Outcome evaluation ACL reconstruction

Arthroscopy: The Journal of Arthroscopic & Related Surgery Online

October 1999, Supplement 1 • Volume 15 • Number 7

<< Back to topic list

° Previous article in Issue • Next article in Issue • Drug links from Mosby's DrugConsult • Genetic information from OMIM

Outcome Evaluation ACL Reconstruction Abstracts

These are the abstracts of the papers presented at the Second Biennial Meeting of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Washington, DC, May 29- June 3, 1999.

31. Arthroscopic Assisted Anterior Cruciate Ligament Reconstruction Using Patella Tendon Autograft: Minimum Two-Year Follow-Up Evaluation,

Sethu Ramanathan, F.R. C. S., F.R. C. S. (Orth. ) Hany Atria

Outcome Evaluation ACL Reconstruction

Purpose: "To evaluate the outcome of Arthroscopic assisted Anterior Cruciate Ligament (ACL) reconstruction using patellar tendon autograft in a Gulf population. Method: We treated 163 patients between 1991 and 1995 with chronic ACL injury by reconstruction using a patellar tendon autograft and interference screw fixation using a two incision technique. Of these, 156 were available for review at 24 months. Objective, subjective and functional tests (Lysholm scoring) were performed for evaluation. Results: There were significant improvements in physical examination test results (Lachman, anterior drawer and pivot shift) postoperatively, and 139 patients (89%) had negative pivot shift results. Good range of motion was achieved and the mean results of Lysholm score was 90. Two patients had

http••••WW2•us•e•sevierhea•th•c•rn/inst/serve?s•••DB&group=•utcome+Eva•uation+ACL+Reconstruction (1 of 7) [12/13t2007 12:44:48 PM]


superficial infection that responded fully to antibiotics and two patients had an acute "pull-out" of the tibial end of the graft following an injury during the rehabilitation period. Three patients had persistent fixed flexion deformity of 20 degrees, which responded to arthroscopic excision of the "cyclops" lesion. Anterior knee pain was present in six patients of which only three were significant. All but two patients were able to kneel for daily prayers and squat on the floor according to local custom comfortably. Conclusion: This study demonstrates that Arthroscopic assisted ACL reconstruction using the patella tendon gave good outcome objectively, subjectively and by functional scoring in a Gulf population. Significance: Most of our patients' lifestyle includes kneeling for daily prayers and squatting on the floor in their daily activities. The good outcome and the low incidence of Anterior knee pain clarifies the apprehensions and substantiates the validity of using patella tendon graft for ACL reconstruction in these patients.

32. Comparison of Outcomes of Autograft and AIIograft Anterior Cruciate Ligament Reconstruction.

David Martin, M.D. Gary Poehling, M.D. Walton Curl, M.D. Michelle Naughton, Ph.D.


Hypothesis: We hypothesize that when autograft and allograft ACL reconstruction outcomes are compared objectively, patients from both groups will have similar long-term outcomes, but patients with allograft reconstructions will have reduced, short-term post-operative morbidity. Methods: Patients (15-50 years old) scheduled for either autograft or allograft ACL reconstruction surgery were asked to complete questionnaires to document their physical functioning and health- related quality of life. Physicians assessed knee range of motion and joint stability. Data were collected before surgery and at 1 week, 6 weeks, 3 months, 6 months, one year, and annually after surgery. Medical charge data relating to the two reconstruction procedures were collected through the institutional financial data base. Results: Patients in the autograft group (n=47; 62% male) were significantly younger than the allograft patients (n=103; 69% male). (25 years versus 31 years, respectively). AIIograft patients reported more pain/discomfort in transfer-related activities and leg-related symptoms than autograft patients (p=.02) at 6 weeks post-surgery. However, pain as measured by the visual analog scale and the pain scale of the SF-36 (p=.006) was greater for autograft patients. Range of flexion was greater for the allograft patients (p=.004). There were no significant differences at 6 months and one year between the allograft and autograft patients in either knee function or health-related quality of life. Conclusions: This preliminary data analysis of the short-term outcomes of allograft and autograft surgery suggests that both patient groups experience similar post-surgical outcomes. Follow-up data will be collected to document long-term outcomes. This study was supported by a grant from the Musculoskeletal Transplant Foundation.

