Langzeitergebnisse nach konservativ behandelten veralteten vorderen Kreuzbandrupturen

Seitz, H.; Chrysopoulos, A.; Egkher, E.; Mousavi, Mehdi

doi:10.1007/978-3-642-79242-7_229

Cited by 4 publications

(6 citation statements)

References 5 publications

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“…Our results were superior to those reported in patients treated nonoperatively [13,17,28]. Persistent instability is seen in up to 92% of the latter, progressive osteoarthritis in all cases [28], and, most importantly, further knee injuries in up to 25% due to persistent instability [13,17,28].…”

Section: Discussioncontrasting

confidence: 84%

Revision ACL reconstruction using autogenous patellar tendon graft

Eberhardt

Kurth

Hailer

et al. 2000

Knee Surg Sports Traumatol Art

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This retrospective study examined revision anterior cruciate ligament reconstruction using a bone-tendon-bone autograft of the patellar ligament. We followed up 44 patients (mean age 27.9 years) for an average of 41.2 months. Clinical examination with the Lachmann and pivot shift tests showed clearly improved stability; KT-1000 arthrometer measurements had a mean difference of 3.5 mm in side-to-side comparison. The evaluated knee scores were significantly improved (P<0.01); the median Lysholm score was 85 and the median Tegner activity score 5.0 at follow-up. In the IKDC ranking system 75.0% of knees were rated normal or nearly normal (grades A and B). According to a modified Fairbank scale, progression of radiographic signs of osteoarthritis was noted in 36.4%. There was a significant difference (P<0.05) in progression of radiographic signs of osteoarthritis between patients with major (grades III, IV) versus minor (grades I, II) lesions of the articular cartilage surface and between knees with versus without extensive synovitis due to previous synthetic graft reconstruction (P<0.05). Revision anterior cruciate ligament reconstruction using an autogenous patellar tendon graft shows good results with improved knee function compared to the prerevision status and is in line with various operative techniques described in the literature. Progression of osteoarthritis must be expected in patients with major lesions of the articular cartilage surface and knees with long-term extensive synovitis due to previous anterior cruciate ligament reconstruction using synthetic grafts.

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Section: Discussioncontrasting

confidence: 84%

Revision ACL reconstruction using autogenous patellar tendon graft

Eberhardt

Kurth

Hailer

et al. 2000

Knee Surg Sports Traumatol Art

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“…Whereas Frobell et al (14,15) found no significant improvement in activity level following anterior cruciate ligament reconstruction and Tsoukas et al (21) provided no specific data, in 4 of the 8 nonrandomized studies anterior cruciate ligament reconstruction led to a significantly higher level of activity (Tegner score: 0 to 1.5 points) than conservative treatment (-2 to -3 points) (4,7,21,22). Seitz et al (4) and Fink et al (29) showed higher rates of return to preinjury sporting level after surgery, with optimum stability following surgery. In contrast, Grindem et al (25) found no significant differences in terms of return to sport, even with optimum stability following surgery.…”

Section: Secondary Outcomementioning

confidence: 98%

“…This review included 2 prospectively randomized controlled trials (RCTs) (14,15,21), 5 nonrandomized prospective cohort studies (22)(23)(24)(25)(26), and 6 retrospective observational studies (3,4,6,7,(27)(28)(29). A total of 1246 patients were investigated (anterior cruciate ligament reconstruction: n = 675; conservative treatment: n = 571).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Whereas Tsoukas et al (21) found that reconstruction of the anterior cruciate ligament was functionally superior to conservative treatment (IKDC score 86.8 ± 6.5 points versus 77.5 ± 13.8 points), Frobell et al (14,15) found no significant differences in KOOS or Tegner score between surgery and nonsurgical treatment with optional delayed surgery. Of the 13 studies included in the review, 6 showed significantly better knee function (Lysholm, KOOS, IKDC, Tegner, or kinematic parameters) following anterior cruciate ligament reconstruction (4,7,21,22,27,29). Seven studies described similar functional outcomes in both treatment groups (3,14,15,(23)(24)(25)(26)28).…”

Section: Primary Outcomementioning

confidence: 99%

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Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture

