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Arp K, Nedermark J, Ingwersen KG, Ageberg E, Varnum C, Viberg B. Which patients need anterior cruciate ligament reconstruction after initial treatment with rehabilitation? A scoping review. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39045722 DOI: 10.1002/ksa.12378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Some patients with anterior cruciate ligament (ACL) injury initially treated with rehabilitation need ACL reconstruction (ACLR); yet, it is unclear what characterizes these patients. This review aimed to describe predictors for ACLR in patients initially treated with rehabilitation. METHODS A systematic literature search was performed in the Cochrane, Embase, Medline, SportsDiscus and Web of Science databases from inception to 21 February 2023. Articles describing characteristics in adult patients with ACL injury undergoing ACLR after a minimum of 5 weeks rehabilitation were included. It was a priori chosen that characteristics described in at least three articles were considered more certain and could be defined as a predictor for ACLR, and those described in less than three articles were considered less certain and therefore defined as possible predictors. Articles were screened by two independent reviewers. The study was originally intended as a systematic review with meta-analysis, but in case of limited data, we would convert it to a scoping review, as was the case for this review. RESULTS There were 22,836 studies identified, and 181 full texts were screened, of which 10 papers were finally included. Only lower age and higher preinjury activity level were identified as predictors for ACLR. Another 12 possible predictors were identified in single studies. Through an iterative process, potential predictors were categorized into four groups: patient demographics, knee function, patient-reported outcome measures and anatomical structures. CONCLUSION Lower age and higher preinjury activity level were the only predictors for ACLR after initial treatment with rehabilitation. While younger and highly active patients show a higher need for ACLR, more studies focussing on predictors and reasons for delayed ACLR are warranted. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Kamilla Arp
- Department of Orthopedic Surgery, Lillebaelt Hospital-Vejle, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jacob Nedermark
- Department of Orthopedic Surgery, Lillebaelt Hospital-Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - Kim Gordon Ingwersen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy, Lillebaelt Hospital-Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - Eva Ageberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Claus Varnum
- Department of Orthopedic Surgery, Lillebaelt Hospital-Vejle, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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Cao Z, Wang C, Ma Y, Wang J, Wang H, Liu P, Yang Y, Gong X, Wang J, Shi W. Good clinical outcomes of anterior cruciate ligament reconstruction in patients over 60 years of age. Knee Surg Sports Traumatol Arthrosc 2024; 32:1396-1404. [PMID: 38558103 DOI: 10.1002/ksa.12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To evaluate the clinical outcomes following arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) in patients over 60 years and to investigate the potential impact of preoperative osteoarthritis (OA) on these outcomes. METHODS A retrospective study included ACL-injured patients over 60 years who underwent primary arthroscopic ACLR between 2010 and 2020. The Lysholm score and the International Knee Documentation Committee (IKDC) score were assessed preoperatively and at the final follow-up. The Tegner activity scale was performed to evaluate patients' activity levels. Data on return to sports, patient satisfaction, subsequent injuries and complications were collected. Preoperative radiographs were used to grade OA according to the Kellgrene-Lawrence classification. Correlation analysis between OA and clinical outcomes was performed. The rates of achieving the minimal clinically significant difference and patient-acceptable symptoms state were documented. RESULTS A total of 37 patients were included in this study. The mean age at surgery was 62.3 ± 2.3 years, with a mean follow-up of 6.3 ± 3.2 years (range: 2.1-12.4). Patients showed statistically significant (all p < 0.001) improvements in the mean IKDC (38.9 ± 9.4-66.8 ± 12.5), Lysholm (48.8 ± 15.4-83.0 ± 12.8) and Tegner (1-3) scores. Fourteen patients (37.8%) returned to sports. No correlation was observed between the degree of preoperative OA and clinical outcomes (n.s.). CONCLUSION Patients over 60 years with symptomatic ACL-deficient knees could benefit from ACLR, even when mild to moderate OA is present preoperatively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Zhuohan Cao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yong Ma
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jian Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Haijun Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Ping Liu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xi Gong
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jianquan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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D'Ambrosi R, Carrozzo A, Meena A, Corona K, Yadav AK, Annibaldi A, Kambhampati SBS, Abermann E, Fink C. A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature. J Exp Orthop 2024; 11:e12017. [PMID: 38577065 PMCID: PMC10993150 DOI: 10.1002/jeo2.12017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/03/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
