Examination of Early Functional Recovery After ACL Reconstruction: Functional Milestone Achievement and Self-Reported Function

Obermeier, Michael; Sikka, Robby; Tompkins, Marc; Nelson, Bradley J.; Hamilton, Abigail; Reams, Megan; Chmielewski, Terese L.

doi:10.1177/1941738118779762

Cited by 11 publications

(31 citation statements)

References 32 publications

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“…Two studies 13,39 included only patients who underwent right-sided ACLR, while the remaining 3 studies 28,29,37 included both right- and left-sided ACLR cases with comparative analyses. The presence or absence of concomitant procedures was reported in 3 studies.…”

Section: Resultsmentioning

confidence: 99%

Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review

Salem

Park

Friedman

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Guidelines for return to driving after anterior cruciate ligament reconstruction (ACLR) have not been established. Purpose: To review the literature pertaining to driving after ACLR and provide evidence-based guidelines to aid clinicians in counseling patients about driving after ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent reviewers searched PubMed, EMBASE, and the Cochrane Library using the terms anterior cruciate ligament, ACL, drive, and driving. Studies reporting on functional recovery after ACLR were included when data regarding return to driving were reported. Results: Five studies were included. Two studies included patients who underwent right-sided ACLR. Of these, 1 study evaluated bone-patellar tendon-bone autograft and reported that brake response time (BRT) returned to normal approximately 4 to 6 weeks postoperatively. The other study found that BRT returned to normal 3 weeks after allograft ACLR, but 6 weeks elapsed after autograft ACLR before values were not significantly different than controls. One study reported that patients who underwent left-sided hamstring tendon autograft ACLR demonstrated BRTs similar to controls within 2 weeks, while those with right-sided ACLR had significantly slower BRTs until 6 weeks postoperatively. Another study including patients who underwent either right- or left-sided ACLR and employed a manual transmission simulator found that 4 to 6 weeks should elapse after ACLR with hamstring tendon autograft. Survey data from 1 study demonstrated that the mean time for patients to resume driving was 13 and 10 days after right- and left-sided ACLR, respectively. Conclusion: BRT returned to normal values approximately 4 to 6 weeks after right-sided ACLR and approximately 2 to 3 weeks after left-sided ACLR. According to 1 study in this review, ACLR laterality should be disregarded for patients who drive manual transmission automobiles, as a 4- to 6-week time period was required for driving ability to reach the level of healthy controls. Future studies should aim to elucidate the influence of graft choice and transmission type on return to driving after ACLR.

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Section: Resultsmentioning

confidence: 99%

Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review

Salem

Park

Friedman

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Scully et al [23] found that the median time and early nadir for opioid prescription use after musculoskeletal procedures was 6-15 days. Obermeier et al [16], in a recent study of 182 patients undergoing ACLR found a 9 day mean time to discontinue opioid medication. The majority of patients in our study, 85%, fell into Group 1 and required no more than one week of opioid medication or 300-375 morphine equivalents or less.…”

Section: Discussionmentioning

confidence: 99%

“…Opioid use after orthropaedic surgery has been a significant issue [10,12,[13][14][15][16][17]19,21,22]. After ACLR acute pain management is routinely necessary.…”

Section: Discussionmentioning

confidence: 99%

“…With an annual incidence of 68.6 per 100,000 person-years, isolated ACL tears remain a common orthopedic injury [11]. Pain management after ACLR has been studied to varying degrees [12][13][14][15][16][17]. Approximately three decades ago, ACLR was done on an inpatient basis.…”

Section: Introductionmentioning

confidence: 99%

“…It is essential to try and define the minimal amount of opioid necessary for a particular procedure to better understand overprescription [18]. A recent study of 182 patients undergoing ACLR found the mean time to discontinue opioid medication was 9 days after surgery [16]. Anthony et al [13] found that opioid demand after ACLR dropped significantly in the vast majority of patients by the 3 rd postoperative month.…”

Section: Introductionmentioning

confidence: 99%

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Limiting Opioid Prescription after Anterior Cruciate Ligament Reconstruction: A Study of 749 Consecutive Cases

