associated with a higher rate of medial meniscal tears within this prereconstruction time frame. Further high-quality prospective studies may help determine whether this is a causal effect. However, based on current evidence, in those patients for whom ACL reconstruction is indicated, ACL reconstruction within 3 months of injury may be recommended. Registration: CRD42016032846 (PROSPERO)

Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of the Literature

2020 ◽  
Vol 48 (14) ◽  
pp. 3626-3637 ◽  
Author(s):  
Roy A.G. Hoogeslag ◽  
Reinoud W. Brouwer ◽  
Astrid J. de Vries ◽  
Barbara C. Boer ◽  
Rianne Huis in ‘t Veld
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Failure Rate ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Acl Rupture ◽  
Suture Repair ◽  
High Quality ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Anterior cruciate ligament suture repair (ACLSR) was abandoned late last century in favor of anterior cruciate ligament (ACL) reconstruction (ACLR) because of overall disappointing results. However, in recent years there has been renewed and increasing interest in ACLSR for treatment of ACL ruptures. Several contemporary ACLSR techniques are being used, but any difference in effectiveness is unclear. Hypothesis: Contemporary nonaugmented (NA), static augmented (SA), and dynamic augmented (DA) ACLSR leads to (1) comparable outcomes overall and (2) comparable outcomes between proximal third, middle third, and combined ACL rupture locations (a) within and (b) between ACLSR technique categories. Study Design: Systematic review. Methods: An electronic search was performed in the MEDLINE and Embase databases for the period between January 1, 2010, and August 7, 2019. All articles describing clinical and patient-reported outcomes for ACLSR were identified and included, and outcomes for NA, SA, and DA ACLSR categories were compared. Results: A total of 31 articles and 2422 patients were included. The majority of articles (65%) and patients (89%) reported outcomes of DA ACLSR. Overall, there was high heterogeneity in study characteristics and level as well as quality of evidence (19 level 4; 7 level 3; 3 level 2; and 2 level 1). Most studies indicated excellent patient-reported outcomes. Overall, the variability in (and the maximum of) the reported failure rate was high within all ACLSR categories. The variability in (and the maximum of) the reported rate of all other complications was highest for DA ACLSR. Regarding ACL rupture location, the failure rate was highest in proximal ACL ruptures within the SA and DA ACLSR categories; rates of all other reported complications were highest in combined ACL ruptures within the DA ACLSR category. However, no studies in the NA category and only 1 study in the SA ACLSR category evaluated combined ACL ruptures. The majority of studies comparing ACLSR and ACLR found no differences in outcomes. Conclusion: The amount of high-quality evidence for contemporary ACLSR is poor. This makes it difficult to interpret differences among ACLSR categories and among ACL rupture locations and, though promising, to establish the role of ACLSR in the treatment of ACL ruptures. More high-quality large randomized clinical trials with longer follow-up comparing ACLSR and ACLR are needed.

scholarly journals 726 Return to Sport, Patient Reported Outcomes and Satisfaction Following Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C Simpson ◽  
D MacDonald ◽  
J Keating
Keyword(s):  
Anterior Cruciate Ligament ◽  
Patient Satisfaction ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Healthcare Experience ◽  
Patient Reported ◽  
Anterior Cruciate

Abstract Introduction Anterior Cruciate Ligament(ACL) rupture is a common sporting injury. Return to sport is a key objective for patients. The aim of this study was to investigate return to pre-injury level sport at 12- and 24-months post reconstruction and to relate this to types of sport and to patient satisfaction. Method A questionnaire was developed, piloted, and then completed by 77 patients that had undergone ACL reconstruction between 2013-2016. Results 30% of patients returned to pre-injury level of sport at 12 months and 43% by 24 months’ post ACL reconstruction. There was a significant(P = 0.037) relationship between the type of sports that participants played prior to injury and the return to pre-injury level. Sports that involved jumping, hard pivoting and cutting were associated with a lower rate of return to sport. General health profile of the patients was found to be significantly higher in patients that returned to sport(P = 0.024). There was a significant association with return to sport and higher satisfaction and healthcare experience score(P = 0.001). Conclusions Patient satisfaction correlated with return to sport. This was inversely related to sports involving jumping, hard pivoting and cutting. Which further illustrates how patient satisfaction post ACL reconstruction was linked to type of sport.

scholarly journals Evaluating the functional results and complications of autograft vs allograft use for reconstruction of the anterior cruciate ligament: a systematic review

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Ojas Pujji ◽  
Nikita Keswani ◽  
Naomi Collier ◽  
Marion Black ◽  
Lucy Doos
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Functional Results ◽  
Hamstring Tendon ◽  
Reconstruction Technique ◽  
Significant Difference ◽  
Patient Reported ◽  
Anterior Cruciate

