Bilateral Recurrent, Atraumatic Anterior Knee Dislocations in a Pediatric Patient With Congenital Absence of the Anterior Cruciate Ligament

Moreland, Colleen M.; Flanagan, Jill C.; Christino, Melissa A.

doi:10.5435/jaaosglobal-d-20-00078

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…A reference standard, in the context of ACL injury, is a verification tool used to measure the accuracy of the respective index test. MRIs were used as a reference standard in many of the studies [ 3 , 9 , 17 , 18 ]. Whereas, other participants were retrospectively recruited from ACL reconstructive surgeries, leaving arthroscopy as the designated reference standard [ 3 , 7 , 9 ].…”

Section: Resultsmentioning

confidence: 99%

Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review

Allott

Banger

McGregor

2022

BMC Musculoskelet Disord

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Objective This review sought to evaluate the literature on the initial assessment and diagnostic pathway for patients with a suspected Anterior Cruciate Ligament (ACL) tear. Methods MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies, PRISMA guidelines were followed. Studies were included if they used at least one assessment method to assess for ACL injury and participants were assessed at an acute trauma centre within 6-weeks of injury. Article quality was evaluated using the QUADAS-2 checklist. Results A total of 353 studies were assessed for eligibility, 347 were excluded for the following reasons: injuries were not assessed in an acute trauma setting, injuries were not acute, participants had previous ACL injuries or chronic joint deformities affecting the knee, participants were under 18, or participants included animals or cadavers. A total of six studies were included in the review. Common assessment methods included: laxity tests, joint effusion, inability to continue activity, and a history of a ‘pop’ and ‘giving way’ at the time of injury. Diagnostic accuracy varied greatly between the assessment method and the assessing clinician. Gold standard diagnostics were MRI and arthroscopy. A weighted meta-mean calculated the time to reach diagnosis to be 68.60 days [CI 23.94, 113.24]. The mean number of appointments to reach diagnosis varied from 2–5. Delay to surgery or surgical consultation ranged from 61 to 328 days. Conclusion Clinicians in the Emergency Department are not proficient in performing the assessment methods that are used for diagnosis in acute ACL injury. Reliance on specialist assessments or radiological methods inevitably increases the time to reach a diagnosis, which has repercussions on management options. There is an ever-growing demand to improve diagnostic accuracy and efficiency; further exploration into quantitative measures of instability would aid the assessment of peripheral joint assessment.

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Section: Resultsmentioning

confidence: 99%

Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review

Allott

Banger

McGregor

2022

BMC Musculoskelet Disord

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show abstract

“…A reference standard, in the context of ACL injury, is a veri cation tool used to measure the accuracy of the respective index test. MRIs were used as a reference standard in many of the studies (3,14,15,24). Whereas other participants were retrospectively recruited from ACL reconstructive surgeries, leaving arthroscopy the designated reference standard (3,7,15).…”

Section: Reference Standardmentioning

confidence: 99%

Evaluating the Diagnostic Pathway for Acute ACL Injuries in Trauma Centres: A Systematic Review

Allott

McGregor

Banger

2021

Preprint

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Objective: This review sought to evaluate the literature on the initial assessment and diagnostic pathway for patients with a suspected Anterior Cruciate Ligament (ACL) tear.Methods: MEDLINE, EMBASE, and CINAHL were systematically searched for eligible studies. Studies were included if they used at least one assessment method to assess for ACL injury and participants were assessed at an acute trauma centre within 6-weeks of injury. Article quality was evaluated using the QUADAS-2 checklist. Results: A total of 353 studies were assessed for eligibility, 347 were excluded for the following reasons: injuries were not assessed in an acute trauma setting, injuries were not acute, participants had previous ACL injuries or chronic joint deformities affecting the knee, participants were under 18, or participants included animals or cadavers. A total of six studies were included in the review. Common assessment methods included: laxity tests, joint effusion, inability to continue activity, and a history of a ‘pop’ and ‘giving way’ at the time of injury. Diagnostic accuracy varied greatly between the assessment method and the assessing clinician. Gold standard diagnostics were MRI and arthroscopy. A weighted meta-mean calculated the time to reach diagnosis to be 68.60 days [CI 23.94, 113.24]. The mean number of appointments to reach diagnosis varied from 2-5. Delay to surgery or surgical consultation ranged from 61 to 328 days. Conclusion: Clinicians in the Emergency Department are not proficient in performing the assessment methods that are used for diagnosis in acute ACL injury. Reliance on specialist assessments or radiological methods inevitably increases the time to reach a diagnosis, which has repercussions on management options. There is an ever-growing demand to improve diagnostic accuracy and efficiency, innovation into new diagnostic methods that require less specialist training would help improve patient care.

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Imaging the pediatric anterior cruciate ligament: not little adults

Poutre

Meyers

2023

Pediatr Radiol

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Bilateral Recurrent, Atraumatic Anterior Knee Dislocations in a Pediatric Patient With Congenital Absence of the Anterior Cruciate Ligament

Cited by 3 publications

References 15 publications

Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review

Evaluating the diagnostic pathway for acute ACL injuries in trauma centres: a systematic review

Evaluating the Diagnostic Pathway for Acute ACL Injuries in Trauma Centres: A Systematic Review

Imaging the pediatric anterior cruciate ligament: not little adults

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