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Marmura H, Bryant DM. Evaluation of Outcomes After Anterior Cruciate Ligament Reconstruction: What We Know, What We Have, and What to Consider. Clin Sports Med 2024; 43:479-499. [PMID: 38811123 DOI: 10.1016/j.csm.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Measurement of success following anterior cruciate ligament reconstruction (ACLR) hinges on the appropriate use of high quality and meaningful outcome measures. We identified and categorized over 100 outcome measures for ACLR using the International Classification of Functioning, Disability and Health (ICF) model. The ICF model is a useful framework to facilitate decisions about outcome selection and describe recovery following ACL injury. We outline key considerations when selecting outcome measures during study design (purpose, measurement properties, sample size, global assessment) or evaluating reported outcomes (measurement properties, sample size, magnitude/precision, clinical relevance, applicability), and discuss challenges in outcome measurement following ACLR.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON N6A 5B9, Canada; Fowler Kennedy Sport Medicine Clinic, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7, Canada; Bone and Joint Institute, Western University, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, ON N6G 2V4, Canada; Lawson Research, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON N6A 5B9, Canada; Fowler Kennedy Sport Medicine Clinic, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7, Canada; Bone and Joint Institute, Western University, The Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, ON N6G 2V4, Canada; Lawson Research, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 5W9, Canada; Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, ON N6A 5C1, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Health Sciences Centre, 2C1280 Main Street West Hamilton, ON L8S 4L8, Canada.
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Simonsson R, Piussi R, Högberg J, Sundberg A, Hamrin Senorski E. Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction. Clin Sports Med 2024; 43:513-533. [PMID: 38811125 DOI: 10.1016/j.csm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Rehabilitation after an anterior cruciate ligament (ACL) reconstruction requires patience, devotion, and discipline. Rehabilitation should be individualized to each patient's specific need and sport. Return to sport is a continuum throughout the rehabilitation, and patients should not return to performance before passing a battery of muscle function tests and patient-reported outcomes, as well as change of direction-specific tests. Return to full participation should be an agreement between the patient, physical therapist, surgeon, and coach. For minimal risk for second ACL injury, patients should continue with maintenance and prevention training even after returning to sport.
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Affiliation(s)
- Rebecca Simonsson
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Ramana Piussi
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Johan Högberg
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden
| | - Axel Sundberg
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Capio Ortho Center, Arvid Wallgrens Backe 4a, Gothenburg SE-413 13, Sweden
| | - Eric Hamrin Senorski
- Sportrehab Sports Medicine Clinic, Stampgatan 14, Gothenburg SE-411 01, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 455, Gothenburg SE-405 30, Sweden; Swedish Olympic Committee, Olympiastadion 114 33, Stockholm, Sweden.
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Gopinatth V, Garcia JR, Reid IK, Knapik DM, Verma NN, Chahla J. Blood Flow Restriction Enhances Recovery After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arthroscopy 2024:S0749-8063(24)00416-X. [PMID: 38889851 DOI: 10.1016/j.arthro.2024.05.032] [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: 02/04/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating neuromuscular and clinical outcomes of blood flow restriction (BFR) training after anterior cruciate ligament reconstruction (ACLR) compared to non-BFR rehabilitation protocols. METHODS A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines by querying PubMed, MEDLINE, Scopus, the Cochrane Database for Systematic Review, and the Cochrane Central Register for Controlled Trials databases from inception through December 2023 to identify Level I-II RCTs evaluating outcomes of BFR training after ACLR compared to non-BFR rehabilitation. A meta-analysis was performed using random-effects models with standardized mean difference (SMD) for pain, muscle strength, and muscle volume, while mean difference (MD) was calculated for patient-reported outcome measures. RESULTS Eight RCTs, consisting of 245 patients, met inclusion criteria, with 115 patients undergoing non-BFR rehabilitation versus 130 patients undergoing BFR after ACLR. Mean patient age was 27.2 ± 6.7 years, with the majority of patients being male (63.3%, n=138/218). The length of the BFR rehabilitation protocol was most commonly between 8-12 weeks (range, 14 days - 16 weeks). The majority of studies set the limb/arterial occlusion pressure in the BFR group at 80%. When compared to non-BFR rehabilitation, BFR resulted in significant improvement in isokinetic muscle strength (SMD: 0.77, p=0.02, I2: 58%), IKDC score (MD: 10.97, p=<.00001, I2: 77%), and pain (SMD: 1.52, p=.04, I2: 87%), but not quadriceps muscle volume (SMD: 0.28, p=0.43, I2: 76%). CONCLUSION The use of BFR following ACLR led to improvements in pain, IKDC score and isokinetic muscle strength, with variable outcomes based on quadriceps strength, volume and thickness when compared to non-BFR rehabilitation.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA
| | - Jose R Garcia
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Isabel K Reid
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St., Chicago, IL 60612, USA.
