Higher AP laxity with irradiated versus non-irradiated hamstring allograft in DB ACL reconstruction .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(9):16 Knee Surg Sports Traumatol Arthrosc. 2017 Jan;25(1):251-259112 patients scheduled for unilateral anterior cruciate ligament reconstruction were randomized to have the procedure completed using either a gamma-irradiated hamstring allograft or a non-irradiated hamstring allograft. Patients were assessed over a 5-year follow-up after surgery. Findings demonstrated significantly poorer results for instrumented knee laxity and subjective knee stability tests at 5 years in the irradiated allograft group compared to the non-irradiated allograft group. However, there were no differences in functional and activity outcomes.
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)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
2/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
3/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
A tear of the anterior cruciate ligament (ACL) is a common sporting injury. Arthroscopic reconstruction of the ACL is often undergone in those who wish to restore knee stability and return to athletic activities. Though traditionally completed using autogenic tissue sources, there has been a recent increase in the use of allografts in ACL reconstruction. Irradiation remains a common method of graft sterilization, though concerns have been expressed about the potential negative impact of gamma irradiation on mechanical properties of the graft.
Was war die wichtigste Forschungsfrage?
In double-bundle ACL reconstruction, do gamma-irradiated hamstring tendon allografts result in significantly worse knee stability and clinical scores when compared to non-irradiated hamstring tendon allografts, assessed over a minimum of 5-year follow-up?
- Mean instrumented anteroposterior knee laxity at final follow-up was significantly higher in the Ir-Allo group (9.0+/-1.1mm) compared to the Non-Ir-Allo group (5.3+/-1.0mm) (p=0.000).
- The percentage of patients demonstrating side-to-side difference in instrumented AP knee laxity of <3mm was significantly lower in the Ir-Allo group (14/39) compared to the Non-Ir-Allo group (38/44) (p=0.000).
- The percentage of patients demonstrating side-to-side difference in instrumented AP knee laxity of >5mm was significantly higher in the Ir-Allo group (12/39) compared to the Non-Ir-Allo group (4/44) (p=0.000).
- Significant differences between groups at final follow-up were observed for grading of the pivot-shift test (p=0.001), anterior draw test (p=0.000), and Lachman test (p=0.000), with fewer patients in the Ir-Allo group demonstrating negative tests for each when compared to the Non-Ir-Allo group.
- No significant differences in functional outcomes (Overall IKDC, knee ROM, vertical jump, one-legged hop) were observed between groups at final follow-up.
- No significant differences in patient-reported outcome measures (IKDC subjective, Cincinnati knee score, Lysholm, Tegner) were observed between groups at final follow-up.
Was sollte ich mir besonders merken?
In anatomic double-bundle ACL reconstruction with a hamstring allograft, irradiated allografts demonstrated significantly greater knee instability and laxity, including instrumented AP translation and subjective grading using the Lachman, anterior drawer, and pivot shift test, when compared to non-irradiated allografts over a minimum of 5-year follow-up. However, despite significant differences in measured mechanical outcomes, there was still no difference in clinical outcomes.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The results of this study suggest that irradiation of hamstring tendon allografts for use in double-bundle ACL reconstruction may result in poorer mid-term knee laxity and stability, and may result in a higher rate of clinical failure when considering thresholds of anteroposterior side-to-side differences in translation. Despite the lack of significant difference in overall functional outcome in the mid-term between irradiated and non-irradiated hamstring tendon allografts, the data on knee stability from the current study appear to identify non-irradiated hamstring tendon allografts as the potential better choice for graft in anatomic double-bundle ACL reconstruction.
HAFTUNGSAUSSCHLUSS
Der Inhalt dieser Seite dient nur zu Informationszwecken und ist nicht als Ersatz für professionelle medizinische Beratung, Diagnose oder Behandlung gedacht. Wenn Sie eine medizinische Behandlung benötigen, wenden Sie sich immer an Ihren Arzt oder suchen Sie die nächstgelegene Notaufnahme auf. Die Meinungen, Überzeugungen und Standpunkte, die von den Personen auf dieser Seite geäußert werden, spiegeln nicht die Meinungen, Überzeugungen und Standpunkte von OrthoEvidence wider.
0 von 4 monatliche KOSTENLOSE Artikel freigeschaltet