Simonian¹,

Simonian²

2019

AOMD

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Purpose: We document the postoperative opioid use in 749 consecutive patients after Anterior Cruciate Ligament Reconstruction (ACLR). We define three groups of total postoperative opioid usage: 0-1 week, 1-2 weeks and greater than 3 weeks; and define characteristics correlated to each group. Postoperative opioid used was measured by the number of prescriptions given. Methods: Opioid was prescribed in quantities not to exceed a one-week supply. In Group 1, a single prescription of opioid converted to a maximum of 300-375 Morphine Milligram Equivalent (MME) or less(which is equivalent to hydrocodone 7.5 mg per tablet with a total number of 40-50 tablets or less). In Group 2, two prescriptions of opioid, converted to 376-750 MME. In Group 3, three prescriptions or more converted to 751 or greater MME. The following demographics and characteristics were identified for each group: age, gender, tobacco smoke, regular alcohol use, diabetes, anxiety or depression, worker's compensation, history of chemical dependence, and history of intravenous drug use. The following concomitant surgical procedures were identified for each group: menisectomy, chondroplasty, meniscal repair, and microfracture. Results: The great majority of patients, 634 (85%), were in Group 1 requiring no more than a single prescription, one week or less, of opioid. The 115 patients (15%) that exceeded the typical range of the Group 1 opioid requirement (Group 2 & 3) had a statistically significant (p<0.05) association with increased age, alcohol usage, tobacco smoking; anxiety or depression (Group 2 only); and concomitant microfracture. Conclusion: We recommend limiting the initial opioid prescription not to exceed a one-week supply or less (300-375 MME or less) after ACLR. This amount satisfied the opioid requirement for 85% of our patients undergoing primary allograft ACLR. In the last year of this study, opioid prescription did not exceed 300 MME and no opioid prescription exceeded forty tablets. Increased age, alcohol use, tobacco smoking, anxiety or depression and microfracture were significantly associated with increased opioid usage. Clinical Significance: This information should help leave fewer unused opioid in the possession of patients, leaving fewer pills vulnerable to misuse, abuse, and diversion. Another goal would be to use this information to help develop a postoperative pain management protocol or guidelines after ACLR.

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Injuries Associated with Crutch Use: A Narrative Review

Manocha

MacGillivray

Eshraghi

et al. 2020

PM&R

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Crutches are commonly prescribed in physiatric settings to help offload the lower extremities. Crutch use, however, results in abnormal and repetitive weight-bearing through the upper extremities that may result in secondary injury. This narrative review investigates injury types and risk factors associated with crutch use in order to guide healthcare providers on injury prevention strategies. Medline, EMBASE, CINAHL, and the Cochrane Library were systematically reviewed for publications between 1950 and 2018 on neurological, musculoskeletal, or vascular complications associated with crutch use. Titles and abstracts (n = 2395) were screened by two authors. Sixty studies were eligible. Articles were reviewed for level of evidence, crutch type, participant characteristics, and injury characteristics. There were 42 axillary crutch studies, 12 forearm crutch studies, and 6 studies that did not specify crutch type. These studies incorporated 622 individuals, and most were case series or case reports (n = 54). Axillary crutch use was most commonly associated with axillobrachial arterial complications due to pressure from the axillary bar (n = 34). Forearm crutch use was most commonly associated with compressive neuropathies due to pressure from the forearm cuff (n = 6). Improper crutch fitting and/or use were identified as contributing factors to injury in 22 cases. Duration of crutch use and medical comorbidities also influenced the types of injuries seen. There are rare but potentially serious complications associated with crutch use. When prescribing crutches, clinicians should ensure they are properly fit, engage in appropriate gait training, be aware of common crutch-related injuries, and consider potential patient-specific injury risk factors in order to minimize injury risk.

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Examination of Early Functional Recovery After ACL Reconstruction: Functional Milestone Achievement and Self-Reported Function

Abstract: Results can be used to counsel patients on early functional recovery after ACL reconstruction.

Cited by 11 publications

References 32 publications

Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review

Return to Driving After Anterior Cruciate Ligament Reconstruction: A Systematic Review

Limiting Opioid Prescription after Anterior Cruciate Ligament Reconstruction: A Study of 749 Consecutive Cases

Injuries Associated with Crutch Use: A Narrative Review

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