Femoral tunnel increase smaller with interference screw versus cortical button fixation in ACLR .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2018;6(2):15 Knee. 2017 Oct;24(5):1047-105433 patients scheduled for ACL reconstruction were included in this study to compare the effects of different fixation methods on postoperative tunnel widening. Patients were randomized to reconstruction using aperture screw fixation or suspensory cortical button fixation. Tunnel volume was measured over a 6 month period using MRI and CT scans. The results at 6 months indicated no differences between the two groups for tibial tunnel volume (117.7+/-24.1% button group vs. 113.9+/-10.3% screw group (p=0.565)). While the femoral tunnel volume at 6 months was significantly greater in the button group (143.2+/-34.4%) compared to the screw group (119.8+/-19.2%) (p=0.023).
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.
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/5
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?
Anterior cruciate ligament (ACL) reconstruction is often undergone following a tear. Various methods of graft fixation are available in these procedures. Recently, there has been an interest in whether the type of graft fixation used influences widening of either the femoral or tibial bone tunnels.
Qual era a principal questão de investigação?
In ACL reconstruction, does change in tunnel volume after 6 months significantly differ between graft fixation with bioabsorbable interference screws and suspensory extra-cortical button fixation?
- On MRI, the percent change in tibial tunnel volume from baseline to 6 months did not significantly differ between the button group (96.4+/-19.0%) and the screw group (108.0+/-14.9%) (p=0.060). Similarly, on CT, the percent change in tibial tunnel volume from baseline to 6 months did not significantly differ between the button group (117.7+/-24.1%) and the screw group (113.9+/-10.3%) (p=0.565).
- On MRI, the percent change in femoral tunnel volume from baseline to 6 months was significantly greater in the button group (154.3+/-38.0%) compared to the screw groups (110.9+/-20.7%) (p<0.001). Similarly, on CT, the percent change in tibial tunnel volume from baseline to 6 months was significantly greater in the button group (143.2+/-34.4%) compared to the screw group (119.8+/-19.2%) (p=0.023).
De que é que me devo lembrar mais?
In ACL reconstruction, graft fixation with adjustable-length loop cortical buttons demonstrated significantly greater femoral tunnel volume increase within the first 6 months after surgery when compared to fixation with absorbable interference screws. Both types of fixation demonstrated similar degrees of tibial tunnel volume increase in the first 6 months after surgery.
Como é que isto afectará o tratamento dos meus doentes?
The results of this study suggest that short-term enlargement of the femoral tunnel may be larger with the use of an adjustable-length loop cortical button as opposed to a bioabsorbable interference screw in ACL reconstruction. Nevertheless, there is still considerable debate on the correlation between tunnel widening and clinical outcomes in these cases. Follow-up studies over the longer term are needed to determine if early tunnel enlargement is associated with latent complications after ACL reconstruction.
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