Does ACL Reconstruction Alter Natural History?

Chalmers, Peter N.; Mall, Nathan A.; Moric, Mario; Sherman, Seth L.; Paletta, George P.; Cole, Brian J.; Bach, Bernard R.

doi:10.2106/jbjs.l.01713

Cited by 229 publications

(99 citation statements)

References 89 publications

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“…Intermediate and long-term follow-up of ACLR patients has demonstrated a high prevalence of radiographic findings consistent with post-traumatic OA 6,7,8 . Which factors, including concomitant pathology, the original injury, surgical techniques, or other as yet unidentified factors, are most responsible for the development of radiographic changes is unknown.…”

Section: Introductionmentioning

confidence: 99%

KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study

Wasserstein

Huston

Nwosu

et al. 2015

Osteoarthritis and Cartilage

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Objective The prevalence of radiographic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) approaches 50%, yet the prevalence of significant knee pain is unknown. We applied three different models of Knee injury and Osteoarthritis Outcome Score (KOOS) thresholds for significant knee pain to an ACLR cohort to identify prevalence and risk factors. Design Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort patients with a unilateral primary ACLR and normal contralateral knee were assessed at 2 and 6 years. Independent variables included patient demographics, validated Patient Reported Outcomes (PRO; Marx activity score, KOOS), and surgical characteristics. Models included: (1) KOOS criteria for a painful knee = quality of life subscale <87.5 and ≥2 of: KOOSpain <86.1, KOOSsymptoms <85.7, KOOSADL <86.8, or KOOSsports/rec <85.0; (2) KOOSpain subscale score ≤72 (≥2 standard deviations below population mean); (3) 10-point KOOSpain drop from 2 to 6 years. Proportional odds models (alpha≤0.05) were used. Results 1,761 patients of median age 23 years, median BMI 24.8 kg/m2 and 56% male met inclusion, with 87% (1530/1761) and 86% (1506/1761) follow-up at 2 and 6 years, respectively. At 6 years, n=592 (39%), n=131 (9%) and n=169 (12%) met criteria for models #1 through #3, respectively. The most consistent and strongest independent risk factor at both time-points was subsequent ipsilateral knee surgery. Low 2-year Marx activity score increased the odds of a painful knee at 6 years. Conclusions Significant knee pain is prevalent after ACLR; with those who undergo subsequent ipsilateral surgery at greatest risk. The relationship between pain and structural OA warrants further study.

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Section: Introductionmentioning

confidence: 99%

KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study

Wasserstein

Huston

Nwosu

et al. 2015

Osteoarthritis and Cartilage

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“…Even though the first-line treatment in ACL injury most often uses patellar or hamstring tendon grafts [21], the optimal graft material remains controversial, regardless of the graft tissue selected. Synthetic grafts are among the options in ACL reconstruction [5].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Knee Joint Stability Following Anterior Cruciate Ligament Reconstruction Using the Ligament Advanced Reinforcement System

Krupa¹,

Królikowska

Reichert

2017

Polim. Med.

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The anterior cruciate ligament (ACL) of the knee joint plays a complex role in the stabilization of the knee joint, resisting anterior displacement and excessive rotation of the tibia relative to the femur [1]. Reconstruction of the ACL of the knee joint [2] followed by a postoperative physiotherapeutic procedure [3] is the standard ACL injury treatment for individuals wishing to return to high-level sports activities. There are numerous current treatment options for ACL reconstruction, and in choosing the technique, the surgeon's experience and numerous patient-specific factors, as well as cost and efficacy, are taken under consideration [4,5]. Broadly, the available graft options include autografts and allografts, as well as synthetic ligaments. The autograft choices consist of the patellar, hamstring (Fig. 1), and quadriceps tendons, while allografts include the quadriceps, patellar, Achilles, hamstring, anterior and posterior tibialis tendons, and the fascia lata AbstractBackground. One of the goals of the synthetic materials used in knee joint reconstruction of the anterior cruciate ligament (ACL) is to improve the strength and stability of the graft immediately after the reconstruction. One of the synthetic grafts is a non-absorbable synthetic ligament device made of terephthalic polyethylene polyester fibers, the Ligament Advanced Reinforcement System (LARS). Objectives. The aim of the study was to assess postoperative knee joint stability in patients who had undergone ACL reconstruction using the LARS graft. Material and Methods. The study group was comprised of 20 males who had undergone primary unilateral intraarticular ACL reconstruction using LARS. The patients were evaluated one day before the reconstruction and an average of six weeks postoperatively. Knee stability was evaluated manually using the Lachman test, anterior drawer test and pivot-shift test. Knee active range of motion (ROM) was measured. Results. Preoperatively, the Lachman test indicated abnormal/2+ results in the vast majority of the patients. The postoperative results in most of the patients were normal/0. The anterior drawer test results were also abnormal/2+ preoperatively and normal/0 postoperatively. The pivot-shift test was positive in all of the patients before the ACL reconstruction and negative after the surgery. In general, no differences were found in the ROM between the involved and uninvolved limbs and in the between-measurement comparison. Conclusions. The evaluation demonstrated significant progress from the preoperative to postoperative results in reducing anterior translation and anterolateral rotational instability of the tibia in patients who had undergone ACL reconstruction using the synthetic LARS graft. In the short-term follow-up assessments, restoration of anterior and anterolateral rotational stability of the operated knee joints was observed (Polim. Med. 2016, 46, 2, 155-161).

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“…They concluded that while ACLR did not prevent secondary osteoarthritis, initial meniscal resection was a risk factor for osteoarthritis with no differences in osteoarthritis prevalence seen between graft types 39 . A recent systematic review compared operatively and non-operatively treated patients at a mean of 14 years after ACL injury 40 and found no significant differences between groups in radiographic osteoarthritis 40 . The operative group had less subsequent surgery and meniscal tears, as well as increased Tegner change scores however there were no differences in Lysholm or IKDC scores between groups 40 .…”

Section: Impairment Resolutionmentioning

confidence: 99%

“…A recent systematic review compared operatively and non-operatively treated patients at a mean of 14 years after ACL injury 40 and found no significant differences between groups in radiographic osteoarthritis 40 . The operative group had less subsequent surgery and meniscal tears, as well as increased Tegner change scores however there were no differences in Lysholm or IKDC scores between groups 40 . The current evidence does not support the use of ACLR to reduce secondary knee osteoarthritis after ACL injury.…”

Section: Impairment Resolutionmentioning

confidence: 99%

Controversies in Knee Rehabilitation

Failla

Arundale

Logerstedt

et al. 2015

Clinics in Sports Medicine

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Controversy in management of athletes exists after anterior cruciate ligament injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no re-injury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to pre-injury sports. Using these criterions, we will review the success rates of current management strategies after ACL injury and provide recommendations for the counseling of athletes after ACL injury.

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Does ACL Reconstruction Alter Natural History?

Cited by 229 publications

References 89 publications

KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study

KOOS pain as a marker for significant knee pain two and six years after primary ACL reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) prospective longitudinal cohort study

Postoperative Knee Joint Stability Following Anterior Cruciate Ligament Reconstruction Using the Ligament Advanced Reinforcement System

Controversies in Knee Rehabilitation

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