10 years after ACL surgery, patients stay active with high quality of life

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Patients could perform sports-related functions and maintain a high knee-related quality of life a decade after Anterior Cruciate Ligament (ACL) surgery, though activity levels decline over time found a cohort study over 10 years.

The Multicentre Orthopaedics Outcome Network (MOON)  study, presented at the American Orthopaedic Society for Sports Medicine’s Annual Meeting Toronto, Ontario, Canada,  received the O’Donoghue Sports Injury Research Award.

“Our data shows significant improvements in patient-reported outcome measures from IKDC and KOOS two years after surgery, which was maintained at six and 10 years,” commented corresponding author Dr Kurt P Spindler, from the Cleveland Clinic department of orthopaedic surgery. “These improvements were noted across a substantial population of 1,320 patients, who made up 83% of our original study group.”

Patients with unilateral ACL reconstructions were identified and enrolled between 2002 and 2004 from seven sites in the MOON group. Of those treated, 90% underwent a primary ACLR, and 10% a revision ACLR. Graft choice was 42% autograft bone-patellar-bone, 31% autograft soft tissue, and 27% allograft.

“An active patient may view an ACL injury as devastating, but our research adds to short- and long-term studies that show a good prognosis for return to pre-injury quality of life,” noted Spindler. “This can help medical providers continue to make good treatment decisions, and present these injuries as simply a setback.

Factors affecting lower outcome scores within the study population included lower baseline scores (prior to surgery), a higher body mass index, smoking, and a history of meniscus surgery.

Abstract

Title: Biceps Tenodesis versus Tenotomy in Treatment of Lesions of Long Head of Biceps Brachii in
Patients Undergoing Arthroscopic Shoulder Surgery

Objectives: To compare subjective patient-reported outcomes and objective clinical results between
biceps tenotomy and tenodesis in patients with lesions of the long head of biceps tendon (LHBT).
Methods: The study is a prospective, randomized, controlled trial targeting patients +18 years
undergoing arthroscopic shoulder surgery to manage a lesion of the LHBT (+/- rotator cuff repair).
Patients were excluded if they had previous surgery on their affected shoulder or any other significant
medical comorbidity that could alter the effectiveness of the surgical intervention. Patients were
allocated intraoperatively to undergo tenodesis or tenotomy via computer randomization once a LHBT
lesion was confirmed. The primary outcome measure was the American Shoulder and Elbow Society
standardized assessment of shoulder function (ASES). Secondary outcomes included: Western Ontario
Rotator Cuff index (WORC), surgery time, patient reported pain and cramping, presence of a cosmetic
deformity, elbow flexion and supination strength, and power. Study time points were pre, and 3, 6, 12,
and 24 months post-operative. Magnetic resonance imaging (MRI) was conducted at 12-months postoperative.
Results: Fifty-six participants were randomly assigned to each group. Table 1 summarizes the results to
12-months post-operative (collection of data to 24-months post-operative is ongoing until 2017). There
were no significant differences in ASES score at pre- or post-surgery time points. In addition, no
significant differences were found in WORC, surgery time, pain, or cramping. There was one significant
difference in strength identified, the ratio of affected versus unaffected elbow flexion strength was
greater in the tenodesis group (0.9 (SD=0.2)) versus the tenotomy group (0.8 (SD=0.3)) at 6-months
post-operative. Otherwise, there were no differences in strength ratio identified for elbow flexion or
supination strength or power at any time point. At 12-months post-surgery, the relative risk of cosmetic
deformity in the tenotomy group relative to the tenodesis group based on patient report was 1.36
(p=0.41) with 12 out of 33 patients in the tenotomy group reporting a bulge in their upper arm
compared to 8 out of 30 in the tenodesis group. Similar results were found based on clinical evaluation
with a relative risk of 1.7 (p=0.36). MRI findings were available on 40 patients at the 12-month postoperative
period. Of 23 in the tenodesis group, one was not intact and retracted 18 cm and two were
partially torn. Of the 17 in the tenotomy group, none appeared retracted.

American Orthopaedic Society for Sports Medicine material
AOSSM 2017 abstract book


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