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.
Cette étude a été identifiée comme étant potentiellement à fort impact.
L'indicateur High Impact de l'ENP, basé sur l'IA, estime l'influence qu'un article est susceptible d'avoir en intégrant des signaux provenant à la fois de la revue dans laquelle il est publié et du contenu scientifique de l'article lui-même.
Développé à l'aide d'un traitement du langage naturel de pointe, le modèle High Impact de l'ENP prédit avec plus de précision les futures citations d'une étude que le seul facteur d'impact de la revue.
Cela permet d'identifier plus tôt les recherches cliniquement significatives et aide les lecteurs à se concentrer sur les articles les plus susceptibles d'influencer les pratiques futures.
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?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
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 de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
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.
Quelle était la principale question de recherche ?
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.
De quoi dois-je me souvenir en priorité ?
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.
Comment cela affectera-t-il les soins prodigués à mes patients ?
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.
AVIS DE NON-RESPONSABILITÉ
Le contenu de cette page est fourni à titre d'information uniquement et n'est pas destiné à remplacer un avis médical, un diagnostic ou un traitement professionnel. Si vous avez besoin d'un traitement médical, demandez toujours l'avis de votre médecin ou rendez-vous au service des urgences le plus proche. Les opinions, croyances et points de vue exprimés par les individus sur le contenu de cette page ne reflètent pas les opinions, croyances et points de vue d'OrthoEvidence.
0 de 4 articles mensuels GRATUITS débloqués
