Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation

Musahl, Volker; Engler, Ian D.; Nazzal, Ehab M.; Dalton, Jonathan; Lucidi, Gian Andrea; Hughes, Jonathan D.; Zaffagnini, Stefano; Villa, F.; Irrgang, James J.; Fu, Freddie H.; Karlsson, Jón

doi:10.1007/s00167-021-06825-z

Cited by 48 publications

(49 citation statements)

References 198 publications

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“…From these results, it could be concluded that patients’ age and physical activity level are substantial for determining the most cost-effective strategy in ACL injury cases. One of the important reasons for this finding may be due to the greater need to regain a stable knee and return to sports as quickly as possible, particularly for young and active people with high-activity level [ 4 , 16 , 23 ]. Therefore, the clinician should pay more attention to the patients’ age and physical activity level of the patients when considering the appropriate treatment for the ACL injuries cases.…”

Section: Discussionmentioning

confidence: 99%

“…ACL reconstructive surgery (ACLR) is frequently performed for managing ACL injuries by orthopedic surgeons, although in selected patients ACL injuries can be managed successfully with non-operative treatment with rehabilitation (NO) [ 4 , 16 , 36 , 37 ]. One of the most important reasons for surgery is to regain a stable knee and return to sports as quickly as possible, particularly for young and active people [ 4 , 23 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

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“Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review”

Deviandri

Veen

Lubis

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To systematically review the literature on health-economic evaluations of anterior cruciate ligament (ACL) injury between reconstruction surgery (ACLR) and non-operative treatment (NO) and suggest the most cost-effective strategy between the two. Methods All economic studies related to ACLR versus NO post-ACL injury, either trial based or model based, published until April 2022, were identified using PubMed and Embase. The methodology of the health-economic analysis for each included study was categorized according to the four approaches: cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost–benefit analysis (CBA), and cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Results Of the seven included studies, two compared the strategies of early ACLR and NO alone, and five compared early ACLR and NO with optional delayed ACLR. All studies performed a CUA, and one study performed a CBA additionally. The CHEC scores of the included studies can be considered good, ranging from 15 to 18 from a maximum of 19. Applying the common standard threshold of $50,000 per QALY, six studies in young people with high-activity levels or athletes showed that early ACLR would be preferred over either NO alone or delayed ACLR. Of six studies, two even showed early ACLR to be the dominant strategy over either NO alone or delayed ACLR, with per-patient cost savings of $5,164 and $1,803 and incremental per-patient QALY gains of 0.18 and 0.28, respectively. The one study in the middle-aged people with a moderate activity level showed that early ACLR was not more cost-effective than delayed ACLR, with ICER $101,939/QALY using the societal perspective and ICER $63,188/QALY using the healthcare system perspective. Conclusion Early ACLR is likely the more cost-effective strategy for ACL injury cases in athletes and young populations with high-activity levels. On the other hand, non-operative treatment with optional delayed ACLR may be the more cost-effective. Level of evidence Systematic review of level III studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review”

Deviandri

Veen

Lubis

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Quadriceps strengthening and achieving full knee extension are a major focus of rehabilitation after ACL reconstruction [ 14 ]. It is reported that quadriceps atrophy is associated with deficits in performance-based functional tests [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, the rehabilitation protocol can be individualized. In recent years, the rigid rehabilitation protocols that center around time intervals following ACL reconstruction have gradually been replaced by criteria-based guidelines [ 5 , 14 ]. Developed in the same direction, the KNEESUP Compact system allows patients to achieve their individualized criterion-based milestones under the supervision of medical staffs.…”

Section: Discussionmentioning

confidence: 99%

A novel home-based rehabilitative knee brace system is a viable option for postoperative rehabilitation after anterior cruciate ligament reconstruction: a report of 15 cases

