Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology

Krutsch, Werner; Zellner, Johannes; Baumann, Florian; Pfeifer, Christian; Nerlich, Michael; Angele, Peter

doi:10.1007/s00167-015-3830-2

Cited by 72 publications

(99 citation statements)

References 45 publications

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“…The cartilage lesions did not show any differences in treatment at these time points. In contrast, it was found that meniscus injuries associated with ACL reconstruction could be better reconstructed if the surgery was performed in the course of the first 6 months after trauma (77.2% reconstructions of medial menisci within the first 6 months as opposed to 46.1% medial meniscus suturing in the months 7–12 after injury) (Krutsch et al, 2017 ). These results were confirmed by a further study.…”

Section: Reviewmentioning

confidence: 99%

The role of meniscal repair for prevention of early onset of osteoarthritis

et al. 2018

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BackgroundThe meniscus plays an important role in the integrity of the knee joint. Therefore, meniscus tissue preserving techniques for the therapy of meniscus injuries seem to be reasonable. One of the important questions is whether meniscal repair can prevent the knee joint from early onset of osteoarthritis.MethodsAccording to the review of the current literature, the principles of a successful meniscal repair are explained and the functional outcome and its impact on the prevention of osteoarthritis are analyzed in this article.ResultsCurrent data show a positive impact of a successful meniscus repair on the functional outcome in long-term. By this a protective effect on the development of osteoarthritis via the repair of meniscus lesions to restore the meniscus integrity can be confirmed. However, higher rates of re-operations in context to meniscus suturing have to be considered.ConclusionDue to the improved functional outcomes as well as preventive effect on the development of osteoarthritis within the knee joint in long-term, it is of importance to preserve as much meniscus tissue as possible in meniscus therapy. Patients previously have to be informed about the higher revision rate in context to meniscus suturing.

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Section: Reviewmentioning

confidence: 99%

The role of meniscal repair for prevention of early onset of osteoarthritis

et al. 2018

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“…Early surgery (<3 week) has shown higher incidences of postoperative stiffness and a fixed flexion deformity with higher rates of manipulation under general anesthesia as compared to delayed repair. 5 20 21 22 …”

Section: Resultsmentioning

confidence: 99%

Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Goyal

Tanwar

Joshi

et al. 2017

IJOO

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Background:Multiligamentous injuries of knee remain a gray area as far as guidelines for management are concerned due to absence of large-scale, prospective controlled trials. This article reviews the recent evidence-based literature and trends in treatment of multiligamentous injuries and establishes the needful protocol, keeping in view the current concepts.Materials and Methods:Two reviewers individually assessed the available data indexed on PubMed and Medline and compiled data on incidence, surgical versus nonsurgical treatment, timing of surgery, and repair versus reconstruction of multiligamentous injury.Results:Evolving trends do not clearly describe treatment, but most studies have shown increasing inclination toward an early, staged/single surgical procedure for multiligamentous injuries involving cruciate and collateral ligaments. Medial complex injuries have shown better results with conservative treatment with surgical reconstruction of concomitant injuries.Conclusion:Multiligamentous injury still remains a gray area due to unavailability of a formal guideline to treatment in the absence of large-scale, blinded prospective controlled trials. Any in multiligamentous injuries any intervention needs to be individualized by the presence of any life- or limb-threatening complication. The risks and guarded prognosis with both surgical and non-surgical modalities of treatment should be explained to patient and relations.

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“…Among these factors, timing of surgical treatment after ACL injury is still controversial (Krutsch et al 2015; Kwok et al 2013). In this study, we divided patients into two groups according to the preoperative periods of 60 days.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review classified the injury-to-surgery interval as either early (ranging from within 2 days to 7 months) or delayed (ranging from 3 weeks to 24 years) and found that 8 articles recommended early reconstruction, whereas the majority of the literature found no difference in outcome between early and delayed surgery (Andernord et al 2013). These indicate that the effect of the timing of surgery after injury is still controversy (Krutsch et al 2015; Kwok et al 2013). …”

Section: Introductionmentioning

confidence: 99%

Inflammatory cytokine levels in synovial fluid 3, 4 days postoperatively and its correlation with early-phase functional recovery after anterior cruciate ligament reconstruction: a cohort study

et al. 2016

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BackgroundSynovial fluid was collected prior to and at 3 to 4 days after ACL reconstruction to investigate the correlation between inflammatory cytokine levels in the acute phase after surgery and physical functional recovery at 3 months postoperatively.Methods For this purpose, 79 patients with ACL reconstruction using semitendinosus tendons were included in the study. Median days from injury to surgery were 80 days (13–291 days). Synovial fluid was obtained just before surgery and at 3 to 4 days after surgery. Physical activity of each patient was evaluated at 3 months postoperatively, and scored from 0 (hard to walk) to 5 (run). Patients able to jog (score 4) or run (score 5) were considered as the “quick recovery” group and others (scores 1–3) as the “delayed recovery” group.ResultsPhysical activity recovery scores in the early surgery group (preoperative period less than 60 days; Group I) were significantly better than those in the delayed surgery group (Group II). Among the cytokines tested, TNF-alpha and IL10 levels in synovial fluid were significantly higher in Group II at 3 to 4 days postoperatively, while levels of these cytokines were quite comparable preoperatively between the groups. Increased IL1-beta expression was noted in the delayed recovery group at 3 to 4 days postoperatively. In addition, levels of IL6, IL10 and IFN-gamma also tended to increase in patients with delayed recovery.ConclusionDelayed ACL reconstruction increases levels of inflammatory cytokines in synovial fluid after surgery and correlates with a prolonged recovery of short-period physical activity of the patients.

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Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology

Abstract: Prospective cross-sectional cohort study, Level II.

Cited by 72 publications

References 45 publications

The role of meniscal repair for prevention of early onset of osteoarthritis

The role of meniscal repair for prevention of early onset of osteoarthritis

Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Inflammatory cytokine levels in synovial fluid 3, 4 days postoperatively and its correlation with early-phase functional recovery after anterior cruciate ligament reconstruction: a cohort study

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