scholarly journals Socioeconomic Status Impacts Outcomes Following Anterior Cruciate Ligament Reconstruction Status

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
Akash R. Patel ◽  
Ryan Smith ◽  
Kavish Gupta ◽  
Curtis Vandenberg
Keyword(s):  
Socioeconomic Status ◽  
Graft Failure ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Commercial Insurance ◽  
Insurance Group ◽  
Operative Complications ◽  
The Government ◽  
Anterior Cruciate

Objectives: Delays in pediatric and adolescent anterior cruciate ligament reconstruction (ACLR) are associated with increased prevalence of concomitant knee injuries and worse post-operative outcomes. However, few studies have described the factors that may contribute to these delays and adverse events. This study seeks to determine the impact socioeconomic status has on outcomes following ACLR. Methods: Patients who underwent primary ACLR at a pediatric hospital between 2009 and 2015 were retrospectively reviewed. Variables included clinical outcomes and post-operative complications, as well as chronologic, demographic, and socioeconomic factors. Post-operative complication variables included graft failure, return to operating room, stiffness, and infection. Socioeconomic status was measured using health insurance type (commercial vs. government) and city block group level median household income levels derived from 2009-2015 U.S. Census Bureau data. Patients were excluded if they had multiligamentous knee injuries, prior ACLR, presented more than 365 days after injury, or had missing medical record data. Results: Overall, 127 patients (69 male, 58 female) were included in data analysis. The mean age at time of surgery was 15.0 ± 2.3 years (range = 9 to 21 years). There were 68 patients in the commercial insurance group and 59 patients in the government insurance group. Patients in the commercial insurance group had an average household median income of $87,767 (SD = $38,325) compared to $51,366 (SD = $25,330) in the government insurance group, p = < 0.0001. Patients in the government insurance group demonstrated greater delays in time from injury to first appointment (p = 0.0003), injury to MRI (p = 0.021), injury to surgery (p = < 0.0001), first appointment to surgery (p = 0.0036), and injury to return to play, p = 0.044 (Table 1). At time of surgery, 81% (48/59) of patients in the government insurance group presented with concomitant meniscal injuries compared 65% (44/68) of patients in the commercial insurance group, p = 0.034 (Odds Ratio = 2.38). Post-operatively, 22% (13/58) of patients in the government insurance group experienced decreased knee range of motion (“stiffness”) compared to 9% (6/68) in the commercial insurance group, p = 0.033 (Odds Ratio = 2.99). No significant differences were found between insurance types for rates of concomitant chondral injuries, graft failure, re-operation, or post-operative infection. Conclusion: Pediatric patients with government health insurance may experience delays in receiving definitive knee injury management and be at risk for complications and diminished outcomes. These delays are likely multifactorial, and may be attributed to decreased access to care, familial resources, and social support. Of note, our findings suggest a significant discrepancy in time to treatment as well as rates of concomitant knee injuries and post-operative complications between government and commercial insurance types. [Table: see text]

scholarly journals RETURN TO PLAY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2020 ◽  
Vol 26 (6) ◽  
pp. 478-486
Author(s):  
Rodrigo A. Goes ◽  
Victor R. A. Cossich ◽  
Bráulio R. França ◽  
André Siqueira Campos ◽  
Gabriel Garcez A. Souza ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Best Practice ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Return To Play ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Strength Assessment ◽  
Anterior Cruciate

ABSTRACT The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.

Systematic Review of Single-Bundle Anterior Cruciate Ligament Reconstruction Outcomes