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Kaarre J, Herman ZJ, Grassi A, Hamrin Senorski E, Musahl V, Samuelsson K. Comparison of Improvement in Patient-Reported Knee Function After Revision and Multiple-Revision ACL Reconstruction Compared With Primary ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231217725. [PMID: 38145220 PMCID: PMC10748942 DOI: 10.1177/23259671231217725] [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: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 12/26/2023] Open
Abstract
Background Graft failure after anterior cruciate ligament reconstruction (ACLR) is a debilitating complication often requiring revision surgery. It is widely agreed upon that functional knee outcomes after revision ACLR (r-ACLR) are inferior compared with those after primary reconstruction. However, data are scarce on outcomes after multiple-revision ACLR (mr-ACLR). Purpose To compare patient-reported knee function in terms of Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and 1-year postoperatively after primary ACLR, r-ACLR, and mr-ACLR and evaluate the pre- to postoperative improvement in KOOS scores for each procedure. Study Design Cohort study; Level of evidence, 3. Methods Patients from the Swedish National Knee Ligament Registry who underwent their index ACLR between 2005 and 2020 with a minimum age of 15 years at the time of surgery were included in this study. All patients had pre- and postoperative KOOS data. The 1-year postoperative KOOS and the pre- to postoperative changes in KOOS were assessed between patients who underwent primary ACLR and those who underwent subsequent r-ACLR and mr-ACLR. Results Of 20,542 included patients, 19,769 (96.2%) underwent primary ACLR, 760 (3.7%) underwent r-ACLR, and 13 (0.06%) underwent mr-ACLR. Patients who underwent r-ACLR had significantly smaller pre- to postoperative changes on all KOOS subscales compared with patients undergoing primary ACLR (P < .0001 for all). Furthermore, patients in the mr-ACLR group had significantly smaller changes in the KOOS-Pain subscale compared with patients in the r-ACLR group (-9 ± 23.3 vs 2.5 ± 18; P = .024). Conclusion The study results indicated that while improvement is seen after primary ACLR, r-ACLR, and mr-ACLR, the greatest improvement in functional outcomes is observed after primary ACLR. Patients who underwent at least 1 r-ACLR, specifically mr-ACLR, had lower postoperative outcome scores, indicating that primary ACLR may provide the best chance for recovery after ACL injury.
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Affiliation(s)
- Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary J. Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Kaarre J, Herman ZJ, Persson F, Wållgren JO, Alentorn-Geli E, Senorski EH, Musahl V, Samuelsson K. Differences in postoperative knee function based on concomitant treatment of lateral meniscal injury in the setting of primary ACL reconstruction. BMC Musculoskelet Disord 2023; 24:737. [PMID: 37715148 PMCID: PMC10503181 DOI: 10.1186/s12891-023-06867-z] [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: 05/02/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Concomitant lateral meniscal (LM) injuries are common in acute anterior cruciate ligament (ACL) ruptures. However, the effect of addressing these injuries with various treatment methods during primary ACL reconstruction (ACLR) on patient-reported outcomes (PROs) is unknown. Therefore, the purpose of this study was to compare postoperative Knee injury and Osteoarthritis Outcome Score (KOOS) at 2-, 5-, and 10-years after isolated primary ACLR to primary ACLR with various treatment methods to address concomitant LM injury. METHODS This study was based on data from the Swedish National Knee Ligament Registry. Patients ≥ 15 years with data on postoperative KOOS who underwent primary ACLR between the years 2005 and 2018 were included in this study. The study population was divided into five groups: 1) Isolated ACLR, 2) ACLR + LM repair, 3) ACLR + LM resection, 4) ACLR + LM injury left in situ, and 5) ACLR + LM repair + LM resection. Patients with concomitant medial meniscal or other surgically treated ligament injuries were excluded. RESULTS Of 31,819 included patients, 24% had LM injury. After post hoc comparisons, significantly lower scores were found for the KOOS Symptoms subscale in ACLR + LM repair group compared to isolated ACLR (76.0 vs 78.3, p = 0.0097) and ACLR + LM injury left in situ groups (76.0 vs 78.3, p = 0.041) at 2-year follow-up. However, at 10-year follow-up, no differences were found between ACLR + LM repair and isolated ACLR, but ACLR + LM resection resulted in significantly lower KOOS Symptoms scores compared to isolated ACLR (80.4 vs 82.3, p = 0.041). CONCLUSION The results of this study suggest that LM injury during ACLR is associated with lower KOOS scores, particularly in the Symptoms subscale, at short- and long-term follow-up. However, this finding falls below minimal clinical important difference and therefore may not be clinically relevant. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden.
