The Impact of Delay to Anterior Cruciate Ligament Reconstruction on Patient-Reported Outcomes and Concurrent Knee Injuries PDF Download

Author: Danny Arora
Publisher:
ISBN:
Category :
Languages : en
Pages : 0

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Book Description
The ideal timing of anterior cruciate ligament reconstruction is debatable after ligament tear. Purpose: To investigate the effects of delay from time of injury to reconstruction, on the cost-effectiveness, the incidence of concurrent knee pathology, and the patientsâ quality of life. Methods: We performed 2 systematic reviews and 1 multicenter cohort study, looking at the effects of delay, from injury to surgery, on the cost-effectiveness, concurrent knee injuries, and on quality of life, respectively. Results: Despite substantial heterogeneity, ligament reconstruction was costeffective in each study. A significant increase in medial meniscal and cartilage pathology was found as of 3 monthsâ post-injury, at which point, a decline in quality of life was also detected, 2 years post-operatively. Conclusion: An increase in delay from time of injury to surgery can lead to an increase in cost, medial meniscal and cartilage pathology, and a potential decline of quality of life.

Author: David Scott Logerstedt
Publisher:
ISBN: 9781124883113
Category : Anterior cruciate ligament
Languages : en
Pages :

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The overall goal of this work was to identify the physical impairments, activity limitations, and self-reported outcomes after ACL injury, surgery, and rehabilitation. The development of clinical guidelines and performance standards can provide clinicians with practice patterns and benchmarks to optimize patient outcomes and address complications that may arise. By identifying the physical impairments, activity limitations, and self-reported outcomes and responses to injury, surgery, and rehabilitation, we can better predict which impairments and limitations impact patients' knee function and subsequent recovery and implement interventions to facilitate full knee recovery. Our first experimental study identified a group of individuals with knee function within normal ranges at baseline testing (n=15). Subsequently individuals who did (n=34) or did not (n=52) have a treatment response to perturbation training based on the change scores in the self-report questionnaires and the global knee function question were identified. At baseline testing, responders and nonresponders had lower self-reported outcomes scores than the knee function within normal ranges group. Responders had lower KOS-ADLS and GRS scores than nonresponders. After training, responders and nonresponders had lower self-reported outcomes scores than knee function within normal ranges group. Nonresponders had lower IKDC2000 scores than responders. The involved limb improved in all physical performance measures from baseline to post-training test. Clinicians should implement a battery of tests using performance-based and self-report outcomes to describe patients' function and maximize successful outcomes. Secondly, we prospectively followed 83 subjects after ACL injury to 12 months after ACL reconstruction. Limb-to-limb symmetries are reduced and normal limb symmetry is restored after perturbation training and returned to similar levels 6 months after reconstruction. Performance-based values on the involved limb and selfreported outcomes are sensitive to change over time and were clinically relevant improvements. Based on the current research, we suggest a rehabilitation program consisting of perturbation training and aggressive quadriceps strength pre-operatively and a systematic criteria-based post-operative program in order to restore normal limb symmetry and maximize functional recovery for patients undergoing ACL reconstruction. Additionally, of the 83 subjects we followed prospectively, 55 subjects had complete pre-operative data and IKDC2000 scores at 6 months and 52 subjects had complete pre-operative data and IKDC2000 scores at 12 months to examine the relationship of pre-operative quadriceps strength and post-operative self-reported knee function and to investigate how other pre-operative factors may influence this relationship. Pre-operative quadriceps strength can predict IKDC2000 scores 6 months after ACL reconstruction, but did not predict IKDC2000 scores 12 months after reconstruction. These results confirm the importance of good quadriceps strength prior to ACL reconstruction in predicting better knee function after surgery. Factors, such as gender, meniscal injury, pre-operative BMI, and pre-operative quadriceps activation ratio, that are known to influence quadriceps strength and self-reported outcomes do not influence the relationship between pre-operative quadriceps strength and post-operative IKDC2000 scores. Our last experimental study was to determine if one-legged hop tests conducted pre-operatively and 6 months after surgery would predict self-reported knee function 1 year after ACL reconstruction. Single hop, cross-over hop, triple hop, and 6-m timed hop limb symmetry indexes 6 months after ACL reconstruction significantly predicted self-reported knee function within normal ranges 1 year after surgery. The 6-meter timed hop was the strongest individual predictor of self-reported knee function and had the highest discriminative accuracy. Pre-operative one-legged hop test did not predict self-reported knee function within normal ranges 1 year after ACL reconstruction. A comprehensive test battery may be needed to increase the sensitivity in predicting self-reported knee function. A systematic review was performed to establish performance standards for the single hop for distance after ACL reconstruction. Thirty-two articles were included in the final analysis. Individuals had lower single hop symmetry indexes and hop distances early after surgery that improved up to 13 months after ACL reconstruction. Individuals with patella tendon-bone autografts had lower hop symmetry index and large limb-to-limb differences than other graft types between 3 and 7 months after surgery. Clinicians can use these performance-based standards to guide their expectations after ACL reconstruction and direct their interventions if a patient is not meeting pre-determined criteria to progress their rehabilitation. Two systematic reviews were performed to develop evidence-based clinical practice guidelines for patients with musculoskeletal impairments related to knee ligamentous injuries, and knee meniscal and chondral injuries based on musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). MEDLINE, CINAHL, and the Cochrane Database of Systematic Reviews (1966 through January 2009) were systematically reviewed for any relevant articles related to classification, outcome measures, and intervention strategies for ligament injuries and instabilities of the knee, and meniscal and chondral injuries of the knee. When relevant articles were identified their reference lists were hand-searched in an attempt to identify other articles that might have contributed to the outcome of clinical practice guidelines. Recommendations were made regarding clinical course, risk factors, diagnosis and classification, differential diagnosis, examination, and interventions. Individual clinical research articles were graded and the overall strength of the evidence supporting the recommendations made in these guidelines were also graded.

