Recovery of knee extension and incidence of extension deficits following anterior cruciate ligament injury and treatment: a systematic review protocol

Ektas, Nalan; Scholes, Corey; Kulaga, Selin; Kirwan, Garry; Lee, Binglong; Bell, Christopher

doi:10.1186/s13018-019-1127-8

Cited by 10 publications

(10 citation statements)

References 29 publications

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“…This review was reported as per the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement 13 . A protocol for the systematic review was established a priori 14 and registered on the PROSPERO International Prospective Register of Systematic Reviews, registration number CRD42018092295.…”

Section: Methodsmentioning

confidence: 99%

“…An updated search was performed in November 2021. Searches were performed with the terms in the protoco 14 in post-review databases (Pubmed, Cochrane Trials Database and The Lens (lens.org)). The Lens is an open-access platform archiving hundreds of millions of scholarly articles.…”

Section: Methodsmentioning

confidence: 99%

“…Meta-analysis (PRISMA) statement 13 . A protocol for the systematic review was established a priori 14 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint…”

Section: This Review Was Reported As Per the Preferred Reporting Itemmentioning

confidence: 99%

“…• The results for the proposed systematic review protocol 14 will be reported in a series of separate manuscripts categorised by study design and measurement methods. • Alternative software was used to conduct data analysis.…”

Section: Protocol Deviationsmentioning

confidence: 99%

“…The results for the proposed systematic review protocol 14 will be reported in a series of separate manuscripts categorised by study design and measurement methods. The methods and results presented herein describe the analysis of randomised control studies collected within the framework of the systematic review protocol.…”

Section: Protocol Deviationsmentioning

confidence: 99%

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Incidence and prognostic factors of knee extension deficits following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomised controlled trials

Ektas¹,

Scholes²,

Harrison-Brown³

et al. 2020

Preprint

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Background and aimsKnee extension deficits complicate recovery from ACL injury and reconstruction, however the incidence of knee extension loss is not well defined. The aim of this review was to identify the incidence of loss of extension (LOE) following ACL rupture and reconstruction, explore the definitions of knee extension deficits reported and identify prognostic factors affecting LOE incidence.Methods and analysisA systematic search was conducted in Medline, Cochrane Library and PEDro for studies in publication up to September 2019, with no restrictions on publication year. References were screened and assessed for inclusion using predetermined eligibility criteria. Randomised controlled trials (RCTs) that quantified knee angle, loss of extension or incidence of extension deficit were included for quality assessment and data extraction. Statistical summaries were generated and meta-analyses performed in two parts to examine: (i) the probability of a datapoint being zero incidence compared to a non-zero incidence, and (ii) the relationship between the predictors and non-zero LOE incidence.ResultsA sample of 8594 papers were retrieved using the search criteria, with 48 studies meeting eligibility criteria. Pooled results from 4065 participants were included for analysis, with 3965 participants who had undergone ACLR. The proportion of included studies judged at an overall low risk of bias was small (6%). The analysis revealed median LOE incidence of 15.9% (IQR 1.4 - 46.5) at a median follow up from treatment of 4.9 months (IQR 1.9 - 24). Median LOE incidence was 23 % (IQR 8.4 - 50.0) for the subset of studies reporting up to 12 months of follow up. The observed group and study were the most important predictors for whether a datapoint reported an incidence of extension deficit. Time to follow up (P < 0.001) and graft type (P = 0.02) were found to have a significant influence on non-zero LOE incidence (%).ConclusionsThis review examined the definitions for the measurement and interpretation of postoperative knee extension, and established the trajectory of knee extension deficit after ACL injury and reconstruction. While factors associated with loss of extension were identified, the trajectory of knee extension deficits were difficult to infer due to discrepancies in measurement techniques and patient variation. Clinicians should expect up to 1 in 3 patients to present postoperatively with loss of extension of at least 3 degrees, which may partially resolve over time. Future work should focus on the development of a standardised framework for postoperative measurement and reporting of LOE.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: This Review Was Reported As Per the Preferred Reporting Itemmentioning

confidence: 99%

Section: Protocol Deviationsmentioning

confidence: 99%

Section: Protocol Deviationsmentioning

confidence: 99%

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Incidence and prognostic factors of knee extension deficits following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomised controlled trials

Ektas¹,

Scholes²,

Harrison-Brown³

et al. 2020

Preprint

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Knee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction

Neal

Williams

Alfayyadh

et al. 2022

Journal Orthopaedic Research

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Gait alterations after anterior cruciate ligament reconstruction (ACLR) are commonly reported and have been linked to posttraumatic osteoarthritis development. While knee gait alterations have been studied at several time points after ACLR, little is known about how these biomechanical variables change earlier than 6 months after surgery, nor is much known about how they differ over the entire stance phase of gait. The purpose of this study was to examine knee gait biomechanical variables over their entire movement pattern through stance at both 3 and 6 months after ACLR and to study the progression of interlimb asymmetry between the two postoperative time points. Thirty‐five individuals underwent motion analysis during overground walking 3 (3.2 ± 0.5) and 6 (6.4 ± 0.7) months after ACLR. Knee biomechanical variables were compared between limbs and across time points through 100% of stance using statistical parametric mapping; this included a 2 × 2 (Limb × Time) repeated measures analysis of variance and two‐tailed t‐tests. Smaller knee joint angles, moments, extensor forces, and medial compartment forces were present in the involved versus uninvolved limb. Interlimb asymmetries were present at both time points but were less prevalent at 6 months. The uninvolved limb's biomechanical variables stayed relatively consistent over time, while the involved limb's trended toward that of the uninvolved limb. Statement of Clinical Significance: Interventions to correct asymmetrical gait patterns after ACLR may need to occur early after surgery and may need to focus on multiple parts of stance phase.

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Management of the Stiff ACL Reconstruction

Sayegh

Burgess

Paulino

et al. 2022

Revision Anterior Cruciate Ligament Reconstruction

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Recovery of knee extension and incidence of extension deficits following anterior cruciate ligament injury and treatment: a systematic review protocol

Cited by 10 publications

References 29 publications

Incidence and prognostic factors of knee extension deficits following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomised controlled trials

Incidence and prognostic factors of knee extension deficits following anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomised controlled trials

Knee joint biomechanics during gait improve from 3 to 6 months after anterior cruciate ligament reconstruction

Management of the Stiff ACL Reconstruction

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