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fabian Persson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | - Jonas Olsson Wållgren
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, the NU Hospital Group, Trollhättan, Sweden
| | - Eduard Alentorn-Geli
- Instituto Cugat, Hospital Quironsalud Barcelona, Barcelona, Spain
- Mutualidad de Futbolistas Españoles - Delegación Catalana, Barcelona, Spain
- Fundación García Cugat, Barcelona, Spain
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Göteborgsvägen 31, 43180, Gothenburg, Mölndal, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Fahlbusch H, Behrendt P, Akoto R, Frosch KH, Krause M. ACL reconstruction provides superior stability than ACL repair in patients with Schenck III and IV knee joint dislocations: first results of a 12 month follow-up study. Arch Orthop Trauma Surg 2023; 143:5751-5758. [PMID: 37062000 PMCID: PMC10449953 DOI: 10.1007/s00402-023-04884-0] [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: 01/29/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE Acute knee dislocation is a rare but devastating multi-ligamentous knee injury with only limited evidence-based surgical technique recommendations. The aim of this study was a comparison of two different anterior cruciate ligament (ACL) restoration techniques as part of an early total surgical care concept: (1) repair of ACL with additional internal bracing (ACLIB) compared to; (2) ACL reconstruction with autograft (ACLR). METHODS Retrospective, clinical-study of patients with an acute type III or IV knee dislocation (according to Schenck classification), in which the ACL was treated with ACLIB or ACLR within 12 days. The PCL was sutured and internally braced in all cases. Medial and lateral complex injuries were repaired and additionally laterally augmented by an Arciero reconstruction. After a minimum 12 months follow-up different patient-reported outcome measurements (IKDC, Lysholm, VAS, Tegner Score) and instrumental stability assessment by Rolimeter -test and stress radiographs (Telos™) were analyzed. Groups were compared by t test with p < 0.05 considered significant. RESULTS In total, 20 patients (5 IIIM, 5 IIIL and 10 IV) were included in this study with an average follow-up of 13.7 ± 2.6 months. There were significant differences in instrumental stability testing (side-to-side difference (SSD) of anterior tibial translation: ACLIB 2.7 ± 1.5 mm vs. ACLR 1.3 ± 1.3; p = 0.0339) and stress radiography (SSD ACL: ACLIB 3.4 ± 2.2 mm vs. ACLR 0.4 ± 2.7; p = 0.0249) between groups. ACLIB group showed greater ROM in terms of flexion (SSD Flexion: ACLIB 7.8 ± 9.9° vs. ACLR 16 ± 7.0°; p = 0.0466; Total Flexion overall 125.5 ± 11.8°). No clinically relevant differences in patient-reported outcome scores (Lysholm Score: ACLIB 82 ± 16.4 vs. ACLR 85 ± 10.4; IKDC subjective score: ACLIB 70.4 ± 17 vs. ACLR 76.6 ± 8.3) were determined. CONCLUSION ACLR provides superior translational stability than ACLIB in terms of instrumental testing and stress radiography. Both techniques were equivalent with respect to PROMS and led to good and excellent clinical results. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- H Fahlbusch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Behrendt
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Orthopaedics, Asklepios St. Georg, Hamburg, Germany
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - R Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - K H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Berk AN, Piasecki DP, Fleischli JE, Trofa DP, Saltzman BM. Trends in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Orthop J Sports Med 2023; 11:23259671231174472. [PMID: 37284137 PMCID: PMC10240869 DOI: 10.1177/23259671231174472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 06/08/2023] Open
Abstract