33. Outcome, Quality of Life and Generic SF36 Health Measures Following Anterior

http://www2.us.elsevierhealth.com/inst/serve?s...DB&group Outcome + Evaluation ÷ACL ÷ Reconstruction (2 of 7) [12/13/2007 12:44:48 PM]


Cruciate Ligament Reconstruction.

T.J.W. Spalding, F.R.C.S. (Orth.) A. Foggitt, F.R.C.S. P. Dunleavy, M.C.S.P.

Outcome Evaluation ACL Reconstruct ion

Objective: To evaluate outcome following anterior cruciate ligament (ACL) reconstruction in terms of quality of life, general health, function and the IKDC grading system. Methods: Patients undergoing ACL reconstruction were entered into a prospective study collecting pre and post-operative data including the IKDC grading, Mohtadi Quality of Life Outcome Measure Questionnaire (QOL), SF36 Health outcome, KT 1000 arthrometry, Lysholm score, Tegner activity level score, isokinetic strength testing and a purpose designed functional assessment. Results: Data is available on 70 patients at one year and 40 at two years. 84% are classified IKDC Normal or Nearly Normal Quality of Life was significantly improved following reconstruction (p<0.01), but improvement lagged behind specific measures such as the IKDC and Lysholm score. IKDC grades rarely improved after 9 months, but quality of life reached a peak at 12 months. There was no significant improvement at the 24 month assessment. IKDC Grades Normal and Nearly Normal, and KT1000 manual maximum side to side arthrometry difference showed a poor correlation with the QOL score. The recovery of health outcome on the SF36 was similar to the pattern for QOL. Conclusion: Recovery of knee function and quality of life can be prolonged after ACL reconstruction. The IKDC grading system is not sensitive in describing quality of life aspects following surgery. Significance: The Mohtadi Quality of Life Outcome Questionnaire produces an expression of outcome that is relevant to the patient and more accurately expresses the difference between a normal and nearly normal knee.

34. (Cancelled) Unsatisfactory Results After Conservative Treatment of Anterior Cruciate Ligament (ACL) Rupture in a Low Demand Population.

D. EygendaaL M.D. A. Beumer A.J.M. Sauter


Purpose: "To evaluate the results of conservative treatment of isolated, total ACL rupture in a population of low demand athletes." Method: 58 Low demand athletes had sustained arthroscopically proven, isolated, total ACL rupture. 46/58 (32 m, 14 f, av. age 33.1 y) Were traced, after an average of 8,26 years after trauma. All were interviewed, all underwent physical examination and were asked to perform a one legged hop test. X- rays were made of both knees; tibial translation was measured with the Biodex kneelaxity tester. Results: At follow-up the average subjective functional (Lysholm) score was 77.5 (pre-trauma 99,7), 12 patients had suffered secondary meniscal injury in the period between trauma and follow-up. 32/46 Patients had to quit or decrease sports activities. 2 Patients judged the overall result as excellent, 26



as good, 15 as fair and 3 as poor. Tibial translation was 7,7 MM (SD 2,6) for the uninjured knee and 11,26 MM (SD 3,68) for the injured knee. Patients needed an average of 3,63 seconds more to perform a one legged hop test with the injured knee in comparison with the uninjured side. 10 Patients showed minimal signs of osteoarthritis on the X-ray of the injured knee only. Conclusion: Conservative treatment of total isolated anterior cruciate ligament rupture in a low demand population does not show satisfactory results. Significance: As conservative treatment of ACL rupture in a low demand population does not show satisfactory results ACL reconstruction may be indicated more often in this population.

