Younger age and greater preoperative function predict compliance with 2-year follow-up visits after ACL reconstruction: an analysis of the PIVOT multicentre trial

2018 ◽  
Vol 3 (5) ◽  
pp. 251-257 ◽  
Author(s):  
Jayson Lian ◽  
João Victor Novaretti ◽  
Neel K Patel ◽  
Adam C Popchak ◽  
Ryosuke Kuroda ◽  
...  
Keyword(s):  
Rating Scale ◽  
Cruciate Ligament ◽  
Univariate Analysis ◽  
International Knee Documentation Committee ◽  
Activity Level ◽  
Level Of Evidence ◽  
Younger Age ◽  
Patient Reported ◽  
The Usa

ObjectivesThe purpose of this investigation was to identify clinical and demographic variables that may predict compliance, defined as patient follow-up at 1-year and 2-year postoperative appointments, after anterior cruciate ligament reconstruction (ACLR).MethodsA total of 107 patients undergoing primary ACLR across four centres were prospectively followed for 2 years. Demographic and clinical data were recorded preoperatively and postoperatively, including patient-reported outcomes such as the Marx Activity Rating Scale, Cincinnati Occupational Rating Scale (CORS), International Knee Documentation Committee Subjective Knee Evaluation Form and Activities of Daily Living Scale (ADLS). Compliance was retrospectively defined using the presence or lack of outcome measures at 1-year and 2-year postoperative visits. Univariate analysis was done to compare demographic and clinical variables between compliant and non-compliant patients at 1-year and 2-year follow-up. Significant variables were entered into a logistic regression model. Significance was set at p<0.05.ResultsThe overall rate of compliance at 1-year and 2-year postoperative appointments was 83.2% (89/107) and 57.0% (61/107), respectively. Regression analysis showed that residence in Kobe, Japan compared with Pittsburgh, USA (OR 10.28; 95% CI 1.0003 to 105.28), and ‘very strenuous’ (OR 16.74; 95% CI 3.21 to 87.43) and ‘strenuous’ (OR 18.78; 95% CI 2.01 to 175.78) preinjury activity level were independent factors associated with compliance at 1-year follow-up. At 2 years follow-up, younger age (OR 0.95; 95% CI 0.91 to 0.997), and greater preoperative score on CORS (OR 1.03; 95% CI 1.01 to 1.06) and on ADLS (OR 1.04; 95% CI 1.01 to 1.07) were independently associated with compliance.ConclusionWhile patients with greater level of strenuous activity were more likely to follow-up after ACL surgery at 1 year, patients who were younger and had higher preoperative function measured by CORS and ADLS were more likely to follow-up at 2 years. Differences in follow-up rates among the USA, Italy, Sweden and Japan may highlight important cultural, socioeconomic and infrastructural differences across international healthcare systems. Orthopaedic surgeons may consider the results of this study during preoperative discussion with their patients and design of future ACL clinical research trials.Level of evidenceLevel III, prospective cohort.

scholarly journals Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament—Clinical Results after a Long-Term Follow-Up

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 075-079 ◽  
Author(s):  
Paolo Parchi ◽  
Gianluca Ciapini ◽  
Carlo Paglialunga ◽  
Michele Giuntoli ◽  
Carmine Picece ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Rating Scale ◽  
Cruciate Ligament ◽  
Case Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Purpose The aim of this retrospective study was to evaluate the subjective and functional outcome of anterior cruciate ligament (ACL) reconstruction with the synthetic Ligament Advanced Reinforcement System (LARS) ligament. Methods Twenty-six patients were reviewed at an average follow-up of 11.6 years. Objective clinical evaluation was performed with stability tests. Patient-reported outcomes (Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score, and Cincinnati Knee Rating Scale) were used to assess subjective and functional outcomes. Results Overall satisfactory results were obtained in 22 cases (84.6%). Four patients (15.4%) showed mechanical failure of the graft. No cases of synovitis or infection were reported. Conclusion LARS ligament can be considered a safe and suitable option for ACL reconstruction in carefully selected cases, especially elderly patients needing a rapid postoperative recovery. Level of Evidence Level IV, retrospective case series.

