ACL reconstruction: No increased risk of adverse outcome with early or delayed surgery .
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Questo studio è stato identificato come potenzialmente ad alto impatto.
La metrica High Impact di OE, guidata dall'AI, stima l'influenza che un articolo potrebbe avere integrando i segnali della rivista in cui è stato pubblicato e il contenuto scientifico dell'articolo stesso.
Sviluppato utilizzando un'elaborazione del linguaggio naturale all'avanguardia, il modello High Impact di OE prevede in modo più accurato la futura performance citazionale di uno studio rispetto al solo fattore di impatto della rivista.
Ciò consente di riconoscere prima le ricerche clinicamente significative e aiuta i lettori a concentrarsi sugli articoli che hanno maggiori probabilità di influenzare la pratica futura.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(5):84 Arthroscopy. 2013 Mar;29(3):556-65. doi: 10.1016/j.arthro.2012.09.005. Epub 2013 Jan 12Exclusive Author Interview
Dr. Chris Servant discusses the optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness.
Eight studies (4 randomized control trials and 4 cohort studies) were included in this analysis which investigated the impact of early versus late surgery on stiffness outcomes of anterior cruciate ligament (ACL) reconstruction. Adverse outcomes of arthrofibrosis, stiffness, or range of motion deficits were reported for a minimum of one year postoperatively in the included studies. The results of the analysis indicated that surgery characterized as either early or delayed did not increase the risk of adverse stiffness outcomes.
Were the search methods used to find evidence (original research) on the primary question or questions stated?
Was the search for evidence reasonably comprehensive?
Were the criteria used for deciding which studies to include in the overview reported?
Was the bias in the selection of studies avoided?
Were the criteria used for assessing the validity of the included studies reported?
Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?
Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?
How would you rate the scientific quality of this evidence?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
4/4
Introduction
3/4
Accessing Data
2/4
Analysing Data
2/4
Results
3/4
Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
There has been recent interest in the timing of anterior cruciate ligament (ACL) reconstruction following ACL injury, with some advocating that delayed surgery can lead to reduced prevalence of arthrofibrosis and improved postoperative stiffness. Although there has been evidence to support this claim, research has also been undertaken which has found no difference between the early and delayed surgery. Due to these conflicting findings, a synthesis of existing literature was undertaken to determine if there was a significant relationship between the timing of surgery and postoperative stiffness experienced by patients.
Qual era la domanda di ricerca principale?
Did delaying ACL reconstruction significantly reduce the incidence of postoperative motion loss and knee stiffness compared to early surgery, measured after a minimum of 12 months postoperatively?
- Search strategy concluded with finding four RCTs (3 Level I evidence and 1 Level II evidence) and four cohort studies (all Level II evidence).
- The three Level I studies were analyzed for risk of adverse outcomes (reduced range of motion, arthrofibrosis, stiffness, extension deficit) associated with variable cutoff points for early surgery (2, 3, and 10 weeks), and indicated there were no significant differences in outcome in any of the studies (2 weeks: RR 1.38 (95%CI 0.10-20.16); 3 weeks: RR 0.34 (95%CI 0.04-3.14); 10 weeks: RR 3.81 (95%CI 0.44-33.08).
- Analysis of 7 included studies (1 excluded because it did not report poolable outcomes) indicated there was no significant increase in risk of adverse outcome associated with early or delayed surgery when stratified by different cutoff points for early surgery (1, 2, 3, 10, 12, and 20 weeks).
- A sensitivity analysis considering individual outcomes of arthrofibrosis incidence, extension deficit >3°, and flexion deficit >3° and stratified for different criteria of early surgery observed no clear overall trend.
Che cosa devo ricordare di più?
There was no increased risk of adverse outcome, with respect to arthrofibrosis, stiffness and ROM deficit, observed associated with early surgery compared to delayed surgery following ACL injury.
Come influenzerà l'assistenza ai miei pazienti?
The results of this analysis suggest that there is no increased risk of arthrofibrosis or range of motion deficit between early and delayed ACL reconstruction, provided a modern surgical technique and an accelerated postoperative rehabilitation protocol is implemented. The overall strength of this evidence is debatable, however, considering the nonuniformity in classification of "early" surgery (1 to 20 weeks), as well as the inclusion of a considerable amount of Level II evidence (primarily cohort studies). Future research should be guided by establishing definitive criteria for early versus late surgery and outcomes should be investigated in randomized controlled trials before any conclusive statements can be made.
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