Purpose The aim of the present systematic review was to quantitatively synthesize the best literature evidence regarding osteoarthritis developing after anterior cruciate ligament reconstruction (ACLR), including only studies with a follow-up duration of at least 20 years. Material and Methods A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on four electronic databases (PubMed, Scopus, EMBASE and Cochrane Library). The outcome measures extracted from the studies were failure rate, subsequent knee surgery on the same knee, radiographic development of osteoarthritis measured with Kellgren-Lawrence, International Knee Documentation Committee (IKDC) radiographic score and Ahlbäck classification. The health of both the ACLR knee and the contralateral knee was compared. Results A total of 1552 patients were included in the study, of which 1290 (83.11%) were operated on using a patellar tendon graft, 190 (12.24%) with hamstrings, 27 (1.73%) with an iliotibial band and 45 (2.89%) with patellar tendon plus a ligament augmentation device (LAD). The mean age at the time of surgery was 25.18 ± 1.91 years, and the mean follow-up time was 23.34 ± 2.56 years. Analysing IDKC Score at final follow-up, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 33.2% (324/976) of the patients showed a moderate to severe degree (Grade C or D) of osteoarthritis, while for Kellgren-Lawrence, ACLR Group showed a higher degree of OA compared with contralateral healthy knee (p < 0.01), but only 28.9% (196/678) of the patients showed a moderate to severe degree (Grade III or IV) of osteoarthritis. In total, 1552 patients were registered, 155 reruptures (9.98%) and a total of 300 (19.3%) new surgeries, of which 228 meniscectomy (14.69%), 21 (1.35%) knee arthroplasty and 17 (1.09%) hardware removal were recorded. Conclusions ACL reconstruction appears to result in mild osteoarthritis in the long term in most of the patients and only less than 33.2% develop a moderate to severe degree of knee OA according to IKDC radiographic score. A slight degree of osteoarthritis appears to be present in ACLR knees compared with contralateral healthy knees. Level of Evidence Level IV.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Ospedale Galeazzi—Sant'AmbrogioMilanItaly
- Dipartimento di Scienze Biomediche per la SaluteUniversità degli Studi di MilanoMilanItaly
| | - Alessandro Carrozzo
- Orthopaedic Unit, Sant'Andrea HospitalUniversity of Rome La SapienzaRomeItaly
| | - Amit Meena
- Division of OrthopedicsShalby Multi‐Specialty HospitalJaipurIndia
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
| | - Katia Corona
- Department of Medicine and Health Sciences “Vincenzo Tiberio”University of MoliseCampobassoItaly
| | | | | | | | - Elisabeth Abermann
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
| | - Christian Fink
- Gelenkpunkt—Sports and Joint SurgeryFIFA Medical Centre of ExcellenceInnsbruckAustria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health SciencesMedical Informatics and TechnologyInnsbruckAustria
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Smeets A, Ghafelzadeh Ahwaz F, Bogaerts S, Berger P, Peers K. Comparison of immediate versus optional delayed surgical repair for treatment of acute anterior cruciate ligament injury through a parallel, multicentric, pragmatic randomized controlled trial - IODA trial. BMC Sports Sci Med Rehabil 2024; 16:22. [PMID: 38238809 PMCID: PMC10797880 DOI: 10.1186/s13102-024-00816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Standard care for anterior cruciate ligament (ACL) injuries often includes surgical reconstruction of the ACL. However, two randomized controlled trials [1, 2] (RCT) concluded that conservative treatment does not result in inferior clinical outcomes compared to immediate ACL reconstruction. More research is needed to verify these results and assess whether patient-specific parameters determine if a patient would benefit from one treatment option over the other. METHODS This is a pragmatic, multi-center RCT with two parallel groups. Patients with an acute ACL injury will be recruited from Belgian hospitals. Patients will be randomized to conservative treatment (rehabilitation + optional delayed surgery) or immediate ACL reconstruction (< 12 weeks). The primary outcome is the Knee injury and Osteoarthritis Outcome Score (KOOS) at 7 months (short term) and 1-year long term) post-injury. These following additional outcomes will be administered at 4 and 7 months (short term) and 1, 2, and 3 years post-injury (long term): patient-reported outcomes concerning knee symptoms, knee function and quality of life, functional knee tests, time to return to pre-injury activity level and return to work, structural knee joint damage and cartilage health (only at 4 months and 3 years post-injury), as well as adverse events such as re-rupture rates. Furthermore, the secondary objective is to identify (through a predictive analysis) individuals who would benefit the most from early reconstruction versus those who should rather be treated conservatively. DISCUSSION This large RCT will assess the clinical effectiveness of both surgical and conservative treatment. In addition, it will be the first study that provides insights into which patient-specific factors predict successful outcomes after conservative treatment of ACL injuries. These results will be the first step toward early patient identification regarding treatment decisions. This is urgently needed to avoid (1) delayed surgeries and prolonged rehabilitation and (2) unnecessary surgeries. TRIAL REGISTRATION this trial was registered on ClinicalTrials.gov (NCT05747079) on 10/02/2023.