Background Despite the prevalence of patient-reported outcomes (PROs) to evaluate results after anterior cruciate ligament (ACL) reconstruction, there exists little standardization in how these metrics are reported, which can make wider comparisons difficult. Purpose To systematically review the literature on ACL reconstruction and report on the variability and temporal trends in PRO utilization. Study Design Systematic review. Methods We queried the PubMed Central and MEDLINE databases from inception through August 2022 to identify clinical studies reporting ≥1 PRO after ACL reconstruction. Only studies with ≥50 patients and a mean 24-month follow-up were considered for inclusion. Year of publication, study design, PROs, and reporting of return to sport (RTS) were documented. Results Across 510 studies, 72 unique PROs were identified, the most common of which were the International Knee Documentation Committee score (63.3%), Tegner Activity Scale (52.4%), Lysholm score (51.0%), and Knee injury and Osteoarthritis Outcome Score (35.7%). Of the identified PROs, 89% were utilized in <10% of studies. The most common study designs were retrospective (40.6%), prospective cohort (27.1%), and prospective randomized controlled trials (19.4%). Some consistency in PROs was observed among randomized controlled trials, with the most common PROs being the International Knee Documentation Committee score (71/99, 71.7%), Tegner Activity Scale (60/99, 60.6%), and Lysholm score (54/99, 54.5%). The mean number of PROs reported per study across all years was 2.89 (range, 1-8), with an increase from 2.1 (range, 1-4) in studies published before 2000 to 3.1 (range, 1-8) in those published after 2020. Only 105 studies (20.6%) discretely reported RTS rates, with more studies utilizing this metric after 2020 (55.1%) than before 2000 (15.0%). Conclusion There exists marked heterogeneity and inconsistency regarding which validated PROs are used in studies related to ACL reconstruction. Significant variability was observed, with 89% of measures being reported in <10% of studies. RTS was discretely reported in only 20.6% of studies. Greater standardization of outcomes reporting is required to better promote objective comparisons, understand technique-specific outcomes, and facilitate value determination.
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Affiliation(s)
- Alexander N. Berk
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Dana P. Piasecki
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - James E. Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - David P. Trofa
- Department of Orthopaedics, NewYork–Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Bryan M. Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, USA
- OrthoCarolina Research Institute, Charlotte, North Carolina, USA
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
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Fox MA, Engler ID, Zsidai BT, Hughes JD, Musahl V. Anatomic anterior cruciate ligament reconstruction: Freddie Fu's paradigm. J ISAKOS 2023; 8:15-22. [PMID: 35988888 DOI: 10.1016/j.jisako.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/26/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022]
Abstract
Anterior cruciate ligament (ACL) reconstruction techniques have evolved over the past four decades. There is evidence that non-anatomic reconstruction techniques, such as traditional transtibial drilling, fail to recreate the native anatomy of the ACL, which can lead to increased rotatory knee instability, revision risk, and post-traumatic osteoarthritis. Anatomic ACL reconstruction has emerged as the gold standard, with the goal of restoring the patient's native anatomy and knee kinematics. This review will summarise the relevant anatomy, modern anatomic ACL reconstruction techniques, and literature supporting anatomic ACL reconstruction as the new paradigm. LEVEL OF EVIDENCE: Level V, review article.
