Non-operative treatment of the MCL in combined ACL MCL injuries .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(5):89 J Bone Joint Surg Am. 2009 Jun;91(6):1305-12.47 patients with combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries were randomized to receive either operative treatment on both ACL and MCL or operative treatment just on ACL. It was observed that the non-operative treatment of the MCL led to a greater range of motion and recovery of quadriceps power generation during early follow-ups.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
3/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Isolated MCL injuries are commonly treated with non-operative care. However, there is no consensus for the standard of care in patients who have injured both ACL and MCL ligaments in the same knee. Surgical repair of both ligaments, while providing knee stability, has recently found to be associated with decreased post-operative range of motion and quadriceps muscle power. This trial examined differences in range of motion and quadriceps power between operative and non-operative treatment of the MCL in combined ACL and MCL injuries.
Qual era a principal questão de investigação?
In patients with combined ACL and MCL injuries (tears), does non-operative treatment of the MCL provide better postoperative range of motion, without sacrificing stability when compared to operative repair?
- Flexion deficit was greater in the MCLS group (both ACL and MCL repair) at all follow-up time points, but was only significant at 6 weeks (100 vs 112 degrees; p=0.009), 12 weeks (119 vs 128 degrees; p=0.043), and 32 weeks (130 vs 136 degrees; p=0.011)
- At 1 and 2 year follow-up, knee flexion was similar between the two groups (MCLS =132 and MCLNO= 134 degrees; MCLS=134 and MCLNO=137 degrees)
- At 1 year, quadriceps muscle power was 30.7% in the MCLS group and 20.5% in the MCLNO group (p=0.015). At 104 weeks, this difference was no longer significant, but favoured the MCLNO group (14.4% vs 9.7%; p=0.2)
- 96% (45/47) patients exhibited normal flexion, according to the International Knee Documentation Committee criteria
De que é que me devo lembrar mais?
Results from this study favoured the non-operative treatment for the MCL in patients with combined ACL and MCL injuries. At one year, quadriceps muscle power was greater in the non-operative group. However, at two years, muscle power, and ROM were equal in both groups.
Como é que isto afectará o tratamento dos meus doentes?
This study indicates that non-operative treatment of the MCL in combined ACL and MCL injuries provides improved quadriceps muscle power recovery and ROM when examined during short term follow-up, with no differences apparent at long term follow-up.
AVISO LEGAL
O conteúdo desta página destina-se apenas a fins informativos e não pretende substituir o aconselhamento, diagnóstico ou tratamento médico profissional. Se necessitar de tratamento médico, procure sempre o conselho do seu médico ou dirija-se ao serviço de urgência mais próximo. As opiniões, crenças e pontos de vista expressos pelos indivíduos no conteúdo encontrado nesta página não reflectem as opiniões, crenças e pontos de vista da OrthoEvidence.
0 de 4 artigos mensais GRATUITOS desbloqueados
