The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Anterior Cruciate Ligament Injuries

Shea, Kevin G.; Carey, James L.; Richmond, John C.; Sandmeier, Robert; Pitts, Ryan T.; Polousky, John D.; Chu, Constance R.; Shultz, Sandra J.; Ellen, Mark I.; Smith, Angela H.; LaBella, Cynthia R.; Anderson, Allen F.; Musahl, Volker; Myer, Gregory D.; Jevsevar, David S.; Bozic, Kevin J.; Shaffer, William O.; Cummins, Deborah; Murray, Jayson; Patel, Nilay A.; Shores, Peter; Woznica, Anne; Martinez, Yasseline; Gross, Leeaht; Sevarino, Kaitlyn

doi:10.2106/jbjs.n.01257

Cited by 84 publications

(89 citation statements)

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“…However, this result may be due to the evaluation modality that was available for us to judge the outcome of ACL surgery at the time the analysis was conducted. Recent first class review guidelines [18] have shown that both double-bundle and single-bundle ACL reconstruction confirmed the similarity of both techniques that can be recommended for the patients. With the currently available evaluation technique, there might be a limit to clearly define the difference of both techniques.…”

mentioning

confidence: 88%

Single- Vs. Double-Bundle ACL Reconstruction

Kurosaka

Kuroda

Nagai

2016

ACL Injury and Its Treatment

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Multiple bundle ACL reconstruction, especially focused on doublebundle ACL reconstruction was discussed in this article. Although crucial factors and denominators that influence the outcome of ACL reconstruction are not elucidated, we believe that anatomically oriented graft replacement in reconstruction of the ruptured ACL structure will be certainly the future direction of this surgery. The study of anatomy of the ACL insertion site and intra-articular graft orientation in the young and normal population would be mandatory for the better understanding of future ACL reconstruction. Also better evaluation system that includes both subjective and objective approach should be refined in the future. As the technology advancement is seen in many fields of surgical technique, navigation system or some other types of newer technique will surely be introduced in ACL reconstruction technique field. Biological intervention of ACL surgery is surely one of the challenging issues for future ACL reconstruction. Since ACL is the tissue that has blood supply, biological application to facilitate the implanted graft to heal to normal ACL tissue may be one of the attainable possibilities and may be easier than healing of nonvascularized tissue like an articular cartilage damage or torn meniscus. We are still on the way to get the normal ACL tissue back to the torn ACL knee; however, anatomic approach of the double-bundle ACL reconstruction of the ACL tissue may be one of the possible solutions to this currently unsolved problem for the athletic population.

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confidence: 88%

Single- Vs. Double-Bundle ACL Reconstruction

Kurosaka

Kuroda

Nagai

2016

ACL Injury and Its Treatment

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“…Strong evidence supports the use of the history and physical examination as effective diagnostic tools for ACL injury 5. The history gives an idea of the patient's activity level and mechanism of injury, and the physical examination has been shown to be as sensitive and specific as imaging modalities 19…”

Section: Acl Reconstruction: Current State Of the Artmentioning

confidence: 99%

“…The most recent evidence-based clinical practice guideline on the management of ACL was published according to a systematic review that considered the most important topics about this injury 5. The highest quality studies, related to diagnosis, treatment, rehabilitation and return to sports (RTS), were reviewed and most of them were included in this article.…”

Section: Acl Reconstruction Main Articles: Reviews State Of the Artmentioning

confidence: 99%

“…Physical examination should include range of motion (ROM), the Lachman test, the pivot shift test, and evaluation of concomitant ligamentous, meniscal and neurovascular injuries 5. According to the most recent meta-analysis of ACL tear diagnosis, the Lachman and the pivot shift tests have a sensitivity of 0.77 and 0.28, respectively, and a specificity of 0.53 and 0.81, respectively, without anaesthesia (positive likelihood ratio (LR) 4.50 and 5.5, negative LR 0.22 and 0.84, respectively).…”

Section: Acl Reconstruction: Current State Of the Artmentioning

confidence: 99%

“…According to the most recent meta-analysis of ACL tear diagnosis, the Lachman and the pivot shift tests have a sensitivity of 0.77 and 0.28, respectively, and a specificity of 0.53 and 0.81, respectively, without anaesthesia (positive likelihood ratio (LR) 4.50 and 5.5, negative LR 0.22 and 0.84, respectively). 5 20 The pivot shift test should be standardised to avoid interindividual and intraindividual variability and improve measurement accuracy 21. Additionally, instrumented measurements (KT-arthrometer) can objectively evaluate the anteroposterior (AP) tibial translation, and allows the evaluation of the postoperative results 22…”

Section: Acl Reconstruction: Current State Of the Artmentioning

confidence: 99%

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Anterior cruciate ligament reconstruction

et al. 2016

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Females demonstrate lower levels of activity, psychological readiness and strength symmetry after anterior cruciate ligament reconstruction than males, and also recovery of quadriceps strength and hop symmetry is delayed in females undergoing reconstruction with a quadriceps tendon autograft

Ebert,

Calvert,

Radic

2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate sex‐based recovery differences in patients undergoing anterior cruciate ligament reconstruction (ACLR) with a hamstring (HT) or quadriceps (QT) tendon autograft.MethodsThis study included 97 patients, including 50 females (HT = 25, QT = 25) and 47 males (HT = 24, QT = 23), assessed presurgery and at 12‐ and 24‐month postoperatively via surveys, laxity, isokinetic knee extensor and flexor torque and a 6‐hop performance battery. Limb symmetry indices (LSIs) were calculated. Outcomes were compared between males and females, as well as within each graft type.ResultsMales reported significantly higher Tegner scores at 12 (p = 0.029) and 24 (p = 0.031) months, Anterior Cruciate Ligament Return to Sport after Injury scores at 12 (p = 0.009) and 24 (p = 0.010) months, and a significantly higher lateral hop LSI at 12 (p = 0.045) months, knee extensor torque LSI at 12 (p = 0.020) months, and knee flexor torque LSI at 12 (p = 0.001) and 24 (p = 0.039) months. Females undergoing ACLR with a QT (vs. HT) graft demonstrated a lower knee extensor torque LSI at 12 (p = 0.006) months, a lower lateral hop LSI at 12 (p = 0.038) months, and a lower medial hop LSI at 12 (p = 0.042) months.ConclusionsFemales reported less activity and psychological readiness, as well as strength symmetry. Furthermore, the recovery of quadriceps strength and hop symmetry was delayed in females (vs. males) undergoing ACLR with a QT graft. A better understanding of these differences will assist in counselling on expectations, determining the most appropriate graft construct and permitting more targeted rehabilitation.Level of EvidenceLevel IV.

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The American Academy of Orthopaedic Surgeons Evidence-Based Guideline on Management of Anterior Cruciate Ligament Injuries

Cited by 84 publications

References 0 publications

Single- Vs. Double-Bundle ACL Reconstruction

Single- Vs. Double-Bundle ACL Reconstruction

Anterior cruciate ligament reconstruction

Females demonstrate lower levels of activity, psychological readiness and strength symmetry after anterior cruciate ligament reconstruction than males, and also recovery of quadriceps strength and hop symmetry is delayed in females undergoing reconstruction with a quadriceps tendon autograft

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