Differences in Baseline Characteristics and Outcome Among Responders, Late Responders, and Never-Responders After Anterior Cruciate Ligament Reconstruction

2021 ◽  
pp. 036354652110478
Author(s):  
Per-Henrik Randsborg ◽  
Dakota Adamec ◽  
Nicholas A. Cepeda ◽  
Andrew Pearle ◽  
Anil Ranawat
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Patient Characteristics ◽  
International Knee Documentation Committee ◽  
Patient Reported Outcome Measures ◽  
Return To Sports ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Anterior Cruciate

Background: Loss to follow-up in registry studies might affect generalizability and interpretation of results. Purpose: To evaluate the effect of nonresponder bias in our anterior cruciate ligament (ACL) registry. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 2042 patients with ACL reconstruction in the Hospital for Special Surgery ACL Registry between 2009 and 2013 were included in the study. Patients who completed the patient-reported outcome measures at 2 or 5 years were considered responders (n = 808). Baseline data and patient characteristics were compared between responders and nonresponders (n = 1234). Both responders and nonresponders were contacted and invited to complete the International Knee Documentation Committee (IKDC) and Marx scores electronically and respond to questions regarding return to sports and subsequent surgeries. Nonresponders who completed the questionnaires after reminders were considered late responders. The remaining nonresponders were considered never-responders. The late responders (n = 367) completed the questionnaires after a mean follow-up of 7.8 years (range, 6.7-9.6 years), while follow-up for the responders was 6.8 years (range, 5.0-9.7 years). Responders and late responders were then compared in terms of differences in IKDC and Marx scores from baseline to final follow-up. Results: Nonresponders were younger (28.5 vs 31.5 years; P < .001) and more often male (60% vs 53%; P = .003) compared with responders. Responders had a higher level of education and were more likely to be White (79% vs 74%; P = .04). There were no substantial differences in patient characteristics or baseline IKDC and Marx scores between the late responders and never-responders. There were no statistically significant differences in patient-reported outcomes, return to sports, or subsequent surgeries between responders and late responders at a mean follow-up time of 8.8 years (range, 6.7-9.7 years). Repeat email reminders and telephone calls increased response rate by 18% (from 40% to 58%). Conclusion: There was no difference in clinical outcome as evaluated using IKDC and Marx scores between responders and late responders.

Midterm Outcomes following Acute Repair of Grade III Distal MCL Avulsions in Multiligamentous Knee Injuries

2019 ◽  
Vol 33 (08) ◽  
pp. 785-791 ◽  
Author(s):  
Vishal S. Desai ◽  
Isabella T. Wu ◽  
Christopher L. Camp ◽  
Bruce A. Levy ◽  
Michael J. Stuart ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
International Knee Documentation Committee ◽  
Activity Score ◽  
Patient Reported ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Grade Iii

AbstractThere is limited evidence guiding management of medial collateral ligament (MCL) avulsions or functional disruptions distal to the medial joint line. This study aims to determine outcomes of a series of patients with grade III distal MCL injuries managed with acute surgical repair. Patients with grade III, distal MCL injuries, with or without multiligament involvement were identified. Demographic, clinical examination, and midterm patient-reported outcomes (PRO) data were collected. Clinical follow-up included physical examination and ligamentous stress testing at a minimum of 6 months. PROs included Lysholm's knee scoring scale, Tegner's activity score, and subjective International Knee Documentation Committee (IKDC) scores at minimum of 2 years follow-up. Of the 24 eligible patients, outcomes data were available for 20 (83%). Of the 20 included patients, 16 had a concomitant anterior cruciate ligament (ACL) injury, 3 had ACL and posterior cruciate ligament (PCL) injuries, and 1 had an isolated MCL injury. Mean time from injury to surgery was 5 weeks. At mean clinical follow-up of 20.3 months, all patients showed valgus stability and satisfactory range of motion (ROM). Anteroposterior stability was normal in all but one patient who demonstrated a 2+ posterior drawer but with firm end points. At a mean follow-up of 5.7 years for PROs, mean Lysholm's score was 91.5 (standard deviation [SD] = 12.2), median Tegner's activity score was 7 (range, 4–9), and mean subjective IKDC score was 88.8 (SD: 9.9). The surgical repair of grade III distal MCL injuries delivered satisfactory clinical and functional outcomes. Future comparative studies with larger patient samples are needed.