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Affiliation(s)
- Michael A Fox
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Ian D Engler
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Balint T Zsidai
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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Kaarre J, Zsidai B, Narup E, Horvath A, Svantesson E, Hamrin Senorski E, Grassi A, Musahl V, Samuelsson K. Scoping Review on ACL Surgery and Registry Data. Curr Rev Musculoskelet Med 2022; 15:385-393. [PMID: 35829892 PMCID: PMC9463418 DOI: 10.1007/s12178-022-09775-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
Purpose of Review To present an overview of registry-based anterior cruciate ligament (ACL) research, as well as provide insight into the future of ACL registries. Recent Findings During the past decades, the ACL registries have had an important role in increasing our understanding of patients with ACL injuries and their treatment. The registry data has deepened our understanding of factors that have been associated with an increased risk of sustaining an ACL injury and for evaluation of treatment factors and their impact on patient-related outcomes. Recently, registry-based ACL research using artificial intelligence (AI) and machine learning (ML) has shown potential to create clinical decision-making tools and analyzing outcomes. Thus, standardization of collected data between the registries is needed to facilitate the further collaboration between registries and to facilitate the interpretation of results and subsequently improve the possibilities for implementation of AI and ML in the registry-based research. Summary Several studies have been based on the current ACL registries providing an insight into the epidemiology of ACL injuries as well as outcomes following ACL reconstruction. However, the current ACL registries are facing future challenges, and thus, new methods and techniques are needed to ensure further good quality and clinical applicability of study findings based on ACL registry data.
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Affiliation(s)
- Janina Kaarre
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden. .,Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Bálint Zsidai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric Narup
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
| | - Alexandra Horvath
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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10
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Webster KE, Klemm HJ, Feller JA. Choice of Patient-Reported Outcome Measures for Midterm Assessment After Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med 2022; 50:2119-2124. [PMID: 35604331 DOI: 10.1177/03635465221099459] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) have become increasingly popular for assessing subjective elements of a patient's condition. Two frequently used knee-related PROMs after anterior cruciate ligament reconstruction (ACLR) surgery are the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and the Knee injury and Osteoarthritis Outcome Score (KOOS). However, completing the full versions of both measures represents a considerable responder burden. PURPOSE To compare a variety of KOOS short forms with each other as well as the IKDC-SKF in a large sample of ACLR patients between 2 and 6 years after surgery. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS The KOOS and IKDC-SKF were administered between 2 and 6 years (mean, 3 years) after ACLR surgery to a cohort of 832 patients (men, n = 489; women, n = 343). Two single-item assessment numerical evaluations were also completed for knee function and satisfaction. The following short form versions were calculated from the full KOOS: the KOOS-12 short form, KOOS-Physical Function Short form (KOOS-PS), KOOS-Joint Replacement Short form (KOOS-JR), and KOOS-Global. Descriptive statistics were calculated for all PROMs and associations between measures were explored using nonparametric (Spearman rho) correlations. Floor or ceiling effects were considered present if >15% of patients reported the worst (floor effect) or best (ceiling effect) possible score. Age and sex comparisons were also made for each PROM. RESULTS Ceiling effects were present for all KOOS short form versions. They were highly evident for the KOOS-JR and KOOS-PS (37%-44%), but they were only marginally above the threshold for the KOOS-12 and KOOS-Global (16%). The KOOS-12 and KOOS-Global had the highest correlation with the IKDC-SKF but only explained 58% to 59% of the variance in scores. The KOOS-12 and KOOS-Global were very highly correlated (ρ = 0.98). Only moderate correlations were seen between the single-item assessments and the IKDC-SKF or various KOOS short forms. There was a negligible association between patient age and PROM scores, but there was no significant sex difference for any of the PROMs. CONCLUSION The IKDC-SKF together with either the KOOS-Global or KOOS-12 may provide a comprehensive range of knee-related PROMs with minimized responder burden at 2 to 6 years after ACLR.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Haydn J Klemm
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
| | - Julian A Feller
- OrthoSport Victoria, Epworth HealthCare, Melbourne, Australia
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11
