Evidence based medicine in clinical practice: how to advise patients on the influence of age on the outcome of surgical anterior cruciate ligament reconstruction: a review of the literature

Sloane, Paul; Brazier, Hugh; Murphy, Andrew W.; Collins, Tim

doi:10.1136/bjsm.36.3.200

Cited by 16 publications

(9 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the absence of guidelines, the cost of simply obtaining the original research articles can be substantial, estimated to be in one example on finding information about ACL reconstruction from 2002 approximately $800 in interlibrary loan costs to answer the question [46].…”

Section: Evidence-based Medicine As An Information Framework-backgroundmentioning

confidence: 99%

Should We Be Teaching Information Management Instead of Evidence-based Medicine?

Hurwitz

Slawson

2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward in many regards, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine and surgery. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients and be valid. WHERE ARE WE NOW?: Today, orthopaedic surgery is in the post-Flexner era of passive didactic learning combined with the practical experience of surgery as taught by supervising experts. The medical student and house officer fill their memory with mountains of facts and classic references 'just in case' that information is needed. With libraries and now internet repositories of orthopaedic information, all orthopaedic knowledge can be readily accessed without having to store much in one's memory. Evidence is often trumped by the opinion of a teacher or expert in the field. WHERE DO WE NEED TO GO?: To improve the quality of orthopaedic surgery there should be application of the best evidence, changing practice where needed when evidence is available. To apply evidence, the evidence has to find a way into practice without the long pipeline of change that now exists. Evidence should trump opinion and unfounded practices. HOW DO WE GET THERE?: To create a curriculum and learning space for information management requires effort on the part of medical schools, residency programs and health systems. Internet sources need to be created that have the readily available evidence-based answers to patient issues so surgeons do not need to spend all the time necessary to research the questions on their own. Information management is built on a platform created by EBM but saves the surgeon time and improves accuracy by having experts validate the evidence and make it easily available.

show abstract

Section: Evidence-based Medicine As An Information Framework-backgroundmentioning

confidence: 99%

Should We Be Teaching Information Management Instead of Evidence-based Medicine?

Hurwitz

Slawson

2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Actual age is not a factor of importance for the decision to perform an ACL reconstruction ( Barber et al 1996 , Sloane et al 2002 ).…”

Section: Questions Addressed In the Guidelinementioning

confidence: 99%

Guideline on anterior cruciate ligament injury

Meuffels¹,

Poldervaart²,

Diercks³

et al. 2012

Acta Orthopaedica

View full text Add to dashboard Cite

The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury.The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association.What is the role of physical examination and additional diagnostic tools?Which patient-related outcome measures should be used?What are the relevant parameters that influence the indication for an ACL reconstruction?Which findings or complaints are predictive of a bad result of an ACL injury treatment?What is the optimal timing for surgery for an ACL injury?What is the outcome of different conservative treatment modalities?Which kind of graft gives the best result in an ACL reconstruction?What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy?These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice.

show abstract

“…4,[7][8][9][10][11] Several studies have shown excellent results of ACL reconstruction in patients over the age of 40, including a greater return to activity and a reduced incidence of re-injury and instability. 6,[12][13][14][15][16][17][18][19][20][21][22][23] This would suggest that the pre-injury level of activity and motivation for recovery are more important indications for considering ACL reconstruction than age alone.…”

mentioning

confidence: 99%

Reconstruction of the anterior cruciate ligament in patients over 50 years

Dahm

Wulf

Dajani

et al. 2008

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

The records of patients aged 50 years or over who underwent primary reconstruction of the anterior cruciate ligament between 1990 and 2002 were reviewed. There were 35 knees in 34 patients that met the inclusion criteria. The mean age of the patients was 57 years (50 to 66) and the mean clinical follow-up was for 72 months (25 to 173). A total of 23 knees were reconstructed with patellar tendon allograft, and 12 with patellar tendon autograft. The mean pre-operative knee extension was 1 degrees (-5 degrees to 10 degrees) and flexion was 129 degrees (125 degrees to 150 degrees) and at follow-up these values were 0 degrees (-5 degrees to 5 degrees) and 135 degrees (120 degrees to 150 degrees), respectively. Pre-operatively there were 31 knees (89%) with a Lachman grade 2+ or 3+. Post-operatively, 33 knees (94%) were Lachman grade 0 or 1+. The mean pre- and post-operative International Knee Documentation Committee scores were 39 (23 to 72) and 90 (33 to 100) respectively. The mean pre- and post-operative Lysholm scores were 50 (18 to 68) and 92 (28 to 100) respectively and the mean University of California Los Angeles activity scores were 8.5 before injury (4 to 10), 4.3 (3 to 6) after injury and 8.3 (4 to 10) post-operatively. There were three graft failures (8.6%) requiring revision. We conclude that reconstruction of the anterior cruciate ligament in carefully-selected patients aged 50 years or over can achieve similar results to those in younger patients, with no increased risk of complications.

show abstract

Evidence based medicine in clinical practice: how to advise patients on the influence of age on the outcome of surgical anterior cruciate ligament reconstruction: a review of the literature

Cited by 16 publications

References 17 publications

Should We Be Teaching Information Management Instead of Evidence-based Medicine?

Should We Be Teaching Information Management Instead of Evidence-based Medicine?

Guideline on anterior cruciate ligament injury

Reconstruction of the anterior cruciate ligament in patients over 50 years

Contact Info

Product

Resources

About