Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament

Spindler, Kurt P.; Warren, Todd A.; Callison, J. Claiborne; Secic, Michelle; Fleisch, Sheryl B.; Wright, Rick W.

doi:10.2106/jbjs.d.01842

Cited by 86 publications

(76 citation statements)

References 32 publications

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“…The effective sample size of the 2002 cohort was more than enough to consider the factors mentioned previously in our hypothesis, but not large enough to include all measured exposures in the model. The inclusion of additional variables as candidate predictors in the model was based on previously published studies (ie, ‘pop’ at the time of injury 26 ) and expert opinion of the group.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Activity Level 2 Years after Anterior Cruciate Ligament Reconstruction (ACLR)

2010

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Objective ACL deficient subjects are at risk of knee injury with cutting and pivoting activities; in accord, ACL reconstructions (ACLR) are performed to restore stability to allow for return to cutting and pivoting activities. The Marx activity level is a validated patient-reported measure to quantify the amount and frequency of running, cutting, decelerating, and pivoting performed. Our objective was to quantify activity level 2 yrs after ACLR and identify explanatory variables measured at baseline (demographics, concomitant meniscal/articular cartilage injuries and their treatment) associated with activity level at short-term follow-up (2 yrs). Methods In 2002, the multicenter consortium began enrolling subjects undergoing ACLR at six recruitment sites. This ongoing multicenter cohort study targets follow-up at 2, 6, and 10 years. The current study reports two-year follow-up of subjects enrolled in 2002. Participants in the multicenter ACLR cohort completed a series of validated, patient-oriented questionnaires that included activity level assessment. Follow-up questionnaires were collected by mail between 1/01/04 and 6/01/05 to assess changes. Measurement of intraarticular pathology, techniques of ACLR, and secondary procedures were recorded at baseline by participating surgeons. Multivariable proportional odds ordinal logistic regression was used to assess predictors of activity level after adjusting for baseline patient characteristics. Interquartile range (IQR) odds ratios (OR) are given for continuous variables, IQROR demonstrate the effect of increasing a baseline variable from its first quartile to its third quartile. The fitted model that used OR to specify predicted probabilities of exceeding any activity level was translated into predicted mean activity level and is presented in a nomogram for more interpretability. Results Of the 446 subjects that underwent unilateral ACLR, follow-up was obtained on 393 (88%). The cohort is 56% male, median age 23 yrs. Median and IQR activity level was 12 (8–16) at baseline, and declined to 9 (3–13) at follow-up. After controlling for other baseline factors such as age, marital and student status, contralateral knee status, sport and competition level, and articular cartilage/meniscal injuries, the following factors were predictors of activity level at 2-year follow-up. High baseline activity level was associated with higher activity at 2 yrs (IQROR=3.8, 95% CI=2.0–7.4, p<0.0001), and lower baseline BMI (IQROR=1.37, 95% CI=1.04–1.82, p=0.027). The following baseline factors were associated with lower activity: female gender (OR=0.60, 95% CI=0.39–0.91, p=0.015); smoking within 6 months (IQROR=0.55, 95% CI=0.33–0.92, p=0.023); and revision ACLR (IQROR=0.41, CI=0.20–0.83, p=0.014). Conclusions (1) The proportion of subjects returning to the same or higher level of activity two years after ACLR was 45%, and evaluation of post treatment activity levels should control for patients’ preoperative activity since this is a strong predictor of future activity. (2) Assum...

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Section: Methodsmentioning

confidence: 99%

Predictors of Activity Level 2 Years after Anterior Cruciate Ligament Reconstruction (ACLR)

2010

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“…[6][7][8][9][10] Studies on outcomes after knee injury have often used a retrospective approach and have focused primarily on the effects of interventions such as surgical techniques on adult subjects. [11][12][13][14][15][16][17] Diagnostic measures such as radiographic and magnetic resonance imaging or clinician-based measures, such as joint effusion, range of motion, ligament laxity, or reinjury, were used to measure the effectiveness of the treatments provided. Although these measures are important for the medical provider, they may not capture the full impact that a knee injury can have on a young athlete.…”

Section: Introductionmentioning

confidence: 99%

Changes in Self-Reported Knee Function and Health-Related Quality of Life After Knee Injury in Female Athletes

McGuine

Winterstein²,

Carr³

et al. 2012

Clinical Journal of Sport Medicine

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“…ACL reconstruction has been demonstrated to improve clinical instability of the knee joint, reduced knee laxity, and decrease risk of late meniscus tear and surgery [3,33,84,98,99,115]. …”

Section: Introductionmentioning

confidence: 99%

Graft healing in anterior cruciate ligament reconstruction

Ekdahl

Wang

Ronga

et al. 2008

Knee Surg Sports Traumatol Arthr

200

146

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Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge of this process have been made based primarly on animal models. According to the findings of this review, some surgical and postoperative variables are known to directly affect time-course and quality of graft-tunnel healing. The type of graft, graft motion, and fixation methods have shown to directly affect time-course and quality of graft-tunnel healing. Therefore, the application of early and aggressive rehabilitation protocols should be cautious when using soft-tissue graft, allografts, and direct or aperture type of fixation for ACL reconstruction. With regard to graft placement, several cadaveric models showed biomechanical advantages of a more anatomical graft location; however, there are no studies that explore the relationship between graft placement and healing process. The precise effect of graft tensioning, graft/tunnel diameter disparity, and graft length within the bone tunnel in the graft healing process remains unclear and requires more research. To enhance graft-tunnel healing, tissue-engineering approaches, including the use of growth factors, mesenchymal stem cells, and periosteum graft augmentation, have been tested on animal models. These have shown promising results in terms of enhancement of bone-graft healing rate.

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Clinical Outcome at a Minimum of Five Years After Reconstruction of the Anterior Cruciate Ligament

Abstract: Callison, J. Claiborne Jr.; Secic, Michelle; Fleisch, Sheryl B.; and Wright, Rick W., ,"Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament

Cited by 86 publications

References 32 publications

Predictors of Activity Level 2 Years after Anterior Cruciate Ligament Reconstruction (ACLR)

Predictors of Activity Level 2 Years after Anterior Cruciate Ligament Reconstruction (ACLR)

Changes in Self-Reported Knee Function and Health-Related Quality of Life After Knee Injury in Female Athletes

Graft healing in anterior cruciate ligament reconstruction

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