The Clinically Important Difference and Patient Acceptable Symptomatic State for Commonly Used Patient-Reported Outcomes After Knee Cartilage Repair

2020 ◽  
Vol 49 (1) ◽  
pp. 193-199
Author(s):  
Jaskarndip Chahal ◽  
Drew A. Lansdown ◽  
Annabelle Davey ◽  
Aileen M. Davis ◽  
Brian J. Cole
Keyword(s):  
Characteristic Curve ◽  
International Knee Documentation Committee ◽  
Baseline Score ◽  
Limited Information ◽  
Knee Cartilage ◽  
Level Of Evidence ◽  
Clinically Important Difference ◽  
Younger Age ◽  
Cartilage Restoration ◽  
Patient Reported

Background: In patients undergoing cartilage restoration of the knee, limited information is available regarding clinically important difference (CID) and Patient Acceptable Symptomatic State (PASS) estimates for commonly used patient-reported outcome measures (PROMs). Purpose: The objective of this study was to determine the CID and PASS in the population with knee cartilage restoration for the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC) score, and the Lysholm score. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Between 2012 and 2017, patients who underwent a cartilage restoration procedure were prospectively enrolled. Patients completed the KOOS, IKDC, and Lysholm, all of which were scored from 0 to 100, and completed relevant anchor questions at baseline and 1 year postoperatively. Receiver operating characteristic curve analyses were conducted to determine CID and PASS cutoff points. Multivariable regression analyses were performed to determine the effect of age, sex, and baseline score on likelihood of achieving CID and PASS. Results: Of the 113 patients enrolled, 53 (47%) were male, and the mean age was 36 years. The CID values for the PROMs were 10.7 for KOOS Symptoms, 8.3 for KOOS Pain, 8.8 for KOOS Activities of Daily Living (ADL), 30.0 for KOOS Sports and Recreation, 18.8 for KOOS Quality of Life (QOL), 9.2 for IKDC, and 13.0 for Lysholm. The PASS values were 71.5 for KOOS Symptoms, 72.2 for KOOS Pain, 86.8 for KOOS ADL, 43.8 for KOOS Sports and Recreation, 50.0 for KOOS QOL, 62.1 for IKDC, and 70.0 for Lysholm. Patients with higher baseline scores were more likely to achieve PASS for the IKDC (odds ratio, 2.28; P = .03). Baseline score did not have an effect on the likelihood of achieving CID. Younger age was an independent predictor of achieving PASS and CID across all outcomes ( P < .05), but sex did not have such an effect. Conclusion: This study determined CID and PASS values for the KOOS, IKDC, and Lysholm scores among patients treated with knee cartilage restoration. Younger age was a positive prognostic variable, and higher baseline scores implied achieving PASS for the IKDC. The information in this study can be used in designing randomized controlled trials, counseling individual patients as to anticipated outcomes, and conducting responder analyses when evaluating new cartilage technology from a regulatory perspective.

scholarly journals Double-Layered Quadriceps Tendon Autografts Provide Lower Failure Rates and Improved Clinical Results Compared With Hamstring Tendon Grafts in Revision ACL Reconstruction