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Marmura H, Tremblay PF, Getgood AMJ, Bryant DM. The Knee Injury and Osteoarthritis Outcome Score Does Not Have Adequate Structural Validity for Use With Young, Active Patients With ACL Tears. Clin Orthop Relat Res 2022; 480:1342-1350. [PMID: 35238805 PMCID: PMC9191602 DOI: 10.1097/corr.0000000000002158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Knee Injury and Osteoarthritis Outcome Score (KOOS) is well known and commonly used to assess young, active patients with ACL injuries. However, this application of the outcome measure has been called into question. There is currently no evidence supporting the structural validity of the KOOS for this patient population. Structural validity refers to whether a questionnaire meant to provide scores on different subscales behaves as intended in the populations of interest. Structural validity should be assessed for all questionnaire measures with multiple items or subscales. QUESTIONS/PURPOSES Does the KOOS demonstrate adequate structural validity in young, active patients with ACL tears, when evaluated using (1) exploratory and (2) confirmatory factor analyses? METHODS Between January 2014 and March 2017, 1033 patients were screened for eligibility in the Stability 1 randomized controlled trial from nine centers in Canada and Europe. Patients were eligible if they had an ACL deficient knee, were between 14 and 25 years old, and were thought to be at higher risk of reinjury based on the presence of two or more of the following factors: participation in pivoting sports, presence of a Grade 2 pivot shift or greater, generalized ligamentous laxity (Beighton score of 4 or greater), or genu recurvatum greater than 10°. Based on this criteria, 367 patients were ineligible and another 48 declined to participate. In total, 618 patients were randomized into the trial. Of the trial participants, 98% (605 of 618) of patients had complete baseline KOOS questionnaire data available for this analysis. Based on study inclusion criteria, the baseline KOOS data from the Stability 1 trial represents an appropriate sample to investigate the structural validity of the KOOS, specifically for the young, active ACL deficient population.A cross sectional retrospective secondary data analysis of the Stability 1 baseline KOOS data was completed to assess the structural validity of the KOOS using exploratory and confirmatory factor analyses. Exploratory factor analysis investigates how all questionnaire items group together based on their conceptual similarity in a specific sample. Confirmatory factor analysis is similar but used often in a second stage to test and confirm a proposed structure of the subscales. These methods were used to assess the established five-factor structure of the KOOS (symptoms [seven items], pain [nine items], activities of daily living [17 items], sport and recreation [five items], and quality of life [four items]) in young active patients with ACL tears. Incremental posthoc modifications, such as correlating questionnaire items or moving items to different subscales, were made to the model structure until adequate fit was achieved. Model fit was assessed using chi-square, root mean square error of approximation (RMSEA) and an associated 90% confidence interval, comparative fit index (CFI), Tucker-Lewis index (TLI), as well as standardized root mean square residual (SRMR). Adequate fit was defined as a CFI and TLI > 0.9, and RMSEA and SRMR < 0.08. RESULTS Structural validity of the KOOS was not confirmed when evaluated using (1) exploratory or (2) confirmatory factor analyses. The exploratory factor analysis, where the 42 KOOS items were allowed to group naturally, did not reflect adequate fit for a five-factor model (TLI = 0.828). Similarly, the confirmatory factor analysis used to investigate the KOOS structure as it was originally developed, revealed inadequate fit in our sample (RMSEA = 0.088 [90% CI 0.086 to 0.091]). Our analysis suggested a modified four-factor structure may be more appropriate in young, active ACL deficient patients; however, the final version presented here is not appropriate for clinical use because of the number and nature of post-hoc modifications required to reach adequate fit indices. CONCLUSION The established five-factor structure of the KOOS did not hold true in our sample of young, active patients undergoing ACL reconstruction, indicating poor structural validity. CLINICAL RELEVANCE We question the utility and interpretability of KOOS subscale scores for young, active patients with ACL tears with the current form of the KOOS. A modified version of the KOOS, adjusted for this patient population, is needed to better reflect and interpret the outcomes and recovery trajectory in this high-functioning group. A separate analysis with a defined a priori development plan would be needed to create a valid alternative.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
| | - Paul F. Tremblay
- Department of Psychology, Western University, London, ON, Canada
| | - Alan M. J. Getgood
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dianne M. Bryant
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton ON, Canada
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12