35. ACL Deficient Patients With Lesser Perceived Functional Deficits Demonstrate Internal Beliefs Regarding Health Status.

Darren Johnson, M.D. Tim Brindle, M.S. John Nyland, Ed.D. David Caborn, M.D.


Purpose: This investigation attempted to determine if a relationship exists between patient beliefs about whether their health status is related more to internal or external factors and their perceived functional limitations following ACL rupture. Method: Seventy ACL deficient patients completed an 11 question Health Locus of Control Scale (Internal versus External Beliefs) and the Medical Outcomes Study-17 Short-Form Health Survey (MOS-17) approximately 1 week prior to reconstructive surgery. Subjects received instruction in question format and response options for each form. Following data collection, the Health Locus of Control Scale scores were totaled (with higher scores indicating more external beliefs) and the median score of the MOS-17 was determined (scores ranging from 1-3 with 1 indicating greater perceived functional limitations). A Kruskal-Wallis analysis of variance assessed differences between MOS-17 groupings. A probability value of - .05 indicated statistical significance. Results: Patients with a median MOS-17 score of 3 (lesser perceived functional limitations) demonstrated Health Locus of Control Scale scores which were lower than patients with a median MOS-17 score of 1 (greater perceived functional limitations) (p = .045). Patients who demonstrated a median MOS-17 score of 2 did not differ significantly from either of the other groups. Conclusion: There appears to be a relationship between the perceived functional limitations of an ACL deficient patient and their beliefs regarding whether their health status is controlled primarily by internal or external factors. Patients who had the least perceived functional limitations regarded their health status as being controlled by internal factors while patient who had the greatest perceived functional limitations regarded their health status as being controlled more by external factors. Significance: Determining the psychological predisposition of a patient prior to ACL reconstruction may enhance the clinical decision making process. This information may influence surgical graft choice with considerations of tissue morbidity, pain, further perceived functional limitations, and even whether conservative management would be more efficacious. Further studies are underway comparing these relationships with post-operative functional outcome measures.



36. Clinical Parameters Predictive of Functional Status Following ACL Reconstruction.

James J. Irrgang, M.S., P. 7-., A. T.C. Deryk Jones, M.D. Kathleen Pantano, M.S., P. 7-. Christopher D. Hamer, M.D. Freddie H. Fu, M.D.


Purpose: The purpose of this project was to identify those symptoms and findings from physical examination that predict functional status 2 to 4 years following ACL reconstruction. Methods: Patients who underwent ACL reconstruction 2 to 4 years prior returned to the clinic for an examination which included assessment of symptoms (pain, swelling, partial & full giving way), range of motion (ROM) (passive extension & flexion), laxity (30 lb. KT-1000, Lachman, anterior drawer, posterior sag, medial & lateral joint opening & pivot & reverse pivot shift), & functional strength (hop & vertical jump). Functional status was measured with the Activities of Daily Living Scale & Sports Activity Scales of the Knee Outcome Survey as well as with 2 global measures of function during activities of daily living & sports on a 0 to 100 scale. Multiple regression analysis was used to assess the relationship between functional status & symptoms, ROM, laxity & functional strength. Results: 104 patients (64% males, average age 30.0, range 16 to 49 yrs.) returned to the clinic for an examination an average of 2.9 yrs. following surgery. 92% underwent primary & 8% underwent revision ACL reconstruction. After controlling for chronicity of injury (episodes of instability prior to surgery) & primary vs. revision reconstruction, symptoms, ROM, laxity & functional strength accounted for 45% (p<.001), 5.2% (p=.035), 6.8% (p=.37) & 4.6% (p=.052) of the variation in functional status respectively. The best subset of predictors were: pain, swelling, side to side difference in flexion, AP translation, & varus rotation, which accounted for 72% (p<.001) of the variation in functional status. Discussion: 3 to 5 years following ACL reconstruction, the patient's perception of functional status is primarily determined by symptoms with relatively small contributions from ROM, laxity and functional strength to prediction of functional status are relatively small.