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110469
Author(s):  
Lena Eggeling ◽  
Stefan Breer ◽  
Tobias Claus Drenck ◽  
Karl-Heinz Frosch ◽  
Ralph Akoto
Keyword(s):  
Cruciate Ligament ◽  
Case Series ◽  
Quadriceps Tendon ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Failure Rates ◽  
Level Of Evidence ◽  
Quadriceps Tendon Graft ◽  
Patient Reported

Background: We developed a quadriceps-tendon graft technique using a double-layered, partial-thickness, soft tissue quadriceps tendon graft (dlQUAD) for anterior cruciate ligament reconstruction (ACLR). This technique allows simple femoral loop button fixation and a limited harvest depth of the quadriceps tendon. Purpose: To evaluate the outcome of patients undergoing revision ACLR using the dlQUAD technique compared with a hamstring tendon graft (HT). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 114 patients who underwent revision ACLR between 2017 and 2018 were included in this retrospective case series. At a mean follow-up of 26.9 ± 3.7 months (range, 24-36), 89 patients (dlQUAD: n = 43, HT: n = 46) were clinically examined. In addition, patients completed the Lysholm score, Tegner activity scale, subjective International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score, and visual analog scale (VAS) for pain. Postoperative failure of the revision ACLR was defined as a side-to-side difference (SSD) in Rolimeter testing ≥5 mm or a pivot-shift grade of 2 or 3. Results: Nine patients (10.1%) were identified with a failed revision ACLR. There was a significantly lower failure rate with dlQUAD versus the HT group (2.3% vs 17.4%; P = .031). The mean postoperative SSD was significantly less in the dlQUAD group (1.3 ± 1.3 mm [range, 0-5] vs 1.8 ± 2.2 mm [range, 0-9]; P = .043). At the latest follow-up, Tegner and IKDC scores significantly improved in the dlQUAD group compared with the HT group (Tegner: 5.8 ± 1.8 vs 5.6 ± 1.5; P = .043; IKDC: 83.8 ± 12.2 vs 78.6 ± 16.8; P = .037). The pain VAS score was also significantly reduced in the dlQUAD group compared with the HT group (0.9 ± 1.1 vs 1.6 ± 2.0; P = .014). Conclusion: The dlQUAD and HT techniques both demonstrated significant improvement of preoperative knee laxity and satisfactory patient-reported outcome measures after revision ACLR. Compared with the HT grafts, the dlQUAD technique showed lower failure rates and small increases in Tegner and IKDC scores.

scholarly journals Comparison of Weightbearing and Nonweightbearing Juvenile Osteochondritis Dissecans Lesions of the Lateral Femoral Condyle

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110269
Author(s):  
Liang Zhou ◽  
Shawn M. Gee ◽  
Philip L. Wilson ◽  
Sharon Huang ◽  
K. John Wagner ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
International Knee Documentation Committee ◽  
Lateral Femoral Condyle ◽  
Consecutive Series ◽  
Level Of Evidence ◽  
Juvenile Osteochondritis Dissecans ◽  
Patient Reported ◽  
Mri Scans