2008 ◽  
Vol 36 (10) ◽  
pp. 2028-2036 ◽  
Author(s):  
Paul B. Lewis ◽  
A. Dushi Parameswaran ◽  
John-Paul H. Rue ◽  
R. Bach Bernard
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Graft Failure ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background There is increasing interest in comparing the efficacy of single-bundle versus double-bundle anterior cruciate ligament reconstruction. Challenging this comparison, however, has been the lack of an established consensus on the success of single-bundle reconstruction. Hypothesis The current outcomes of single-bundle reconstruction can be clarified from a large unbiased body of evidence for future comparisons with double-bundle reconstructions. Study Design Systematic review. Methods A systematic review of 11 randomized, controlled trials comparing patellar tendon and hamstring tendon grafting is reported. The respective outcomes of each group were combined to assist the orthopaedic surgeon in assessing the current success of single-bundle reconstruction. The primary factors assessed were tibial subluxation and side-to-side differences in laxity. Secondary outcomes included concomitant injuries and treatments, complications, graft failure, range of motion, and radiographic evidence of degenerative changes. Results In this review of 1024 single-bundle anterior cruciate ligament reconstructions, 495 concomitant meniscal tears, 95 chondral injuries, and 2 posterior cruciate ligament tears were noted. The complication rate was 6%, and graft failure 4%. Reported pivot-shift test results were negative in 81 % of cases; reported Lachman tests were negative in 59% cases; and KT-1000 arthrometer side-to-side differences were ≤5 mm in 86% of cases. Flexion and extension deficits were reported in 9 of 11 studies through mean range of motion or deficit ranges. Radiographic changes of articular surface abnormalities were observed in 7% of the knees at follow-up investigation. Conclusion Systematic review of a significant body of unbiased outcome data on single-bundle anterior cruciate ligament reconstruction demonstrates it to be a safe, consistent surgical procedure affording reliable results. Clinical Relevance These results may be used to assist orthopaedic surgeons in evaluating the benefit and practicality of pursuing new anterior cruciate ligament reconstruction techniques over standard single-bundle anterior cruciate ligament reconstruction.

scholarly journals Outcomes of single bundle arthroscopic anterior cruciate ligament reconstruction in a limited resource setting

2020 ◽  
pp. jisakos-2020-000500
Author(s):  
Binod Sherchan ◽  
Saroj Rai ◽  
Nira Tamang ◽  
Siddhartha Dhungana ◽  
Laxmi Kanta Sharma ◽  
...  
Keyword(s):  
Graft Failure ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Cruciate Ligament Reconstruction ◽  
Lachman Test ◽  
Urban Group ◽  
Anterior Cruciate ◽  
Rural Group

ObjectivesDespite various challenges, orthopaedic sports surgeons are still providing the arthroscopic service in low-income and middle-income countries like Nepal; however, it is hardly being reported. The main purpose of this study was to compare the clinical outcomes and complications of patients undergoing arthroscopic anterior cruciate ligament reconstruction (ACLR) in the urban group and that of the rural group.MethodsWe evaluated a total of 194 patients, including 98 patients in the urban group and 96 patients in the rural group, undergoing arthroscopic ACLR between August 2015 and February 2018, and had completed a minimum of 2-year follow-up. Subjective evaluations were performed using the Tegner-Lysolm score and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Laxity assessments were performed using the Lachman test and the Pivot-shift test. Functional evaluation included the range of motion, single-leg hop test and overall IKDC score. Radiological assessment was performed according to the IKDC guidelines. SPSS was used for data analysis.ResultsThere was statistically significant differences in the subjective assessments between 2 groups. No statistically significant differences existed between 2 groups in terms of laxity and functional assessments. However, the proportion of laxity, in terms of Lachman test and Pivot-shift test, was higher in the young and active individuals and the proportion of abnormal and severely abnormal in all parameters of functional outcomes was higher in the older female in the rural group. Graft failure occurred in 19 (17.6%) knees in the urban group and 17 (16.8%) knees in the rural group. Graft failure in the urban group was higher in young and active male patients, whereas failure in the rural group was more in female patients. Similarly, overall infection occurred in 13 (6.2%) knees, including 5 (2.3%) deep infections and 8 (3.8%) superficial infections.ConclusionWe advised similar rehabilitation protocol for all the patients; however, the outcomes were significantly lower in patients living in rural areas as they are found to have poor compliance with the rehabilitation protocol. The overall graft failure rate was 17.2%; however, the reoperation rate was higher in the urban group than the rural group. The rate of deep infection was higher in the rural group as compared with the urban group.Level of evidenceLevel III, retrospective comparative study.

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