et al. 2022

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Purpose To investigate the functional outcomes for patients who used a novel home-based rehabilitative system during the postoperative period after anterior cruciate ligament (ACL) reconstructions. Methods Patients undergoing ACL reconstruction surgeries were prospectively enrolled. A home-based rehabilitation system, which is composed of a knee brace with a motion tracker, a mobile app, and a web portal, was applied. Patients could complete the rehabilitation exercise through the audio guidance and the real-time tracking system which displayed the achieved motions on the user interface of the app. Feedbacks from the patients, including the International Knee Documentation Committee (IKDC) scores, were collected and uploaded to the web portal. Each patient would meet a specialized physical therapist face-to-face once a month. At postoperative 6 months, every patient received a GNRB arthrometer examination and a Cybex isokinetic dynamometer examination. Results A total of 15 patients (10 males and 5 females) were enrolled and followed for at least 6 months. The mean time of return to full knee extension was 1.5 months. The mean difference in laxity measured by GNRB arthrometer at 134 N significantly improved at postoperative 6 months (1.8 ± 1.6 mm) compared to that measured preoperatively (3.4 ± 1.9 mm) (p = 0.024). The peak torques of flexor and extensor muscles measured by Cybex isokinetic dynamometer remained unchanged at postoperative 6 months (p = 0.733 and 0.394, respectively). The patients’ IKDC score became smaller at postoperative 1 month (p = 0.011) and significantly improved at postoperative 6 months (p = 0.002). Conclusion Using a home-based rehabilitative knee brace system after ACL reconstruction is a viable option as patients maintained their knee muscle strengths maintained their muscle strength and achieve similar or better knee range of motion six months postoperatively.

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“…Surgery on a stiff knee ensures that it will remain stiff after surgery because a stiff knee has a worse natural history than a knee with an insufficient ACL. The arthroscopic technique is currently used for most ACL reconstructions and its benefits include improved aesthetics, less disruption of the quadriceps mechanism, faster recovery, and preservation of articular cartilage hydration (8,36,37).…”

Section: Surgical Treatment Of Lca Injurymentioning

confidence: 99%

Anterior Cruciate Ligament, Description, Rupture and Treatment

Pesántez¹,

García²,

Ulloa³

et al. 2023

EPRA

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Introduction: the anterior cruciate ligament (ACL) along with the posterior cruciate ligament are the central stabilizers of the knee. Rupture of the ACL usually occurs in active and young people. For a correct diagnosis it is necessary a good clinical history, examination and a complementary study. The literature recommends surgical treatment in athletes and young people. Objective: to detail current information related to anterior cruciate ligament injury, embryology, anatomy, biomechanics, incidence, risk factors, diagnosis, management, approach and treatment of the disease. Methodology: a total of 72 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 46 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar, SciELO and Cochrane; the terms used to search for information in Spanish, Portuguese, German and English were: ACL, anterior cruciate ligament, anterior cruciate ligament, Vordere Kreuzband. Results: ACL deficiency not only causes instability episodes but also changes in joint mechanics that may lead to degenerative changes. Meniscal lesions are linked to 50% of these injuries. The Lachman test is the most accurate clinical diagnostic test, with a reported combined sensitivity of 85% and specificity of 94%. The anterior drawer test has high sensitivity and specificity for chronic ACL tears (92% sensitivity and 91% specificity), but lower accuracy for acute cases. In MRI, the following statistics were found in patients with acute ACL injuries in several studies: specificity 98-100% and sensitivity 94%. Conclusions: The ACL is a specialized band of connective tissue located in the knee joint that joins the tibia and femur. It consists primarily of collagen fibers, making up 70% of its dry weight.Variation in the anatomy of the intercondylar groove of the distal femur is a factor that appears to be related to an increased risk of ACL injury. ACL injuries are rarely diagnosed with an MRI, but in some circumstances, such as a meniscal tear or bone contusion, this test may be useful. The decision on the course of treatment for a patient with an ACL injury depends on a number of variables. Surgical reconstruction in anterior cruciate ligament (ACL) tears has proven to be a very effective technique that usually provides satisfactory results. Patients with ACL insufficiency may receive conservative treatment, which may involve activity modification, rehabilitation, and sometimes bracing. Proprioception and strength deficits should be taken into account when designing rehabilitation programs for knees with ACL insufficiency. KEY WORDS: ligament, anterior cruciate, ACL, rupture.

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Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation

Cited by 48 publications

References 198 publications

“Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review”

“Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review”

A novel home-based rehabilitative knee brace system is a viable option for postoperative rehabilitation after anterior cruciate ligament reconstruction: a report of 15 cases

Anterior Cruciate Ligament, Description, Rupture and Treatment

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