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Fukuda H, Ogura T, Asai S, Omodani T, Takahashi T, Yamaura I, Sakai H, Saito C, Tsuchiya A, Takahashi K. Bone-patellar tendon-bone autograft maturation is superior to double-bundle hamstring tendon autograft maturation following anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:1661-1671. [PMID: 34424354 DOI: 10.1007/s00167-021-06653-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The primary purpose of this study was to evaluate the second-look arthroscopic findings 1 year postoperatively and magnetic resonance imaging (MRI) findings 2 years after anterior cruciate ligament reconstruction (ACLR) using bone-patellar tendon-bone autograft (BTB) or hamstring tendon autograft (HT). Secondary purpose included clinical results from physical examination, including range of motion, Lachman test, pivot shift test, and knee anterior laxity evaluation, and the clinical score for subjective evaluations at 2 years after surgery. METHODS Between 2015 and 2018, 75 patients with primary ACL injuries were divided into either the BTB group (n = 30) or HT group (n = 45). When using HT, an anatomical double-bundle ACLR was performed. BTB was indicated for athletes with sufficient motivation to return to sporting activity. Graft maturation on second-look arthroscopy was scored in terms of synovial coverage and revascularization. All participants underwent postoperative MRI evaluation 2 years postoperatively. The signal intensity (SI) characteristics of the reconstructed graft were evaluated using oblique axial proton density-weighted MR imaging (PDWI) perpendicular to the grafts. The signal/noise quotient (SNQ) was calculated to quantitatively determine the normalized SI. For clinical evaluation, the Lachman test, pivot shift test, KT-2000 evaluation, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were used. RESULTS Arthroscopic findings showed that the graft maturation score in the BTB group (3.6 ± 0.7) was significantly greater than that in the anteromedial bundle (AMB; 2.9 ± 0.2, p = 0.02) and posterolateral bundle (PLB; 2.0 ± 0.9, p = 0.001) in the HT group. The mean MRI-SNQs were as follows: BTB, 2.3 ± 0.5; AMB, 2.9 ± 0.9; and PLB, 4.1 ± 1.1. There were significant differences between BTB, AMB, and PLB (BTB and AMB: p = 0.04, BTB and PLB: p = 0.003, AMB and PLB: p = 0.03). Second-look arthroscopic maturation score and MRI-SNQ value significantly correlated for BTB, AMB, and PLB. No significant differences were detected in clinical scores. There was a significant difference (p = 0.02) in the knee laxity evaluation (BTB: 0.9 ± 1.1 mm; HT: 2.0 ± 1.9 mm). CONCLUSION BTB maturation is superior to that of double-bundle HT based on morphological and MRI evaluations following anatomical ACLR, although no significant differences were found in clinical scores. Regarding clinical relevance, the advantages of BTB may help clinicians decide on using the autograft option for athletes with higher motivation to return to sporting activity because significant differences were observed in morphological evaluation, MRI assessment, and knee anterior laxity evaluation between BTB and double-bundle HT. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hideaki Fukuda
- Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama Funabashi-shi, Chiba, 274-0822, Japan.
| | - Takahiro Ogura
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Shigehiro Asai
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Toru Omodani
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Tatsuya Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Ichiro Yamaura
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Hiroki Sakai
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Chikara Saito
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Akihiro Tsuchiya
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
| | - Kenji Takahashi
- Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hasama, Funabashi, Chiba, 274-0822, Japan
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13
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Marom N, Xiang W, Wolfe I, Jivanelli B, Williams RJ, Marx RG. High variability and lack of standardization in the evaluation of return to sport after ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1369-1379. [PMID: 33978778 DOI: 10.1007/s00167-021-06594-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Return to sport (RTS) after ACL reconstruction (ACLR) has been recognized as an important outcome, which is associated with success of the surgery. This study aimed to assess the methods used to determine return to sport after ACLR in the published literature, report on variability of methods and evaluate their strength in establishing accurate RTS data. METHODS Electronic databases (PubMed, Cochrane Library and Embase) were searched via a defined search strategy with no limits, to identify relevant studies from January 2008 to December 2020 for inclusion in the review. Defined eligibility criteria included studies specifically measuring and reporting on return to sport after ACLR with a clear methodology. Each included study was assessed for the definition of successful RTS, successful return to pre-injury level of sport and for methods used to determine RTS. RESULTS One hundred and seventy-one studies were included. Of the included studies, six studies (4%) were level of evidence 1 and seventy-two studies (42%) were level of evidence 4. Forty-one studies (24%) reported