Author: Anne Fältström
Publisher: Linköping University Electronic Press
ISBN: 9176857360
Category : Anterior cruciate ligament
Languages : en
Pages : 109

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Background: Anterior cruciate ligament (ACL) injury is a severe and common injury, and females have 2-4 times higher injury risk compared to men. Return to sport (RTS) is a common goal after an ACL reconstruction (ACLR), but only about two thirds of patients RTS. Young patients who RTS may have a 30-40 times increased risk of sustaining an additional ACL injury to the ipsi- or contralateral knee compared with an uninjured person. Aims: The overall aim of this thesis was to increase the knowledge about female football players with ACLR, and patients with bilateral ACL injuries, and to identify predictors for additional ipsi- and/or contralateral ACLR. Methods: This thesis comprises four studies. Study I and II were cross-sectional, including females who sustained a primary ACL rupture while playing football and underwent ACLR 6–36 months prior to study inclusion. In study I, 182 females were included at a median of 18 months (IQR 13) after ACLR. All players completed a battery of questionnaires. Ninety-four players (52%) returned to football and were playing at the time of completing the questionnaires, and 88 (48%) had not returned. In study II, 77 of the 94 active female football players (from study I) with an ACLR and 77 kneehealthy female football players were included. A battery of tests was used to assess postural control (the Star excursion balance test) and hop performance (the one-leg hop for distance, the five jump test and the side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using two-dimensional analyses. Study III, was a cohort study including all patients with a primary ACLR (n=22,429) registered in the Swedish national ACL register between January 2005 and February 2013. Data extracted from the register to identify predictors for additional ACLR were: patient age at primary ACLR, sex, activity performed at the time of ACL injury, primary injury to the right- or left knee, time between injury and primary ACLR, presence of any concomitant injuries, graft type, Knee injury and Osteoarthritis Outcome Score and Euroqol Index Five Dimensions measured pre-operatively. Study IV was cross-sectional. In this study, patient-reported knee function, quality of life and activity level in 66 patients with bilateral ACL injuries was investigated and outcomes were compared with 182 patients with unilateral ACLR. Results: Factors associated with returning to football in females were; short time between injury and ACLR (0–3 months, OR 5.6; 3–12 months OR 4.7 vs. reference group >12 months) and high motivation (study I). In all functional tests, the reconstructed and uninvolved limbs did not differ, and players with ACLR and controls differed only minimally. Nine to 49% of the players with ACLR and controls had side-to-side differences and movement asymmetries and only one fifth had results that met the recommended guidelines for successful outcome on all the different tests (study II). Main predictors for revision and contralateral ACLR were younger age (fourfold increased rate for <16 vs. >35-year-old patients), having ACLR early after the primary injury (two to threefold increased rate for ACLR within 3 months vs. >12 months), and incurring the primary injury while playing football (study III). Patients with bilateral ACL injuries reported poorer knee function and quality of life compared to those who had undergone unilateral ACLR. They had a high activity level before their first and second ACL injuries but an impaired activity level at follow-up after their second injury (study IV). Conclusions: Female football players who returned to football after an ACLR had high motivation and had undergone ACLR within one year after injury. Players with ACLR had similar functional performance to healthy controls. Movement asymmetries, which in previous studies have been associated with increased risk for primary and secondary ACL injury, occurred to a high degree in both groups. The rate of additional ACLR seemed to be increased in a selected group of young patients who desire to return to strenuous sports like football quickly after primary ACLR. Sustaining a contralateral ACL injury led to impaired knee function and activity level.