Background: Repetitive microtrauma may contribute to osteochondritis dissecans (OCD) lesions of the femoral condyle. The effect of differential loading between OCD weightbearing (WB) zones has not been studied. Purpose: To determine whether clinical and radiographic variables differ by WB zone in lateral femoral condyle OCD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed a consecutive series of patients aged <18 years with lateral femoral condyle OCD lesions presenting at a single institution between 2004 and 2018. Patients with OCD lesions outside of the lateral femoral condyle were excluded. Lesions were localized on radiographs using the Cahill and Berg classification, referencing the Blumensaat line and an extension of the posterior femoral cortex. Progeny bone characteristics evaluated at baseline and 24-month follow-up included ossification, distinct borders from parent bone, and displacement. Baseline lesion dimensions were measured on magnetic resonance imaging (MRI) scans. We evaluated posttreatment pain level, return-to-activity rate, and patient-reported outcome measures (PROMs) including the Pediatric International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Pediatric Functional Activity Brief Scale. Results: A total of 62 lateral femoral condyle OCD lesions (mean follow-up, 24.1 months) presented within the study period: 26 WB lesions and 36 nonweightbearing (NWB) lesions. At presentation, no differences between the lesion types were observed in symptom chronicity or symptomatology. NWB lesions were deeper on MRI scans (sagittal depth, 7.11 vs 5.96 mm; P = .046; coronal depth ratio, 0.05 vs 0.01 mm; P = .003), were more likely to develop progeny bone (69.4% vs 44%; P = .047), and demonstrated higher radiographic healing rates (52.8% vs 24%; P = .025) compared with WB lesions. PROMs at follow-up were available for 25 of 62 patients (40.3%), with no statistically significant differences between cohorts at any time. Return to full activity was observed in 72% of WB and 82.1% of NWB lesions ( P = .378). Conclusion: Lateral femoral condyle OCD lesions of the knee in WB and NWB zones presented similarly at initial evaluation; however, NWB lesions demonstrated higher rates of progeny bone formation and radiographic healing at mean 2-year follow-up.

scholarly journals An electronic patient-reported outcomes measurement system in paediatric orthopaedics

2019 ◽  
Vol 13 (4) ◽  
pp. 431-437 ◽  
Author(s):  
M. J. Sabatino ◽  
C. V. Gans ◽  
A. J. Zynda ◽  
J. S. Chung ◽  
S. M. Miller ◽  
...  
Keyword(s):  
International Knee Documentation Committee ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Activity Level ◽  
Level Of Evidence ◽  
Assess Patient Satisfaction ◽  
Patient Reported ◽  
Group 2 ◽  
Level Scale ◽  
Tegner Activity Level

Purpose The purpose of the study was to evaluate the reliability, review differences and assess patient satisfaction of electronic patient-reported outcome measures (PROMs) compared with paper PROMs. Methods Participants between 12 and 19 years of age with a knee-related primary complaint were randomized into two groups. Group 1 completed paper PROMs followed by electronic, while Group 2 received the electronic followed by paper. PROMs included the Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Tegner Activity Level Scale, Visual Analogue Scale (VAS), PedsQL Teen and a satisfaction survey. Results In all, 87 participants were enrolled with one excluded due to incomplete PROMs. Of the 86 participants, 54 were female and 32 were male with an average age of 14.3 years (12 to 18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC (0.946; p < 0.001), HSS Pedi-FABS (0.923; p < 0.001), PedsQL Teen (0.894; p < 0.001), Tegner Activity Level Scale before injury (0.848; p < 0.001) and the Tegner Activity Level Scale after (0.930; p < 0.001). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 versus 4.6; p < 0.001). While not significant, a trend was noted in which electronic PROMs took, overall, less time than paper (10.0 mins versus 11.2 mins; p = 0.096). Of all participants, 69.8% preferred the electronic PROMs, 67.4% felt they were faster, 93.0% stated they would complete forms at home prior to appointments and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion PROMs captured electronically were reliable when compared with paper. Electronic PROMs may be quicker, will not require manual scoring and are preferred by patients. Level of Evidence II

scholarly journals Delaying ACL Reconstruction Beyond 6 months from Injury Impacts Likelihood for Clinically Significant Outcome Improvement

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0036
Author(s):  
Yining Lu ◽  
Bhavik Patel ◽  
Benedict Nwachukwu ◽  
Alexander Beletsky ◽  
Avinesh Agarwalla ◽  
...  
Keyword(s):  
Negative Impact ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Event Analysis ◽  
Delayed Surgery ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Clinically Significant ◽  
Time From Injury