The aim of our review is to identify the reconstruction technique that has a superior functional outcome and decreased number of complications for the anterior cruciate ligament (ACL). We have divided our review into 2 sections. Our primary question evaluates the functional results and complications of autografts compared to allografts for ACL reconstruction. Our subsidiary question evaluates the functional results and complications of bone-patellar tendon-bone (BPTB) autografts compared to hamstring tendon autografts. We conducted a systematic review (SR) based on high quality evidence provided by Cochrane, PubMed and National Health Service evidence searches for papers comparing different ACL reconstruction techniques. Results from 2 primary studies, 1 SR and 1 meta-analysis showed no significant statistical difference when comparing clinical outcomes such as pain, range of motion, laxity, International Knee Documentation Committee score, single assessment numerical evaluation score, Tegner activity score and patient reported satisfaction with regards to autografts vs allografts. Allografts had worse outcomes for postoperative tibial tunnelling and graft failure. Results of 3 SRs showed statistically significant differences in incidence of anterior knee pain, kneeling pain and knee stability, which were all found to be greater amongst those who had received a BPTB autograft. Knee extension was significantly reduced in patients with BPTB grafts when compared to patients with Hamstring tendon autografts. However, with regards to return to prior levels of activity, there was no statistically significant difference between those that received BPTB autografts and those that received Hamstring tendon autografts. Autograft reconstruction of the ACL was shown to provide better postoperative outcomes when compared to allograft reconstruction, although the difference was not statistically significant. When researching different autograft options BPTB autografts were associated with greater pain but also greater stability of the knee joint postoperatively when compared to hamstring tendon autografts.

scholarly journals Association Between Psychological Readiness, Patient Reported Outcomes and Return to Sports Following Primary Anterior Cruciate Ligament Reconstruction: Readiness Outcomes Affecting Return-to-Sport (ROAR)

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0048
Author(s):  
Jessica Traver ◽  
Melissa Christino ◽  
Ryan Coene ◽  
Kathryn Williams ◽  
Dai Sugimoto ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Age Groups ◽  
Return To Sport ◽  
Functional Testing ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Objectives: Successful return-to-sport (RTS) following anterior cruciate ligament (ACL) reconstruction can be affected by several variables, including a patient’s physical and psychological states throughout the rehabilitation process. Several studies have reported patients with increased fear-of-reinjury may be at risk for secondary injury following ACL reconstruction. The primary objective was to compare the relationship between ACL-RSI, Pedi-IKDC, Pedi-FABS, and PROMIS-Psychological Stress Experiences (PSE) across various age groups and graft types between patients undergoing primary ACL reconstruction at the 6 month post-operative visit. Secondary outcome was timing of RTS clearance. Methods: Patients prospectively enrolled were 8-30 years old who underwent primary ACL reconstruction at a large pediatric academic sports medicine center from August 2018 until February 2019. They were evaluated at their 6 month follow-up appointment and underwent functional RTS testing. Patients were divided into 3 groups based on their age: Pre-Adolescent (ages 8-14), Adolescent (ages 15-18), and Adult (ages >18) to reflect their psychological/emotional maturity. Demographic information, time to RTS clearance, and functional testing measurements were collected. Analysis included one-way ANOVA and Kruskal-Wallis tests. Results: A total of 100 patients were included in the study (57 males, 43 females; mean age, 17.3±2.9 years). RTS functional testing was performed at a mean of 6.3±0.7 months after primary ACL reconstruction. The 3 age groups consisted of Pre-Adolescent (n=13), Adolescent (n=62), and Adult (n=25). The graft types were HS (n=79), BTB (n=14), ITB (n=7). Mean ACL-RSI scores were significantly different among age groups (Pre-Adolescent 80.3±10.6, Adolescent 60.4±23.3, Adult 54.3±21.3; p=0.003) and graft type (HS 61.2±22.0, BTB 52.9±26.4, ITB 82.1±9.7; p=0.019). Scores were significantly different among the 3 age groups for IKDC (Pre-Adolescent 85.4±12.1, Adolescent 77.5±13.8, Adult 61.0±8.4; p<0.001). Scores were not significantly different among the three age groups for Pedi-FABS (Pre-Adolescent 24.9±5.4, Adolescent 23.6±8.1, Adult 20.6±9.2; p=0.212). The mean PROMIS-PSE t-scores were significantly different among the age groups (Pre-Adolescent 45.8±8.6, Adolescent 52.0±7.2, Adult 53.8±8.1; p=0.009) and graft type (HS 52.4±7.7, BTB 52.7±6.6, ITB 40.9±4.9; p<0.001). There were no significant differences for average timing of RTS clearance among the 3 age groups (Pre-Adolescent 8.5±1.5 months, Adolescent 8.0±1.3 months, Adult 8.1±1.2 months; p=0.618). Conclusion: This study suggests that psychological profiles and subjective perceptions of knee function following ACL reconstruction may vary in young patients of different ages. Pre-adolescent patients had better scores on all patient reported outcomes compared to adolescent and adult patients. Age-related differences in patient reported outcomes should be considered when evaluating young athletes. [Figure: see text]

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