Author: Dale M. Daniel
Publisher: Lippincott Williams & Wilkins
ISBN:
Category : Medical
Languages : fa
Pages : 584

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Author: Frank R. Noyes
Publisher: Springer Nature
ISBN: 3030223612
Category : Medical
Languages : en
Pages : 709

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Book Description
The wealth of information provided in this unique text will enable orthopedic surgeons, medical practitioners, physical therapists, and trainers to ensure that athletes who suffer anterior cruciate ligament (ACL) injuries, or who require major knee operations for other reasons, have the best possible chance of safely resuming sporting activity at their desired level without subsequent problems. Divided into seven thematic sections, the coverage is wide-ranging and encompasses common barriers to return to sport, return to sport decision-based models, and the complete spectrum of optimal treatment for ACL injuries, including preoperative and postoperative rehabilitation. Advanced training concepts are explained in detail, with description of sports-specific programs for soccer, basketball, and tennis. Readers will find detailed guidance on objective testing for muscle strength, neuromuscular function, neurocognitive function, and cardiovascular fitness, as well as validated assessments to identify and manage psychological issues. In addition, return to sport considerations after meniscus surgery, patellofemoral realignment, articular cartilage procedures, and knee arthroplasty are discussed. Generously illustrated and heavily referenced, Return to Sport after ACL Reconstruction and Other Knee Operations is a comprehensive resource for all medical professionals and support staff working with athletes and active patients looking to get back in the game with confidence.

Author: Jenna Goodwin
Publisher:
ISBN: 9781634845960
Category : Medical
Languages : en
Pages : 110

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Book Description
Injury to the anterior cruciate ligament (ACL) is common and typically affects young individuals; in particular, girls have higher rates of sustaining non-contact ACL injuries than boys when they engage in sports that involve jumping, pivoting, and changing direction. Multiple intrinsic and extrinsic risk factors for ACL injury have been identified, including anatomic variations, neuromuscular deficits, hormonal status and other related factors. Despite a lack of scientifically validated and published guidelines to help clinicians decide between conservative and surgical treatment, patient-specific criteria, such as age, pain, recurrent joint instability, desired level of activity, occupation and presence of potential concomitant injuries, should be considered. Neuromuscular training can reduce the risk of ACL injury, especially when combined with other strength training exercises. Chapter One in this book outlines the current state of knowledge regarding the risk factors, treatment and prevention of ACL injuries. Chapter Two provides is a better understanding of what associated factors are identified following ACL tear and explore the current understanding of the impact these have on treatment and subsequent outcome. The final chapter discusses surgical and rehabilitation concepts of matrix-induced autologous chondrocyte implantation in the treatment of knee articular cartilage defects.