Objectives: A growing number of investigations have demonstrated the negative impact of delaying treatment on clinical and radiographic outcomes in orthopedic surgery. However, the effect of delayed surgery on patient-reported outcomes (PROs) in those undergoing anterior cruciate ligament reconstruction (ACLR) remains unknown. The purpose of this study was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of delay to surgery. Methods: A retrospective cohort study was performed to identify all patients undergoing primary ACLR between January 2017 and January 2018, with a minimum follow-up of one year. Patient demographics, comorbid medical conditions, and outcome scores on the International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcomes (KOOS) Score were compared between patients with greater than six months from time of injury to ACLR and those with less than six months. CSOs were defined using minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB). Multivariate logistic regression was performed to produce odd ratios (OR) for outcome achievement and Weibull parametric survival analysis was performed to produce hazard ratios (HR) for relative time to outcome achievement. CSOs and time to CSOs at 1- and 2-year follow-ups were compared. Results: A total of 416 patients were included, with an average age of 34.7±14.4 years; 154 (37%) patients sustained ACL injury greater than six months prior to surgery. On multivariate analysis, these patients had significantly reduced likelihood to achieve the SCB on the KOOS Sport (OR: 0.2, 95% CI: 0.05-0.98, P = 0.04), PASS on the IKDC (OR: 0.58, 95% CI: 0.40-0.82, P = 0.03) and KOOS Pain (OR: 0.68, 95% CI: 0.49-0.93, P = 0.002) , as well as greater likelihood to undergo revision ACLR (OR: 8.99, 2.28-30.36, P < 0.001) at 1-year follow-up. At 2-years follow-up, patients with greater than 6 months of time from injury to ACLR> 6 months similarly experienced significantly reduced likelihood to achieve the PASS on the IKDC (OR: 0.15, 95% CI: 0.05-0.43, P < 0.001), KOOS Sport (OR: 0.38, 95% CI: 0.16-0.85, P = 0.02), KOOS Pain (OR: 0.31, 95% CI: 0.13-0.68, P = 0.012), KOOS Symptoms (OR: 0.32, 95% CI: 0.14-0.69, P = 0.004), KOOS activities of daily living (ADL) (OR: 0.05, 95% CI: 0.00-0.85, P = 0.04), and a greater likelihood to undergo revision ACLR (OR: 8.34, 95% CI: 3.51-11.4, P = 0.001). Finally, patients with delayed ACLR experienced delayed achievement of multiple CSOs on time-to-event analysis (HR: 1.55-6.48). No impact of surgical timing on achievement of the MCID was observed. Conclusion: Patients with greater than 6 months from time of injury to ACLR reported inferior PROM scores, reduced likelihood to achieve CSOs, and increased rates of revision surgery at 1-year and 2-years follow-up. These patients also reported significantly delayed achievement of CSOs. This information should be offered during preoperative counseling to illustrate the potential risk of delayed surgery in active patients with acute ACL rupture. [Table: see text][Table: see text][Table: see text]

Anterior Cruciate Ligament Reconstruction versus Nonoperative Treatment: Better Function and Less Secondary Meniscectomies But No Difference in Knee Osteoarthritis—A Meta-Analysis

Cartilage ◽  
2021 ◽  
Vol 13 (1_suppl) ◽  
pp. 1658S-1670S
Author(s):  
Marco Cuzzolin ◽  
Davide Previtali ◽  
Stefano Zaffagnini ◽  
Luca Deabate ◽  
Christian Candrian ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Level Of Evidence ◽  
Knee Oa ◽  
Anterior Cruciate ◽  
The Impact