on return to a specific sport and 130 studies (76%) reported on return to multiple sports or general sport. Sixteen studies (9%) reported on RTS in the pediatric population, 36 (21%) in the adult population and 119 (70%) reported on a mixed-aged population. The most commonly used definition of successful RTS was return to the same sport (44 of 125 studies, 35%). The most common method used to determine RTS was a non-validated study-specific questionnaire (73 studies, 43%), which was administered in various ways to the patients. Time of RTS assessment was variable and ranged between 6 months and 27 years post-surgery. CONCLUSION This review demonstrates high variability in defining, evaluating and reporting RTS following ACLR. The findings of this study reveal low reliability and unproven validity of methods used to evaluate RTS and highlight the challenges in interpreting and using RTS data reported in literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Niv Marom
- Department of Orthopaedic Surgery, Meir Medical Center, 59 Tcharnihovsky St., 4428164, Kfar Saba, Israel. .,The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - Isabel Wolfe
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Bridget Jivanelli
- Hospital for Special Surgery, Kim Barrett Memorial Library, New York, NY, USA
| | - Riley J Williams
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Robert G Marx
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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14
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Olivares-Jabalera J, Fílter-Ruger A, Dos’Santos T, Afonso J, Della Villa F, Morente-Sánchez J, Soto-Hermoso VM, Requena B. Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13351. [PMID: 34948963 PMCID: PMC8704173 DOI: 10.3390/ijerph182413351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.
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Affiliation(s)
- Jesús Olivares-Jabalera
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
| | | | - Thomas Dos’Santos
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, All Saints Building, Manchester Campus John Dalton Building, Manchester Campus, Manchester Metropolitan University, Manchester M15 6BH, UK
- Manchester Institute of Sport 2.01, Manchester Metropolitan University, Manchester M1 7EL, UK
| | - Jose Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sports of the University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, 40132 Bologna, Italy;
| | | | - Víctor Manuel Soto-Hermoso
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
| | - Bernardo Requena
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
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15
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Patel AD, Bullock GS, Wrigley J, Paterno MV, Sell TC, Losciale JM. Does sex affect second ACL injury risk? A systematic review with meta-analysis. Br J Sports Med 2021; 55:873-882. [PMID: 34001504 DOI: 10.1136/bjsports-2020-103408] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine sex-based differences in risk of a second ACL injury (overall and by laterality) following primary ACL reconstruction in athletes who are attempting to return to sport. DESIGN Systematic review with meta-analysis. DATA SOURCES Systematic search of five databases conducted in August 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting sex-based differences in the incidence of second ACL injury in athletes attempting to return-to-sports and who were followed for at least 1 year following primary ACL reconstruction. RESULTS Nineteen studies were included in this review, with seven studies excluded from the primary meta-analysis due to high risk of bias. The remaining 12 studies (n=1431 females, n=1513 males) underwent meta-analysis, with all 19 studies included in a sensitivity analysis. Total second ACL injury risk was 21.9% (females: 22.8%, males: 20.3%). Females were found to have 10.7% risk of an ipsilateral ACL injury and 11.8% risk of a contralateral ACL injury. Males were found to have 12.0% risk of an ipsilateral ACL injury and 8.7% risk of a contralateral ACL injury. No statistically significant differences were observed for total second ACL injury risk (risk difference=-0.6%, 95% CI -4.9 to 3.7, p=0.783, I2=41%) or contralateral ACL injury risk (risk difference=1.9%, 95% CI -0.5% to 4.4%, p=0.113, I2=15%) between sexes. Females were found to have a 3.4% absolute risk reduction in subsequent ipsilateral ACL injury risk compared with males (risk difference=-3.4%, 95% CI -6.7% to -0.02%, p=0.037, I2=35%). CONCLUSION Both sexes have >20% increased risk of experiencing a second ACL injury. Any difference in the absolute risk of either a subsequent ipsilateral or contralateral ACL injury between sexes appears to be small. REGISTRATION PROSPERO (CRD42020148369).
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Affiliation(s)
- Akash D Patel
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jordan Wrigley
- Duke University Medical Center, Durham, North Carolina, USA
| | - Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Timothy C Sell
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Justin M Losciale
- Faculty of Medicine, Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada .,Arthritis Research Canada, Vancouver, British Columbia, Canada
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