Author: Michael J. Alaia
Publisher: Springer Nature
ISBN: 3030969967
Category : Medical
Languages : en
Pages : 371

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Anterior cruciate ligament reconstruction is one of the most common procedures performed in sports medicine centers. However, these procedures can carry a long-term failure rate as high as 5-15%%, and when these procedures fail, revision is significantly more complex. Considerable factors need to be assessed in patients that are indicated for surgery, as revisions carry a higher failure rate and potentially less optimal outcomes and return to sport and activity. These factors include, but are not limited to, the status of the meniscus, overall alignment, graft options, placement of prior implants or tunnels, collateral ligament quality, and whether or not the revision must be staged into two procedures. This text provides a comprehensive, case-based presentation of the most efficient and practical treatment algorithms for patients in need of revision ACL repair and reconstruction. Opening chapters discuss the initial patient work-up, radiography, surgical indications, graft options, and pre-operative considerations and preparations. The main portion of the book then describes both common factors leading to revision surgery as well as the surgical techniques themselves, illustrated via plentiful operative photos and vivid clinical case material. The management of osteolysis, ligamentous laxity, extra-articular tenodesis, plane correction, and meniscus deficiency, among others, are discussed in detail. Special populations, such as the pediatric patient, the elite athlete and the female athlete, are discussed as well. Shedding light on this challenging surgical repair, Revision Anterior Cruciate Ligament Reconstruction is the go-to resource for sports medicine and orthopedic surgeons, knee specialists and residents and fellows in these areas.

Author: Mathew Failla
Publisher:
ISBN: 9781369351613
Category : Anterior cruciate ligament
Languages : en
Pages : 142

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Book Description
Anterior cruciate ligament (ACL) injury is a transformative and demoralizing knee injury commonly affecting athletes who participate in activities where jumping, cutting, and pivoting maneuvers are frequently used. Emerging outcomes research suggests recovery after ACL injury is more vexed than previously thought. Many athletes continue to experience less than normal knee function despite modern advances in arthroscopic surgical technology, various graft options, and the development of rehabilitation standards. Merely reconstructing the ligamentous tear does not guarantee return to previous level of function, return to previous activity or activity level, and does not prevent post-traumatic osteoarthritis development. While factors such as age, sex, body mass index (BMI), graft type, concomitant injury, and surgical variables are associated with altered outcomes; these factors are non-modifiable to rehabilitation professionals. Establishing modifiable factors associated with outcomes after ACL injury and ACLR can lead to the potential to impact standards of care and rehabilitation protocols to impede poor outcomes in the future. Pre-operative rehabilitation has been shown to lead to improved outcomes following ACLR. The addition of pre-operative milestones prior to undergoing ACLR have been used to reduce negative outcomes, such as arthrofibrosis and quadriceps strength weakness. The purpose of this work is to examine the effects of pre-operative rehabilitation on improving outcomes 2 years after ACLR, examining pre- and early post-operative modifiable factors that are related to 2 year outcomes, and explore second injury rates and predictors in a cohort that underwent extended pre-operative rehabilitation. Athletes with ACL injury who underwent ACLR served as subjects for this work. Athletes completed demographic, clinical, functional, and patient-reported outcome measures before and after an extended program of pre-operative rehabilitation. Subjects returned at 6 months and 24 months after reconstruction for follow-up testing. Second injury rates and successful or unsuccessful outcomes assessment was completed at 2 year follow-up. The addition of extended pre-operative training was associated with higher functional outcome scores at 2 years after reconstruction. Besides improving outcomes, waiting until completion of the extended pre-operative rehabilitation to perform a screening battery resulted in a more robust prediction of function 2 years after ACLR. Clinical and functional measures that are modifiable to rehabilitation specialists successfully predicted 2 year function as well as successful or unsuccessful outcome following ACLR. The benefits of additional rehabilitation and higher standards are evident throughout this work. Raising the bar of pre-operative strength, functional performance, and patient-reported outcome scores was associated with higher functional scores 2 years after ACLR. This highlights the importance of achieving higher clinical and functional standards before undergoing ACLR. In addition, the need to achieve higher standards of function early after ACLR features the importance of progressive post-operative protocols and utilizing objective measures to identify those at increased risk of poorer outcomes or second ACL injury. No matter the time-point, success was associated with higher clinical and functional outcomes further perpetuating the importance of rehabilitation in improving outcomes.

Author: Norimasa Nakamura
Publisher: Springer
ISBN: 3662527421
Category : Medical
Languages : en
Pages : 520

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This book provides the reader with the best available evidence on the most pressing issues relating to reconstruction of the anterior cruciate ligament (ACL) with the goal of supporting surgical reconstruction of the ACL and improving outcomes for patients. Key topics for which evidence-based information is presented include selection of graft material and source, the use of different surgical techniques, graft rupture in relation to surgical technique, and progression to osteoarthritis. The book will aid the surgeon in making decisions with respect to fixation devices and tensioning, the bundles to be reconstructed, and whether to preserve remnants or partial bundle ruptures. An evidence-based stance is taken on evolving topics such as the anatomy of the tibial insertion site of the ACL and the role of the anterolateral capsule and posteromedial corner in high-grade rotatory instability. Furthermore, novel technical developments for measurement of knee laxity and soft tissue navigation are discussed. The reader will also find useful information on general issues concerning physical examination, arthroscopic setup, timing of reconstruction, anesthesia, and anticoagulation.

Author: Waleed F. Manzour
Publisher:
ISBN:
Category : Anterior cruciate ligament
Languages : en
Pages : 400

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Book Description
Isolated injury of the anterior cruciate ligament (ACL) is less frequent and typically perceived as less severe than ACL injuries with concurrent damage to other knee stabilizing structures. The timing of the ACL reconstructive surgery is thought to be a critical factor that affects the patient's postoperative outcome. No previous study has compared the results of acute reconstruction (interval between injury and surgery less than or equal to 3 months) and chronic reconstruction (interval between injury and surgery greater than 3 months) of isolated ruptures of the ACL. The primary aim of this study was to assess the differences in functional outcomes between two distinct patient populations treated using the same surgical intervention. The secondary aim of this study was to determine which functional outcome variables differed between the acute isolated and chronic isolated patient populations in order to identify the etiology of any long-term functional impairment. Two separate investigations were conducted to address these questions. The first study evaluated the efficacy of an arthroscopic-assisted surgical technique using an autogenous substitute for the ACL in a group of patients who had surgery more than 3 months after isolated injury to their ACL. Fifty-five patients from Cairo, Egypt (mean age, 27.1 ± 4.5 years) underwent ACL reconstruction an average of 7.0 ± 2.6 months (range, 3.3 to 16.6 months) after injury. Patients were evaluated at an average of 2.2 ± .3 years postoperatively (range, 2.0 to 3.4 years) using a battery of objective and subjective tests. No significant differences were observed between the patients' surgical and contralateral normal knees (p>.05). International Knee Documentation Committee (IKDC) scores questionnaire rated 48 of 55 patients (87.3%) as "normal", 5 patients (9.1%) as "nearly normal" and 2 patients (3.6%) as "abnormal"; no patients were categorized as "severely abnormal". The second investigation evaluated the effect of timing of surgery on functional outcomes. From a group of 773 arthroscopic-assisted ACL reconstruction patients in Cairo, Egypt, 200 of 234 patients (mean age, 32.2 ± 6.9 yrs.) with isolated ACL injuries participated in this study. Subjects were assigned to groups based on the interval between ACL injury and surgery. Patients in the acute reconstruction group (n=100) had surgery an average of 62 days postinjury, while the chronic reconstruction group (n=100) had surgery an average of 211 days postinjury. The mean follow-up period was 2.2 ± 0.3 years (range, 2.0 to 3.8 years) for all subjects. There were statistically significant differences between the acute and chronic group in the final score (x2 2=6.43 with p=0.04). IKDC scores rated 62% of the acute and 58% of chronic group patients as "normal", 37% of acute and 38% of chronic group patients as "near normal", and 1% of acute and 4% of chronic group knees as "abnormal". Delaying the ACL reconstruction to allow for reduction of the acute inflammatory process and participation in pre-operative rehabilitation resulted in fewer cases of postoperative arthrofibrosis in the chronic group compared to the acute group. However, delays of surgery more than 3 months between isolated injury of the ACL and surgical reconstruction resulted in greater frequency of arthritic changes.