37. Does Early Return to Vigorous Activity Reduce the Stability of an Anterior Cruciate Ligament Reconstructed With a Hamstring Graft?

Eisaku Fujimoto, M.D. Yoshio Sumen, M.D. Mistuo OchL M.D. Masataka Deie, M.D.


Objective: Accelerated rehabilitation after anterior cruciate ligament (ACL) reconstruction has recently been advocated, but there have been no reports focusing on the relationship between postoperative



stability and timing of return to sports activities. We retrospectively evaluated the timing of return to activity on the postoperative stability of ACL reconstructions. Method: The time to return to running, full speed running, sports activity, unorganized sports games, and organized sports games was evaluated by questionnaire in 47 patients who had ACL reconstructions with a hamstring graft. Patients with bilateral ACL reconstructions or failed reconstructions due to reinjury were excluded. All of the patients' KT-2000 side to side differences were measured at 18 months after surgery. The patients were divided into two groups. Group I consisted of 39 patients whose KT-2000 side to side differences were within 3 mm. Group II consisted of 8 patients whose KT-2000 side to side differences were more than 3 mm. The timing of the start of these five activities was compared between the two groups, and the significance of the difference was determined using analysis of variance. Results: No significant difference was detected between the two groups in the timing of the start of running (P=0.281), full speed running (P=0.359), and sports activities (P=0.269). The average time to return to unorganized sports games in group II was 9 months, and that in group I was 12.8 months after surgery. There was a significant difference between the two groups (P=0.0421). The average time to return to organized sports games in group II was 9 month and that in group I was 13.1 months after surgery. This difference was also significant (P=0.0447). Conclusion & Significance: This study indicates that an early return to vigorous activities is not recommended to ACL reconstructions with a hamstring graft.

38. Patient Characteristics, Surgical Findings and Procedures Which Determine Functional Status in Patients Following ACL Reconstruction.

Deryk Jones, M.D. Mi Lee, B.S. James J. Irrgang, M.S., P. 7-., A. T.C. Christopher D. Hamer, M.D. Freddie H. Fu, M.D.


Introduction: The purpose of this project is to identify surgical findings and procedures which predict functional status following anterior cruciate ligament (ACL) surgery. Methods: Patients who underwent ACL reconstruction by one of two surgeons were surveyed by mail. Operative reports were reviewed. Global reports of function during daily activities and sports as well as the Knee Outcome Survey [Activities of Daily Living Scale (ADLS) and Sports Activities Scale (SAS)] were used to evaluate functional status of the patients (score: 0-total disability, 100-absence symptoms/ functional limitations). Relationships were analyzed by multiple regression using a single measure of function which was produced by combining these four functional measures (principal components analysis). Results: Complete statistics were available on 199 patients (mean follow-up 3.5 years, mean age 29 years, 63% male distribution, 90% sports related injuries, isolated ACL population, ie. no MCL, PCL, LCL injuries). Regression analysis revealed that patient characteristics (time to surgery, sex, mechanism of injury and frequency to giving way) accounted for 5% of the function score while surgical findings accounted for 15.5% of this score. Factors related to the surgical procedure (graft type,



meniscal surgery, primary vs. revision surgery) accounted for only 1.5% of overall function. Medial meniscal tears, medial tibial plateau degeneration and number of episodes of instability prior to surgery were significant factors in determining function (p < 0.05). Individuals with greater than 10 episodes during sports had the lowest scores (SAS:76) compared with patients who gave way once (SAS:89) or 2 to 3 times (SAS:87). Degeneration along other articular surfaces or whether a case was a primary or revision did not significantly correlate with function. Conclusion: Medial tibial plateau changes were important in determining long-term function, a finding consistent with increased episodes of instability before surgery and resultant meniscal pathology.


Date post:	30-Dec-2016
Category:	Documents
Upload:	lytuyen
View:	216 times
Download:	2 times

Outcome evaluation ACL reconstruction

Documents