ACL Reconstruction

Abstract

From individual randomized studies, it is unclear whether patellar tendon grafts or hamstring tendon grafts yield the best functional results after ACL reconstruction. Therefore, we performed a meta-analysis to provide quantitative data to compare patellar with hamstring grafts after ACL reconstruction with regard to knee function. We searched computerized databases for randomized controlled trials reporting one of the following outcomes related to function: final overall International Knee Documentation Committee score and return to preinjury level of activity. Studies were abstracted independently by two reviewers. Random effect models were used to pool the data. Fourteen trials (1263 patients) met the inclusion criteria. We found no difference in final overall International Knee Documentation Committee score or in the number of patients returning to full activity after patellar and hamstring graft reconstruction. Relative risk was 0.90 for final overall International Knee Documentation Committee Class A and 0.94 for return to preinjury level of activity in favor of patellar grafts. Quantitative interaction tests on the effect of treatment based on study quality, randomization status, number of strands used, and length of followup were non significant. At last followup, only 41% and 33% of patients, respectively, had patellar and hamstring grafts reconstructed reported as normal based on the final overall International Knee Documentation Committee score.

Does concomitant meniscectomy affect medium-term outcome of anterior cruciate ligament reconstruction? A preliminary report

“…Clinical outcomes are, however, far from optimal, with one third of patients experiencing residual knee laxity and over 60% with disturbances in knee function [7]. Our study confirmed such observations.…”

“…However, clinical analyses show that one third of subjects undergoing ACL reconstruction (ACLR) have residual instability at follow-up and never reach the pre-injury activity level [7]. Data on whether accompanying knee injuries substantially affect patients’ outcome are not consistent.…”

The relationship between functional levels and fear-avoidance beliefs following anterior cruciate ligament reconstruction

“…Generally, ACLR is perceived to be a successful procedure; however, critical analysis has shown that clinical outcomes are less than optimal, as a recent meta-analysis has shown that normal knee function is restored in only 37% of patients undergoing ACLR [9]. Understanding which physical or psychological impairments contribute most significantly to disability following ACLR will assist in establishing appropriate rehabilitation programs in this patient population to ensure that functional levels are optimized following surgery.…”

Self-Reported Knee Function Can Identify Athletes Who Fail Return-to-Activity Criteria up to 1 Year After Anterior Cruciate Ligament Reconstruction: A Delaware-Oslo ACL Cohort Study

“…33 Despite mechanical stabilization, surgical reconstruction of the ACL does not guarantee a return to previous levels of activity, good knee function, or the preservation of future joint health. 1, 14, 25, 35, 40, 42, 46 Because not all individuals regain optimal knee function after ACL reconstruction, 3, 8 it is critical to understand if knee function is associated with other clinical factors that may provide insight into the patient's current functional status. The International Knee Documentation Committee 2000 Subjective Knee Form (IKDC2000) has been used frequently after ACL reconstruction to measure knee function.…”