Current practice variations in the management of anterior cruciate ligament injuries in Croatia

Mahnik, Alan

doi:10.5312/wjo.v4.i4.309

Cited by 21 publications

(26 citation statements)

References 42 publications

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“…This supports previous studies that have identified activity demands and instability as important factors [18–20]. Orthopaedic surgeons considered that a physically demanding occupation was a very important factor for recommending surgery (grading “3” twice as many times compared to “2”).…”

Section: Discussionsupporting

confidence: 88%

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Grevnerts

Fältström

Sonesson

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the study was to (1) study and compare the factors that Swedish orthopaedic surgeons and physical therapists consider important for recommending ACL reconstruction and, (2) to assess how orthopaedic surgeons and physical therapists consider their own and each others, as well as patients’, roles are in the treatment decision.MethodsA web-based survey assessing the relevance of 21 predetermined factors, in the choice to recommend ACL reconstruction, was sent to orthopaedic surgeons and physical therapists. Respondents were also asked to rate the importance of the assessment made by themselves, the other clinician (physical therapists rated the importance of surgeons, surgeons rated the importance of physical therapists), and the patients’ preferences.ResultOrthopaedic surgeons agreed of eight, and physical therapists of seven factors as important in the choice to recommend ACL reconstruction. The factors both groups reported as important were; “patient’s wishes to return to contact/pivoting sports”, “instability in physical activity”, “instability in activities of daily living despite adequate rehabilitation”, “physically demanding occupation”, and “young age”. Both professions rated their own and each others assessments as well as patient’s wishes as important for the decision to recommend ACL reconstruction.ConclusionOrthopaedic surgeons and physical therapists agree about factors that are important for their decision to recommend ACL reconstruction, showing that both professions share a common ground in perceptions of factors that are important in recommending ACL reconstruction.Level of evidenceDiagnostic study: Level III.Electronic supplementary materialThe online version of this article (10.1007/s00167-018-4846-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 88%

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Grevnerts

Fältström

Sonesson

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…All surgeons used an interference screw for tibial fixation. Mahnik, et al [ 26 ] in their study found that routinely used femoral fixation methods are suspensory fixation (62%), followed by cross pins (33%) and biodegradable interference screw (5%). A bioabsorbable interference screw was used in 97% of cases as a fixation method for tibial side fixation.…”

Section: Reviewmentioning

confidence: 99%

Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

Vaishya

Ingole

et al. 2015

Cureus

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Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR.

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“…It is well recognised that the two most common substitutes used in ACLR are the BPTB and STG autografts as supported by the literature as well as the results reported in study three (Chechik et al, 2013;Mahnik et al, 2013;McRae et al, 2011). The BPTB autograft exhibits properties that are between two and four times stiffer than the STG autograft, indicating that less force is required to regain AP stability in the BPTB autograft when compared to the STG (Burks & Leland, 1988;Hamner, Brown, Steiner, Hecker, & Hayes, 1999;Noyes, Butler, Grood, Zernicke, & Hefzy, 1984;Suggs et al, 2003).…”

Section: Surgical Considerationssupporting

confidence: 58%

Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

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BackgroundAnterior cruciate ligament reconstruction (ACLR) is an effective procedure for restoring stability and function. Being a technically demanding procedure, patient outcomes are highly dependent on numerous surgical factors, which are critical for success. The application of tension to the graft prior to tibial fixation is one such factor and is considered essential for the restoration of joint stability, normal knee biomechanics, graft revascularisation and patient function. In applying tension, a key factor is the amount of force applied to the graft. However, the method of applying the tension, position of the knee during tensioning, properties of the graft material, tunnel placement and graft fixation device can all influence the effect that graft tension has on outcomes. Despite the reported importance of graft tension there has been limited empirical evidence defining the best tensioning practice for restoring patient outcome post ACLR. AimsThe goal of this program of research was to explore the effect that different aspects of graft tensioning has on patient function post ACLR. To address the aims of the thesis, three studies were conducted. The first study was a systematic review aimed at examining if a particular amount of tension results in better functional outcomes post ACLR. The second study aimed to compare the effect of two methods of applying graft tension on patient function post ACLR. The study used a prospective randomised controlled trial to compare manual tensioning with the use of a tensioning device. The third study aimed to define current graft tensioning practices and explore the factors that influence surgical decision making. A national survey of Australian orthopaedic surgeons was conducted to achieve the aims of the study. ResultsThe systematic review (study one) revealed that a medium graft tension of 79N to 90N produced the least side-to-side difference (STSD) in anterior posterior (AP) tibial translation as measured by a KT-1000 when compared to tensions <79 or >90N. However, the heterogeneous use of functional outcomes inhibited the ability to draw conclusions on other patient specific functional outcomes.Furthermore, the review highlighted the lack of high quality studies, which also failed to discuss other aspects of graft tension such as the method of applying tension.iii Building on the findings of study one, the second study undertook a RCT to compare the functional outcomes of applying 80N of force with a tensioning device (TD) (n=10) to a manual tensioning method (MT) (n=13) using an estimated force described as a sustained maximum one handed pull.Patients were assessed at pre-surgery and two weeks, three months, six months and 12 months post Based on the findings of study one, tensioning between 79N and 90N appeared to improve the restoration of joint stability, when compared to higher and lower tensions. However, no effect on patient function within 24 months post surgery was apparent. Furthermore, study two observed that tension did not appear to have an...

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Current practice variations in the management of anterior cruciate ligament injuries in Croatia

Abstract: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.

Cited by 21 publications

References 42 publications

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Activity demands and instability are the most important factors for recommending to treat ACL injuries with reconstruction

Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

Graft tensioning in anterior cruciate ligament reconstruction

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