Objectives The impact of anterior cruciate ligament (ACL) reconstruction on knee osteoarthritis (OA) is still unclear. The aim of the current meta-analysis was to compare surgical treatment versus nonoperative management of ACL tears to assess the impact of these approaches on knee OA development at a 5 and 10 years of follow-up. Design A meta-analysis was performed after a systematic literature search (May 2021) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Both randomized and nonrandomized comparative studies with more than 5 years of follow-up were selected. Influence of the treatment was assessed in terms of knee OA development, subjective and objective clinical results, activity level, and risk of further surgeries. Risk of bias and quality of evidence were assessed following the Cochrane guidelines. Results Twelve studies matched the inclusion criteria, for a total of 1,004 patients. Level of evidence was rated low to very low. No difference was documented in terms of knee OA development, Tegner score, subjective International Knee Documentation Committee (IKDC), and Lysholm scores. A significant difference favoring the surgical treatment in comparison with a nonsurgical approach was observed in terms of objective IKDC score ( P = 0.03) and risk of secondary meniscectomy ( P < 0.0001). The level of evidence was considered very low for subjective IKDC, low for knee OA development, objective IKDC, number of secondary meniscectomies, and Lysholm score, and moderate for post-op Tegner score. Conclusions The meta-analysis did not support an advantage of ACL reconstruction in terms of OA prevention in comparison with a nonoperative treatment. Moreover, no differences were reported for subjective results and activity level at 5 and 10 years of follow-up. On the contrary, patients who underwent surgical treatment of their ACL tear presented important clinical findings in terms of better objective knee function and a lower rate of secondary meniscectomies when compared with conservatively managed patents. Protocol Registration: CRD420191156483 (PROSPERO)

scholarly journals Efficacy of Fresh Osteochondral Allograft Transplantation in the Knee for Adults 40 Years and Older

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880544 ◽  
Author(s):  
Devon E. Anderson ◽  
Katlyn S. Robinson ◽  
Jack Wiedrick ◽  
Dennis C. Crawford
Keyword(s):  
Mixed Model ◽  
Young Patients ◽  
Growth Curves ◽  
International Knee Documentation Committee ◽  
Osteochondral Allograft ◽  
Control Group ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Patient Reported

Background: Osteochondral allograft (OCA) transplantation has become a standard therapy for cartilage restoration in young patients. Purpose: To determine the efficacy of fresh OCA transplantation for focal cartilage lesions in patients aged ≥40 years compared with a group of patients aged ≤39 years. Study Design: Cohort study; Level of evidence, 3. Methods: A database was used to identify patients who underwent fresh OCA transplantation in the knee in a single-surgeon practice over a 10-year period and who completed baseline patient-reported outcome (PRO) questionnaires, including the International Knee Documentation Committee (IKDC); Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of Pain, Symptoms, Activities of Daily Living, Quality of Life (QOL), and Sports & Recreation; and Veterans RAND 12-Item Health Survey (VR-12). Patients who completed the same PRO measures at a minimum 12-month follow-up were categorized into 2 groups based on age at surgery and were observed longitudinally. Mixed-model regression was used to predict longitudinal growth curves for each PRO score while controlling for confounding patient and surgical variables. Results: The study group consisted of 38 patients with a mean age of 52.32 years (range, 40-69 years) and mean final follow-up of 44.47 ± 24.32 months. The control group consisted of 42 patients with a mean age of 27.19 years (range, 15-39 years) and mean final follow-up of 33.75 ± 19.53 months. A statistically significant improvement from baseline to final follow-up was seen for the IKDC score and all 5 KOOS subscores in both the study and the control groups ( P < .01 in 10 of 12 comparisons and P < .05 for the other 2 comparisons). Maximum improvements were seen in the KOOS QOL and Sports & Recreation subscores for both groups. There was no statistically significant difference between groups in the change from baseline to final follow-up or in differences at any time point in model-based longitudinal projections for any PRO score through 5 years. Conclusion: There was a significant improvement of outcomes for both groups, with no statistically significant difference between groups over longitudinal follow-up. The efficacy of fresh OCA transplantation in adults aged ≥40 years with a focal chondral lesion and without osteoarthritis is similar to that of younger adults, and benefits are greatest for the KOOS QOL and Sports & Recreation subscales, which reflect functional outcomes.

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