Survey Study of Members of the Canadian Orthopaedic Association on the Natural History and Treatment of Anterior Cruciate Ligament Injury

McRae, Sheila; Chahal, Jaskarndip; Leiter, Jeff; Marx, Robert G.; MacDonald, Peter B.

doi:10.1097/jsm.0b013e318219a649

Cited by 57 publications

(61 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar studies by McRae et al (2011) and Chechik et al (2013) reported preferences for the STG autograft as 73% and 63% respectively, which is considerably lower than the findings of the current study. Unfortunately, it is not clear from the results why such a bias towards the STG autograft was identified among the sample population.…”

Section: Discussioncontrasting

confidence: 72%

“…Eleven studies were identified that conducted a survey primarily related to ACLR surgical practice, however, of the 11 studies identified, only one included a specific question on graft tension (McRae, Chahal, Leiter, Marx, & MacDonald, 2011). This study investigated the method of tensioning; however, did not explore other factors such as the amount of tension or the rationale for graft tensioning (McRae et al, 2011).…”

Section: Literature Review To Identify a Relevant Valid And Reliable mentioning

confidence: 99%

“…This study investigated the method of tensioning; however, did not explore other factors such as the amount of tension or the rationale for graft tensioning (McRae et al, 2011). No previously validated or reliable instrument was available in the current literature; hence, the development of a new survey was required.…”

Section: Literature Review To Identify a Relevant Valid And Reliable mentioning

confidence: 99%

See 2 more Smart Citations

Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

View full text Add to dashboard Cite

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...

show abstract

Section: Discussioncontrasting

confidence: 72%

Section: Literature Review To Identify a Relevant Valid And Reliable mentioning

confidence: 99%

Section: Literature Review To Identify a Relevant Valid And Reliable mentioning

confidence: 99%

See 1 more Smart Citation

Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

View full text Add to dashboard Cite

show abstract

“…Enabling return to competitive sport is a common reason for performing ACLR and most individuals electing to undergo surgery expect to return to pre-injury sport within one year (Feucht et al, 2014;Marx et al, 2003;McRae et al, 2011). Of concern is that more than 50% of non-elite sports participants do not return to pre-injury sport after ACLR (Ardern et al, 2014b), which was a critical determinant of longer-term QOL 5 to 20 years after ACLR in people with knee difficulties (Chapter 6).…”

Section: Return To Sportmentioning

confidence: 99%

“…Rationales for performing an ACLR include facilitating a return to competitive sport (Marx et al, 2003;McRae, Chahal, Leiter, Marx, & MacDonald, 2011) and minimising the risk of post-traumatic knee osteoarthritis (Richmond et al, 2011). However, many ACLreconstructed individuals cease sports participation (Ardern et al, 2014b), develop accelerated knee osteoarthritis (Øiestad et al, 2009), or experience ongoing fear of re-injury (Ardern et al, 2012a) and poor knee-related QOL (Chapter 4).…”

Section: Introductionmentioning

confidence: 99%

Long-term quality of life following anterior cruciate ligament injury and reconstruction

Filbay¹

View full text Add to dashboard Cite

The anterior cruciate ligament (ACL) serves to stabilise the knee complex and prevent intraarticular knee structures from sustaining damage during multiaxial, high impact movement. An ACL rupture most commonly occurs in adolescents and young adults taking part in competitive sports and causes substantial disruption to the knee joint. Anterior cruciate ligament reconstruction (ACLR) is the most common treatment offered to ACL-ruptured individuals worldwide. Individuals undergoing this surgery often have high expectations that rarely match surgical outcomes. Return to sport rates are low, re-injury fears are widespread and many individuals develop knee osteoarthritis within ten years of ACLR. This mismatch between expectations and actual outcomes has great potential to impact longer-term quality of life (QOL). The primary aims of this thesis were to: (i) generate a detailed picture of longer-term QOL following ACLR, and (ii) identify factors related to longer-term QOL in people with knee pain, symptoms or functional limitations following ACLR.The first study in this thesis is a systematic review that revealed impaired knee-related QOL at 5 to 20 years after ACLR. However, it became evident that research into factors impacting upon QOL in this population was scarce. The systematic review found that having a subsequent knee injury, an additional knee surgery after ACLR, and developing severe radiographic osteoarthritis were associated with worse QOL outcomes. The second study in this thesis is a systematic review that investigated QOL more than five years after ACL rupture in individuals who remained ACL-deficient (did not undergo ACLR) and compared QOL between ACLdeficient and ACL-reconstructed groups. This systematic review found that ACL-deficient individuals reported comparable QOL outcomes to those who underwent ACLR 5 to 25 years previously. All studies that reported QOL after ACLR included asymptomatic participants without knee difficulties, which may underestimate the degree of QOL impairment experienced by people with ongoing knee difficulties.The third study in this thesis used a cross-sectional design to describe QOL outcomes in 162 individuals with knee pain, symptoms or functional limitations 5 to 20 years following ACLR.It showed that individuals who did not return to sport after ACLR reported poorer knee-related and health-related QOL, compared to people who returned to pre-injury levels of sport. Higher body mass index (BMI) and subsequent surgery were also related to worse QOL after ACLR.This was the first study to show that return to sport was associated with QOL impairment more than five years after ACLR. However, quantitative assessment of QOL may overlook important considerations with regard to an individual's life priorities, expectations, values and concerns.To provide a detailed understanding of QOL following ACLR, qualitative interviews were performed with 17 individuals with knee difficulties 5 to 20 years following ACLR. This was the first qualitative study to explore QOL following...

show abstract

Beyond guidelines: A qualitative clinical stakeholder study of optimal management of anterior cruciate ligament rehabilitation

Dunphy¹,

Button

Murray³

et al. 2022

Musculoskeletal Care

View full text Add to dashboard Cite

Aims: This study gathered expert perspectives in the management of anterior cruciate ligament (ACL) rehabilitation to explore current practice, variations in care and optimal management strategies. Materials and methods:This was a qualitative semi-structured interview study. The participants' experiences were considered in terms of their roles as employees, managers, clinicians and professional gatekeepers. Purposive and snowball sampling were used to recruit physiotherapists and orthopaedic surgeons. Participants were included if they had a proven record in clinical management or research involving ACL patients. Persons were excluded if they could not speak English. Interviews were conducted in person, via skype or over the phone at a time convenient to the participant. Data was analysed using a framework analysis and critical realist approach.Results: Results included 24 interviews that were conducted with 19 physiotherapists and 5 surgeons. Themes of variation in current care and optimal care were explored including subthemes of patient centred practice, evidence based medicine, resources, self-management, multidisciplinary teamwork, training and expertise were explored. Participant's perceptions of current care were that it was a location 'lottery' that significantly varied for patients across the UK. Conclusions:Stakeholders identified that optimal management should be patient centred and incorporate adequate equipment, specific training for physiotherapists and a closely communicating multidisciplinary team. Research is needed to explore cost effective models of optimal rehabilitation that include return to sport strategies.

show abstract

Survey Study of Members of the Canadian Orthopaedic Association on the Natural History and Treatment of Anterior Cruciate Ligament Injury

Cited by 57 publications

References 20 publications

Graft tensioning in anterior cruciate ligament reconstruction

Graft tensioning in anterior cruciate ligament reconstruction

Long-term quality of life following anterior cruciate ligament injury and reconstruction

Beyond guidelines: A qualitative clinical stakeholder study of optimal management of anterior cruciate ligament rehabilitation

Contact Info

Product

Resources

About