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Affiliation(s)
- Annemie Smeets
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Research group of Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences & Physiotherapy, KU Leuven, Leuven, Belgium
| | - Feryal Ghafelzadeh Ahwaz
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium.
| | - Stijn Bogaerts
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Department of Physical & Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Berger
- Department of Orthopaedic Surgery, University of Leuven, Leuven, Belgium
| | - Koen Peers
- Research group of Physical & Rehabilitation Medicine, Department of Development & Regeneration, KU Leuven, Leuven, Belgium
- Department of Physical & Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
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Häner M, Petersen W. [Treatment of acute injury of the anterior cruciate ligament : Always only reconstruction?]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:8-17. [PMID: 37597054 DOI: 10.1007/s00113-023-01357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
The aim of treatment of a ruptured anterior cruciate ligament (ACL) is the return of the patient to an acceptable level of activity without giving way phenomena as well as adequate treatment of prognostically relevant concomitant lesions. The treatment of acute ACL ruptures can be either early reconstruction or a primary physiotherapy with optional later reconstruction. Which path is taken depends on possible concomitant injuries that require early surgical intervention (e.g., repairable meniscal injury or distal rupture of the medial collateral ligament) and on patient-specific factors (age, level of activity). Isolated ruptures of the ACL can also be primarily treated without surgery. Then the injured knee joint should first be so far conditioned by rehabilitative measures that pain, swelling and posttraumatic restriction of movement are improved and neuromuscular training can be started. A screening test consisting of jumping tests, patient-reported outcome measures and the testing for giving way phenomena can be suitable to differentiate compensators (copers) from noncompensators (non-copers). Surgical reconstruction of the ACL should be recommended to non-compensators in the sense of participatory decision-making. Activity modification (adapter) can also be considered as a treatment strategy. If instability events (giving way) or secondary meniscal lesions occur during nonsurgical therapy, cruciate ligament reconstruction should be considered.
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Affiliation(s)
- Martin Häner
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland
| | - Wolf Petersen
- Sportklinik Berlin und Klinik für Orthopädie und Unfallchirurgie, Martin Luther Krankenhaus, Caspar-Theyß-Str. 27-31, 14193, Berlin, Deutschland.
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Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020390. [PMID: 36837591 PMCID: PMC9967347 DOI: 10.3390/medicina59020390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/11/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies.
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Paudel YR, Sommerfeldt M, Voaklander D. Increasing incidence of anterior cruciate ligament reconstruction: a 17-year population-based study. Knee Surg Sports Traumatol Arthrosc 2023; 31:248-255. [PMID: 35948850 DOI: 10.1007/s00167-022-07093-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) injuries are one of the most frequently studied injuries in orthopedic care and research. However, limited epidemiological data are available in Canada regarding trend and distribution of anterior cruciate ligament reconstruction (ACLR). In this paper, our purpose was to assess trends of ACLR between 2002/03 and 2018/19 by age, sex, season of surgery, and location (inpatient vs outpatient) of surgery. METHODS In this descriptive epidemiological study of retrospective data available from Alberta Ministry of Health, we report annual incidence of ACLR between 2002/03 until 2018/19 among Albertans aged 10 years and older. Information was collected by authors from physician claims database for primary ACLR and revision ACLR and linked with other databases. Incidence proportions (number of ACLR/100,000 population) were calculated and compared by age category and gender over the study period. RESULTS A total of 28,401 primary ACLR and 2085 revision ACLR were identified during the study period. Age-standardized annual incidence of primary ACLR increased from 40.6 to 51.2 per 100,000 population aged 10 years and older. Average annual increase in ACLR incidence was higher among females (1.8% per years) compared to males (0.96% per year). The overall peak incidence and peak incidence among males was observed in 20-29 year age group, whereas peak incidence in females was observed in 10-19 years of age. The number of ACLR in females outnumbers those among males for 10-19 year age group. Generally, a lower proportion of ACLR were conducted in summer compared to other seasons. Primary ACLR conducted in outpatient setting increased from 72% in 2002/03 to 97% in 2018/19. CONCLUSION The incidence of ACLR is increasing in Alberta, especially among females and among younger cohorts under 20 years of age. This information can help clinicians to provide patient education and policy-makers to design and implement targeted ACL injury prevention programs. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Mark Sommerfeldt
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Don Voaklander
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Filbay SR. Surgery or rehabilitation for anterior cruciate ligament injury: where are we now? Lancet 2022; 400:543-545. [PMID: 35988554 DOI: 10.1016/s0140-6736(22)01580-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Stephanie R Filbay
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, VIC 3010, Australia.
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