ACL reconstruction: No increased risk of adverse outcome with early or delayed surgery .
This report has been verified
by one or more authors of the
original publication.
Este estudio ha sido identificado como potencialmente de alto impacto.
La métrica de alto impacto de OE, impulsada por la IA, estima la influencia que probablemente tendrá un artículo integrando señales tanto de la revista en la que se publica como del contenido científico del propio artículo.
Desarrollado mediante el procesamiento del lenguaje natural más avanzado, el modelo de Alto Impacto de OE predice con mayor precisión el futuro rendimiento de las citas de un estudio que el factor de impacto de la revista por sí solo.
Esto permite reconocer antes las investigaciones clínicamente significativas y ayuda a los lectores a centrarse en los artículos con más probabilidades de configurar la práctica 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?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
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.
¿Cuál era la pregunta principal de la investigación?
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.
¿Qué es lo que más debo recordar?
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.
¿Cómo afectará esto al cuidado de mis pacientes?
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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