Krause¹,

Freudenthaler²,

Frosch³

et al. 2018

Deutsches Ärzteblatt International

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upture of the anterior cruciate ligament is a common injury (incidence: 68.6 per 100 000 patient years) that mostly affects young, physically active patients and can lead to chronic instability (1). The lateral tibial plateau in particular is prone to anterior subluxation (anteroposterior instability), as the ligament no longer restricts movement and the axis of rotation can shift medially. Isolated injury to the posterior cruciate ligament is rarer (incidence: 1.8 per 100 000 patient years) (2). Chronic anteroposterior instability, which manifests in 8 to 50% of cases after surgical treatment and 75 to 87% after conservative treatment (3-7), is associated with increased risk of posttraumatic osteoarthritis of the knee (prevalence: 24.5 to 51.2%) (8), restricted knee function with reduced activity level (17% of competitive athletes do not return to competitive level) (9), and reduced quality of life (score of 54 to 77 on the KOOS QOL [Knee injury and Osteoarthritis Outcome Score: Quality of Life] versus 81 to 92 points in the uninjured population) (10). Despite intensive research into anterior cruciate ligament rupture, there is a lack of high-quality studies to determine clear treatment strategies for anterior cruciate ligament-deficient adults. According to the current S1 Guideline of the Association of Scientific Medical Societies in Germany (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften), anterior cruciate ligament reconstruction with autologous tendon graft is indicated for associated injuries to the collateral ligaments, meniscal injuries suitable for reconstruction, or a marked feeling of instability or subjective loading requirement. It is the first-line treatment for symptomatically unstable patients, in order to restore passive stability of the knee joint. According to meta-analyses and cohort studies, anterior cruciate ligament reconstruction can prevent secondary meniscal and cartilage injuries and restore previous activity levels (11-13). Until recently there was only one randomized controlled trial, though this was widely recognized, comparing outcomes following early surgery and following conservative treatment with optional delayed surgery. The findings of this trial indicate that nonsurgical treatment with possible delayed surgery leads to comparable subjective knee function and quality of life (14, 15). On the basis of these findings, coverage Summary Background: Anterior cruciate ligament (ACL) rupture is a serious injury in patients who are typically young and athletically active, with potential long-term complications including functional limitation, posttraumatic osteo arthritis of the knee, and impaired quality of life. ACL reconstruction is now considered the gold standard of treatment for regaining stability and improving knee function. Conservative treatment is an alternative. Methods: To compare operative and conservative treatment, we reviewed pertinent publications retrieved by a systematic search in Ovid MEDLINE, the Cochrane Database of Systematic...

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“…Anterior cruciate ligament (ACL) deficiency causes functional disability during sports activity. Conservative management has usually failed to return the patient to full participation in sports requiring cutting, pivoting and jumping [5,8,12,19,30,31,37,39,[41][42][43]. Clinical long-term follow-up studies in ACL-deficient knees have demonstrated degenerative findings leading to osteoarthritis [8,9,13,15,19,20,30,31,33,37,39,45].…”

Section: Introductionmentioning

confidence: 99%

Articular cartilage homeostasis after anterior cruciate ligament reconstruction

Taşkıran

Duran

et al. 1998

Knee Surgery, Sports Traumatology, Arthroscopy

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Several factors may be responsible for osteoarthritis after anterior cruciate ligament (ACL) reconstruction. The detrimental effect of the surgical technique may explain part of the progression of the pathologic process. In this study, the effect of ACL reconstruction on articular cartilage was investigated by measuring proteoglycan fragments (PF) in synovial fluid collected from patients who had undergone this operation. Synovial samples were obtained from 44 patients with chronic ACL deficiency aged 26 +/- 7 years preoperatively, and from some of them, samples were collected for monitoring at 1 month (n = 22), 3 months (n = 17), 6 months (n = 18) and 12s month (n = 18). Synovial fluid taken from 12 contralateral asymptomatic knees of 12 patients (not necessarily opposite knees of ACL-deficient cases) served as controls. Preoperative values were significantly larger than controls (P < 0.05). PF level reached its maximum value in the 1st month (P < 0.05) and then gradually decreased. It was significantly lower than preoperative values at 6 and 12 months but still greater than controls (P < 0.05). It seems that surgical trauma affects cartilage metabolism for the first 3 months postoperatively. Although reconstruction of the ACL contributes to articular cartilage homeostasis, a complete return to normal values cannot be achieved in 1st postoperative year at least in knees with chronic ACL deficiency. Long-term monitoring is needed to see whether these findings are early signs of osteoarthritis. Further studies may more clearly demonstrate the effect of the surgical procedure on knees with acute and subacute ACL deficiency.

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Langzeitergebnisse nach konservativ behandelten veralteten vorderen Kreuzbandrupturen

Cited by 4 publications

References 5 publications

Revision ACL reconstruction using autogenous patellar tendon graft

Revision ACL reconstruction using autogenous patellar tendon graft

Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture

Articular cartilage homeostasis after anterior cruciate ligament reconstruction

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