Long‐term outcomes of anterior cruciate ligament reconstruction surgery: 2020 OREF clinical research award paper

Autor: Braden C. Fleming, Glenn A. Tung, Paul D. Fadale, Gary J. Badger, Robert M. Shalvoy, Michael J. Hulstyn
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Knee Joint
Anterior cruciate ligament reconstruction
medicine.medical_treatment
Anterior cruciate ligament
0206 medical engineering
02 engineering and technology
Osteoarthritis
Article
law.invention
Young Adult
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Outcome Assessment
Health Care
medicine
Long term outcomes
Humans
Orthopedics and Sports Medicine
030203 arthritis & rheumatology
Anterior Cruciate Ligament Reconstruction
medicine.diagnostic_test
business.industry
Anterior Cruciate Ligament Injuries
Magnetic resonance imaging
Middle Aged
Osteoarthritis
Knee
musculoskeletal system
medicine.disease
Magnetic Resonance Imaging
020601 biomedical engineering
ACL injury
Biomechanical Phenomena
Surgery
surgical procedures
operative
Clinical research
medicine.anatomical_structure
Female
business
human activities
Zdroj: J Orthop Res
ISSN: 1554-527X
0736-0266
Popis: ACL injuries place the knee at risk for post-traumatic osteoarthritis (PTOA) despite surgical anterior cruciate ligament (ACL) reconstruction. One parameter thought to affect PTOA risk is the initial graft tension. This randomized controlled trial (RCT) was designed to compare outcomes between two graft tensioning protocols that bracket the range commonly used. At 7 years postsurgery, we determined that most outcomes between the two tension groups were not significantly different, that they were inferior to an uninjured matched control group, and that PTOA was progressing in both groups relative to controls. The trial database was also leveraged to gain insight into mechanisms of PTOA following ACL injury. We determined that the inflammatory response at the time of injury undermines one of the joint's lubricating mechanisms. We learned that patients continue to protect their surgical knee 5 years postinjury compared to controls during a jump-pivot activity. We also established that presurgical knee function and mental health were correlated with symptomatic PTOA at 7 years, that there were specific anatomical factors associated with poor outcomes, and that there were no changes in outcomes due to tunnel widening in patients receiving hamstring tendon autografts. We also validated a magnetic resonance imaging technique to noninvasively assess graft strength. In conclusion, the RCT determined that initial graft tensioning does not have a major influence on 7-year outcomes. Therefore, surgeons can reconstruct the ACL using a graft tensioning protocol that is within the window of the two graft tensioning techniques evaluated in this RCT.
Databáze: OpenAIRE
Externí odkaz: